Pharmacotherapy review: a proposal to improve medication adherence among hypertensive patients

A revisão da farmacoterapia é uma avaliação estruturada dos medicamentos com o objetivo de proporcionar aos pacientes o alcance dos objetivos terapêuticos por meio da forma adequada de administração dos medicamentos. O objetivo foi analisar a influência da revisão da farmacoterapia, por meio do aprazamento dos medicamentos, na adesão à medicação e no controle da hipertensão arterial sistêmica. Trata-se de um estudo de intervenção não controlado desenvolvido em três momentos distintos. No primeiro, realizou-se a coleta de dados sobre o perfil dos pacientes e de suas medicações e a avaliação da adesão; no segundo momento, realizou-se a entrega do relatório da revisão aos pacientes e na terceira etapa avaliou-se o resultado da adesão e pressão arterial. A influência da revisão foi medida por meio de testes estatísticos (pharmacotherapy review is a structured assessment of medicines, which aims to obtain a partnership with patients to achieve drug treatment goals and agreement about drug dosage, as well as when and how the drugs should be administered. The objective was to analyze the influence of pharmacotherapy review, by scheduling drug administration to improve medication adherence among antihypertensive patients. This study was an uncontrolled intervention developed in three distinct stages. The first stage included data collection on the profile of patients and their medications, and a preliminary assessment of medication adherence. In the second stage, the review report was delivered to patients. In the third stage, the results of blood pressure and medication adherence were assessed. The influence of the revision was measured through statistical tests (

Proposta de orientação farmacêutica na alta hospitalar a partir de overview e experiências profissionais

A orientação farmacêutica de alta hospitalar (AH) pode contribuir no manejo da saúde do paciente, em especial no uso racional de medicamentos. Esta busca melhorar a adesão ao tratamento; reduzir as reações adversas; e diminuir readmissões hospitalares e mortalidade. Este estudo tem como objetivo descrever o processo de orientação farmacêutica de AH, identificando as fases e os materiais utilizados. Caracteriza-se como um overview, incluindo estudos de revisão sistemática sobre orientação de AH com ação de farmacêuticos. Como critérios de exclusão adotou-se: trabalhos que abordavam especificamente um problema de saúde ou uma população ou não descreviam o processo de AH. Também foi realizada uma oficina entre os proponentes com experiência em orientação farmacêutica de AH. Observou-se que para a orientação de alta é necessário contextualizar o paciente no seu ambiente domiciliar tanto antes quanto após a hospitalização. O processo de alta contempla diversas atividades e serviços, como: conciliação medicamentosa, aconselhamento (educação em saúde) e revisão da farmacoterapia. Adotou-se como estratégias as listas de medicamentos e seu aprazamento, resumos de alta e formulários de conciliação. Foi possível observar que muitos autores referem a necessidade de acompanhamento pós-alta com a adoção de estratégias como chamadas telefônicas, visitas domiciliares e troca de mensagens de texto. Com base nos resultados foi possível sistematizar uma proposta de serviço farmacêutico de orientação de AH e concluir que, a comunicação entre os profissionais de saúde e paciente ou cuidador durante ou após a AH é fundamental para promover melhores resultados clínicos

Pharmacotherapy review: a proposal to improve medication adherence among hypertensive patients

Abstract Pharmacotherapy review is a structured assessment of medicines, which aims to obtain a partnership with patients to achieve drug treatment goals and agreement about drug dosage, as well as when and how the drugs should be administered. The objective was to analyze the influence of pharmacotherapy review, by scheduling drug administration to improve medication adherence among antihypertensive patients. This study was an uncontrolled intervention developed in three distinct stages. The first stage included data collection on the profile of patients and their medications, and a preliminary assessment of medication adherence. In the second stage, the review report was delivered to patients. In the third stage, the results of blood pressure and medication adherence were assessed. The influence of the revision was measured through statistical tests (p<0.05). The study included 40 patients with a mean age of 58.0 (SD:11.3) years; 72.5% were women. Thirty-three (82.5 %) patients required some intervention, after when there was a significant increase in the number of daily doses (p=0.039) and drug intakes (p=0.025). There was a significant increase in the adherence rate, according to both the Morisky-Green test (p<0.001) and self-reported assessment (p=0.004). There was also an improvement in the levels of systolic (p<0.001) and diastolic (p=0.002) blood pressure and in the number of patients with controlled hypertension (p=0.006). The pharmaceutical service enhanced medication adherence and control of systemic blood pressure; however, it increased the complexity of treatment

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status