O cuidado farmacêutico na redução do impacto da pandemia de COVID-19 na saúde cardiovascular de pacientes hipertensos e diabéticos

Introdução: A pandemia de COVID-19 impactou na prestação de serviços à saúde aos pacientes portadores de doenças crônicas e o Medication Therapy Management (MTM-PC), parte integrante do cuidado farmacêutico, pode acarretar melhora dos parâmetros clínicos impactados pela pandemia. O objetivo deste estudo foi avaliar o impacto clínico do cuidado farmacêutico na hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) diante às mudanças impostas pela pandemia de COVID-19 no âmbito da atenção primária à saúde. Métodos: Trata-se de um estudo quase-experimental, single arm, do tipo antes e depois, com a coleta de dados de 01 julho de 2019 a 31 de outubro de 2022. Foram incluídos no estudo dados de pacientes do consultório farmacêutico da Farmácia Universitária- UFJF que foram divididos em pré-pandemia e pandemia, considerando o baseline e os dados relativos à reintrodução do atendimento presencial no consultório como endpoint. Foram coletados dados de pressão arterial, perfil lipídico, glicemia capilar, uso de estatinas e ácido acetilsalicílico, risco cardiovascular e dados psicossociais, consequências do isolamento social na saúde mental, prescrição de medicamentos e hábitos de vida. Os dados foramanalisados no software MINITAB v19, considerando o nível de significância de 5%. Resultados: Durante a pandemia sem o MTM-PC verificou-se que a pressão arterial e o HDL aumentaram, PAS 117,5±8,86 e 134,75±12,43; PAD 71,25±3,54 e 83,25±11,65; HDL 45,25± 7,80 e 52,38±12,52. Comparativamente, verificou-se que os valores de pressão arterial se mantiveram e os parâmetros de hemoglobina glicada e HDL melhoraram com o MTM-PC, HbA1c 7,890±1,798, [p=0,028] e 7,325±1,30; HDL48,00±6,00 e 59,00±10,56, [p=0,020]. Consequentemente, refletiu-se no aumento do risco cardiovascular pela pandemia, tanto na escala global 13,69±8,08 para 22,38±7,28, quanto otimizada, 8,35± 6,71 para 16,10±5,83, [p=0,38], havendo a quebra de tendência no aumento do risco com o MTM-PC. A carga terapêutica dos medicamentos utilizados para hipertensão e diabetes se manteve abaixo do valor limite de 75%. Conclusão: Evidenciou-se que a pandemia modificou parâmetros como pressão arterial e risco cardiovascular. E que o MTM-PC foi capaz de reduzir o impacto da pandemia na hemoglobina glicada, melhorar os níveis de colesterol HDL e quebrar uma tendência do aumento do risco cardiovascular.Introduction: The COVID-19 pandemic has impacted the provision of health services to patients with chronic diseases, and the Medication Therapy Management, an integral part of pharmaceutical care can lead to an improvement in clinical parameters impacted by the pandemic. The objective of this study was to assess the clinical impact ofMTM-PC on systemic arterial hypertension and diabetes mellitus (DM) in comparison with the changes imposed by the COVID-19 pandemic in the primary healthcare scope. Methods: This is a quasi-experimental, single-arm, before-and-after study, with data collection from July 1, 2019 to October 31, 2022. Data from patients at the pharmaceuticalservices, of the teaching-Pharmacy of UFJF, were included in the study and were divided into pre-pandemic and pandemic period, considering baseline data and the data related to the reintroduction of face-to-face care in the office as an endpoint.. Data were collected on blood pressure, lipidic profile, glycemia, use of statins and acetylsalicylic acid, cardiovascular risk, and psychosocial data, consequences of social isolation on mental health, medication prescription and life habits. Data were analyzed using the MINITAB v19 software, considering a significance level of 5%. Results: During the pandemic without MTM-PC it was found that blood pressure and HDL increased comparing the pre-pandemic with the pandemic without MTM-PC, respectively, SBP 117.5±8.86 and 134.75±12.43; DBP 71.25±3.54 and 83.25±11.65; HDL 45.25±7.80 and 52.38±12.52. Comparatively, it was verified that the blood pressure values were maintained and, the MTM-PC changed parameters like HbA1c 7.890±1.798, [p=0.028] and 7.325±1.30; HDL48.00±6.00 and 59.00±10.56, [p=0.020]. There was a change in both mean of cardiovascular risk, the global scale 13.69±8.08 to 22.38±7.28 and the optimized scale 8.35±6.71 to 16.10±5.83, [p=0.38], with a break in the trend of increased risk with the MTM-PC. The therapeutic load of drugs used for hypertension and diabetes remained below the limit value of 75%. Conclusion: There was evidence that the pandemic changed parameters such as blood pressure and cardiovascular risk. Additionally, the MTM-PC may be able to reduce the impact of the pandemic on glycated hemoglobin, improve HDL cholesterol levels and break a trend of increased cardiovascular risk

How much to invest in glycemic control of a patient with diabetes mellitus type 2? A constant dilemma for the Brazilian Public Health System (SUS)

Diabetes mellitus type 2 (DM2) affects millions of people worldwide and causes several complications for the patient, consuming large sums of financial resources from the health services. This study aims to estimate the financial investment of DM2 treatment for glycemic control of the patient, from the point of view of the municipal Public Health System (SUS). The Delphi technique was used to validate the opinion of a team of judges, specialists in DM2, and health service managers, on the investment necessary for glycemic control of patients with DM2 through the application of questionnaires. In order for the patient to achieve glycated hemoglobin (A1c) < 7%, an investment of US$ 2,419.06 (value/patient/year) is necessary. As the value of A1c increases, investment is reduced. This result reveals the intention to allocate resources for the prevention of DM2 and its complications

Clinical characteristics and risk for severe COVID-19: a systematic review: Características clínicas e risco para COVID-19 grave: uma revisão sistemática

COVID-19 has evolved into a serious clinical condition, especially in patients with comorbidities. However, the literature has diverged in relation to the main characteristics of patients prone to severe evolution. Objective: This study aimed to understand different variables that may be associated with the clinical management of COVID-19 for a better clinical response and prognosis. Methods: This is a systematic review in which the search in PubMed, Cochrane, EMBASE and LILACS databases. A manual and gray literature search on Google Scholar was also conducted. There was no country or region restriction and only studies in Portuguese, English and Spanish were included. Results: Of the 21 studies included in Primary Health Care (PHC) for eligibility, five studies from five countries involving 27,754 patients were analysed and, of the four eligible studies, one study was included for secondary care. Overall, the mean age of the COVID-19 population in PHC was around 41 years old, the number of cases was higher for females and, there was no difference between the groups without and with exposure, sex (ρ=0.322) and age (ρ=0.395). More than half of the patients had symptoms and, 47% had comorbidities. Heart diseases were the most prevalent among them. Approximately 79% of those infected had non-essential occupation. There was evidence that non-essential occupation was associated with infected individuals (ρ=0.002). Conclusions: This review identified that there may be greater vulnerability to contamination and aggravation of COVID-19 in female individuals, with adult age in non-essential activity, presence of chronic non-communicable diseases

Ações estratégicas do centro de informação sobre medicamentos da Farmácia Universitária (UFJF) para promoção ao uso racional de medicamentos e enfrentamento da COVID-19: Strategic actions by the University Pharmacy drug information center (UFJF) to promote the rational use of medicines and face COVID-19

Os Centros de Informação sobre Medicamentos (CIMs) são capazes de fornecer informações, com base em evidências científicas, para toda a sociedade. Com o avanço da COVID-19 e da desinformação, esse serviço pode se tornar um grande aliado para a sociedade. O objetivo foi descrever os primeiros indicadores do CIM da Farmácia Universitária da Universidade Federal de Juiz de Fora (CIM-FU-UFJF) na proposta de combate à desinformação na COVID-19 e promoção do Uso Racional de Medicamentos (URM). Trata-se de um estudo observacional descritivo analítico de levantamento. Foi realizada uma busca na literatura acerca dos Centros de Informação Sobre Medicamentos, utilizando as bases de dados para informações de fontes primárias BVS e LILACS e MEDLINE (PubMED), além de algumas fontes terciárias de livros para assuntos específicos. O período do estudo se estendeu de junho de 2021 a abril de 2022. Os indicadores foram estruturados para mensurar o alcance das ações. Após a estruturação do organograma e fluxograma do CIM-FU-UFJF, deu-se início a etapa de busca e identificação de demandas para, sequencialmente, iniciar a busca por evidências científicas sobre os variados assuntos. Os materiais foram estruturados digitalmente e divulgados nas redes sociais do CIM-FU-UFJF e por um programa próprio na rádio universitária. O CIM-FU-UFJF apresenta 412 seguidores, a média de 57 aprovações “curtidas”, 32 compartilhamentos e 345 visualizações por publicação. O programa semanal na rádio, conhecimento encapsulado, teve cinco roteiros elaborados com base nas publicações de maior alcance. As ações do CIM-FU-UFJF mostraram-se de fácil expansão na comunidade, sendo capaz de atuar com grande disseminação para o combate à notícias tendenciosas e promoção ao URM

Development and validation of a pharmacoeconomic tool for decision-making in the implementation of pharmaceutical care for hypertensive patients in the public health system

Introdução e objetivo: A hipertensão arterial sistêmica (HAS) é fator de risco para 9,4 milhões de mortes em todo o mundo. No Brasil, a HAS atribuiu um custo anual de aproximadamente um bilhão e meio ao Sistema Único de Saúde (SUS). O cuidado farmacêutico (CF) é capaz de evitar complicações da HAS e reduzir custos em saúde. A análise em longo prazo do CF mostrou que o retorno líquido do investimento nesta prática farmacêutica pode chegar à R$3.791.111,13 em dez anos. Com a metodologia desenvolvida para esta análise foi possível elaborar uma ferramenta farmacoeconômica para a implementação do CF no SUS. Contudo, para esta ferramenta tornar-se aplicável na sociedade há necessidade de desenvolvê-la e validá-la. Em adição, é possível aprimorá-la, acrescentando a mensuração do retorno monetário ao avaliar as morbidades associadas às complicações da HAS. Este trabalho tem como objetivo desenvolver e validar a ferramenta farmacoeconômica para auxiliar a tomada de decisão na implantação do CF no SUS incorporando Human Netwok Disease para prever o impacto epidemiológico e o retorno de investimento desta prática farmacêutica. Métodos: Trata-se de um estudo farmacoeconômico com aplicação de modelagens, aninhado a uma revisão sistemática. Os resultados da revisão sistemática foram tabulados e aplicados na reestruturação e desenvolvimento da ferramenta farmacoeconômica. Adicionalmente, o modelo de Markov foi reestruturado para mensurar o efeito de tratamento do CF em dez anos e seu impacto sobre as doenças cardiovasculares (DCV) e doença renal crônica (DRC) e morbidades associadas às mesmas, por estudos de proteômicas que abordam o Human Netwok Disease. Em adição, a ferramenta foi programada com os dados deste estudo e então validada, em duas etapas: validação de conteúdo de um questionário para validação de softwares e validação douso daferramenta para análise do constructo. Resultados: Foram recuperados 41 estudos na revisão sistemática. O modelo de CF mais prevalente foi aquele desenvolvimento pelo próprio autor, 27 estudos (65,9$ 268,53,o que representou a redução para R$251,47 no custo do paciente hipertenso por ano para o SUS. O Numero Necessário para Tratar em dez anos foi o CF tratar quatro e oito pacientes para se evitar a óbito por DCV e DRC, respectivamente. A redução em mortes por morbidades associadas às complicações foi mensurada no RR de 0,92 (0,90 - 0,93; IC95$ 3,791,111.13 over ten years. Alongside the methodology developed for this analysis was possible to elaborate a pharmacoeconomic tool for the implementation of PC in BPHS. However, for this tool becomes applicable in society there is a need for programming and validate it. In addition, it is possible to improve itself by adding the measurement of the monetary return when evaluating the morbidities associated with the complications of SAH. Then, this study aims to programme and validates the pharmacoeconomic tool to assist the decision-making process in the implementation of the PC in the BPHS incorporating Human Network Disease to predict the epidemiological impact and return of investment of this pharmaceutical practice. Methods: It is a pharmacoeconomic study with application of modeling, nested to a systematic review. The results of the systematic review were tabulated and applied in the restructuring and development of the pharmacoeconomic tool. In addition, the Markov model was restructured to measure the effect of CF treatment in ten years and its impact on cardiovascular diseases (CVDs) and chronic kidney disease (CKD) and morbidities associated with them, by studies of proteomics that address Human Netwok Disease. In addition, the tool was programmed with the data from this study and then validated in two steps: content\'s validation of a questionnaire for validation of software and double validation of the tool\'s feasibility for analysis of the construct. Results: 41 studies were retrieved in the systematic review. The most prevalent PC model was the development by the author himself, 27 studies (65.9%). The quality of studies that showed worsening in blood pressure values was worse than the others, w = 7.00 [p = 0.036]. The mean reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the intervention group compared to the control group was -7.71 (95% CI, -10.93 to -4.48) and -3, 66 (95% CI, -5.51 to -1.80), [p <0.001]. Regarding cardiovascular risk, the PC functioned as a protection factor RR = RR = 0.570 (95% CI 0.431 - 0.750). The Plot funnel showed that there was no asymmetry to support a bias p = 0.4949. When compared to conventional care, PC was a cost-effective strategy in 78.0% of the simulations for the life-years gained (LYGs) and 69.0% for quality-adjusted life years (QALYs). It is worth noting that there was a 64.3% and 59.5% chance of PC being more cost-effective than conventional care for LYGs and QALYs, respectively. There was a return on investment for PC of R$268.53, which represented a reduction to R$ 251.47 in the cost of the hypertensive patient per year for the SUS. The number needed to treat in 10 years means that PC must treat four and eight patients to avoid death due to CVD and CKD, respectively. The reduction in morbidities associated with complications was measured in the RR of 0.92 (0.90 - 0.93, 95% CI) [p <0.05]. After being programmed, the tool was registered as Pharmatool®. The programming of the tool made possible the planning for the investment in PC programs and, thus, it would be possible to plan goals, in ten years, for population followed-up by PC, indicators as blood pressure control, SAH complications to be avoided and financial return of monetary application carried out in the structuring of the CF. The validation questionnaire for Pharmatool® was satisfactory for content validity. It presented reliable interpretability, more than 50% of the answers considered satisfactory in all the questions. The internal consistency analysis showed the Cronbach\'s alpha equal to 0.819. The satisfaction of Pharmatool® users was greater than 75%.Conclusion: The systematic review and meta-analysis data incorporated in the Markov model showed more robust results for the projection of costs and outcomes, which evidenced that the FC was a cost-effective strategy to SUS regarding life expectancy and quality of life and, able to have a return on investment reducing the cost of hypertensive patients to SUS. In addition, the validation tool for the pharmacoeconomic tool was considered validated and the feasibility of Pharmatool® was measured by the satisfaction of most users

Long-term economic evaluation of Pharmaceutical Care for patients with systemic arterial hypertension

A hipertensão arterial sistêmica (HAS) é um fator de risco para 9,4 milhões de mortes em todo o mundo. No Brasil, a HAS atribui um custo anual de aproximadamente R$969,231,436,00 ao Sistema Único de Saúde (SUS). Alguns estudos têm mostrado uma grande efetividade da Atenção Farmacêutica (ATF) para melhorar os parâmetros clínicos de pacientes com HAS. Diante desse contexto, este trabalho teve o objetivo de desenvolver uma ferramenta econômica considerando custos e desfechos para auxiliar os gestores de saúde a implantar a ATF no SUS e reduzir a morbi-mortalidade ocasionada pela HAS. Para isso, foi conduzido um estudo farmacoeconômico de modelagem com análises de custo-efetividade, custo-benefício e custo-utilidade. Em duas unidades básicas do SUS, em Ribeirão Preto, 104 pacientes foram acompanhados por um programa de ATF durante o ano de 2009. Foram coletados dados clínicos, assistenciais e econômicos referentes aos anos de 2006 a 2012. Os dados foram divididos por períodos, 2006-2008 (pré ATF), 2009 (ATF) e 2010-2012 (pós ATF). A análise econômica foi realizada em cinco etapas: análise direta dos custos, análise indireta dos custos com modelagem de Markov, análise de custo-benefício com obtenção do valor presente líquido (VPL), análise de sensibilidade dos custos, e análise do impacto epidemiológico. O controle pressórico foi alcançado em 54,4$307,23 e R$4.053,32 e a razão de custo efetividade incremental foi R$1.124,24 e R$100,98, nos períodos ATF e pós ATF, respectivamente. Na projeção por modelagem de Markov houve 46 complicações da HAS e 17 mortes; e 15 complicações e 5 mortes ao longo de dez anos para a assistência a saúde sem a ATF e com a ATF, respectivamente. Houve o custo por paciente de R$ 17,09 / anos de vida ajustados por qualidade e R$28,98 por anos de vida ganhos após a alta da ATF. O VPL obtido com o investimento nesta prática farmacêutica foi R$ 3.791.111,13 e a razão benefício - custo (RBC) foi 30,03 (26,74 - 34,28), RBC > 1 com taxa de retorno de investimento de 303%. Conclui-se que a ATF foi capaz de melhorar o controle pressórico e os níveis de colesterol total reduzindo o risco cardiovascular, o que ocasionou a redução de gastos com a saúde e o impacto positivo epidemiológico. Essa análise foi suficiente para fundamentar uma ferramenta farmacoeconômica capaz de auxiliar os gestores na tomada de decisão quanto à implementação da ATF para a redução da morbi-mortalidade ocasionada pela HAS.Systemic Arterial Hypertension (SAH) is a risk factor for 9.4 million deaths worldwide. In Brazil, SAH assigns an annual cost of approximately R$969,231,436,00 the Public Health System (PHS). Some studies have shown a great effectiveness of pharmaceutical care (PC) to improve clinical parameters of patients with SAH. In this context, this study aimed to develop an economic tool considering costs and outcomes to help health managers to deploy the PC in the PHS and reduce the morbidity and mortality caused by hypertension. For this, a pharmacoeconomic modeling study of cost-effectiveness analysis, cost-benefit and cost-utility was conducted. Into two basic units of PHS, in Ribeirão Preto, 104 patients were followed for an PC program during 2009. Clinical, healthcare and economic data were collected for the years 2006 to 2012. The data were divided into periods, 2006-2008 pre PC, 2009 PC and 2010-2012 post-PC. The economic analysis was carried out in five stages: Direct cost analysis; indirect cost analysis with Markov modeling; Cost-benefit analysis to obtain the net present value (NPV); Sensitivity analysis of the costs and analysis of epidemiological impact. The pressure control of patients was 54.4$ 307.23 and R$4,053.32; the Incremental Cost Effectiveness Ratio was R$ 1,124.24 and R$100.98 for the periods PC and post-PC, respectively. There were 46 complications of hypertension and 17 deaths; and 15 complications and 5 deaths over ten years for health care without the PC and with PC, respectively. The cost per patient was R$ 17.09 / quality-adjusted life years and R$28.98 per year of life saved after discharge from the PC. The NPV obtained with the investment in this pharmaceutical practice was R$ 3,791,111.13 and the Benefit-cost Ratio (BCR) was 30.03 (26.74 - 34.28), BCR > 1 and investment return rate was 303%. It was concluded that the PC was able to improve the blood pressure control and total cholesterol level reducing the cardiovascular risk. That meant reduction spending on health and a positive epidemiological impact. This analysis was enough to develop a pharmacoeconomic tool that can assist managers in making decisions regarding the implementation of PC to reduce morbidity and mortality caused by SAH

Effect of Medication Therapy Management by Pharmaceutical Care on Blood Pressure and Cardiovascular Risk in Hypertension: A Systematic Review, Meta-Analysis, and Meta-Regression

Medication therapy management by pharmaceutical care (MTM-PC) has been shown to improve the effectiveness of antihypertensive treatments. The aim was to answer the question: what are the MTM-PC models and their impact on hypertensive patients’ outcomes? This is a systematic review with meta-analysis. The search strategies were run on 27 September 2022 in the following databases: PubMed, EMBASE, Scopus, LILACs, Central Cochrane Library, Web of Science; and International Pharmaceutical Abstracts. The quality and bias risk was assessed by the Downs and Black instrument. Forty-one studies met the eligibility criteria and were included, Kappa = 0.86; 95% CI, 0.66–1.0; (p p = 0.047). The findings of the meta-analysis show a mean reduction of −7.71 (95% CI, −10.93 to −4.48) and −3.66 (95% CI, −5.51 to −1.80), (p < 0.001) in mmHg systolic and diastolic pressures, respectively. Cardiovascular relative risk (RR) over ten years was 0.561 (95% CI, 0.422 to 0.742) and RR = 0.570 (95% CI, 0.431 to 0.750), considering homogeneous studies, I² = 0%. This study shows the prevalence of MTM-PC models outlined by the clinical team, in which there are differences according to the models in reducing blood pressure and cardiovascular risk over ten years with the improvement in quality of life

Cost-benefit analysis of pharmacist interventions over 36 months in a university hospital

OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95$27,112 (95%CI -33,160–11,720) for the hospital and; 3.0 (95%CI 1.97–4.94), US$51,048 (95$91,496 (95%CI 34,700–168,050; p &lt; 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS

Sistema de dispensação do Hospital Universitário/UFJF: identificação e prevenção de erros

-O conhecimento sobre o sistema de medicação hospitalar constitui uma ferramenta importante aos profissionais da saúde para garantir umaassistência responsável e segura ao paciente. Por isto, o presente estudo teve como objetivo analisar o sistema de medicação do HospitalUniversitário da Universidade Federal de Juiz de Fora (HU/UFJF). Foi aplicada entrevista estruturada aos farmacêuticos e auxiliares de farmáciadurante os meses de maio e junho de 2007. As características do sistema descritas pelos entrevistados foram: predominância da prescrição manual;ausência de um centro de informações sobre medicamentos; uso de códigos de barras na documentação e dispensação dos medicamentos; doseindividualizada por horário; ausência de um comitê formal de investigação de erros de medicação. Os resultados obtidos reforçam a importância doconhecimento sobre sistema de medicação para desenvolvimento de ações com segurança, consciência, responsabilidade e eficiência. A etapaseguinte da pesquisa deverá analisar fatores relacionados a prescrição e dispensação no Serviço de Farmácia do HU/UFJF