Implementação da dispensação de medicamentos em farmácias comunitárias: compreensão do processo e proposição de estratégias

Abstract

Introduction: The process of implementing clinical pharmacy services, including drug dispensing, is complex and multifactorial. Thus, it is necessary to understand in depth the process for implementing this service. Objective: To understand the process of implementation of drug dispensing in community pharmacies. Methods: The study is being conducted from July 2019 to December 2021. In the first step, a cross-sectional survey was carried out to understand the self-reported work process of Brazilian community pharmacists in relation to drug dispensing. In the second step, two qualitative study was carried out with pharmacists from a private chain community pharmacy to understand their perceptions about drug dispensing and the factors that can influence the implementation of the service. The factors were categorized according to the Apoteca framework. In the third steep, a study was carried out to describe the strategies used to implement the drug dispensing. This study was approved by the Research Ethics Committee (number 3.698.806). Results: In the first step, a total of 625 community pharmacists answered the survey. Most pharmacists reported always or frequently performing 17 (54%) steps described in the instrument. The stage that pharmacists reported performing most frequently was informing the name of the drug (n=569, 91.04%) and documentation was the main stage that pharmacists reported never or rarely performing (n=424, 67.84%). In the second step, 18 interviews were conducted, and the perceptions of pharmacists were divided into three categories: characteristics of the service, importance of the service, and ethical conflict. Regarding the factors, 47 factors that can influence the implementation of the dispensing were identified. These factors were allocated to seven categories: support from community pharmacy chain, pharmacy infrastructure, pharmacy characteristics, medicines and other health products, pharmacist, dispensing work process, pharmacy team, and patient. These factors were divided into seven categories: community pharmacy network support, pharmacy infrastructure, pharmacy characteristics, medicines and other health products, pharmacist, drug dispensing work process, pharmacy staff, and patient. The factors were allocated to the four domains of the Apoteca framework, with emphasis on the administrative (14) and technical (15) domains. In step three, political-administrative interventions were carried out to sensitize the pharmacy team and organize the flows and processes within the community pharmacies. The technical intervention consisted of theoretical-practical training for pharmacists, with training of 32 hours. Attitudinal interventions occurred mainly through motivational lectures. Conclusion: Most pharmacists in the study reported performing most of the dispensing steps contained in the instrument. Most pharmacists are aware of the main importance of the service and the factors identified highlight the multifactorial nature of the implementation process. In addition, it was possible to describe the process of implementation of the dispensing. These results can serve as a model for future implementations of clinical pharmacy services.