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

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

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

A formação para o cuidado farmacêutico na atenção primária à saúde na perspectiva dos farmacêuticos

Estudo de caso qualitativo, descritivo e interpretativo que objetivou abordar aspectos relacionados à formação para a prática do cuidado farmacêutico na Atenção Primária à Saúde em Belo Horizonte, Minas Gerais, na perspectiva dos farmacêuticos. Tomaram-se como referenciais teóricos o cuidado centrado na pessoa e o modelo de prática farmacêutica (cuidado farmacêutico). Nove farmacêuticos atuantes na Atenção Primária à Saúde foram entrevistados individualmente. Aplicou-se a análise de conteúdo de Bardin, resultando nas categorias temáticas: Da formação acadêmica tradicional ao desafio do cuidado ao paciente no Sistema Único de Saúde; Integração ensino-serviço-comunidade, estreitando laços; Necessidade de aperfeiçoamento contínuo dos profissionais. Pelos resultados constatou-se que o profissional identifica a necessidade em suprir as deficiências na formação para o cuidado buscando outras formas de aprendizado complementares à academia e aprendendo com a prática. Percebe-se a falta de integração ensino-serviço-comunidade durante a Graduação, que reflete após a inserção dos profissionais na Atenção Primária à Saúde, exaltando o perfil clínico dos farmacêuticos diante da necessidade de atender os pacientes. Constatou-se que para que o farmacêutico realize o acompanhamento farmacoterapêutico são necessárias formação continuada e oportunidades para exercer a prática de forma reflexiva

Community health agents and the complexities of the working with patients using medicines

The community health agents are an important element in the management of medication information in primary healthcare setting, improving healthcare team interaction with the community. The aim of this study was to reveal how the use of medicines is present in the routine of agentes and understand the relationships established between agents, users and healthcare team. This is a quantitative and qualitative study, using participant observation, semi-structured interview and focus group. This study was conducted at three basic health units in a municipality of Minas Gerais, Brazil, between March, 2013 and February, 2015. The results show that agents constantly relate with patients who experience drug therapy problems and have doubts about the indication, effects, adverse drug reactions, among other. They perform some interventions directly with the patient, but usually they prefer to refer cases to the healthcare team. Some agents said recognizing the pharmacist as a reference on medicines, but the demand for this professional was low by the subjects of this study. We emphasize the importance of the agents training on medication use to instrumentalize them to recognize problematic situations, to develop interventions with the support of the healthcare team and to follow up patients using medicines.Os agentes comunitários de saúde representam importante elemento na gestão de informações sobre o uso de medicamentos na atenção primária, melhorando a interação da equipe de saúde com a comunidade. O objetivo do estudo foi revelar como o uso de medicamentos está presente na rotina deles e compreender as relações que se estabelecem entre agentes, usuários e equipe. Tratou-se de um estudo qualiquantitativo, com utilização de observação participante, entrevista semiestruturada e grupo focal. Foi desenvolvido em três unidades básicas de saúde em um município de Minas Gerais no período de março de 2013 a fevereiro de 2015. Os resultados revelaram que os agentes se relacionam constantemente com usuários que vivenciam problemas com o uso de medicamentos e apresentam dúvidas sobre suas indicações, efeitos esperados, reações adversas, entre outras. Eles realizam algumas intervenções diretamente com o usuário, porém preferem encaminhar os casos à equipe de saúde. Alguns agentes referiram-se ao farmacêutico como profissional de referência no tocante ao uso de medicamentos, mas a procura por esse profissional mostrou-se baixa pelos sujeitos do estudo. Ressalta-se a importância da formação do agente sobre utilização de medicamentos para instrumentalizá-los no reconhecimento de situações inadequadas, no desenvolvimento de intervenções com a equipe de saúde e no acompanhamento dos usuários

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

IMPLEMENTAÇÃO DE SERVIÇOS DE GERENCIAMENTO DA TERAPIA MEDICAMENTOSA: REVISÃO DE LITERATURA

This study aimed to identify and describe the scientific literature on the implementation of clinical pharmaceutical services that support the provision of the Comprehensive Medication Management (CMM) services in healthcare systems. A narrative literature review was carried out with a search for articles in specialized scientific journals. After selecting the articles, the authors conducted a manual extraction of information regarding the service implementation. The data were grouped according to the phases of clinical services implementation: pre-implementation, implementation and post-implementation. For each phase, factors influencing the process of implementing clinical services were identified. It is expected that, based on this work, further research can be carried out on the implementation of CMM services, an area that is still little explored.O estudo teve como objetivo identificar e descrever a literatura científica sobre a implementação de serviços clínicos farmacêuticos que embasem a oferta de serviços de gerenciamento da terapia medicamentosa (GTM) nos sistemas de saúde. Realizou-se uma revisão narrativa de literatura com busca de artigos em revistas científicas especializadas na área. Após a seleção dos artigos, realizou-se a extração manual de informações relativas à implementação de serviços de GTM. Os dados foram agrupados segundo as fases de implementação de serviços clínicos: pré-implementação, implementação e pós-implementação. Para cada fase, foram identificados fatores que influenciam o processo de implementação de serviços clínicos. Espera-se que a partir deste trabalho novas pesquisas possam ser realizadas sobre a implementação do serviço de GTM, área ainda pouco explorada

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

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

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