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Pharmacists' confidence when providing pharmaceutical care on anticoagulants
a multinational survey

There's a difference with the classical VKA and NOACs' in methods for assessing it and also the consequences of non-adherence due to NOACs’ shorter half-lives. As such, patient monitoring, education, and medication adherence is of critical importance with these novel agents,

This is the first international survey assessing confidence levels of pharmacists when discussing and managing oral anticoagulation therapy and the main purpose of this needs assessment survey was to identify self-reported gaps in knowledge and confidence among pharmacists in the area of anticoagulation and to explore preferred educational methods to close these gaps.

Interested in the international results?

Check out our abstracts/presentations/publications below

Interested in your national data?

Check below if your country already participates and has relevant data. If not, don't hesitate to contact us. We can help you with the translation of the survey and the subanalysis of your national data to present/publish locally!

Participating countries so far

Arabic states (Qatar, Kuwait, UAE, Saudi Arabia)
Argentina
Australia
Belgium
Brazil
Canada
Croatia
Czech Republic
England
France
Germany
Hungary
Ireland
New Zealand
Portugal

Slovakia
Spain

The Netherlands

Main contact: Dr. Filipa Alves da Costa filipa.alvesdacosta@ipact.org

Interprofessional guideline to support patients receiving oral anticoagulation therapy
a Delphi consensus statement

International guidelines for the management of thromboembolism are widely available. However, recommendations on the broader spectrum of pharmaceutical anticoagulation care are largely lacking. Through iPACT, an interprofessional guideline to support patients receiving oral anticoagulation therapy was developed.

Based upon the outcome of the Delphi consensus statement, eightteen recommendations form the iPACT guideline and provide the base for optimization of anticoagulation care across different countries and healthcare systems. Future work involves translating the guideline recommendations into clinical practice with an assessment on the impact of patient care.

The guideline is currently under submission.

 

18 recommendations

Title

Main recommendation

1. Shared care/ self-management

Patients and their caregivers should have access to appropriate and consistent information and support, in order to make informed choices about the use of oral anticoagulants, the implications of choosing not to take them, and the possibility to self-manage their anticoagulant therapy.

2. Patient communication and engagement

Communication with and the involvement of patients and their caregivers should be considered an integral component of safe and effective pharmaceutical anticoagulant care.

3. Patient education

Patients and their caregivers should be provided with - and at all times have access to - clear, understandable, and evidence-based information on oral anticoagulant therapy to ensure safe and effective use of oral anticoagulants.

4. Therapy plan

To maximize the effect and minimize the risks of therapy, an appropriate individualized therapy plan should be provided to each patient on oral anticoagulants. This therapy plan should be periodically reviewed throughout the course of anticoagulant therapy.

5. Lifestyle, cultural-specific, and clinical aspects

Lifestyle, cultural-specific, and clinical aspects should be taken into account in the management of patients on oral anticoagulant therapy.

6. Adherence to medication

In patients using oral anticoagulant medication, adherence and persistence to therapy should be assessed and supported. Patients and their caregivers should be educated on adherence.

7. INR-monitoring

In patients using VKA’s, the international normalised ratio (INR) should be monitored regularly to ensure safe and effective anticoagulant therapy.

8. Pharmacogenetic assessment

Pharmacogenetic testing may be considered in selected high-risk patients to ensure safe and effective anticoagulant dosing

9. Transfer of care between health care settings

Accurate information about patients’ oral anticoagulant therapy, including current medications, should be transferred accurately between different health care settings to ensure seamless care.

10. Medication reconcilliation and medication review

In patients on oral anticoagulant therapy, medication reconciliation and medication review should be performed on a regular basis to ensure safe, effective, and clinically appropriate use of medication.

11. Medication supply

Patients on oral anticoagulants should have a continuous supply of oral anticoagulants, including appropriate dosing instructions, to ensure safe and effective therapy.

12. Telemedicine

Patients on oral anticoagulant therapy should be offered telemedicine as a service, in order to support them with the use of their anticoagulants and to give them remote access to care.

13. Pharmacovigilance

The incidence (if any), prevalence, and recurrence of oral anticoagulant-related adverse events should be determined, monitored, and reported.

14. Screening

Patients with risk factors (age > 65 years, diabetes, hypertension, or common AF symptoms) not receiving anticoagulant therapy should be routinely screened on AF, and (if needed) referred to a physician for diagnosis

15. Governance

A governance framework (e.g., clinical guidelines, audits, and standard operating procedures (SOPs)) should be developed to ensure safe and effective oral anticoagulant management. This framework (independent from the pharmaceutical industry) should reflect current guidelines, safe practices, and patient surveys

16. Pharmaceutical workforce

The pharmacy team should have the right skill mix, capability, and capacity to develop and provide safe and high-quality services to patients on oral anticoagulant therapy, in order to prevent adverse patient outcomes (e.g., AF-related stroke, haemorrhage, myocardial infarction)

17. Role of specialized pharmacist/ nurse Specialized pharmacists or nurses should offer ongoing support to patients on oral anticoagulant therapy
18. Continuing Professional Development (CPD) All pharmaceutical staff involved in anticoagulant care should receive an appropriate level of Continuing Professional Development (CPD), including staff training, ongoing educational development, and documented competency assessment, to ensure safe and effective anticoagulant care

Top 5 recommendations of the iPACT guideline

1. INR-monitoring: patients using VKAs, the international normalized ratio (INR) should be monitored regularly to ensure the safety and effectiveness oforal anticoagulation therapy (OAT).

2. Transfer of care between health care settings: accurate information about patients’ OAT, including current medications, should be transferred accurately between different health care settings to ensure seamless care.

3. Adherence to medication: In patients using oral anticoagulation medication, adherence to and persistence with therapy should be assessed and supported. Patients and their caregivers should be educated on adherence.

4. Patient communication and engagement: communication with and the involvement of patients and their caregivers should be considered an integral component of safe and effective interprofessional OAT-care.

5. Medication reconciliation and medication review: In OAT-patients, medication reconciliation and medication review should be performed on a regular basis to ensure the safe, effective, and clinically appropriate use of medication.

How did we develop this iPACT guideline?

Methods: Two systematic literature searches were performed on existing guidelines on OAT-management and interventions to improve OAT-use. A four-round internet-based Delphi exercise was subsequently conducted with international OAT-experts, to develop interprofessional guideline recommendations. Two broader consultation rounds took place. Items were ranked on a 1 – 10 scale of agreement. Mean and median levels of agreement were reported. A median agreement score of ≥7.5 was considered the threshold for consensus. Level of importance was rated on a 1-3 scale.

Results: Delphi round 1 resulted in a description of 20 domains relevant for interprofessional anticoagulation care. After processing input of both the expert panel and international key opinion leaders (KOLs), the domains were translated into 18 interprofessional guideline recommendations. After Delphi round 2, consensus of opinion was achieved for all recommendations. Median level of agreement varied between 8.5-10.0, whereas mean level of importance was rated between 1.1-2.0 (SD: 0.2-0.7).

Want to implement this guideline in your country?

We can help! We have different tools and best-practices available to help you implement this guideline in your country.

Main contact: Dr. Bart van den Bemt bart.vandenbemt@ipact.org

 

Early detection of Atrial Fibrillation (EDAF) by community pharmacists
Know Your Pulse campaign

Atrial fibrillation is the most common cardiac arrhythmia globally, responsible for one third of strokes and often resulting in death or incapacity. This condition, frequently asymptomatic, is estimated to be up to 50% undiagnosed. Reducing this risk with appropriate detection and management strategies offers substantial economic and patient benefits. Both ESC and iPACT recommends (opportunistic) screening for AF by pulse taking or ECG rhythm strip in patients >65 years of age or other risk factors and (if needed) referred to a physician for diagnosis.

Partnership between iPACT and Atrial Fibrillation Association

Since screening for AF is recommended in both ESC and iPACT guidelines, iPACT created a partnership with the Atrial Fibrillation Association (AFA) to test a model whereby pharmacists are actively involved in (opportunistic) screening for AF. It was the largest multi-country ‘Know Your Pulse’ campaign since the creation of the concept by AFA in 2008. The goal was to assess the feasibility of pharmacists implementing pulse checks in community pharmacy to enable identification of new cases of AF and subsequent initiation of anticoagulation. Results are very promising and comparable to other international studies.

Know Your Pulse campaign - iPACT

The partnership is established in 2016, but in two campaigns we were able to involve seventy-eight pharmacies in ten different countries (Canada, Czech Republic, Hong Kong, Hungary, France, New Zealand, Portugal, Spain, Switzerland, United Kingdom) and a total of 2475 patients were screened through a simple 'know your pulse' (either manual or medical device) performed by the community pharmacist. 1,4% percent was diagnosed with AF.


Join the Know Your Pulse campaign 2018 in your country!

The Know Your Pulse campaign 2018 is currently being prepared and we welcome all people who want to support and facilitate the campaign in their country. Whether it's only a pilot case with one pharmacy or a large campaign involving bigger regions, we welcome all the support.

Contact Dr. Filipa Alves da Costa filipa.alvesdacosta@ipact.org

What's in it for you?

In return, you get access to an international validated protocol and the possibility to share best practices with other contributors. National data can be analyzed, published and compared to international data.

Recommendation 14 of the iPACT guideline:

Patients with risk factors (e.g., age > 65 years, diabetes, hypertension, or common AF symptoms) not receiving OAT should be routinely screened on AF, and (if needed) referred to a physician for diagnosis.

1. Screening for AF could be performed by any trained health care provider in primary care settings (e.g., by community pharmacist, and/or general practitioner) as well as by physicians in hospital settings

2. Screening for AF could be carried out by any appropriately validated method, including the use of electronic devices to enhance the reliability of detection (e.g., mobile app)

3. When AF is found to be present at screening, patients should be referred to their treating physician for diagnosis. The health care provider who performed the screening procedure should advise the patient of the risks of not completing the follow-up process

Main contact: Dr. Filipa Alves da Costa filipa.alvesdacosta@ipact.org

 

How to Check Your Pulse

Portuguese

English

Spanish

Czech

Chinese

Chinese Hong Kong version

Dutch

German

Hungarian

Arabic

French

Flemmish

 

Potential Role of Pharmacists in AF Screening
(Found: 3)

Module 1 - AF Screening - Spanish

1.19 MB

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Module 1 - Potential Role of Pharmacists in AF Screening - English

1.77 MB

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Screening for Atrial Fibrillation

282.67 KB

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Pharmacists’ Global engagement in the Heart Rhythm Week
(Found: 5)

Module 2 Czech

643.97 KB

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Module 2 English

474.06 KB

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Module 2 French

456.3 KB

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Module 2 Portuguese

566.07 KB

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Module 2 Spanish

596.33 KB

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Screening using Kardia AliveCor
(Found: 5)

Creating an account

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Module 3 English

1.89 MB

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NICE Appraisal

182.09 KB

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NICE pathway

184.12 KB

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Portuguese

626.38 KB

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Posters Detect Protect Correct (DPC) and Know Your Pulse (KYP)
(Found: 20)

In this section you will find two models of posters to display at the venue where you will be holding the awareness campaign. You can use both models simultaneously or choose one of them.


Arabic - Detect, Protect and Correct

227.11 KB

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Arabic - Know Your Pulse

276.21 KB

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Chinese - Know Your Pulse

328.14 KB

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Chinese - Detect, Protect and Correct

294.19 KB

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Czech - Detect, Protect and Correct

250.58 KB

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Czech - Know Your Pulse

293 KB

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Dutch - Detect, Protect and Correct

245.84 KB

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Dutch - Know Your Pulse

271.07 KB

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English - Detect, Protect and Correct

2.69 MB

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English - Know Your Pulse

8.44 MB

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French - Detect, Protect and Correct

245.2 KB

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French - Know Your Pulse

282.5 KB

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German - Detect, Protect and Correct

256.08 KB

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German - Know Your Pulse

282.71 KB

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Hungarian - Detect, Protect and Correct

263.45 KB

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Hungarian - Know Your Pulse

283.15 KB

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Portuguese - Detect, Protect and Correct

2.69 MB

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Portuguese - Know Your Pulse

1.68 MB

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Spanish - Detect, Protect and Correct

255.29 KB

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Spanish - Know Your Pulse

933.83 KB

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Pull out card
(Found: 9)

Chinese

903.35 KB

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Czech

803.35 KB

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Dutch

821.14 KB

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English

123.08 KB

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French

821.73 KB

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German

825.25 KB

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Hungarian

830.64 KB

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Portuguese

823.81 KB

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Spanish

4.57 MB

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Patient information leaflet
(Found: 9)

Chinese for Hong Kong

335.66 KB

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Czech

166.6 KB

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Dutch

171.05 KB

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English

325.43 KB

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French

172.7 KB

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German

169.64 KB

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Hungarian

174.24 KB

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Portuguese

359.45 KB

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Spanish

405.24 KB

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Informed consent
(Found: 3)

English

301.3 KB

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Portuguese

94.81 KB

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Portuguese_Casa do Povo

94.6 KB

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Module 4 Entering the data on a web app
(Found: 3)

Data Collection Sheet

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Module 4

954 KB

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Web app link URL

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Referral letter
(Found: 4)

Courrier D'orientation - Français

22.37 KB

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Hoja de Derivacion ya diagnosticado - Espanol

74.22 KB

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Minuta de Carta de Referencia - Português

20.2 KB

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Referral Letter - English

19.51 KB

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Checklist
(Found: 5)

Chinese: Arrhythmias

846.8 KB

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English: AFib

764.35 KB

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English: Arrhythmias

1.89 MB

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Portuguese: Afib

2.06 MB

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Spanish: Afib

1.89 MB

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Media Coverage
(Found: 2)

Media Release AA/AFA

425.21 KB

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Spanish Journal Ficheiro

237.52 KB

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Awareness Campaign
(Found: 4)

iPACT Benefits of active involvement of community pharmacists in ‘Know your pulse awareness’ campaign (abstract ESC 2017)

45.08 KB

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Portugal - Awareness campaign on Atrial Fibrillation in Portuguese pharmacies first results (abstract PCNE17)

3.08 KB

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Spain - Determinación de pulso irregular en farmacia comunitaria española, como cribado de fibrilación auricular (abstract)

374.27 KB

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United Kingdom - Know your pulse awaraness campaign involving pharmacists for greater outreach (abstract PCNE17)

3.29 KB

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Early detection of AF material
Early Detection of AF materials (joint AFA/iPACT) - English speaking countries
(Found: 10)

1_KYP Pull out card-iPACT

122.94 KB

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3_161020-Checklist - Palpitations-iPACT

1.85 MB

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3_Arrhythmia Checklist-iPACT

1.89 MB

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3_Atrial Fibrillation Checklist-iPACT

764.19 KB

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4_Factsheet - Atrial fibrillation-iPACT

309.21 KB

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5_161020-Checklist - Your heart in your hands-iPACT

518.49 KB

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7_161019-vh-FINAL-Booklet - Patient and primary care checklist-iPACT

1.98 MB

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DOC 2_KYP Poster-iPACT

8.44 MB

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DOC 2_Poster Detect Correct Protect International-iPACT

2.67 MB

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Pharmacist-led atrial fibrillation reviews save NHS £82m

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Early Detection of AF materials (joint AFA/iPACT) - Chinese speaking countries
(Found: 6)

1 Pull out card KYP China

903.35 KB

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2 DPC Stroke Flyer China

294.19 KB

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2 Know Your Pulse Poster China

328.14 KB

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4 AF Factsheet HK

335.66 KB

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4 AF Patient Information-China

1.07 MB

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Arrhythmia Checklist China

846.8 KB

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Early Detection of AF materials (joint AFA/iPACT) - Czech speaking countries
(Found: 4)

1 KYP Pull out card CZ

803.35 KB

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2 DPC Stroke Poster CZ

250.58 KB

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2 Know Your Pulse Poster CZ

293 KB

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4 AF Factsheet CZ

166.6 KB

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Early Detection of AF materials (joint AFA/iPACT) - French speaking countries
(Found: 4)

1 Pull out card KYP Factsheet France corrected

821.73 KB

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2 DPC Stroke Flyer France

245.2 KB

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2 Know Your Pulse Poster France

282.5 KB

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4 AF Factsheet France corrected

172.7 KB

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Early Detection of AF materials (joint AFA/iPACT) - German speaking countries
(Found: 4)

1 Pull Out card - German corrected

825.25 KB

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2 DPC Stroke Flyer German

256.08 KB

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2 Know Your Pulse Poster German

282.71 KB

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4 AF Factsheet German

169.64 KB

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Early Detection of AF materials (joint AFA/iPACT) - Hungarian speaking countries
(Found: 5)

1 Pull out card KYP Factsheet HUN corrected

830.64 KB

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2 DPC Stroke Flyer HUN

263.45 KB

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2 DPC Stroke Poster HUN

263.45 KB

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2 Know Your Pulse Poster HUN

283.15 KB

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4 AF Factsheet HUN

174.24 KB

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Early Detection of AF materials (joint AFA/iPACT) - Dutch speaking countries
(Found: 3)

1 Pull out card Factsheet Dutch

821.14 KB

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2 DPC Stroke Flyer Dutch

245.84 KB

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2 Know Your Pulse Poster Dutch

271.07 KB

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Early Detection of AF materials (joint AFA/iPACT) - Portugese speaking countries
(Found: 5)

1 Pull out card Portugal

823.81 KB

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2 Poster DPC Stroke Portugal

256.32 KB

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2_Poster-Portuguese-KYP iPACT

1.68 MB

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3 AF Checklist Portugal

275.82 KB

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4_AFA PT Atrial Fibrillation Factsheet-iPACT

359.45 KB

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Early Detection of AF materials (joint AFA/iPACT) - Arabic speaking countries
(Found: 2)

DPC Stroke Flyer Qatar

227.11 KB

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Know Your Pulse Poster Qatar

276.21 KB

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Early Detection of AF materials (joint AFA/iPACT) - Spanish speaking countries
(Found: 11)

1_Spanish - KYP Pull out card iPACT

4.57 MB

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2 DPC Stroke Flyer Spain corrected - Cópia

257.14 KB

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2-FINAL-A4-KYP Poster-Spanish-iPACTv1_SEFAC_2017 - Cópia

926.02 KB

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4 AF Factsheet Dutch

171.05 KB

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4_SPANISH_AFA ES Atrial Fibrillation-iPACT

389.34 KB

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AFcampanya_ICTUS_adhesiu_140mmTR - Cópia

73.91 KB

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Cartell x FARMÀCIES_297x420 - Cópia

480.83 KB

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DOC 2 Final-Detect Correct Protect-Spanish-iPACT

2.67 MB

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DOC 2-FINAL-A4-KYP Poster-Catalan-iPACTv1

867.35 KB

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DOC 2-FINAL-A4-KYP Poster-Spanish-iPACTv1 - Cópia

871.47 KB

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DOC 3 Atrial Fibrillation Checklist-Spanish-iPACT

1.89 MB

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Grant Proposal Requests

A committee can submit a proposal for a project to the DRM-F Board. To be approved, the proposal must be in line with the mission and values of DRM-F listed below. The board will provide feedback on the application within a 2 month time frame period. Please review the "Process of Submission and Approval" section for more information.

A committee can submit a proposal for a project to the DRM-F Board. This proposal should be in line with the mission and values of DRM-F. The following principles will apply to all projects:


  • Must be Aligned to the strategic imperatives of IPACT.
  • Must demonstrate a global impact.
  • Must be conducted in an open and transparent manner.
  • Confidentiality of information received in the course of the arrangement will be respected and never used outside the scope of the project;
  • All patient identifiers will be removed from data to preserve and respect patient confidentiality in line with the Data Protection Act.
  • Potential implications for patients, healthcare professionals and decision makers.

Data ownership


  • All data generated by the project will be owned by DRM-F/IPACT
  • No data will be disclosed to any third party except on the explicit agreement of all parties;
  • Patient confidentiality will be maintained at all times.

Please list any relevant qualifications that you or your organization have.
Insert a paragraph giving a summary of the aims, objectives and scope of the project and how this fits into the strategic vision of IPACT.
Please note that the duration of the project, KPIs and outputs must be transparent from the outset. Any deviations from project criteria and agreed outputs must be highlighted to the IPACT board for approval.

* Required fields

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Process of submission and approval

All project proposal must be uploaded onto the IPACT website. The IPACT business manager (BM) will check for new proposals on the website on a fortnightly basis and confirm receipt of the project proposal to the applicant.

The BM will ensure the project has met the administrative criteria for submission (see table 1). If that is not the case, the BM will contact the applicants and request modification of proposal (within 15 days). Once the proposal meets the criteria, the BM will alert all board members and send them a copy of the project plan to be reviewed to judge if it fits into the general aims of the iPACT strategic plan (within another 15 days). The BM will upload project onto the board section of the IPACT website. This allows the board to have track of the submission date. The board review should be made according to the criteria listed in table 2. The voting of the proposal will be on the agenda for the next face-to-face board meeting. All members must fill in the grid before the meeting and issue a final rank/opinion about the possibility of considering the activity for the coming year. 5 members must always constitute the board so that no tie is possible. The board needs to provide feedback to the candidate activity in 2 months.


Table 1: Administrative criteria for proposals submitted for funding with PID:

Criteria Yes/No
Responsible team for project development and implementation documented, including any potential subcontractors.
Deliverables clearly defined.
Timelines outlined.

Table 2: Strategic and scientific criteria for proposals submitted for funding:

Criteria Yes/No* Points (1-5)
Does the activity meet any of the broad objectives of iPACT
Is the activity generalizable to a global audience?
Is the need for such a project well established?
Does the activity clearly contribute to improve patient care?
Are various countries involved?
If subcontracting has given proof of 3 budget submissions?
Deliverable is clear and attainable within the timeline indicated?
Is the project methodologically sound?
Is there enough information to indicate that payment is only made upon delivery of the final product? Or depending on the amount on clear deliverables?
Is the budget presented clearly justified by the amount of work or by the substantial contribution for raising patient care?
Is there enough information to indicate that payment is only made upon delivery of the final product? Or depending on the amount on clear deliverables?

* If no, define if it may be possible to seek further clarification on the proposal or if it immediately fails. In some situations the board may ask for amendments to the proposal to meet the strategic aims of IPACT.


1. Changes to project proposal after approval

Where deviations have been made to agreed project criteria and outputs, the committee will reconvene to discuss validity of the project and determine whether payment for services is still valid.


2. Declaration of Interests

All declarations of interest must be declared within PID. If the project requires subcontracting to medical writers, statisticians etc, it is the responsibility of the project owner to ensure there are no conflict of interests. IPACT board will request additional information on interests in such cases.


3. Payment structure

A fixed hourly rate of hourly rate of 50 euros is provided for IPACT projects, however there may be exceptions e.g. for the development of training videos. Where it is felt that the rate may differ, this must be stated within the PID.

Within the project initiation document an estimated number of hours to complete the project will be required. Projects will be reviewed at each milestone (date pre agreed with IPACT board) to ensure alignment with the agreed PID and to provide remuneration. Where there are delays, the board must be informed within two weeks of agreed review milestone date. If projects are significantly delayed e.g. over one month, the board and project manager will meet to discuss barriers to completion, potential solutions or to exit project agreement where appropriate.

Note: Where additional resources are needed e.g. statistical analysis, medical writing the payment will be made directly by IPACT to the named individual.


4. Criteria for project remuneration

Below is an example of remuneration milestones for a scientific project. Where education modules or videos are being developed, milestones for remuneration will differ and this will be agreed by the board and project lead.

Milestone of scientific project % Of total remuneration
Project approved 10%
Data collection 10%
Results 10%
Write up 10%
On publication/poster presentation/on website 60%