Sono 73 i lavori scientifici internazionali che dimostrano l’efficacia di screening e programmi per la prevenzione condotti attraverso le farmacie del territorio. E’ quanto rivela la meta-analisi condotta da un team di farmacisti ospedalieri inglesi dell’università londinese del Middlesex e pubblicata nei giorni scorsi dal Pharmaceutica Journal, la rivista della Royal pharmaceutical society (l’ordine dei farmacisti britannico). Gli autori, in sintesi, hanno condotto un’indagine sistematica nelle principali banche dati delle ricerche scientifiche internazionali (Scopus, Web of Science, OvidSP, PubMed, Medline e Cinahl) per individuare gli studi pubblicati dal 2000 a oggi che contenessero evidenze sul ruolo sanitario delle farmacie del territorio. La ricerca ha consentito di mettere assieme due meta-analisi, 7 reviews di letteratura scientifica, 23 studi internazionali e 41 studi descrittivi, che il team ha quindi organizzato e analizzato per parole chiave.
Nell’insieme, le ricerche dimostrano che la partecipazione delle farmacie è determinante nei programmi di disassuefazione dal fumo e promozione della salute, negli screening e nelle campagne di prevenzione, nei piani per l’accesso alla contraccezione d’emergenza e nei servizi vaccinali. «In generale» scrivono gli autori «le evidenze che arrivano dalla letteratura dimostrano che le farmacie possono erogare servizi sanitari pubblici sia a livello di comunità sia per singole categorie di pazienti».
Di particolare interesse per la realtà italiana gli studi che hanno valutato il contributo delle farmacie nelle campagne vaccinali. Una ricerca retrospettiva condotta in Canada a un anno di distanza dal provvedimento che, nella provincia della Nuova Scotia, aveva autorizzato la vaccinazione nelle farmacie, dimostra che la copertura vaccinale nella popolazione è cresciuta dal 35,8 al 41,8%. Stesse evidenze da una revisione della letteratura condotta negli Usa per valutare le ricadute di politiche dirette a consentire la vaccinazione nelle farmacie. In particolare, la review dimostra che quando il servizio è fornito dalle farmacie del territorio la popolazione è più incline a vaccinarsi e le coperture di conseguenza si alzano.
Di estrema rilevanza anche la questione costi. Anche se gli autori ammettono che sul tema servirebbero maggiori ricerche, è senz’altro significativo lo studio condotto dal Psnc britannico (l’ente che negozia con il servizio sanitario le convenzioni del settore) dal quale emerge che i servizi assicurati dalle farmacie hanno assicurato nel 2015 tre miliardi di sterline di risparmi. I programmi per lo sviluppo dell’automedicazione responsabile, in particolare, hanno generato il 40% di tali economie, i servizi di supporto alle terapie farmacologiche il 31%, le campagne sanitarie il 29%.
| Public health themes | Publication/study type (n) | Author/year | Design | Country (n) | Level of evidence | Summary |
|---|---|---|---|---|---|---|
| *Reviewed multiple public health topics with the findings reported according to themes in this paper | ||||||
| Smoking cessation (n=12) | Meta-analysis (2) | Saba et al. 2014 | Included three RCT, two before/after studies with control group | Sweden (1), UK (3), USA (1) | Level A | Conclusive evidence on the effectiveness of smoking cessation services delivered by community pharmacists. Cessation interventions that included provision of behavioural modification counselling were more effective. Time pressures and non-availability of appropriate training limited implementation of service in community pharmacies. |
| *Brown et al. 2016 | Included 10 RCT, one nRCT, one before/after study with control group | Australia (2), Japan (1), Canada (1), UK (4), USA (2), Netherlands (1) Denmark (1) | Level A | |||
| Literature review (2) | Anderson et al. 2003 | Included two RCT, three nRCT | Sweden (1), Germany (1), UK (2), Switzerland (1) | Level A | ||
| Agomo 2012 | Included four surveys, one report, three reviews, one guideline document | UK (4), USA (3), Malaysia (1), Turkey (1) | Level A | |||
| Descriptive (8) | William et al. 2000, Çalgan 2007, Thananithisak et al. 2008, Nimpitakpong et al. 2010, Hoch et al. 2012, Mohamed et al. 2013, Kurko et al. 2010, El Hajj et al. 2012 | Cross sectional survey | Qatar (1), UK (1), USA (1), Finland (1) Thailand (2), Turkey (1) and Sudan (1) | Level C | ||
| Weight management (n=7) | Literature review (3) | *Anderson et al. 2003 | One before/after study with no control group | Denmark | Level B | Available evidence demonstrates the feasibility and acceptability of the service, however, the data on effectiveness are mixed relative to reduction in weight and BMI compared with other primary care settings and/or commercial providers. Interventions that included lifestyle advice on diet, physical activity and behavioural changes were more effective. Privacy concerns, time constrains and perceived lack of expertise and specialist knowledge were key barriers identified from consumer surveys. |
| *Brown et al. 2016 | Included three RCT, one before/after study with control group, one nRCT | UK (2), USA (2), Thailand (1) | Level A | |||
| Hermansyah et al. 2016 | one RCT | Thailand (1) | ||||
| Interventional (1) | Boardman and Avery 2014 | Before and after study with no control group | UK (1) | Level B | ||
| Descriptive (5) | Newlands et al. 2011, Weidmann et al. 2012, Umet al. 2012, Um et al. 2013, Weidmann et al. 2015 | Cross sectional survey (3), qualitative interviews (2) | UK (3), Australia (2) | Level C | ||
| Health promotion and education campaigns (n=8) | Interventional (2) | Castillo-García et al. 2011 | Before/after evaluation plus cross sectional survey | Spain | Level B | Effective in improving public knowledge and awareness of targeted health related issue. Although pharmacists were generally positive about role, they indicated lack of knowledge and inadequate training limited their involvement in providing the service |
| Murphy and Dipietro 2012 | Before/after with no control group | USA | ||||
| Descriptive (6) | Laliberte et al. 2012, Schmiedel et al. 2013, Beshir and Bt Hamzah 2014, Real et al. 2014, Ayoubet al. 2016, Mizoguchi et al. 2016 | Cross sectional survey and one participatory research | Malaysia (1), Jordan (1), Canada (1), Argentina (1), Germany (1), Japan (1) | Level C | ||
| Disease screening and prevention activities (n=13) | Interventional (9) | Hourihan et al. 2003, Krass et al. 2003, Krass et al. 2007, Peterson et al. 2010, Fuller et al. 2011, Perraudin et al. 2015, Sushilkumar 2015, Tsuyuki et al. 2016, Sandhu et al. 2016 | One RCT, Cohort study with follow up (8) | Canada (2), Australia (4), France (1), New Zealand (1) India (1) | Level B | Intervention increased access and was effective in early identification of at-risk group with subsequent referral to physician. Also provides an avenue for lifestyle modification counselling to service users |
| Descriptive (4) | Watson et al. 2003, Weidle et al. 2014, Lowres et al. 2015, Schmiedel et al. 2016 | Cross sectional survey and one qualitative interview | Australia (1), USA (1), Germany (1), UK (1) | Level C | ||
| Vaccination and immunization (n=6) | Literature review | Burson et al. 2016 | Included 25 cross sectional surveys, four cohort studies, four case control studies, four experimental studies, three modelling studies, seven single-subject design | USA (47) | Level A | Data indicates that community pharmacists’ involvement in service provision improved coverage, expanded access and increased likelihood of uptake |
| Interventional (2) | Isenor et al. 2016, Buchan et al. 2017 | Before/after with no control group | Canada (2) | Level B | ||
| Descriptive (3) | Valiquette and Bédard 2015, Evans et al. 2016, Kulczycki et al. 2017 | Qualitative interviews and one cross sectional survey | UK (1), Canada (1), USA (1) | Level C | ||
| Alcohol dependence advice and drug misuse services (n=6) | Literature review (2) | Watson and Blenkinsopp 2009 | Three before/after studies with no control group | UK (3) | Level B | Limited evidence on effectiveness of service. The literature also reports poor uptake by the public and limited overall involvement by community pharmacists. This was primarily due to lack of training, adequate knowledge and confidence in providing the service. However, the evidence suggests feasibility and acceptability of the service. |
| *Brown et al. 2016 | Two RCT | UK (2) | Level A | |||
| Intervention (2) | Khan et al. 2013 | Before/after study with no control group | UK | Level B | ||
| Cochran et al. 2016 | Cohort study | USA | ||||
| Descriptive (3) | McCaig et al. 2011, Horsfield et al. 2011, Sheridan et al. 2012 | Cross sectional survey and one qualitative interview | USA (1), New Zealand (2) | Level C | ||
| Emergency contraception and sexual health (n=4) | Literature review (3) | *Anderson et al. 2003 | Three before/after study with no control group, two cross-sectional surveys, one qualitative interview | UK (4), USA (2) | Level B | Promoted improved access to emergency contraception with users indicating they valued the ease and convenience of the service. |
| Anderson and Blenkinsopp 2006 | Included one RCT, five before/after studies, nine qualitative interviews/focus groups and cross sectional surveys | Canada (3), Sweden (2), South Africa (1), Europe (1), France (1), Norway (1), Portugal (1) USA (6), UK (7) | Level A | |||
| Agomo 2012 | One RCT, two reviews, cohort study and cross sectional surveys | USA (4), Belgium (1), UK (2) | Level A | |||
| Descriptive (2) | Baraister et al. 2007 | Service evaluation plus qualitative interview | UK (1) | Level C | ||
| Gale and Watson 2011 | Cross sectional survey | UK (1) | Level C | |||
| Cost-effectiveness studies (n=8) | Descriptive (3) | Pharmacy Research UK 2014, Royal Pharmaceutical Society 2014, Oswald & Adcock 2016 | Commissioned reports (3) | UK (3) | Level B | Community pharmacy-based public health services, such as smoking cessation and disease screening, are cost effective. Intervention cost are off-set by reduction in use of other health services and increased quality adjusted life gained (QALYs) |
| Interventional (5) | Thavorn & Chaiyakunapruk 2008, Perraudin et al. 2013, Lowres et al. 2014, Wright et al. 2015a & 2015b | Cohort studies and one economic modelling estimate | UK (2), Thailand (1), France (1), Australia (1) | Level B | ||
