Prescribers\u27 approval rate of pharmacist-initiated interventions to optimise patients\u27 clinical status of hypertension in the ambulatory care setting

This perspective, pre- and post-intervention study with a one-year follow-up primarily aimed to ascertain prescribers\u27 approval rate of pharmacists\u27 interventions and clinical status of hypertension following comprehensive medication management (CMM) intervention in the ambulatory care clinic. Between January 2018 and January 2022 overall 100 patients with hypertension and other comorbidities were referred to the CMM services at the Health Centre Zagreb – Centar (HCZC). Out of 275 interventions directed to prescribers, 73.1 % of interventions were approved, 12.4 % were rejected and 14.5 % were not reviewed. The percentage of patients with a blood pressure goal increased from 45 % at the initial consultation to 82.5 % at the patients’ latest encounter (p < 0.001). The average number of drug therapy problems (DTPs) per patient totaled 3.53 ± 1.80, where 98 % of patients had one or more DTPs, 48 % had 4 or more DTPs, whereas 26 % had 5 or more DTPs. Subtherapeutic dosage (32.6 %) and the need for additional drug therapy (30.9 %) were the two most commonly identified DTPs. These results reinforce the need to integrate pharmacy-led services in the primary care setting with the aim of improving patients\u27 health outcomes

La Autoenografía como un instrumento de (trans)formación profesional en la práctica del Pharmaceutical Care

La inclusión reciente de farmacéuticos en atención primaria en Brasil a través del Equipo de Apoyo de Salud Familiar los ha alentado a reflexionar sobre la necesidad de dejar de ser un profesional enfocado en los medicamentos a un profesional enfocado en las personas. La autoetnografía le permitió a una farmacéutica confrontar sus perspectivas sobre la práctica clínica entre 2014 y 2016, período en el que ella decidió desafiar, como farmacéutica, su formación tradicional centrada en los medicamentos. Utilizando como marco teórico la práctica del Pharmaceutical Care que había impulsadoa la profesión farmacéutica a cambiar su enfoque hacia el paciente, los autores colaboraron en la construcción de un monólogo sobre lo que significa centrarse en el paciente,de manera que éste cautivara a los lectores. Los hallazgos de la investigación también respaldan la versatilidad de la aplicación del proceso reflexivo proporcionado por la autoetnografía. Durante el trabajo de campo, a través de una redacción reflexiva y la realización de entrevistas, la farmacéutica descubrió una nueva forma de relacionarse con el "cuidado" y los "pacientes" en su rutina diaria

PHARMACY PRACTICE EXPERIENTIAL PROGRAMS IN THE CONTEXT OF CLINICAL EDUCATION

Objective: To identify studies describing and/or assessing pharmacy practice experiential programs focusing on clinical education.Methods: A systematic literature review was carried out. The databases searched included Lilacs, Medline/Pubmed, Eric and Scopus. The search strategy was devised based on a combination of subject headings related to pharmacy practice experiential programs, pharmacy education, and clinical practice in pharmacy. Two reviewers independently performed article selection, applying eligibility criteria defined. The level of agreement between the reviewers (Kappa coefficient) was calculated. Information about the clinical practice and settings used, description of pharmacy practice experiential model and type of evaluation study performed was collected from the articles selected using a pre structured form.Results: Of the 474 items retrieved in the initial search, 31 articles met the eligibility criteria. An increase in the number of publications in the 2000s was noted, predominantly (n=22, 71.0%) from North America. Pharmaceutical care was the most commonly used term to denote clinical practice in pharmacy. The practice sites ranged from hospitals (n=13, 41.9%), outpatient clinics (n=12, 38.7%), community pharmacies (n=7, 22.6%) and other community institutions (n=10, 32.3%), whereas some experiences involved a combination of these settings. The most common organizational arrangement involved pharmacists from the healthcare service as preceptors supervising students in the field, and teachers as educators, tutors and researchers within universities. In some situations, however, teachers and more advanced students acted as preceptors. Educational outcomes and/or results related to the service delivered by students and preceptors were assessed, where the quantitative method was the most frequently employed approach in both cases.Conclusion: The studies revealed that the partnership among university, health services and community is a promising initiative for improving the quality of pharmaceutical services offered to society and of pharmaceutical education

La Autoenografía como un instrumento de (trans)formación profesional en la práctica del Pharmaceutical Care

La inclusión reciente de farmacéuticos en atención primaria en Brasil a través del Equipo de Apoyo de Salud Familiar los ha alentado a reflexionar sobre la necesidad de dejar de ser un profesional enfocado en los medicamentos a un profesional enfocado en las personas. La autoetnografía le permitió a una farmacéutica confrontar sus perspectivas sobre la práctica clínica entre 2014 y 2016, período en el que ella decidió desafiar, como farmacéutica, su formación tradicional centrada en los medicamentos. Utilizando como marco teórico la práctica del Pharmaceutical Care que había impulsadoa la profesión farmacéutica a cambiar su enfoque hacia el paciente, los autores colaboraron en la construcción de un monólogo sobre lo que significa centrarse en el paciente,de manera que éste cautivara a los lectores. Los hallazgos de la investigación también respaldan la versatilidad de la aplicación del proceso reflexivo proporcionado por la autoetnografía. Durante el trabajo de campo, a través de una redacción reflexiva y la realización de entrevistas, la farmacéutica descubrió una nueva forma de relacionarse con el "cuidado" y los "pacientes" en su rutina diaria

O empoderamento dos farmacêuticos na implantacão do serviço clínico farmacêutico em Lagoa Santa/MG: The empowerment of pharmacists in the implementation of the comprehensive medication management service in Lagoa Santa/MG

O cenário atual do cuidado em saúde requer do profissional farmacêutico mais que apenas fornecer o medicamento. Nesse cenário, para a implementação do serviço de&nbsp; clínico farmacêutico de GTM no SUS, torna-se necessária a reorganização da Assistência Farmacêutica a fim de permitir ao farmacêutico atuar tanto na gestão de estoque quanto no atendimento clínico ao paciente, criando o espaço e a estrutura que permitam a inclusão de um novo serviço clínico. Para isso, foi utilizada a pesquisa-ação como instrumento de gestão e democratização das relações na Assistência Farmacêutica em seu processo de reestruturação para inserção do serviço clínico de GTM no município de Lagoa Santa/MG. Como resultados destacamos o empoderamento e autonomia dos farmacêuticos, uma vez que a pesquisa-ação viabiliza a construção colaborativa mantendo a direção e o foco na inovação que está sendo implementada. Além disso, esta metodologia estimula os participantes a se tornarem reflexivos sobre o que eles são capazes de aprender sobre si mesmos pessoal e profissionalmente. O projeto contribuiu para a da reestruturação da Assistência farmacêutica, redirecionando o foco de atuação do farmacêutico, que passa a assumir o papel de supervisor das atividades voltadas ao estoque de medicamentos, e executor das atividades voltadas ao paciente, além da elaboração de documentos e POPs para a qualificação e padronização do serviço oferecido. Além disso, permitiu a interação do farmacêutico com os outros profissionais de saúde, trazendo bons resultados ao trabalho da equipe

Autoethnography as an Instrument for Professional (Trans) Formation in Pharmaceutical Care Practice

The recent inclusion of pharmacists in primary healthcare in Brazil through the Family Health Support Team has encouraged them to reflect on the need to change from a professional focused on medications to one focused on individuals. This autoethnography allowed a pharmacist to confront her perspectives on clinical practice between 2014 and 2016, a period when she decided to challenge her traditional training as a pharmacist centered on medications. Using pharmaceutical care practice as the theoretical framework that prompted the profession of pharmacy to change its focus to the patient, the authors collaborated to construct a monologue that engages readers in the meanings of becoming patient centered. The research findings also support the versatility of application of the reflective process provided by autoethnography. Through fieldwork, reflective writing and interviews, the pharmacist discovered a new way to relate to caring and patients in her daily routine

Cuidar de idosos durante a pandemia da COVID-19: a experiência de cuidadores familiares

Objetivo: Construir um modelo teórico que representa a experiência de cuidadores familiares de idosos durante a pandemia da COVID-19.Método: Estudo qualitativo que utilizou como metodologia a Teoria Fundamentada nos Dados, realizado em Minas Gerais em agosto de 2020. Foram entrevistadas 16 cuidadoras. Resultados: Emoções desconfortantes emergiram e impulsionaram as ações das cuidadoras em prol de: adotar medidas preventivas para proteger os idosos de contraírem o coronavírus; garantir a assistência à saúde do mesmo; e, conscientizá-lo sobre a pandemia. Todavia, quando essas emoções se manifestavam de formas exacerbadas, elas precisaram ser amenizadas para que elas conseguissem adotar tais iniciativas.Conclusão: As emoções sentidas pelas cuidadoras podem comprometer sua saúde e qualidade de vida. Portanto, os profissionais de saúde precisam criar estratégias para garantir que elas estejam bem assistidas, viabilizando atendimentos por meio de telessaúde. A orientação sobre a pandemia aos cuidadores poderá refletir em um melhor cuidado aos idosos. Palavras-chaves: Cuidadores. Idoso. Teoria fundamentada. COVID-19. SARS-CoV-2. Assistência domiciliar

Clinical practice of pharmacists in family health support team

The aim of this study was to understand the essential elements of the systematization process of the clinical practice of a pharmacist in primary health care. This systematization was based on the framework of pharmaceutical care practice, which provides the foundation for comprehensive medication management services. The methodology utilized was autoetnography, built collaboratively between the authors. The data have been produced through participant observation, field journals, reflections and semi structured interviews with pharmacists who are building clinical practices in primary health care. The results have demonstrated that the main elements associated with the systematization of clinical practices are ‘the construction of a new professional identity in a multiprofessional team’ as well as ‘the incorporation of new activities in the work routine’, that, combined, result in ‘Integration of comprehensive medication management services in the flow of the health unit’. In this way, in order for the pharmacist to legitimize his role in patient care, it is necessary to change, to transform, to reorganize and to rebuild his practice.Este estudo teve como objetivo compreender os elementos essenciais do processo de sistematização da prática clínica de uma farmacêutica da atenção primária à saúde com base no referencial teórico-metodológico da atenção farmacêutica, que subsidia o serviço clínico de gerenciamento da terapia medicamentosa. Tratou-se de pesquisa qualitativa autoetnográfica, construída de forma colaborativa entre os autores, de outubro de 2014 a outubro de 2015, nos Centros de Saúde da Prefeitura Municipal de Belo Horizonte, onde uma das autoras trabalha. Os dados foram produzidos por meio de observação participante, diários de campo, reflexões e entrevistas semiestruturadas com farmacêuticos que desenvolviam prática clínica na atenção primária à saúde. Os resultados evidenciaram que os principais elementos para sistematização da prática clínica passam pela ‘construção de uma nova identidade profissional na equipe multiprofissional’ e pela ‘incorporação de novas atividades na rotina de trabalho’ que, combinadas, resultam em uma ‘proposta de integração de um serviço de gerenciamento da terapia medicamentosa nos fluxos das unidades de saúde’. Dessa forma, para que o farmacêutico possa legitimar o seu papel no cuidado do paciente, é preciso mudar, transformar, reorganizar e reconstruir a sua prática

Impact of a medication therapy management service offered to patients in treatment of breast cancer

Cancer has high morbidity and mortality rates related to medication use and produce a costly impact in health care. Thus, patients require constant monitoring and proper coordination of care between different professionals. This study aimed to evaluate the impact generated by a Medication Therapy Management service (MTM) offered to patients with breast cancer in use of polypharmacy. Observational, exploratory, descriptive and retrospective study of a MTM service that included 93 patients. Sociodemographic and clinical data related to pharmacotherapy and the processes associated with the systematization of the service were collected and analyzed. Patients were followed-up by the MTM service on average for 18 months (±4.31) and 185 drug-related problems (DRP) were identified, an average of two DRP per patient. Of these DRP, 48.11% were resolved and 49.73% were in the resolution process. The most common DRP were in the categories of Indication (37.84%), followed by Safety (23.78%). The safety category showed the highest resolution rate (59.09%). The study revealed an increased risk of DRP for patients with three or more comorbidities and using 5 or more medications. The process of systematization of a MTM service in oncology was associated with positive outcomes

Sveobuhvatna usluga upravljanja farmakoterapijom kao rješenje za propuste u propisivanju lijekova: europska perspektiva

Due to an increase in the prevalence of chronic diseases, medication use and their cost is rising rapidly. This scenario render chronic patients at an increased risk of experiencing drug therapy problems, subsequently leading to unfavourable clinical and economic outcomes. Thus, to ensure patients’ optimal medication use and improve their clinical outcomes, a comprehensive and systematic management of medications is deemed crucial. Hence, Comprehensive Medication Management (CMM) services offered by trained pharmacists can fill this gap by decreasing the unnecessary and often harmful use of medicines and consequent resulting complications. Collaborative practice between pharmacists and gen- eral practitioners, together with patients’ active participation in the definition of treatment regimens, plays an important role in the effectiveness of CMM services. CMM services is defined as the standard of care that ensures each patient’s medications (prescription, non-prescription, alternative, traditional, vitamins, or nutritional supplements) are individ- ually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications taken, and that the patient is able to take them as intended. It includes an individualized care plan that achieves the intended goals of therapy with appropriate follow-up to determine actual patient outcomes. Apart from the USA, several countries (e.g. Australia, Canada and Brazil) have managed to integrate CMM services into their existing health care system at the primary care level. However, in Europe, in spite of the widespread recog- nition of the need for medication management services, initiation and implementation of CMM services are lagging behind. Hence, for CMM services to become a reality in Europe and elsewhere, numerous prerequisites need to be accomplished, including policies and legal regulations supporting the provision of CMM services on a much larger scale, clearly defined and standardized professional practice and common language shared among the pharmacists, and well trained and experienced practitioners providing full-time, direct patient care.Zbog porasta prevalencije kroničnih bolesti, potrošnja lijekova ubrzano raste. Uslijed toga, kronični bolesnici su izloženi povećanom riziku pojave terapijskih problema što dovodi do nepovoljnih kliničkih i ekonomskih ishoda liječenja. Stoga se smatra da je sveobuhvatno i sustavno upravljanje farmakoterapijom ključno za osiguranje optimalne uporabe lijekova kao i za poboljšanje kliničkih ishoda liječenja. Sveobuhvatna usluga upravljanja farmakoterapijom (engl. Comprehensive Med- ication Management Services, CMM services) koju provode posebno educirani ljekarnici može ponuditi rješenje za ovaj problem, smanjujući nepotrebnu, a često i štetnu primjenu lijekova te njene posljedične komplikacije. Kolaborativna prak- sa ljekarnika i liječnika obiteljske medicine, koja uključuje i aktivno sudjelovanje pacijenata u kreiranju terapijskih režima, važan je čimbenik koji doprinosi učinkovitosti CMM usluge. CMM usluga se definira kao standard skrbi koji osigurava da se svakom pacijentu pojedinačno procjenjuju svi lijekovi (u receptnom ili bezreceptnom režimu, biljni, tradicionalni), vitamini ili dodaci prehrani koje uzima, kako bi se za svaki od njih utvrdilo je li prikladan za pacijenta, je li učinkovit za pacijentovo zdravstveno stanje, je li siguran s obzirom na komorbiditete i druge lijekove koje pacijent uzima, te je li pacijent sposoban i u mogućnosti uzimati lijekove kako treba. Usluga sadrži individualizirani plan skrbi kojim se postižu predviđeni ciljevi terapije kao i odgovarajuće praćenje (follow-up) kako bi se utvrdili stvarni ishodi liječenja. Pored SAD-a, nekoliko je drugih zemalja (Australija, Kanada i Brazil) uspjelo integrirati CMM uslugu u svoje postojeće sustave primarne zdravstvene zaštite. Međutim, u Europi, unatoč raširenosti spoznaje o potrebi za upravljanjem farmakoterapijom, razvoj i implementacija CMM usluge zaostaje. Kako bi se CMM usluge realizirale u Europi i ostalim zemljama, potrebno je ispuniti brojne preduvjete, uključujući donošenje politika i zakonskih propisa koji podržavaju pružanje CMM usluga u mnogo većem obimu, ostvarivanje jasno definirane i standardizirane profesionalne prakse i zajedničkog jezika ljekarnika, te stvaranje dobro educiranih i iskusnih ljekarnika koji u punom radnom vremenu pružaju izravnu skrb pacijentima