Condução de formação em farmácia clínica durante a pandemia de Covid 19 – desafios e insights para tempos pós-pandemia

Os farmacêuticos e outros profissionais como força de trabalho da saúde são fundamentais para a resposta a perigos e riscos ambientais, tecnológicos e biológicos, propiciando às comunidades e aos sistemas de saúde a possibilidade de adaptações a desastres e pandemias. Na pandemia de Covid, iniciada em 2019, os profissionais da saúde enfrentaram diversos riscos, sobretudo o de contaminação que tem gerado afastamento do trabalho, doença e morte, além de intenso sofrimento psíquico, que se expressa em transtorno de ansiedade generalizada, distúrbios do sono, medo de adoecer e de contaminar colegas e familiares e também a precarização do trabalho pelas constantes faltas de materiais necessários à assistência. Inserir estudantes de graduação neste contexto de atuação profissional constituiria um risco desproporcional ao benefício da formação na comunidade. Em direção oposta, o cenário de adoecimento e morte dos profissionais chamava as universidades ao desenvolvimento de estratégias de formação que viabilizassem a minimização dos riscos ocupacionais e maximizassem a possibilidade de formação contextualizada e pertinente à atuação profissional no sistema de saúde. Desta forma, para a formação em Farmácia Clínica, especificamente para o Cuidado Farmacêutico a pacientes da Atenção Primária à Saúde adaptou-se a proposta pedagógica do Estágio Supervisionado em Cuidado Farmacêutico na APS do SUS. A condução foi feita em diferentes momentos. No momento inicial, os estudantes foram divididos em trios de trabalho e fizeram atendimentos presenciais ou mediados por tecnologia a pesssoa do convívio próximo, seguindo todas as normas de segurança ocupacional. O critério mínimo de inclusão de pacientes era que a pessoa utilizasse pelo menos 5 medicamentos e fosse portador de doença crônica. No segundo momento, a sistematização e resolução do atendimento foi disponibilizada ao docente, aos colegas e a um outro trio que faria a revisão por pares do atendimento e finalmente, por meio de visualização do vídeo do atendimento, seguido de rounds ocorridos na Plataforma Meet os casos eram apresentados e a condução recebia do feedback dos colegas e da docente. Cada paciente deveria ter pelo menos duas consultas a fim de se fizesse a implantação das intervenções necessária. Ao longo dos semestre letivo pode-se perceber a evolução nas competências de entrevista do paciente para a definição das necessidades de saúde, melhoria no delineamento do plano de cuidado, bem como na implantação das intervenções e da capacidade de avaliação dos resultados

Prevalence of potential drug interactions of clinical importance in primary health care and its associated factors / Prevalência de potenciais interações medicamentosas de importância clínica na atenção primária à saúde e seus fatores associados

Introduction: older patients usually had multiple diseases and so use many medicines. The elevated risks of pharmacotherapy in this population justified the development of ratings for unsafe medicines.Objective: to estimate the prevalence of potential drug interactions of clinical importance in primary health care and its associated factors, improving prescription practices and increasing patient safety.Methods: a cross-sectional study of dependent variable “number of potential drug-drug interactions of clinical importance”, in all medicines and patients who accessed medicines via public primary health care, 2013. The independent variables were socio demographic, accessibility of health services and pharmacotherapy. Multivariate analyses were performed using the Statistical Learning Theory with Exaustive-CHAID algorithm, with test Pearson's chi-square adjusted by the Bonferroni method.Results: a total of 4,037 patients were included in this study and the patient prevalence of at least one drug-drug interaction was 36.5% with severity moderate (66.2%) or major (28.5%). The most prevalent conduct for management of them were monitor the patient (59.0%), adjust the dosage of the medicines (21.9%) and monitoring signs and symptoms (16.7%). In the multivariate analysis by the Theory of Statistical Learning when we compared the “patients who had at least one drug interaction of clinical importance” with those who did not have them at the first hierarchical level of relevance, the variable “number of drugs in use” prevailed with a p value <0.0001. The analysis also proposed 7 different risk strata to explain the distinction between having at least one interaction of clinical importance, namely: 1, 2, 3, 4, 5, 6-7 and> 8 drugs. When comparing patients with 2 medications and those with 8 or more medications, the prevalence of drug interactions increases by about 80%. Using polypharmacy (5 or more drugs) as the cutoff point to make the same comparison, the increase is about 45%. Other variables with statistical relevance to explain having or not having hair were “multiple drug dispensations per month” (p = 0.003 and p = 0.01) and “being elderly” (p = 0.003). Having “multiple drug dispensations per month” reduced the prevalence of interactions by about 10% for both patients with 3 medications (p = 0.003) and those with 6 or 7 medications.Conclusions: the drug-drug interactions showed be different in primary care of hospitals and other place for health care. And the number of medications in use by the patient seems to be the main marker for patient selection for this type of analysis, with polypharmacy being a relevant cutoff point, but above all the use of 8 or more medications indicates a prevalence of more than 90% patients of at least one interaction of clinical importance. There are few studies of potential drug-drug interactions in public primary health care, especially with analysis of the severity and management of them. We recommend more studies for clarify prevalence, types and associated factors

Use of drugs in children aged zero to five years old in Tubarão, Santa Catarina, Brazil

Objetivo: Analisar o perfil de utilização de medicamentos em crianças de zero a cinco anos de idade. Métodos: Estudo transversal baseado em entrevistas realizadas em domicílio com cuidadores (pais, tios ou avós) das crianças cadastradas em dez unidades de Estratégia Saúde da Família (ESF), distribuídas em diferentes pontos geográficos do município de Tubarão, Santa Catarina. Resultados: Foram entrevistados 350 cuidadores, cujas crianças sorteadas possuíam, em média, 2,6 anos de idade. Destas, 56,9% utilizaram, pelo menos, um medicamento nos 15 dias anteriores à entrevista, sendo que 31,1% foram expostas à automedicação e 35,7% utilizaram, pelo menos, um medicamento obtido por prescrição atual. O uso de medicamentos foi associado à faixa etária de até 24 meses, consulta periódica com pediatra e diagnóstico de doenças agudas e doenças crônicas. Entre as crianças medicadas, 19,1% foram expostas a pelo menos um medicamento de forma inadequada (considerando dose, intervalo entre doses ou período de tratamento). Quanto ao armazenamento, 55,2% dos medicamentos estavam guardados em lugar inseguro, ou seja, ao acesso das crianças, e 32,0% em locais inadequados, por estarem expostos a luz, calor ou umidade. Ainda, 45,2% estavam sem bula, 38,9% sem embalagem secundária e 1,6% fora do prazo de validade. Conclusões: As crianças estudadas apresentam uma frequência elevada de uso de medicamentos, devendo ser incentivadas ações que visem ao uso seguro e racional de fármacos nessa população.Objective: To analyze the context of drug use in children aged zero to five years old. Methods: Cross-sectional study based on interviews conducted at home with caregivers (parents, uncles or grandparents) of the children enrolled in ten Family Health Strategy units across different geographical points of the city of Tubarão, Santa Catarina, Brazil. Results: A total of 350 caregivers were interviewed, whose children’s mean age was 2.6 years. Of these, 56.9% had used at least one drug in the 15 days prior to the interview, 31.1% had been exposed to self-medication and 35.7% had used at least one medication obtained by current prescription. The use of medication was associated with the age range up to 24 months, periodic consultation with pediatricians and diagnosis of chronic and acute diseases. Among medicated children, 19.1% inappropriately had been exposed to at least one medication (considering dose, dose interval or period of treatment). Regarding medication storage, 55.2% of interviewees stored them in unsafe places that could be accessed by children and 32.0% in inappropriate places, with exposure to light, heat or humidity. Moreover, 45.2% of the interviewees stored drugs out of their packages, 38.9% without secondary packaging, and 1.6% of drugs had expired date. Conclusions: Drug use is high among children in this age range, and actions aimed at the safe and rational use of these substances in this population should be encouraged

Clinical outcomes of medication therapy management services in primary health care

This study evaluates whether the integration of pharmacists into health-care teams through the delivery of pharmaceutical care-based medication therapy management (MTM) services can improve the clinical outcomes of patients with chronic health conditions in the primary health-care setting. A retrospective descriptive study of 92 outpatients assisted by MTM pharmacists in primary health-care units was carried out over 28 months (median follow-up: 05 months). Patients were followed up by MTM pharmacists, with a total of 359 encounters and a ratio of 3.9 encounters per patient. The prevalence of hypertension, diabetes mellitus and dyslipidaemia was 29.5%, 22.0% and 19.4%, respectively. There was a high prevalence of drug-related problems with a ratio of 3.4 per patient. Pharmacists performed a total of 307 interventions to prevent or resolve drug-related problems. With regard to control of the most prevalent chronic medical conditions, a high percentage of patients reached their therapy goals by the last encounter with the pharmacist: 90.0% for hypertension, 72.3% for diabetes mellitus and 90.3% for dyslipidaemia. MTM services provided by pharmacists resolved drug therapy problems and improved patients' clinical outcomes. This study provides evidence for health-care managers of the need to expand the clinical role of pharmacists within the Brazilian public health-care system

Control measures to trace ≤ 15-year-old contacts of index cases of active pulmonary tuberculosis

This was descriptive study carried out in a medium-sized Brazilian city. In ≤ 15-year-old contacts of index cases of active pulmonary tuberculosis, we assessed compliance with the Brazilian national guidelines for tuberculosis control. We interviewed 43 contacts and their legal guardians. Approximately 80% of the contacts were not assessed by the municipal public health care system, and only 21% underwent tuberculin skin testing. The results obtained with the Chi-square Automatic Interaction Detector method suggest that health care teams have a biased attitude toward assessing such contacts and underscore the need for training health professionals regarding tuberculosis control programs

Utilization of HIV/AIDS treatment services: comparing injecting drug users and other clients

This study compared healthcare utilization by injection drug users (IDUs) and non-IDUs. Data were abstracted from patients' medical records, admitted on HIV/AIDS treatment centers, between 1986 and 2002, forming a non-concurrent cohort study. Variables included: sociodemographics, HIV/AIDS exposure group, healthcare utilization (consultations, procedures, and prescriptions). Descriptive analyses included age-period and cohort effects. Out of 170 patients, with an average age of 30 years, 39.4% were IDUs, 71.8% were males and had low levels of education. At the first consultation, 86.5% neither received an ARV prescription nor had a request for CD4 or viral load. Injection drug users, as compared to non-IDUs, were less likely to receive ARV prescriptions and requests for CD4 lymphocyte and viral load counts, even though the number of consultations did not differ between the two groups. Healthcare utilization increased in calendar-year in the non-IDUs group, parallel to the implementation of the Brazilian health policy of universal care. However, this favorable trend was not observed among IDUs. Differential outcomes for HIV/AIDS among IDUs, towards worse prognosis, suggest difficulties in terms of adherence and follow-up of ARV therapy in this population

Physicochemical Characterization and Paper Spray Mass Spectrometry Analysis of Myrciaria Floribunda (H. West ex Willd.) O. Berg Accessions

Myrciaria floribunda, also known as rumberry, is a tree native to the Brazilian Atlantic Forest, where its fruits have the potential for commercial use. This study evaluates the antioxidant potential, determines the phytochemical profile, and chemically characterizes the rumberry fruit. Accessions were sampled from the Rumberry Active Germplasm Bank of the Federal University of Alagoas, Brazil. Physical characteristics, chemical characteristics, and phenolic compound content were analyzed. Chemical profile characterization was carried out using PSMS. Accessions had an average weight of 0.86 g. Accession AC137 presented a higher pulp yield (1.12 g). AC132 and AC156 had larger fruits, AC137 showed greater firmness (5.93 N), and AC160 had a higher and total phenolic content ratio (279.01 ± 11.11). Orange-colored accessions scored higher in evaluated parameters, except for AC160 for phenolic content. Thirty-two compounds were identified on positive ionization mode and 42 compounds on negative ionization mode using PSMS. Flavonoids, followed by the derivatives of benzoic acid, sugars, and phenylpropanoids, were the most prominent. Myricitrin, quercitrin, and catechin stand out as flavonoids that have been reported in previous studies with antioxidant and antimicrobial properties, in addition to health and therapeutical benefits, demonstrating the potential of the rumberry fruit