LETTERS TO THE EDITOR
A new definition of pharmaceutical care: No, without consensus (Opinion on Barbate Document)
Redefinición de la Atención Farmacéutica: No sin consenso (Opinión sobre el documento de Barbate)
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Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Redefinición de la Atención Farmacéutica: No sin consenso (Opinión sobre el documento de Barbate)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Farmacia Hospitalaria</span> (FH) has published an article that introduces a new definition of <span class="elsevierStyleItalic">pharmaceutical care</span> (PC) together with a rationale for the new definition and for revising the goals and procedures of PC. The authors of the article<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> believe that the concept of PC needs to be updated because medicines have become more complex and specific, new care frameworks have been developed, and a different society with more informed patients has emerged. They also point to the huge advancements achieved in the technological arena.</p><p id="para210" class="elsevierStylePara elsevierViewall">The CMO (Capacity-Motivation-Opportunity) methodology, introduced in 2014 within the framework of the MAPEX (<span class="elsevierStyleItalic">Strategic Map for Outpatient Care</span>) project, claimed that the traditional outpatient PC model had “reached its limit” and that the classical approach to hospital pharmacy outpatient care had to be redesigned<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a>.</p><p id="para220" class="elsevierStylePara elsevierViewall">In 2008, the increasing workload involved in dispensing drugs to outpatients resulted in a reorganization of the procedures used by hospital pharmacy departments. However, we do not believe that there is enough justification for carrying out a blanket amendment to the principles that have governed PC since the concept was introduced in 1990.</p><p id="para230" class="elsevierStylePara elsevierViewall">We believe that greater agility, efficiency and multidisciplinarity can be achieved without breaking away from the healthcare procedures and the doctrine that our profession has so painstakingly developed over the years.</p><p id="para240" class="elsevierStylePara elsevierViewall">The definitions used and then amended by international professional groups have always retained the core elements behind the change suggested by Hepler & Strand<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a>, which shifted the focus of pharmaceutical services from being drug-centered to being patient-centered.</p><p id="para250" class="elsevierStylePara elsevierViewall">The article published in <span class="elsevierStyleItalic">Farmacia Hospitalaria</span> states that “not much progress” has been made in this respect at an international level. Nevertheless, the PCNE working group (Alleman & Van Mil) in 2014 and Holland<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> in 2018 redefined a few concepts, though always based on the seminal tenets laid down by Hepler & Strand.</p><p id="para260" class="elsevierStylePara elsevierViewall">Lastly, it should be mentioned that the Resolution on the implementation of pharmaceutical care for the benefit of patients and health services adopted by the Committee of Ministers of the Council of Europe in March 2020 is also based on Hepler & Strand's definition, which is used for the application of PC in different health services, including hospital-based ones<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a>.</p><p id="para270" class="elsevierStylePara elsevierViewall">The Pharmaceutical Care Foundation was established in 1998 with the purpose of promoting scientific and professional activities related to PC. The Spanish Society of Hospital Pharmacists (SEFH) is one of the Foundation's founding members. Although the article states that the working group that authored it was “made up of members of SEFH and pharmacists from different healthcare units”, it is surprising that the Foundation should not have been invited to support the document. What is more, none of the other relevant scientific societies feature on the list of adherents.</p><p id="para280" class="elsevierStylePara elsevierViewall">In our opinion, the definitions used by the different groups who have played a role in the advancement of PC, as well as the goals they have pursued, remain valid. Only procedures requiring a more extensive application of communication technologies should be redesigned and any changes should be discussed jointly by professionals at different levels of care. This has precisely been the goal of the activities recently carried out by the Foundation, with the participation among other of members of SEFH, which have resulted in a series of conclusions emphasizing the need for pharmacists across different clinical areas to team up and work in a coordinated manner.</p><p id="para290" class="elsevierStylePara elsevierViewall">The Foundation will always be open to considering potential alterations to definitions and procedures intended to optimize patients’ health outcomes by improving their drug therapy. Such alterations should draw on the input of all the healthcare providers involved in pharmacological treatment, many of them represented in our institution.</p><p id="para300" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">A new definition and a new approach to pharmaceutical care: the Barbate Document. Authors’ response</span></p><p id="para310" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Dear Editor-in-Chief,</span></p><p id="para320" class="elsevierStylePara elsevierViewall">We are grateful for the comments made in the letter to the editor about our article. However, we do not share the arguments put forward.</p><p id="para330" class="elsevierStylePara elsevierViewall">First of all, the authors confuse the origins of the CMO methodology in the hospital setting, the MAPEX project, with the scope of the proposal and the redesign of pharmaceutical care<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>. Even if our proposal does result from the problems that characterize specialized care, it in no way limited to that domain, as the CMO methodology is not specific to one particular kind of patient but represents a new model of clinical relationships applicable —as stated in the different sections of our article— to any patient<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a>. This has been repeatedly corroborated by medical and pharmaceutical societies at all clinical levels, as well as by patient associations<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a>.</p><p id="para340" class="elsevierStylePara elsevierViewall">Although the authors themselves point out that <span class="elsevierStyleItalic">only procedures requiring a more extensive application of communication technologies should be redesigned,</span> they are in fact supporting our arguments by admitting that society, the health system, and patients themselves have undergone a radical change and, therefore, it is not advisable to apply a one-size fits-all approach or concepts such as that of “drug related problems,” which are inimical to the creation of a long-term, longitudinal connection with the patient and with other stakeholders, based strictly on pharmacotherapeutic goals<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3,</span></a><a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a>.</p><p id="para350" class="elsevierStylePara elsevierViewall">According to this approach, pharmacists should not only be <span class="elsevierStyleItalic">experts in medicines and their use</span> but, above all, <span class="elsevierStyleItalic">experts in curating the relationship of patients with their drug treatment,</span> who in the foreseeable future are likely to work increasingly as part of multidisciplinary teams comprising healthcare providers of different fields. These are novel aspects not taken into consideration up to now, and which have been absent from previous contributions to the subject.</p><p id="para360" class="elsevierStylePara elsevierViewall">We are fully aware of the fact that our proposal deviates from the traditional approach and that the diffusion of the changes in pharmaceutical care that we have been advocating since 2020 is still limited as compared with that of the established doctrine taught in graduate and postgraduate university programs and used in official documents. Nonetheless, scientific evidence, critical reasoning and the natural evolution of pharmaceutical practice are bound to set the scene for the development and expansion of a new kind of pharmaceutical care.</p><p id="para370" class="elsevierStylePara elsevierViewall">Our proposal does not demand a total break away from the previous model but instead, a recognition of the significance of the foundations laid in the 1990’s<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a> and of the valuable contributions of so many colleagues who have helped advance our profession. We believe that it is now time to implement a disruptive rather than gradual improvement of pharmaceutical care to adapt to the new times so as to avoid being left out of the rapidly evolving landscape around us.</p><p id="para380" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Farmacia Hospitalaria</span> will shortly publish a practical example of how the new methodology involves a significant improvement with respect to the traditional approach, even with regard to traditional variables such as adherence. This is the result of an innovative scientific design and a multilevel patient management approach, including patient stratification, pharmacotherapeutic objective-based care and, obviously, the adoption of such new technologies as may allow the longitudinal and coordinated follow-up that is required<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a>.</p><p id="para390" class="elsevierStylePara elsevierViewall">Lastly, far from wishing to claim ownership of such a significant concept, we would like to build bridges with other professionals to keep developing our profession and advancing pharmaceutical care, not just to homogenize the activities we perform as a group but, above all, to improve the health outcomes of the patients we serve.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-04-14" "fechaAceptado" => "2021-06-10" "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Una nueva definición y reenfoque de la atención farmacéutica: el Documento de Barbate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ R Morillo-Verdugo \n \t\t\t\t\t\t\t\t """ 1 => """ MA Calleja-Hernández \n \t\t\t\t\t\t\t\t """ 2 => """ MA Robustillo-Cortés \n \t\t\t\t\t\t\t\t """ 3 => """ JL Poveda-Andrés \n \t\t\t\t\t\t\t\t """ 4 => """ Grupo de trabajo Documento de Barbate \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7399/fh.11389" "Revista" => array:7 [ "tituloSerie" => "Farm Hosp" "fecha" => "2020" "volumen" => "44" "numero" => "4" "paginaInicial" => "158" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32646347" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El modelo CMO en consultas externas de Farmacia Hospitalaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ MA Calleja Hernández \n \t\t\t\t\t\t\t\t """ 1 => """ R Morillo Verdugo \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2016" "editorial" => "Euromedice-Vivactis;" "editorialLocalizacion" => "Badalona" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Opportunities and responsibilities in Pharmaceutical Care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ CD Hepler \n \t\t\t\t\t\t\t\t """ 1 => """ LM Strand \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Hosp Pharm" "fecha" => "1990" "volumen" => "47" "numero" => "3" "paginaInicial" => "533" "paginaFinal" => "543" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2316538" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A logic model for pharmaceutical care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ C Moltó-Puigmartí \n \t\t\t\t\t\t\t\t """ 1 => """ R Vonk \n \t\t\t\t\t\t\t\t """ 2 => """ G van Ommeren \n \t\t\t\t\t\t\t\t """ 3 => """ I Hegger \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1177/1355819618768343" "Revista" => array:7 [ "tituloSerie" => "J Health Serv Res Policy" "fecha" => "2018" "volumen" => "23" "numero" => "3" "paginaInicial" => "148" "paginaFinal" => "157" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29783864" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1177/1355819618768343" "WWW" => array:1 [ "link" => "DOI: 10.1177/1355819618768343" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Committee of Ministers. Resolution CM/Res(2020)3 on the implementation of pharmaceutical care for the benefit of patients and health services [Internet] [accessed 10/03/2021]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ Council of Europe \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:1 [ "link" => "Available at: https://rm.coe.int/09000016809cdf26" ] ] ] ] ] ] ] ] ] ] "lecturaRecomendada" => array:1 [ 0 => array:2 [ "vista" => "all" "seccion" => array:2 [ 0 => array:3 [ "titulo" => "<span class="elsevierStyleSectionTitle" id="cestitle20">Una nueva definición y reenfoque de la atención farmacéutica: el Documento de Barbate. Respuesta de los autores</span>" "texto" => "<p id="para110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Sr. Editor:</span></p> <p id="para120" class="elsevierStylePara elsevierViewall">Agradecemos los comentarios, sin embargo, no compartimos los argumentos expuestos.</p> <p id="para130" class="elsevierStylePara elsevierViewall">En primer lugar, los autores confunden la génesis, el proyecto MAPEX, en el entorno hospitalario, con el ámbito de actuación de la propuesta y reenfoque de la Atención Farmacéutica<a class="elsevierStyleCrossRef" href="#bibs1"><span class="elsevierStyleSup">1</span></a>. Pese a nacer de una problemática de la atención especializada, la propuesta no se circunscribe, en absoluto, a este ámbito asistencial, ya que la metodología propuesta (CMO) no es exclusiva de un tipo de paciente, sino que representa un nuevo modelo de relación asistencial, aplicable, tal y como se indica en cada uno de los elementos clave que desarrollan los pilares del documento, a cualquier paciente<a class="elsevierStyleCrossRef" href="#bibs2"><span class="elsevierStyleSup">2</span></a>, y así lo han refrendado las sociedades, médicas y farmacéuticas, de todos los niveles asistenciales, así como asociaciones de pacientes firmantes.</p> <p id="para140" class="elsevierStylePara elsevierViewall">Aunque los propios autores señalan que <span class="elsevierStyleItalic">“sólo los procedimientos, necesitados de una mayor aplicación de las tecnologías de la comunicación, podrían ser objeto de una revisión del concepto”,</span> en realidad, nos están dando la razón en su totalidad, admitiendo que la sociedad, sistema sanitario y pacientes ya no son los mismos y que, por tanto, no podemos seguir basándonos en el “café para todos”, el abordaje transversal o en conceptos propios como el “problema relacionado con el medicamento”, el cual nos aleja del vínculo mantenido, longitudinal y basado en objetivos farmacoterapéuticos que pretendemos alcanzar, tanto con el paciente como con el resto de profesionales con los que interactuamos<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3,</span></a><a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a>.</p> <p id="para150" class="elsevierStylePara elsevierViewall">Este salto supone no solo ser <span class="elsevierStyleItalic">expertos en el medicamento,</span> sino, sobre todo, ser <span class="elsevierStyleItalic">expertos en la relación del paciente con su farmacoterapia,</span> ya que el abordaje multidimensional va a ser una máxima, dentro del trabajo multidisciplinar, en el que nos vamos a manejar en los próximos años, aspectos que no han sido tenidos en cuenta hasta ahora ni han aparecido en las aportaciones previas a este concepto.</p> <p id="para160" class="elsevierStylePara elsevierViewall">Reconocemos que, actualmente, la expansión y difusión de nuestra propuesta y reenfoque asistencial que hemos difundido en 2020 es, sin lugar a duda, infinitamente menor que la doctrina tradicional enseñada en facultades y docencia postgrado y utilizada en documentos oficiales. No obstante, la evidencia científica, el razonamiento crítico y la necesaria adaptación a los tiempos, como no puede ser de otra manera, marcarán el crecimiento y expansión de nuestra aportación.</p> <p id="para170" class="elsevierStylePara elsevierViewall">Nuestra propuesta no es de ruptura total, sino que, reconociendo el avance para la profesión de los cimientos puestos en los 90<a class="elsevierStyleCrossRef" href="#bibs5"><span class="elsevierStyleSup">5</span></a> y las aportaciones realizadas por los compañeros que han mejorado la profesión, ahora, entendemos, toca apostar por una mejora, no creciente, sino disruptiva, para adaptarnos a los tiempos que corren y no quedarnos fuera de un entorno que, la época que estamos viviendo lo ratifica, va a una velocidad nunca antes conocida y en la que, si no aportamos valor, quedaremos fuera de juego.</p> <p id="para180" class="elsevierStylePara elsevierViewall">Se publicará próximamente en esta revista un ejemplo práctico sobre cómo esta metodología supone un importante avance respecto al formato tradicional. Incluso con variables muy trabajadas, como la adherencia, pero con un diseño científico y adaptación a los pacientes interniveles, acordes al momento actual, incluyendo estratificación asistencial, trabajo por objetivos farmacoterapéuticos y, obviamente, la ayuda de las nuevas tecnologías para el seguimiento longitudinal y coordinado que se nos demanda<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a>.</p> <p id="para190" class="elsevierStylePara elsevierViewall">Por último, lejos de querer apropiarnos de un concepto tan relevante, nos gustaría tender puentes y, con un ánimo sincero de crecer profesionalmente, estamos abiertos a seguir avanzando conjuntamente, no solo por el beneficio en homogeneización de actividades, como colectivo, sino, sobre todo, por el alcance en resultados en salud que ello supondrá para los pacientes que atendemos y a los que nos debemos.</p>" "vista" => "all" ] 1 => array:3 [ "titulo" => "<span class="elsevierStyleSectionTitle" id="cestitle30">Bibliography</span>" "vista" => "all" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bibs1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MAPEX: Look deeper, looking away" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ R Morillo Verdugo \n \t\t\t\t\t\t\t\t """ 1 => """ J Sáenz De La Fuente \n \t\t\t\t\t\t\t\t """ 2 => """ MA Calleja Hernández \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Farm Hosp" "fecha" => "2015" "volumen" => "39" "numero" => "4" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "DOI: 10.7399/fh.2015.39.4.9407" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bibs2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Una nueva definición y reenfoque de la atención farmacéutica: el Documento de 3arbate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ R Morillo-Verdugo \n \t\t\t\t\t\t\t\t """ 1 => """ MÁ Calleja-Hernández \n \t\t\t\t\t\t\t\t """ 2 => """ MA Robustillo-Cortés \n \t\t\t\t\t\t\t\t """ 3 => """ JL Poveda-Andrés \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Farm Hosp" "fecha" => "2020" "volumen" => "44" "numero" => "4" "paginaInicial" => "158" "paginaFinal" => "162" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "DOI: 10.7399/fh.11389" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bibs3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posicionamiento de la Sociedad Española de Farmacia Hospitalaria sobre Telefarmacia. 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Información del artículo
ISSN: 11306343Idioma original: Inglés
DOI:10.7399/fh.11709
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