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Background Effective communication strategies in health care help to enhance patient empowerment and improve clinical outcomes. Objective Adapt the original Communication Assessment (CAT) instrument for the pharmacist profession (CAT-Pharm) and to test its validity and reliability in two different settings. Setting Five hospital pharmacies in Italy and five community pharmacies in Malta. Method Pilot study involving a standardized multi-step process adhering to internationally accepted and recommended guidelines. Corrections and adjustments to the translation addressed linguistic factors and cultural components. CAT-Pharm, compared to the original CAT, maintained 10 out of the 14 items: one was slightly modified; three were changed to better fit the pharmacist role; one was added. Main outcome measure CAT-Pharm development and testing its practicality to Assess patient perceptions of pharmacists’ interpersonal and communication skills. Results CAT-Pharm was tested on 97 patients in the Italian setting and 150 patients in the Maltese setting to assess the practicality of the tool and its usefulness in investigating gaps and priorities for improving pharmacist-patient communication. Results Show reliability and internal validity of the CAT-Pharm tool. The analysis of patient perceptions of communication with the pharmacist in Italy indicated differences from that in Malta. The different settings provided insight into the utility of CAT-Pharm. Conclusion This study provided a valid and reliable tool that could be applied to assess patient perception of the pharmacist's communication abilities.

OBJECTIVES: The Anatomical-Therapeutic-Chemical Classification (ATC) - defined by the WHO as a “tool for drug utilization monitoring and research in order to improve quality of drug use” - codes active substances and groups them according to the target organ or system and their therapeutic, pharmacological and chemical properties. However, the classification could include inconsistencies, mostly evident for biotechnological products, resulting in possible inappropriate use. The work aimed at determining whether drugs (in particular biologics) are appropriately described by their ATC code,investigating evidence on their use and suggesting solutions to improve the classification pattern. METHODS: Twelve experts critically analyzed the ATC classification and proposed possible solutions. The results were summarized in statements, which were voted to reach a consensus through the Nominal Group Technique. Each expert voted on the statements, and the agreement was defined at 75% of the highest scores. Additionally, to investigate the use of ATC in scientific research, a literature review of its use was also performed. RESULTS: Based on a literature review, a total of 75 studies were analyzed; 99% concerned the appropriate use of ATC classification. Then, based on their experience, the experts identified the following inconsistencies in the ATC code: use of a single ATC code for more than one indication; lack of identification of differences among drug formulations deriving from their pharmacokinetic profile and differences attributable to further characteristics, beyond indication of use and mechanism of action (e.g., blood coagulation factors). Ten statements were identified: 5 regarding critical issues in the ATC code (structural limits at the ATC fifth code level; time-consuming, complex, imprecise coding request/modification procedure) and 5 possible solutions (telematic procedures to modernize the request/modification ATC code process; unique form to request/modify codes, specifying manufacturing process and reference to therapeutic equivalence among active principles; further levels beyond the V to differentiate drug peculiarities). Agreement among experts was reached for all statements. CONCLUSIONS: The ATC code classification pattern should be partially changed to incorporate the peculiarities of biotechnologies to promote their appropriate use.

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