Afonso Cavaco

A European consensus on learning objectives for a core communication curriculum in health care professions

OBJECTIVE To develop learning objectives for a core communication curriculum for all health care professions and to survey the acceptability and suitability of the curriculum for undergraduate European health care education. METHODS Learning objectives for a Health Professions Core Communication Curriculum (HPCCC) in undergraduate education were developed based on international literature and expert knowledge by an international group of communication experts representing different health care professions. A Delphi process technique was used to gather feedback and to provide a consensus from various health care disciplines within Europe. RESULTS 121 communication experts from 15 professional fields and 16 European countries participated in the consensus process. The overall acceptance of the core communication curriculum was high. 61 core communication objectives were rated on a five-point scale and found to be relevant for undergraduate education in health care professions. A thematic analysis revealed the benefits of the HPCCC. CONCLUSIONS AND PRACTICE IMPLICATIONS Based on a broad European expert consensus, the Health Professions Core Communication Curriculum can be used as a guide for teaching communication inter- and multi-professionally in undergraduate education in health care. It can serve for curriculum development and support the goals of the Bologna process.

Consumers' perceptions of community pharmacy in Portugal: a qualitative exploratory study

AbstractObjective: Pharmacists are health professionals who are ideally positioned to perform a primary health care role. However, the definition of professional value needs to be considered not just as professional education and skills, but also in terms of how consumers perceive it. The main aim of this work was to explore the public’s perceptions and attitudes towards community pharmacy in Portugal. Methods: A pure qualitative approach was undertaken. The data were collected through a semi-structured interview, conducted with a ‘snowball’ like sample. First, individuals (n = 15) were interviewed, allowing for adjustment and validation of the interview schedule, followed latter by group interviews with adults in rural and urban areas. Group participants (n = 25) were asked about their behaviour and beliefs, resulting from their perceptions of community pharmacies, pharmacists and medicines. Future expectations regarding the community pharmacy service were also explored. The interviews were tape recorded and transcribed verbatim. An iterative, reflexive coding process was applied, assisted by the qualitative software package QSR NUD*IST v4. The inductive analysis of the extracted codes assembled those codes into themes. Results and discussion: This article will mainly focuses on community pharmacy service representations and cognitions (theme A) and community pharmacy evaluative perceptions and behaviours (theme B). Participants displayed general and contradictory ideas about the actual functions of the pharmacist, including weak conceptualizations and a positive demand for services in relation to product supply. This superficial understanding is in line with previous results from satisfaction studies, confirming a low expectation level. The public’s poor knowledge and low expectations can justify a reduced desire for an extended role of the pharmacist in the community. This uncertain service conceptualization does not define the professional responsibility from a consumer’s perspective. Conclusions: Although these results allow for the development of a framework to describe the perceptions of community pharmacy users, further research is needed to determine the prevalence of these and other possible results.

The value of patient reporting to the pharmacovigilance system: a systematic review.

AIMS Current trends in pharmacovigilance systems are veering towards patient involvement in spontaneous reporting of adverse drug reactions (ADRs). The aim of the current systematic review was to identify what is known and what remains unknown with respect to patient reporting to pharmacovigilance systems. METHODS A systematic literature search was conducted in PubMed, CINAHL, Journals@Ovid and the Cochrane Library. Studies were included if they contained: (i) reviews about patient reporting; (ii) evaluation of patient reports to national or supranational pharmacovigilance authorities; (iii) a comparison between patient and healthcare professional (HCP) reports submitted to pharmacovigilance authorities; and (iv) surveys of patient experiences, opinions and awareness about reporting ADRs. The methodological quality of the studies was assessed according to principles of Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS A total of thirty four studies were included. Five of the studies were reviews (two of which systematic reviews), fourteen retrospective observational studies, nine surveys and six applied mixed research methods. Patient reporting has the advantages of bringing novel information about ADRs. It provides a more detailed description of ADRs, and reports about different drugs and system organ classes when compared with HCP reporting. In addition, patients describe the severity and impact of ADRs on daily life, complementing information derived from HCPs. Patient reporting is relatively rare in most countries. CONCLUSIONS Patient reporting adds new information, and perspective about ADRs in a way otherwise unavailable. This can contribute to better decision-making processes in regulatory activities. The present review identified gaps in knowledge that should be addressed to improve our understanding of the full potential and drawbacks of patient reporting.

Readability of medicinal package leaflets: a systematic review

OBJECTIVE To review studies on the readability of package leaflets of medicinal products for human use. METHODS We conducted a systematic literature review between 2008 and 2013 using the keywords “Readability and Package Leaflet” and “Readability and Package Insert” in the academic search engine Biblioteca do Conhecimento Online, comprising different bibliographic resources/databases. The preferred reporting items for systematic reviews and meta-analyses criteria were applied to prepare the draft of the report. Quantitative and qualitative original studies were included. Opinion or review studies not written in English, Portuguese, Italian, French, or Spanish were excluded. RESULTS We identified 202 studies, of which 180 were excluded and 22 were enrolled [two enrolling healthcare professionals, 10 enrolling other type of participants (including patients), three focused on adverse reactions, and 7 descriptive studies]. The package leaflets presented various readability problems, such as complex and difficult to understand texts, small font size, or few illustrations. The main methods to assess the readability of the package leaflet were usability tests or legibility formulae. Limitations with these methods included reduced number of participants; lack of readability formulas specifically validated for specific languages (e.g., Portuguese); and absence of an assessment on patients literacy, health knowledge, cognitive skills, levels of satisfaction, and opinions. CONCLUSIONS Overall, the package leaflets presented various readability problems. In this review, some methodological limitations were identified, including the participation of a limited number of patients and healthcare professionals, the absence of prior assessments of participant literacy, humor or sense of satisfaction, or the predominance of studies not based on role-plays about the use of medicines. These limitations should be avoided in future studies and be considered when interpreting the results.

Children's Health Risk and Benefits of Fish Consumption: Risk Indices Based on a Diet Diary Follow-Up of Two Weeks

Several epidemiological studies indicate that fish intake is associated with neurocognitive development and visual outcomes in children attributed to long-chain polyunsaturated fatty acids (PUFA). However, methylmercury (MeHg) represents the most toxic and abundant form of environmental mercury (Hg) exposure to humans and exposure occurs primarily through fish consumption. The objective of the study was to describe fish consumption during childhood in Portugal, estimating the intake of Hg from fish and calculating the indices of risk. The group consisted of 233 infants and students aged 7–11 yr and attending 5 primary schools in Lisbon, Amadora, and Sesimbra. Information regarding food consumption habits was collected through a food diary during 2 weeks, completed under the supervision of teachers and parents, where participants registered what was ingested for lunch and dinner during that period. The exposure assessment and indices of risk were calculated for each participant. Individuals were classified according to weekly intake and indices of risk determined per group. In addition, the methods used to collect information on fish intake habits, a food frequency questionnaire and diet diary, are described in relation to quality of information provided. The mean value of fish meals per week was approximately 5. The calculated indices of risk reached values above 1 in more than 50% of the studied population, demonstrating the presence of risk in subsets of the population. While Portuguese children represent an important group of fish consumers, this does not manifest as appreciable benefit with respect to omega-3 ingestion, as children ingest half or less of the recommended value (200 mg/d of omega-3), which is equivalent to being exposed to risk for Hg intoxication. The choice of fish species shows lack of knowledge of fish characteristics. Therefore, risk communication and population education need to be established to prevent consumption of predatory fish species that contribute to the increase in risk toxicity and to encourage ingestion of prey fish, which represent significant levels of high-value nutrients such as PUFA.

Pharmaceutical consultations in community pharmacies: utility of the Roter Interaction Analysis System to study pharmacist–patient communication

Communication is a key issue in the delivery of healthcare services. In the pharmacy context, pharmacist–patient communication may vary from brief counselling episodes to extensive pharmaceutical care consultations. Many community pharmacies have developed practices to facilitate the effective delivery of pharmacy care, in particular to chronic patients, although the nature and extent of the services differ widely from country to country. Diabetes‐focused pharmaceutical care is an example highlighting both the opportunities and challenges associated with an expansion of pharmacy services from product dispensing to pharmaceutical consultations. An area of particular challenge of such an expansion of pharmaceutical services is the development of expertise in the delivery of patient‐centred pharmaceutical consultations. Although well known to medicine and nursing, patient‐centredness has not been routinely incorporated into the training of pharmacists, evaluation of pharmacy practice or conduct of pharmacy‐related research. There are few studies of the communication process based on analysis of an objective record such as an audio or video recording and the common perspective is largely a one‐way information flow from pharmacist to patient. This has hampered the fields ability to link pharmacy communication to outcomes, including patient adherence and satisfaction with services. An extensive body of communication research on physician–patient interaction, employing the Roter Interaction Analysis System (RIAS), exists and the system presents a potentially useful tool in the pharmacy context. The purpose of this essay is to explore the utility of the RIAS for analysis of pharmacist–patient interaction and its implication for improving patient care and optimizing pharmacy‐specific outcomes.

Exposure Assessment of Pregnant Portuguese Women to Methylmercury Through the Ingestion of Fish: Cross-Sectional Survey and Biomarker Validation

Methylmercury (MeHg) contamination is a critical public health problem in Portugal, where fish is an important component of the daily diet. The Portuguese are the third largest consumers in the world (after Japan and Iceland) but first in Europe. Prenatal exposure to MeHg is believed to be linked to fetal/child neurodevelopment and behavioral impairments due to the neurotoxicity of the compound. The objective of this study was to assess the exposure of pregnant Portuguese women to mercury (Hg) due to fish consumption, calculating the indices of risk and confirming exposure through analyses of a biomarker of exposure. The study consisted of a cross-sectional evaluation of 343 pregnant women recruited at their visit to two antenatal care units in Lisbon, Portugal. A food frequency questionnaire was used to estimate prenatal exposure. Total Hg levels in hair were analyzed by atomic absorption, in samples from 186 women. The average fish consumption was 3.1 meals per week. Median Hg level in the hair was 1.26 μg/g (range: 0.07–5.3 μg/g). The mean calculated risk index was 0.81; however, 28% of the pregnant women ingested levels above the provisional tolerable weekly intake (PTWI) level recommended by the World Health Organization (WHO; 1.6 mg/kg per body weight), indicating the possibility of risk due to MeHg exposure. Multiple linear regression analysis showed the risk index was reliably predicted from predatory fish species and number of fish meals consumed per week. Ingestion of black and silver scabbard fish as well as mixed predatory fish cooked in traditional dishes enhanced the toxicity risk. In conclusion, some exposure levels exceeded the reference value; therefore, nutritional counseling needs to be provided to populations at risk.

Quality assurance in European pharmacy education and training

A survey of quality assurance (QA) systems in European faculties of pharmacy was carried out under the auspices of the European Association of Faculties of Pharmacy PHARMINE consortium. A questionnaire based on the quality criteria of the International Pharmaceutical Federation and the Accreditation Council for Pharmacy Education (USA) was sent out to European faculties. Replies were obtained from 28 countries. Just above half has a working QA system. QA scores were high concerning matters such as complete curriculum and training, use of European Credit Transfer System, students’ representation and promotion of professional behavior. QA scores were low concerning matters such as evaluation of achievement of mission and goals, and financial resources. The PHARMINE consortium now has a basis upon which to elaborate and promote QA in European pharmacy faculties.

European pharmacy students' experience with virtual patient technology.

Objective. To describe how virtual patients are being used to simulate real-life clinical scenarios in undergraduate pharmacy education in Europe. Methods. One hundred ninety-four participants at the 2011 Congress of the European Pharmaceutical Students Association (EPSA) completed an exploratory cross-sectional survey instrument. Results. Of the 46 universities and 23 countries represented at the EPSA Congress, only 12 students from 6 universities in 6 different countries reported having experience with virtual patient technology. The students were satisfied with the virtual patient technology and considered it more useful as a teaching and learning tool than an assessment tool. Respondents who had not used virtual patient technology expressed support regarding its potential benefits in pharmacy education. French and Dutch students were significantly less interested in virtual patient technology than were their counterparts from other European countries. Conclusion. The limited use of virtual patients in pharmacy education in Europe suggests the need for initiatives to increase the use of virtual patient technology and the benefits of computer-assisted learning in pharmacy education.

Do community pharmacists actively engage elderly patients in the dialogue? Results from pharmaceutical care consultations.

Little is known about community pharmacist–patient interaction within a consultation room, particularly in terms of patient activation and engagement.