#FAP_ICSCC Primary care pharmacists, support for patient-centred care

Josep Vidal-Alaball

For writing this post, Josep Vidal-Alaball has shared authorship with Anna Maria Bonet Esteve and Aïna Fuster Casanovas.

Health systems have always been more disease-oriented than patient-oriented. In a paternalistic way, the patient's medication has been managed, indicating what he or she has to take and how they have to do it. What consequences has this had? Discomfort in those patients for whom the medication does not suit them, with the consequent interruption of the treatment and the frustration of the professionals for not obtaining results, in addition to the high cost associated with the health system. The social profile of the Catalan population is characterized by progressive ageing and, therefore, by an increase in chronic pathology and associated comorbidities. Fragmented health care among multiple health providers in the system can complicate treatments that are already complex per se. In a context of excessive medicalization of daily life due to the use of medication as one of the main therapeutic resources in the provision of health care, there is an acute need to change the paternalistic management model to promote care that takes into account all stakeholders (1)(2).

Lessons from the opioid crisis, a case of overtreatment with devastating consequences

Cristina Roure
 

If you are regulars of American series such as House, The Affair or This is us, you will be familiar with the classic protagonist who, after an episode of acute pain, ends up becoming addicted to prescription opioids such as Vicodin®, OxyContin® or Percocet®. Do not think that this is a writer’s exaggeration.

In 2015, life expectancy in the United States changed the trend and began to decline for the first time since the First World War. Among the causes, the epidemic of deaths from opioid overdoses, which multiplied by six between 1999 and 2017 (1), surpassing deaths associated with AIDS at its worst or those related to the Vietnam War. The epidemic was declared a national emergency by the United States Department of Health in 2017 and, despite the campaign deployed to combat it (2), 130 people still die in that country every day from opium overdose. If you are interested in the subject and want to delve into it, read the supplement that Nature dedicated to it in September last year.

Precision medicine, hope or hype?

Cristina Roure

Fifteen years after the human genome has been deciphered, after 3 billion dollars and after 13 years of intense network research, the cost of sequencing the entire genome has been reduced a thousand times and more than 20 million people already get concrete results. In a few weeks, from a simple saliva sample, these people will receive comprehensive information about their genetic material for less than $100 thanks to companies such as 23andMe or Ancestry. In the United States, through an alliance between Genomind and the Albertsons pharmacy office chain, patients treated with psychoactive drugs can receive advice from their pharmacist so that their doctor prescribes a pharmaceutical-genetic test and perform it in the same pharmacy office. It’s spectacular that a series of emerging diagnostic technologies target healthy people to predict or detect diseases early: immune footprint to predict various types of cancer and infectious diseases, biomarkers for Alzheimer's disease, or exhaled breath tests for early detection of lung cancer.

The slow progress of clinical safety, a problem of "many hands"

Cristina Roure

In this section we usually discuss overdiagnosis and overtreatment, but today we will talk about the difficulty in achieving safe care environments for patients.

Some will remember the publication in the year 2000 of the report “To err is human. Building a safer Health System” by the Institute of Medicine's Quality Care, which created a big impact in the media due to the alarming figures of deaths caused by medical errors in the USA. (1). Since then, a lot of work has been done in order to improve patient safety, and a lot of progress has been made for the dissemination of the clinical safety culture, and a great deal of effort and resources have been devoted to the implementation of safe practices for reducing the risk of medical errors.