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BACKGROUND: Computerized clinical decision support systems are used by clinicians at the point of care to improve quality of healthcare processes (prescribing error prevention, adherence to clinical guidelines, etc.) and clinical outcomes (preventive, therapeutic, and diagnostics). Attempts to summarize results of computerized clinical decision support systems to support prescription in primary care have been challenging, and most systematic reviews and meta-analyses failed due to an extremely high degree of heterogeneity present among the included primary studies. The aim of our study will be to synthesize the evidence, considering all methodological factors that could explain these differences, and build an evidence and gap map to identify important remaining research questions. METHODS: A literature search will be conducted from January 2010 onwards in MEDLINE, Embase, the Cochrane Library, and Web of Science databases. Two reviewers will independently screen all citations, full text, and abstract data. The study methodological quality and risk of bias will be appraised using appropriate tools if applicable. A flow diagram with the screened studies will be presented, and all included studies will be displayed using interactive evidence and gap maps. Results will be reported in accordance with recommendations from the Campbell Collaboration on the development of evidence and gap maps. DISCUSSION: Evidence behind computerized clinical decision support systems to support prescription use in primary care has so far been difficult to be synthesized. Evidence and gap maps represent an innovative approach that has emerged and is increasingly being used to address a broader research question, where multiple types of intervention and outcomes reported may be evaluated. Broad inclusion criteria have been chosen with regard to study designs, in order to collect all available information. Regarding the limitations, we will only include English and Spanish language studies from the last 10 years, we will not perform a grey literature search, and we will not carry out a meta-analysis due to the predictable heterogeneity of available studies. SYSTEMATIC REVIEW REGISTRATION: This study is registered in Open Science Framework https://bit.ly/2RqKrWp.

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INTRODUCCIÓN: Las farmacias comunitarias representan un papel clave en la respuesta al COVID-19 y especialmente en el control de enfermedades crónicas más allá de la pandemia. OBJETIVO: Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria para prevenir la fragilidad y promover el autocuidado en personas mayores. MÉTODO: Estudio cualitativo de investigación-acción con mapeo de actores, segmentación de perfiles, grupos de discusión, entrevistas en profundidad y sesiones de diseño creativo. Las técnicas utilizadas aseguraron la participación de personas mayores y profesionales en todas las etapas de diseño. RESULTADOS: Se generaron circuitos comunes de comunicación para los nuevos servicios y protocolos de actuación compartidos. Se propusieron nuevos roles profesionales en respuesta a las necesidades, expectativas y preferencias de las personas mayores. Se diseñaron los servicios de detección de fragilidad, adherencia a nuevos medicamentos, toma de constantes y refuerzo terapéutico. El modelo aporta sistemas de comunicación bidireccional entre atención primaria y farmacia comunitaria y reconoce el papel de la farmacia comunitaria en la promoción del autocuidado y gestión de la patología crónica y la medicación. CONCLUSIONES: Se evidencia la importancia de crear un ecosistema más abierto que dé lugar a innovaciones organizativas que aprovechen la proximidad y capilaridad de las oficinas de farmacia, así como la incorporación de la omnicanalidad en la atención, esencial en situaciones de crisis sanitaria como la actual. Asimismo, queda demostrado que las técnicas de diseño cooperativo favorecen la participación de los agentes involucrados, aumentando su contribución e impacto potencial sobre los resultados

INTRODUCTION: Community pharmacies play a key role in response to COVID-19 and especially in the control of chronic diseases beyond the pandemic. OBJECTIVE: To design a new model of health assistance focused on frailty prevention and the self-care promotion among older adults, using share care services between the community pharmacy and the primary healthcare. METHOD: We conducted a qualitative study of action research using methods as actor mapping, segment profile, discussion groups, in-depth interviews and creative design sessions. Using those techniques during all the design stages allowed us to get an effective participation of older adults and professionals. RESULTS: Common communications circuits for the new services, new professional roles and shared action protocols were created. Furthermore, we designed early frailty detection, medication review associated with fall risk, assessment and intervention for adherence to new medications, vital sign checking and hypertension, diabetes and COPD therapeutic reinforcement services. This model provides two-way communication systems with the primary health care and recognizes the community pharmacy functions in the scope of self-care promotion and chronic pathology and medication self-management. CONCLUSIONS: It is highlighted the importance of creating a more open ecosystem within the community. The feedback obtained will allow to design organizational innovations. This has to be done taking advantage of the community pharmacies proximity and capillarity in the territory, as well as the new incorporation of the omni-channel care. Besides, cooperative design techniques have proved to be an encouragement for the participation of the involved agents, increasing their contribution and potential impact on the results

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BACKGROUND: To analyse trends in the rates of consumption of benzodiazepine (BZD) anxiolytics, BZD hypnotics and non-BZD hypnotics and the association with contextual factors. METHODS: Descriptive time series study. Units of analysis were monthly dose per inhabitant per day (DID) and dose per medical card per day(DCD) of benzodiazepine(BZD anxiolytics(BZD-A), BZD hypnotics(BZD-H) and non-BZD hypnotics(Non-BZD-H) between January 2006-December 2015. We analysed 6 primary healthcare districts(PHD) and used defined daily doses (DDDs) to calculate the monthly DIDs(overall and by ATC group). Trends and monthly percentage change (MPC) were analysed through joinpoint regression. RESULTS: The annual DID increased by 26% overall, the trend was different across ATC groups. Consumption in BZD-A and BZD-H increased (27.1%,61.9%), consumption in Non-BZD-H decreased by 35%. There was high variability in DCD across the PHD, with an overall increase of 10.2%(5.7%-22.9%). By ATC, DCD increased by 10.4% in BZD-A(4.2%-22.2%) and by 44.2% in BZD-H(33.2%-76.5%). The overall DCD in the Non-BZD-H decreased by 42.1%(19.7%-50.8%). We found an initial upward trend in consumption of BZD-A until April/2008(monthly percentage change -MPC- +0.5%), followed by a slightly slower increase (+0.1%). No changes in trend were detected in BZD-H. In Non-BZD-H, we observed an upward trend until February/2013(+0.1%), followed by a sharp decrease until August/2013(-6.3%), and finally a slight decrease(-0.3%). CONCLUSIONS: BZD consumption has increased in the last decade, with variability across areas. The changes in trends do not coincide with the financial crisis, introduction of prescriptions by active ingredient, electronic prescriptions or copayment. The only decrease in the Non-BZD-H may be linked to an intervention.