Background: Current evidence of the influence of the medication regimen complexity (MRC) on the patients’ clinical outcomes are not conclusive. Objective: To systematically and analytically assess the association between MRC measured by the Medication Regimen Complexity Index (MRCI) and clinical outcomes. Methods: A search was carried out in the databases Cochrane Library, LILACS, PubMed, Scopus, EMBASE, Open Thesis, and Web of Science to identify studies evaluating the association between MRC and clinical outcomes that were published from January 1, 2004, to April 2, 2018. The search terms included outcome assessment, drug therapy, and medication regimen complexity index and their synonyms in different combinations for case-control and cohort studies that used the MRCI to measure MRC and related the MRCI with clinical outcomes. Odds ratios (ORs), hazard ratios (HRs), and mean differences (WMDs) were calculated, and heterogeneity was assessed using the I2 test. Results: A total of 12 studies met the eligibility criteria. The meta-analysis showed that MRC is associated with the following clinical outcomes: hospitalization (HR = 1.20; 95% CI = 1.14 to 1.27; I2 = 0%) in cohort studies, hospital readmissions (WMD = 7.72; 95% CI = 1.19 to 14.25; I2 = 84%) in case-control studies, and medication nonadherence (adjusted OR = 1.05; 95% CI = 1.02 to 1.07; I2 = 0%) in cohort studies. Conclusion and Relevance: This systematic review and meta-analysis gathered relevant scientific evidence and quantified the combined estimates to show the association of MRC with clinical outcomes: hospitalization, hospital readmission, and medication adherence.

Summary What is known and objective Qualified dispensing is fundamental for the promotion of the rational use of medicines. Documentation is an indicator of quality and one of the essential steps in the care process. However, in Brazil, there are no models of clinical documentation applicable to dispensing practices. Thus, the objective of this study was to develop and validate an instrument to document the dispensing process of prescribed medicines. Methods A methodological development study was carried out from February 2017 to October 2017 in two stages, which were (i) the development of the instrument and (ii) content validation of the proposed instrument. The development phase comprised three stages, which were (i) the elaboration of the prototype based on a previously performed systematic review, (ii) academic brainstorming and (iii) a pre‐Delphi consensus. The content validation process was performed using the Delphi technique. The instrument was sent to 40 experts with experience in dispensing, and the consensus among them was calculated using the content validity index (CVI). The study was approved by the Ethics Committee, and all participants signed an informed consent document detailing the terms of the study. Results In the development stage, three versions of the instrument were generated, which were the prototype, version 1 (changed after academic brainstorming) and version 2 (changed after the pre‐Delphi). In the content validation process of version 2 of the instrument, 23 experts returned their evaluation in the first round of the Delphi process and 17 in the second. All the items obtained a CVI >0.83, which resulted in the validation of the instrument. The final instrument comprised the following sections: general information, the identification of technical and legal problems of prescriptions, the conduct for the resolution of the technical and legal problems of prescriptions, medication dispensed, suspected drug‐related problems, verbal guidance, written guidance, referral and the referral result. What is new and conclusion The developed and validated instrument presents the main variables that should be documented during the dispensing process.

Background Drug dispensing is a clinical pharmacy service that promotes access to medicines and their rational use. However, there is a lack of evidence for the impact of drug dispensing on patients’ health outcomes. Thus, the purpose of this study was to assess the influence of drug dispensing on the clinical, humanistic, and economic outcomes of patients attending community pharmacies. Methods A systematic literature search was performed in April 2021 using PubMed, Web of Science, Cochrane Library, LILACS, and Open Thesis. Two reviewers screened titles, abstracts, and full-text articles according to the eligibility criteria. Methodological quality was assessed using tools from the Joanna Briggs Institute, and the literature was synthesized narratively. Results We retrieved 3,685 articles and included nine studies that presented 13 different outcomes. Regarding the design, they were cross-sectional (n = 4), randomized clinical trials (n = 4), and quasi-experimental (n = 1). A positive influence of drug dispensing on health outcomes was demonstrated through six clinical, four humanistic and three economic outcomes. Eight studies (88,9 %) used intermediate outcomes. The assessment of methodological quality was characterized by a lack of clarity and/or lack of information in primary studies. Conclusions Most articles included in this review reported a positive influence of drug dispensing performed by community pharmacists on patients’ health outcomes. The findings of this study may be of interest to patients, pharmacists, decision makers, and healthcare systems, since they may contribute to evidence-based decision-making, strengthening the contribution of community pharmacists to health care. Trial registration Registration: PROSPERO CRD42020191701.

Objective. To determine the levels of communication apprehension (CA) experienced by health students and compare them according to sex, age range, course, and academic year. Method. A cross-sectional study was conducted at a Brazilian university from December 2019 to May 2020 with dentistry, pharmacy, medicine, and nursing students, recruited by convenience sampling. The students were invited to answer a survey consisting of two sections: general characteristic and the Personal Report of Communication Apprehension (PRCA-24). Univariate and bivariate analyses were conducted. Results. A total of 644 health students answered the survey, of whom 25.5% were classified as having high communication apprehension. Male participants had significantly lower PRCA-24 scores than females. No significant differences were found between PRCA-24 scores by age category or academic year. Medical students had significantly lower mean PRCA-24 scores than pharmacy students. Conclusion.The prevalence of high CA was high and apparently remained stable over time. The highest scores for CA were obtained by women and pharmacy students. Health educators should consider the effects of communication apprehension and use adequate interventions during communication skills training.

Introduction Communication apprehension (CA) refers to an individual’s level of fear or anxiety toward either real or anticipated communication with another person or persons. The Personal Report of Communication Apprehension (PRCA-24) is the most widely used measure of CA, even among healthcare students. Objective This study aimed to undertake a cross-cultural adaptation of this scale, translate it into Brazilian Portuguese, and examine its psychometric properties among healthcare students. Methods The translation and cross-cultural adaptation procedures were undertaken with the objective of establishing compatibility between the original and translated scales. The content validity of the scale was established based on the feedback of a multidisciplinary expert committee. Its psychometric properties were evaluated using a convenience sample of 616 healthcare students. Its construct validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Its internal consistency was examined by computing Cronbach’s alpha and McDonald’s omega coefficients. Its criterion validity was examined against the Interpersonal Communication Competence Scale (ICCS). Results The adapted scale demonstrated acceptable content validity. EFA showed that it was undergirded by one dimension, and this observation was confirmed by the results of CFA. The scale demonstrated excellent internal consistency. Its convergent validity was examined by conducting correlation analysis, and scores on the adapted PRCA-24 were negatively correlated with scores on the ICCS. Conclusion The Brazilian version of the PRCA-24 has satisfactory psychometric properties and is, therefore, suitable for use with Brazilian healthcare students. It can be used to assess their communication needs for the purpose of designing tailored training programs.

The authors have withdrawn this preprint due to author disagreement.

Background: Implementation of clinical pharmacy services, such as drug dispensing, is a complex process. It is necessary to understand the challenges associated with this practice from the perspective of the actors involved to help ensure optimal service provision. Thus, this study aimed to understand the factors that may influence the implementation of drug dispensing in community pharmacies, according to the perceptions of pharmacists. Methods: This qualitative study was based on semi-structured, face-to-face interviews. The participants were pharmacists who worked in a chain of community pharmacies in Brazil, selected based on their direct participation in the implementation process. The interview recordings were transcribed full verbatim and were independently analyzed using thematic analysis, followed by consensus meetings between researchers. The factors identified by the participants were classified according to the Apoteca framework. This study was approved by the Committee of Ethics in Research and all participants signed an informed consent form. Results: We conducted 18 interviews, with 47 factors that may influence the implementation of drug dispensing in community pharmacies being identified. These factors were allocated to seven categories: support from community pharmacy chain (4), pharmacy infrastructure (11), characteristics of the pharmacy, medicines and other health products (4), pharmacist (16), dispensing work process (2), pharmacy team (2), and patient (8). The classification of factors according to the Apoteca framework allocated most of them to administrative (14) and technical (14) domains, followed by attitudinal (13) and political (5) domains. Conclusions: This study identified several factors that can influence the implementation of drug dispensing and classified them according to the domains of the Apoteca framework, highlighting the multifactorial nature of the implementation process. The results of this study can guide the planning of strategies aimed at providing efficient drug dispensing in community pharmacies.

The teaching model based on objective, measurable, and linear knowledge no longer seems to be the most appropriate, given the new responsibilities of pharmacists, who should focus their practices on patient care. The objective of the present study was to analyze students' perception about preparedness to pharmacy practice and to patient-centered care, and identify experiential training barriers Two discussion groups were formed with 12 and 13 individuals to present their perceptions about teaching and learning for pharmaceutical care. The analysis followed the methodology of Bardin. The analysis of the answers indicates that there is a significant gap in the training of pharmacists, with a strong emphasis on theoretical issues and less focus on knowledge acquisition and interpersonal communication, generating poor professional training and relationship barriers. In general, students do not feel prepared to deal with patients. These students identify the lack of infrastructure, such as the lack of a pharmacy and underutilization of the hospital, deficiencies in the curriculum such as the lack of key subjects, lack of clinical practice, and lack of preparation of some teachers, with an excess of classes following the lecture format. These factors influence the teaching and learning of clinical and communication skills, which undermine the pharmacists' ability to carry out clinical interventions, as well as affect the pharmaceutical-patient and pharmaceutical-physician relationship. These results suggest that for the pharmacists' clinical training it is necessary to rethink whether the infrastructure, the curriculum, and the teaching method are adequate for the development of skills and competences.