Enrico Keber

Background: The Italian university system is actively revising the Master of Pharmacy (MPharm) curriculum to reflect post-COVID healthcare needs and a greater clinical focus. Understanding the challenges and opportunities faced by Italian pharmacists that relocated to Great Britain (GB) might provide valuable insights regarding the transferability of knowledge and skills obtained in the Italian pharmacy degree. Aim: The study aimed to capture the perceptions of Italian pharmacists practising in GB regarding the Italian pharmacy degree programme and to explore the challenges and opportunities they face in their new professional environment, ultimately to inform the Italian government and related stakeholders (Ministry of University and Research, MUR) about the need to update the Italian MPharm curriculum to make it more clinically relevant and aligned with international standards. Materials and methods: The authors developed a 50-item survey, pilot tested and reviewed for face and content validity by an expert panel. Participants’ characteristics, reasons for moving to GB, and data on their experience of practising as a pharmacist in Italy and GB were collected using Likert-type items and open- and closed-ended questions. Convenience sampling was used, and a sample power calculation was not deemed necessary. Statistical analysis involved descriptive analysis presenting frequencies and percentages for Likert-type and categorical items. Results: An estimated 281 pharmacists qualified in Italy are registered with the General Pharmaceutical Council in GB. Of these, 54 took part in the survey, resulting in a probable coverage of the sample population of 19.2%. Respondents pointed to the lack of job satisfaction and limited future perspectives as the main reasons to leave Italy (38.9% and 83.3%, respectively). Other reasons to relocate to GB were clinically focused job opportunities and better salaries (68.5% and 79.6%, respectively). Notably, almost two-thirds of the participants affirmed that Italian pharmacy degrees were insufficient to meet the requirements for practising as a pharmacist in GB. Conclusion: Different approaches to teaching clinical pharmacy and practical aspects seen in the pharmacy degree programmes in Italy and GB highlight a clear need for aligning the Italian pharmacy curriculum with the modern requirements of the pharmacy profession. Additionally, this alignment would facilitate the movement of Italian pharmacists into the GB healthcare system and beyond.

Este documento técnico, es el tercero y forma parte de una serie de publicaciones que giran en torno al uso y evaluación de los medicamentos y tecnologías sanitarias desde una perspectiva multidisciplinar a partir de las herramientas que aporta la Economía de la Salud, en general, y la Farmacoeconomía en especial, siempre teniendo en cuenta los Resultados en Salud que se obtienen en diversas patologías fundamentalmente crónicas o de gran impacto en la salud de la población. Fruto de esta colaboración es este tercer Informe Técnico en el que se aborda de forma concisa y clara cuales son los retos a los que enfrentamos debido a la implementación y gestión de programas de vacunación en pacientes inmunocomprometidos. Junto con las mejoras sociales, económicas, demográficas, sanitarias y epidemiológicas, sin duda los medicamentos (y por ende las vacunas) constituyen una de las innovaciones que más han contribuido al bienestar de la sociedad a lo largo de nuestra historia reciente, ayudando a mejorar sustancialmente la esperanza de vida, el estado de salud y la calidad de vida de las personas. Nuestro deseo y objetivo al realizar este documento es aportar un nuevo enfoque en la evaluación de los medicamentos y tecnologías sanitarias basado más en el Valor (social que genera) que en el Gasto (económico que ocasiona) que debe entenderse en este caso como una inversión en un bien público.

Background Ailments such as diarrhoea and antibiotic-associated gut symptoms are generally self-managed using probiotics. Real-world data on reasons behind self-medication with over-the-counter (OTC) products and patient-reported outcomes can be investigated strategically by the pharmacists. Objective This study evaluates the use of Bacillus clausii (Enterogermina^®) at the Italian community pharmacies among self-medicating patients, their treatment habits and perceived benefits. Design This is a multicentre, prospective, non-interventional study which included two visits [at screening (T0) and end of the study (T1) when symptoms had subsided, ≤ 30 days from T0]. Patients who were already inclined to buy B. clausii were enrolled and instructed to complete a questionnaire at T0 and T1. The primary objective was to evaluate the reasons for taking B. clausii. Secondary objectives assessed treatment duration, perceived effectiveness, quality of life (QoL), treatment satisfaction and safety outcomes. Results Overall, 268 patients were enrolled; 99.6% of them were evaluated at T0 and 97.4% at T1, and safety was evaluated in 97.8% who had ≥ 1 dose of B. clausii. At T0, mean age was 50.7 years and majority were females (62.2%). In the interview, main reason stated for using B. clausii at T0 was diarrhoea (56.93%), followed by other gastrointestinal symptoms. Treatment duration was shorter in those with diarrhoea or abdominal pain versus those with constipation or abdominal tension. More than 90% perceived their symptoms to have improved or improved very much. Overall QoL improved in all the aspects measured. Treatment satisfaction was reported by nearly 90% of patients as satisfied, very satisfied or extremely satisfied. No adverse events were reported. Conclusion This is the first pharmacy-based study in Italy that evaluated the real-world usage of an OTC probiotic containing B. clausii among self-medicating adults. Diarrhoea was the most common reason for use, with high-level of perceived effectiveness and patient satisfaction with B. clausii.

(1) Background: Corticosteroids are commonly used for a variety of conditions, but their use might come with significant side effects. Self-medication practices increased during the COVID-19 pandemic, potentially favoring corticosteroid misuse. Studies on this topic are lacking, thus we aim to characterize the misuse of corticosteroids in Italy through pharmacists’ perspectives and sales reports. (2) Methods: We sent to territorial pharmacists a survey that aimed to investigate corticosteroid misuse before and during the pandemic. In parallel, sales reports of the major oral corticosteroids were obtained from IQVIA. (3) Results: We found that 34.8% of clients demanded systemic corticosteroids without a valid prescription, with a rise to 43.9% during the pandemic (p < 0.001). Adults and patients suffering from upper airway diseases or obstructive airway diseases most frequently asked for corticosteroids without an appropriate prescription. The greatest increase after the beginning of the pandemic was seen for lung diseases. Although sales of the major oral corticosteroids decreased during the pandemic, sales of those used for COVID-19 increased. (4) Conclusions: Self-medication with corticosteroids is common and might lead to avoidable toxicities. This tendency increased during the pandemic probably because of incorrect beliefs about the inappropriate use of corticosteroids for treating COVID-19 itself. The development of shared strategies between doctors and pharmacists is essential in defining protocols guiding appropriate patient referral in order to minimize corticosteroid misuse.

Background: Medication overuse is an increasing global problem, especially for those rhinology diseases whose management requires over-the-counter drugs. This observational community pharmacy-based study aimed to investigate the actual use of the best-selling topical nasal medications and to characterize the clinical issues underlying their query through the pharmacist’s perception. Methods: In the pilot phase, a preliminary survey was developed by a team of researchers and tested on a small sample of practitioners to assess usability and intelligibility. Eventual amendments were made according to the feedback obtained, and the final version was submitted to practitioners working in 376 pharmacies evenly distributed over the Italian territory. Results: Two groups of customers (18–30 years old and 60–75 years old) were the ones who most frequently purchased topical decongestants. The dosage applied for sympathomimetic amines was higher than recommended in up to 44.4% and the duration of use longer than 5 days in up to 31.9% of the cases. Patients’ queries of alpha agonists and topical corticosteroids resulted in significantly higher numbers than practitioners’ prescriptions. Allergic rhinitis was the most common disease affecting patients seeking sympathomimetic amines. Conclusions: The prolonged use of sympathomimetic amines in patients suffering from rhinology diseases is a significant problem that requires greater attention in terms of social education and surveillance.

Aim: To develop two versions of the Communication Assessment Tool (CAT) skilled for the setting of community pharmacy and to pilot test it on a selected sample. Materials: Development of two versions of CAT-tool for community pharmacists. Validity and reliability assessments were required to determine the psychometric properties of developed tool versions. To investigate the construct validity of each adapted tool item, confirmatory factor analysis was performed. Reliability was assessed with the Cronbach's Alpha evaluation, internal validity by submitting tool versions to patients of eleven pharmacies from North, Center, and South of Italy for pilot testing. Results: Two CAT versions were developed and tested: CAT-Pharm-community Adherence to therapy and Minor Disease Management versions. First to evaluate pharmacist-patient communication following the dispensing of a prescription drug, second a consultation for minor disease management. Conclusion: Communication tools are useful to implement optimal management of chronic diseases to minimize non-adherence and patients' negative health outcomes.

Community pharmacists represent an important resource for the promotion of a safer and more effective self-management of common skin diseases, as well as the provision of educational support on therapies prescribed by clinicians, ultimately improving patients' adherence. In this study, a semi-structured survey was administered to 154 Italian community pharmacists, in order to acquire information on their counseling activity on dermatological disorders. Collected data provide an overview on the frequency and methodology of counseling offered in Italian community pharmacies, identifying knowledge gaps and misbeliefs. In particular, an overall negative opinion on topical corticosteroid therapy emerged among pharmacists, unveiling a phenomenon previously described as corticophobia. Starting from this observation, we discuss the risks for patients' adherence, associated with corticophobia among pharmacists. Lastly, we briefly report on the main tools desired by pharmacists to improve their education on dermatology, envisioning their implementation with the aim of a more effective counseling.