HIV pharmaceutical care in primary healthcare: Improvement in CD4 count and reduction in drug-related problems

AbstractBackground: Highly active antiretroviral therapy (HAART) is complex and many factors contribute to a patient’s response to initial therapy including adherence, drug effectiveness, and tolerance. Close HAART follow-up is needed, particularly when there are concurrent therapies such as prophylactic antibiotics and medications for the treatment of comorbidities. Objective: To assess the effectiveness of pharmacist intervention in reducing drug related problems in HIV/AIDS outpatients (intervention group) and in improving clinical parameters in the intervention group compared to the control group. Methods: We conducted a prospective controlled intervention study with patients paired by gender and initial T CD4+ lymphocyte (CD4) count. HIV-infected patients of a public outpatient service were enrolled for the study by consecutive and convenience sampling. Patients selected for the study were divided into a control group and an intervention group. Both groups were followed for one year; however, only the intervention group received pharmaceutical care. The primary outcome was the drug related problem (DRP) analysis for the intervention group. Secondary outcomes were CD4 count and viral load evaluation for both groups. Results: There was a total of 143 patients enrolled in this study, with 53 (37.06%) patients in the control group and 90 (62.94%) patients in the intervention group. A total of 202 pharmacist interventions with 193 pharmacist-patient and 9 pharmacist-physician interventions were proposed. After one year of pharmaceutical care, a reduction of 38.43% between the initial and final DRP was found (p=0.0001). The most common DRPs found were related to medication safety. The intervention group showed a mean increase of 84% for the CD4 count in comparison with that observed in the control group. The viral load was not significantly different between the final and initial mean values for both groups. Conclusion: Pharmacist appointments enabled identification, prevention, and solving of drug related problems, especially those related to drug safety. Also, pharmacist interventions improved adherence and increased HAART effectiveness as suggested by the higher elevation in the CD4 count seen in the intervention group in comparison with the control group

Clinical relevancy and risks of potential drug–drug interactions in intensive therapy

AbstractPurposeEvaluate the potential Drug–Drug Interactions (pDDI) found in prescription orders of adult Intensive Care Unit (ICU) of a Brazilian public health system hospital; quantify and qualify the pDDI regarding their severity and risks to the critical patient, using the database from Micromedex®.MethodsProspective study (January–December of 2011) collecting and evaluating 369 prescription orders (convenient sampling), one per patient.ResultsDuring the study 1844 pDDIs were identified and distributed in 405 pairs (medication A×medication B combination). There was an average of 5.00±5.06 pDDIs per prescription order, the most prevalent being moderate and important interactions, present in 74% and 67% of prescription orders, respectively. In total, there were 9 contraindicated, 129 important and 204 moderate pDDIs. Among them 52 had as management recommendation to “avoid concomitant use” or “suspension of medication”, while 306 had as recommendation “continuous and adequate monitoring”.ConclusionThe high number of pDDIs found in the study combined with the evaluation of the clinical relevancy of the most frequent pDDIs in the ICU shows that moderate and important interactions are highly incident. As the majority of them demand monitoring and adequate management, being aware of these interactions is major information for the safe and individualized risk management

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for >; 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through MicromedexTM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results

Impact Of Pharmacist Interventions On Drug-related Problems And Laboratory Markers In Outpatients With Human Immunodeficiency Virus Infection.

Substantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection. In this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia-University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load. After pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1-6.2) to 4.2 (95% CI =3.3-5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm(3) [95% CI =175.8-345.6] to 312.0 cells/mm(3) [95% CI =23.5-40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load. This study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.10631-

Clinical pharmacy as a safety tool in intensive care unit

Orientador: Priscila Gava MazzolaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A farmácia clínica e todas as atividades ligadas a ela tem em si um caráter de melhoria da qualidade e da segurança dos cuidados oferecidos aos pacientes. Essa característica pode ser observada principalmente por meio da realização de intervenções farmacêuticas, que contribuem para a prevenção de erros de medicação e para a otimização da terapia medicamentosa. Estes conceitos são mais fortemente trabalhados atualmente em ambientes de maior risco ao paciente, como as Unidades de Terapia Intensiva (UTI). O objetivo deste trabalho foi descrever o perfil das intervenções farmacêuticas mais frequentes em uma UTI da rede pública de saúde em que as ações de farmácia clínica ainda não fazem parte do serviço de farmácia. Neste estudo foram realizadas, quantificadas e classificas as intervenções farmacêuticas, sendo ainda avaliada a aceitação das intervenções por parte da equipe médica. Trata-se de um estudo transversal, intervencionista, prospectivo, não controlado, com coleta de dados entre agosto de 2014 a setembro de 2015 e amostragem de conveniência. Foram analisadas prescrições de 279 pacientes, todos acima de 18 anos, admitidos na UTI geral para adultos do Hospital de Clínicas da Unicamp durante o período de estudo. Foram analisadas 1300 prescrições (média de 12,5 ± 3,3 por paciente). Cento e trinta e um pacientes receberam ao menos uma intervenção farmacêutica em seu tratamento, o que corresponde a 47% da população estudada. O total de intervenções realizadas no estudo foi de 579 (média de 2,1 ± 3,5 por paciente), sendo que 573 intervenções (99%) foram aceitas pela equipe médica. Destacaram-se as intervenções referentes à presença de interações medicamentosas potenciais (IMP) em prescrição (91%). A maioria das intervenções realizadas foram classificadas como significantes (47%) e muito significantes (45%). Entre as intervenções classificadas como "muito significantes" 8 (3%) foram referentes a ajustes de doses em função de problemas renais ou hepáticos e 254 foram motivadas pela presença de IMP de gravidade importante ou contraindicada na prescrição. Das intervenções "significantes" 12 (4,5%) foram correlacionadas a pedidos de exames para monitoramento de possíveis eventos adversos e 262 foram correlacionadas a IMP de gravidade moderada. Durante o período de estudo foram identificadas, quantificadas e classificadas, 8602 IMP presentes em prescrições, desse total de IMP identificadas, apenas 519 (6%) motivaram intervenções farmacêuticas (IF). Entre as prescrições analisadas, 92% apresentavam ao menos uma IMP, destacando-se a prevalência das interações classificadas como moderadas e importantes, presentes em 79% e 78% das prescrições, respectivamente. Foram comparadas no estudo as bases de dados Micromedex® e UpToDate® quanto à classificação de gravidade das IMP mais frequentemente observadas em prescrições, notando-se um elevado número de informações discordantes entre elas. Os resultados encontrados ilustram o elevado número de intervenções farmacêuticas realizadas em UTI e a boa aceitação delas pela equipe de terapia intensiva. As IMP mostraram-se as principais causas de intervenções, ao mesmo tempo em que se demonstrou a dificuldade de consenso sobre informações referentes a elas. Esses resultados reforçam a necessidade do desenvolvimento da farmácia clínica em UTI da rede pública de saúdeAbstract: Clinical pharmacy and the associated activities have in their core the improvement of quality and safety of patient care. This characteristic can be observed through pharmaceutical interventions that contribute to the prevention of medication errors and pharmacotherapy optimization. These concepts are employed in environments with higher risk to the patients, as Intensive Care Units (ICU). The aim of this study was to describe the profile of pharmaceutical interventions more frequent in a public system ICU where the clinical pharmacy service is not yet established. This exploratory study intended to perform, quantify, and classify pharmaceutical interventions, as well as to evaluate acceptance of these interventions by the medical team. It was a transversal, interventionist, prospective, not-controlled study with data gathering of 13 months (from August 2014 to September 2015) and convenient sampling. Were analyzed prescriptions from 279 patients, all above 18 years old, admitted to the general adult ICU of the Clinics Hospital of Unicamp. Were analyzed 1300 prescriptions (average of 12.5±3.3 per patient). One hundred and thirty-one patients received at least one pharmaceutical intervention in their treatment, which corresponds to 47% of the studied population. Were performed a total of 579 interventions (average of 2.1±3.5 per patient), and 573 interventions (99%) were accepted by the medical team. Interventions related to potential drug-drug interactions (pDDI) were highlighted in prescriptions (91%). Most interventions were classified as "significant" (47%) and "very significant" (45%). Among interventions classified as "very significant", 8 (3%) were related to dose adjustment for renal or liver problems and 254 were motivated by the presence of major or contraindicated pDDIs. Of the "significant" interventions, 12 (4.5%) were related to requesting monitoring exams to identify possible adverse events and 262 were correlated to moderate pDDIs. During the study period were identified, quantified and classified 8602 pDDIs in prescriptions. From these, only 519 (6%) motivated pharmaceutical interventions. Among analyzed prescriptions, 92% presented at least one pDDI, highlighting the prevalence of interactions classified as moderate and major, present in 79% and 78% of prescriptions, respectively. Were compared in the study two databases: Micromedex® and UpToDate® concerning pDDIs¿ severity classification more frequently observed in prescriptions, detecting a large disagreement between them. Results found show a significant number of pharmaceutical interventions performed in the ICU and their good acceptance by the intensivist team. Interactions were the main cause for intervention, and the difficulty of consensus of information between them was demonstrated. These results emphasize the need for development of clinical pharmacy in ICUs of the public health systemDoutoradoCiencias BiomedicasDoutora em Ciências Médicas01P-1743-2016CAPE

Drug interaction analysis in medical prescriptions at the Intensive Care Unit (ICU) from Hospital das Clínicas (HC, Unicamp) : relevance of Clinical Pharmacy in Intensive Care Unit (ICU)

Orientador: Priscila Gava MazzolaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A incidência de interações medicamentosas em prescrições de unidades de terapia intensiva (UTI) é conhecidamente superior ao número de interações observado em outros setores hospitalares. O nível de complexidade tecnológica desta unidade, o elevado número de medicamentos a que os pacientes estão expostos e as dificuldades inerentes aos cuidados críticos são fatores que evidenciam a necessidade de elaborada avaliação da farmacoterapia utilizada em medicina intensiva. A atuação do farmacêutico clínico, composta entre outros fatores, pelo rastreamento e detecção de interações medicamentosas potenciais teóricas (IMPT), pode ser vista como uma colaboração importante para a qualidade do serviço e mais uma contribuição para a segurança no uso dos medicamentos em UTI. Este estudo baseia-se na avaliação de uma amostragem de prescrições médicas de UTI e tem por objetivo avaliar a incidência de IMPT em prescrições feitas na Unidade de Terapia Intensiva (UTI) de um hospital da rede pública de saúde (Hospital de Clínicas - UNICAMP), quantificá-las e classificá-las quanto ao seu grau de severidade, traçando com isso um perfil das IMPT presentes nas prescrições deste setor. No período de janeiro a dezembro de 2011 foram avaliadas prescrições de 369 pacientes, todos maiores de 18 anos, média de idade de 57,03 ± 14,62, internados por mais de 24 horas na UTI adulto. Foram prescritos no período avaliado 205 diferentes tipos de medicamentos, média de 13,04 ± 4,26 por prescrição. Entre as prescrições avaliadas 89% apresentaram interações medicamentosas potenciais teóricas, obtendo-se uma média por prescrição de 5,00 ± 5,06. Os 405 tipos de IMPT observadas nas prescrições foram classificadas, utilizando a base de dados Micromedex®, destacando-se a prevalência das IMPT moderadas e graves, presentes em 74% e 67% das prescrições, respectivamente. Além dos dados relativos ao perfil farmacoterapêutico da UTI em estudo, foi observada ainda na pesquisa correlação estatisticamente significativa entre as IMPT e tempo de internação em UTI dos pacientes e o número de medicamentos prescritos. Os resultados encontrados contribuem para o delineamento do perfil de risco relativo às IMPT em terapia intensiva, demonstrando que há uma elevada incidência de interações medicamentosas potenciais moderadas em prescrições de UTI. Ressalta-se com ele a necessidade de atuação do farmacêutico clínico nesta área, a fim de contribuir com a equipe multidisciplinar na redução de riscos provenientes da terapia medicamentosaAbstract: The incidence of drug interactions in prescriptions of intensive care units (ICU) is known to exceed the number of interactions than the observed in other hospital settings. The level of technological complexity of this unit, the elevated number of drugs to which patients are exposed and the difficulties inherent in critical care are factors that highlight the need for elaborated evaluation of pharmacotherapy used in intensive care medicine. The role of the clinical pharmacist, composed among other factors, by tracking and detection of theoretical potential drug interactions (TPDI), can be seen as an important contribution to the quality of service and as another security barrier to the use of medication in the ICU. This study is based on the evaluation of a sample of medical prescriptions of ICU and aims to assess the existence of theoretical potential drug interactions in prescriptions made in the Intensive Care Unit (ICU) of a public health hospital (Clinic Hospital - UNICAMP), to quantify and classify them as to their degree of severity, tracing with it a profile of present TPDI in this setting. From January to December 2011, prescriptions of 369 patients were evaluated, all over 18 years old, mean age of 57.03 ± 14.62, hospitalized for more than 24 hours in adult ICU. Two hundred five different types of drugs were prescribed in the study period, average of 13.04 ± 4.26 per prescription. Among the evaluated prescriptions, 89% presented theoretical potential drug interactions, resulting in an average of 5.00 ± 5.06 per prescription. The 405 types of observed TPDI in the prescriptions were classified using database Micromedex ®, highlighting the prevalence of moderate and severe TPDI present in 74% and 67% of prescriptions, respectively. In addition to the data on pharmacotherapeutic profile of ICU under study, it was observed in the survey statistically significant correlation between TPDI and duration of hospital stay in the ICU and the number of prescription drugs. The results contribute to design the relative risk profile of TPDI in intensive care, showing that there is a high incidence of moderate potential drug interactions in prescriptions of ICU. The results emphasized the need for performance of the clinical pharmacist in this area, in order to contribute to the multidisciplinary team to reduce risks from drug therapyMestradoCiencias BiomedicasMestra em Ciências Médica

Prevalence Of Potential Drug-drug Interactions In The Intensive Care Unit Of A Brazilian Teaching Hospital

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for > 24 hours and age of >= 18 years. Potential Drug-Drug Interactions were quantified and classified through Micromedex (TM) database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 +/- 4.26 ( mean +/- standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 +/- 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results.531National Council of Technological and Scientific Development (CNPq. Brasilia, DF, Brazil)Sao Paulo Research Foundation (FAPESP. Sao Paulo, SP, Brazil)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Abstract Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for > 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through MicromedexTM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results