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The ''Classification of Pharmaco-Therapeutic Referrals'' (''CPR'') is a
taxonomy Taxonomy is the practice and science of categorization or classification. A taxonomy (or taxonomical classification) is a scheme of classification, especially a hierarchical classification, in which things are organized into groups or types. ...
focused on defining and grouping together situations requiring a referral from
pharmacists A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructi ...
to
physicians A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
(and vice versa) regarding the
pharmacotherapy Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery (surgical therapy), radiation (radiation therapy), movement (physical therapy), or other modes. Among physicians, sometimes the term ''medical ther ...
used by the
patients A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...
. It has been published in 2008. It is bilingual: English/Spanish (''Clasificación de Derivaciones Fármaco-terapéuticas''). It is a simple and efficient classification of pharmaco-therapeutic referrals between physicians and pharmacists permitting a common inter-professional language. It is adapted to any type of referrals among health professionals, and to increase its specificity it can be combined with ATC codes,
ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms ...
, and
ICPC-2 PLUS ICPC-2 PLUS is an extended terminology classified to ICPC-2 International Classification of Primary Care, which aids data entry, retrieval and analysis. ICPC-2 PLUS takes into account the frequency distribution of problems seen in primary health car ...
. It is a part of the ''MEDAFAR Project'', whose objective is to improve, through different scientific activities, the coordination processes between physicians and pharmacists working in
primary health care Primary health care, or PHC, refers to "essential health care" that is based on scientifically sound and socially acceptable methods and technology. This makes universal health care accessible to all individuals and families in a community. PHC in ...
.


Supporting institutions

* Pharmaceutical Care Foundation of Spain (''Fundación Pharmaceutical Care España'') * Spanish Society of Primary Care Doctors (''Sociedad Española de Médicos de Atención Primaria'') (SEMERGEN)


Authors

* Raimundo Pastor Sánchez (
Family practice Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primar ...
, "Miguel de Cervantes" Primary Health Centre SERMAS
Alcalá de Henares Alcalá de Henares () is a Spanish city in the Community of Madrid. Straddling the Henares River, it is located to the northeast of the centre of Madrid. , it has a population of 193,751, making it the region's third-most populated municipality ...
Madrid Madrid ( , ) is the capital and most populous city of Spain. The city has almost 3.4 million inhabitants and a metropolitan area population of approximately 6.7 million. It is the second-largest city in the European Union (EU), and ...
– Spain) * Carmen Alberola Gómez-Escolar (
Pharmacist A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructi ...
, Vice-President ''Fundación Pharmaceutical Care España'') * Flor Álvarez de Toledo Saavedra (
Community pharmacist A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instruc ...
, Past-President ''Fundación Pharmaceutical Care España'') * Nuria Fernández de Cano Martín (
Family practice Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primar ...
, "Daroca" Primary Health Centre SERMAS
Madrid Madrid ( , ) is the capital and most populous city of Spain. The city has almost 3.4 million inhabitants and a metropolitan area population of approximately 6.7 million. It is the second-largest city in the European Union (EU), and ...
– Spain) * Nancy Solá Uthurry (Doctor in Pharmacy, ''Fundación Pharmaceutical Care España'')


Structure

It is structured in 4 chapters (E, I, N, S) and 38 rubrics. The terminology used follows the rules of ICPC-2.International Classification Committee of WONCA. ICPC-2 International Classification of Primary care (2 ed.). Oxford: Oxford University Press; 1998. Each rubric consists in an alphanumeric code (the letter corresponds to the chapters and the number to the component) and each title of the rubric (the assigned name) is expressed and explained by: – A series of terms related with the title of the rubric. – A definition expressing the meaning of the rubric. – A list of inclusion criteria and another list with exclusion criteria to select and qualify the contents corresponding to a rubric. – Some example to illustrate every term. It also includes a glossary of 51 terms defined by consensus, an alphabetical index with 350 words used in the rubrics; and a standardized model of inter-professional referral form, to facilitate referrals from community pharmacists to primary care physicians.


Classification of Pharmaco-Therapeutic Referrals MEDAFAR


E. Effectiveness / efficiency

* E 0.
Effectiveness Effectiveness is the capability of producing a desired result or the ability to produce desired output. When something is deemed effective, it means it has an intended or expected outcome, or produces a deep, vivid impression. Etymology The ori ...
/
Efficiency Efficiency is the often measurable ability to avoid wasting materials, energy, efforts, money, and time in doing something or in producing a desired result. In a more general sense, it is the ability to do things well, successfully, and without ...
, unspecified * E 1. Indication * E 2. Prescription and dispensing conditions * E 3.
Active substance An active ingredient is any ingredient that provides biologically active or other direct effect in the diagnosis, cure, mitigation, treatment, or prevention of disease or to affect the structure or any function of the body of humans or animals. T ...
/
excipient An excipient is a substance formulated alongside the active ingredient of a medication, included for the purpose of long-term stabilization, bulking up solid formulations that contain potent active ingredients in small amounts (thus often referred ...
* E 4.
Pharmaceutical form Dosage forms (also called unit doses) are pharmaceutical drug products in the form in which they are marketed for use, with a specific mixture of active ingredients and inactive components (excipients), in a particular configuration (such as a cap ...
/
how supplied Dosage forms (also called unit doses) are pharmaceutical drug products in the form in which they are marketed for use, with a specific mixture of active ingredients and inactive components (excipients), in a particular configuration (such as a cap ...
* E 5. Dosage * E 6.
Quality Quality may refer to: Concepts *Quality (business), the ''non-inferiority'' or ''superiority'' of something *Quality (philosophy), an attribute or a property *Quality (physics), in response theory * Energy quality, used in various science discipl ...
* E 7. Storage * E 8.
Consumption Consumption may refer to: *Resource consumption *Tuberculosis, an infectious disease, historically * Consumption (ecology), receipt of energy by consuming other organisms * Consumption (economics), the purchasing of newly produced goods for curren ...
* E 9. Outcome.


I. Information / health education

* I 0.
Information Information is an abstract concept that refers to that which has the power to inform. At the most fundamental level information pertains to the interpretation of that which may be sensed. Any natural process that is not completely random, ...
/
Health education Health education is a profession of educating people about health. Areas within this profession encompass environmental health, physical health, social health, emotional health, intellectual health, and spiritual health, as well as sexual and r ...
, unspecified * I 1.
Situation Situation and its derivations may refer to: Situation Common uses *A concept similar to scenario, relating to a position (location) or a set of circumstances. *A job People * ''The Situation'' (TV personality), nickname of American reality TV p ...
/ reason for encounter * I 2.
Health problem A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
* I 3. Complementary examination * I 4.
Risk In simple terms, risk is the possibility of something bad happening. Risk involves uncertainty about the effects/implications of an activity with respect to something that humans value (such as health, well-being, wealth, property or the environm ...
* I 5. Pharmacological treatment * I 6. No pharmacological treatment * I 7.
Treatment goal In medicine, an indication is a valid reason to use a certain test, medication, procedure, or surgery. There can be multiple indications to use a procedure or medication. An indication can commonly be confused with the term diagnosis. A diagnosis ...
* I 8. Socio-healthcare system.


N. Need

* N 0.
Need A need is dissatisfaction at a point of time and in a given context. Needs are distinguished from wants. In the case of a need, a deficiency causes a clear adverse outcome: a dysfunction or death. In other words, a need is something required for a ...
, unspecified * N 1. Treatment based on
symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...
and/or signs * N 2. Treatment based on socio
economic An economy is an area of the production, distribution and trade, as well as consumption of goods and services. In general, it is defined as a social domain that emphasize the practices, discourses, and material expressions associated with th ...
-
work Work may refer to: * Work (human activity), intentional activity people perform to support themselves, others, or the community ** Manual labour, physical work done by humans ** House work, housework, or homemaking ** Working animal, an animal t ...
issues * N 3. Treatment based on
public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
issues * N 4.
Prevention Prevention may refer to: Health and medicine * Preventive healthcare, measures to prevent diseases or injuries rather than curing them or treating their symptoms General safety * Crime prevention, the attempt to reduce deter crime and crim ...
* N 5. Healthcare provision * N 6. Complementary test for treatment control * N 7. Administrative activity * N 8. On
patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other heal ...
request (
fears Fear is an intensely unpleasant emotion in response to perceiving or recognizing a danger or threat. Fear causes physiological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear in ...
,
doubts Doubt is a mental state in which the mind remains suspended between two or more contradictory propositions, unable to be certain of any of them. Doubt on an emotional level is indecision between belief and disbelief. It may involve uncert ...
, wants).


S. Safety

* S 0.
Safety Safety is the state of being "safe", the condition of being protected from harm or other danger. Safety can also refer to the control of recognized hazards in order to achieve an acceptable level of risk. Meanings There are two slightly di ...
, unspecified * S 1.
Toxicity Toxicity is the degree to which a chemical substance or a particular mixture of substances can damage an organism. Toxicity can refer to the effect on a whole organism, such as an animal, bacterium, or plant, as well as the effect on a subs ...
* S 2.
Interaction Interaction is action that occurs between two or more objects, with broad use in philosophy and the sciences. It may refer to: Science * Interaction hypothesis, a theory of second language acquisition * Interaction (statistics) * Interaction ...
* S 3.
Allergy Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic derm ...
* S 4.
Addiction Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, one of which is the usage of a drug, despite substantial harm and other negative consequences. Repetitive drug use o ...
(dependence) * S 5. Other
side effects In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequenc ...
* S 6.
Contraindication In medicine, a contraindication is a condition that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a reason to use a certain tre ...
* S 7.
Medicalisation Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evi ...
* S 8. Non-regulate substance * S 9.
Data In the pursuit of knowledge, data (; ) is a collection of discrete values that convey information, describing quantity, quality, fact, statistics, other basic units of meaning, or simply sequences of symbols that may be further interpret ...
/
confidentiality Confidentiality involves a set of rules or a promise usually executed through confidentiality agreements that limits the access or places restrictions on certain types of information. Legal confidentiality By law, lawyers are often required ...
.


See also

*
Pharmaceutical care Pharmaceutical care is the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life. Definition Hepler and Linda Strand's definition is the most well-known ...
*
Referral (medicine) In medicine, referral is the transfer of care for a patient from one clinician or clinic to another by request. Tertiary care is usually done by referral from primary or secondary medical care personnel. In the field of sexually transmitted dise ...


References


Bibliography


Pastor Sánchez R, Alberola Gómez-Escolar C, Álvarez de Toledo Saavedra F, Fernández de Cano Martín N, Solá Uthurry N. Clasificación de Derivaciones Fármaco-terapéuticas (CDF). MEDAFAR. Madrid: IMC; 2008.

Álvarez de Toledo Saavedra F, Fernández de Cano Martín N, coordinadores. MEDAFAR Asma. Madrid: IMC; 2007.

Álvarez de Toledo Saavedra F, Fernández de Cano Martín N, coordinadores. MEDAFAR Hipertensión. Madrid: IMC; 2007.

Aranaz JM, Aibar C, Vitaller J, Mira JJ, Orozco D, Terol E, Agra Y. Estudio sobre la seguridad de los pacientes en atención primaria de salud (Estudio APEAS). Madrid: Ministerio de Sanidad y Consumo; 2008.

Aranaz JM, Aibar C, Vitaller J, Ruiz P. Estudio Nacional sobre los Efectos Adversos ligados a la Hospitalización. ENEAS 2005. Madrid: Ministerio de Sanidad y Consumo; 2006.

Criterios de derivación del farmacéutico al médico general/familia, ante mediciones esporádicas de presión arterial. Consenso entre la Sociedad Valenciana de Hipertensión y Riesgo Vascular (SVHTAyFV) y la Sociedad de Farmacia Comunitaria de la Comunidad Valenciana (SFaC-CV). 2007.
* Fleming DM (ed). The European study of referrals from primary to secondary care. Exeter: Royal College of General Practitioners; 1992.
Foro de Atención Farmacéutica. Documento de consenso 2008. Madrid: MSC, RANF, CGCOF, SEFAP, SEFAC, SEFH, FPCE, GIAFUG. 2008.
{dead link, date=August 2017 , bot=classifieads , fix-attempted=yes * García Olmos L. Análisis de la demanda derivada en las consultas de medicina general en España. Tesis doctoral. Madrid: Universidad Autónoma de Madrid; 1993.
Garjón Parra J, Gorricho Mendívil J. Seguridad del paciente: cuidado con los errores de medicación. Boletín de Información Farmacoterapéutica de Navarra. 2010;18(3)
* Gérvas J. Introducción a las classificaciones en Atención Primaria, con una valoración técnica de los "Consensos de Granada". Pharm Care Esp. 2003; 5(2):98-104. * Hospital Ramón y Cajal, Área 4 Atención Primaria de Madrid. Guía Farmacoterapéutica. Madrid; 2005. CD-ROM. * Ley 29/2006, de 26 de julio, de garantías y uso racional de los medicamentos y productos sanitarios. BOE. 2006 julio 27; (178): 28122-65. * Ley 41/2002, de 14 de noviembre, básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica. BOE. 2002 noviembre 15; (274): 40126-32. * Ley Orgánica 15/1999, de 13 de diciembre, de Protección de Datos de Carácter Personal. BOE. 1999 diciembre 14; (298): 43088-99. * Organización Médica Colegial. Código de ética y deontología médica. Madrid: OMC; 1999. * Palacio Lapuente F. Actuaciones para la mejora de la seguridad del paciente en atención primaria ditorial FMC. 2008; 15(7): 405-7. * Panel de consenso ad hoc. Consenso de Granada sobre Problemas Relacionados con medicamentos. Pharm Care Esp. 1999; 1(2):107-12. * Prado Prieto L, García Olmos L, Rodríguez Salvanés F, Otero Puime A. Evaluación de la demanda derivada en atención primaria. Aten Primaria. 2005; 35:146-51. * Starfield B. Research in general practice: co-morbidity, referrals, and the roles of general practitioners and specialists. SEMERGEN. 2003; 29(Supl 1):7-16. * WONCA Classification Committee. An international glossary for general/family practice. Fam Pract. 1995; 12(3): 341-69.
World Alliance for Patient Safety. International Classification for Patient Safety (ICPS). 2007.


External links


Classification of Pharmaco-Terapeutic Referrals (CPR)

Clasificación de Derivaciones Fármaco-terapéuticas (CDF)

MEDAFAR

SEMERGEN

Fundación Pharmaceutical Care España

ICPC-2e
(by the Norwegian Centre for Informatics in Health and Social Care)]
International Classification of Diseases (ICD)

ICD-10

Código ATC (''Anatomical Therapeutic Chemical drug classification)''
Medical manuals Pharmacological classification systems Primary care Clinical procedure classification