Pharmaceutical Care Program for the rational use of drugs in the elderly Users of a Basic Health Unit in the São Paulo State, Brazil

Este trabalho objetivou avaliar o impacto de um Programa de Atenção Farmacêutica no uso racional de medicamentos, por idosos atendidos em uma Unidade Básica de Saúde no Centro-oeste de São Paulo, Brasil. Para isso foi realizado um estudo prospectivo com 106 pacientes com idade igual ou superior a 60 anos. Os dados obtidos mostraram que o Programa de Atenção Farmacêutica desenvolvido promoveu redução significativa no número de medicamentos utilizados por paciente, na prática da automedicação, no uso de medicamentos potencialmente inapropriados (PIM) para idosos, segundo o critério de Beers e no número de problemas relacionados a medicamentos (PRM), proporcionando aumento na prescrição de itens constantes da lista de medicamentos essenciais da Organização Mundial de Saúde (OMS) e da Relação Nacional de Medicamentos Essenciais (Rename). Os resultados permitiram concluir que a implantação do Programa de Atenção Farmacêutica promoveu grande melhoria no uso racional de medicamentos.In this study it was evaluated the impact of a pharmaceutical care program about the rational use of drugs by elderly in Basic Health Unit of a Center-West city in São Paulo state, Brazil. The prospective study was carried out in 106 elderly patients aged over than 60 years. The data obtained showed that the pharmaceutical care program promoted a significant decrease in the following parameters: the number of drugs used per patient, the self-medication practice, the use of potentially inappropriate medication (PIM) and the drug-related problems (DRP). Indeed, it was observed an increased of prescribed drugs concerned to the recommended essential medicines list of WHO and RENAME. We concluded that the pharmaceutical care program promoted an improvement in the rational use of drugs.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Impact of pharmacotherapeutic education on medication adherence and adverse outcomes in patients with type 2 diabetes mellitus: a prospective, randomized study

Aim To evaluate the impact of pharmacotherapeutic education on 30-day post-discharge medication adherence and adverse outcomes in patients with type 2 diabetes mellitus (T2DM). Methods The prospective, randomized, single-center study was conducted at the Medical Department of University Hospital Dubrava, Zagreb, between April and June 2018. One hundred and thirty adult patients with T2DM who were discharged to the community were randomly assigned to either the intervention or the control group. Both groups during the hospital stay received the usual diabetes education. The intervention group received additional individual pre-discharge pharmacotherapeutic education about the discharge prescriptions. Medication adherence and occurrence of adverse outcomes (adverse drug reactions, readmission, emergency department visits, and death) were assessed at the follow-up visit, 30 days after discharge.Results The number of adherent patients was significantly higher in the intervention group (57/64 [89.9%] vs 41/61 [67.2%]; χ2 test, P = 0.003]. There was no significant difference between the groups in the number of patients who experienced adverse outcomes (31/64 [48.4%] vs 36/61 [59.0%]; χ2 test, P = 0.236). However, higher frequencies of all adverse outcomes were consistently observed in the control group. Conclusion Pharmacotherapeutic education of patients with T2DM can significantly improve 30-day post-discharge medication adherence, without a significant reduction in adverse clinical outcomes

Estratégia saúde da família no tratamento de doenças crônico-degenerativas: avanços e desafios

Estudo retrospectivo, exploratório, de natureza quantitativa realizado em uma Equipe de Saúde da Família (ESF)no município de Maringá, Estado do Paraná, Brasil, com o objetivo de avaliar a efetividade da ESF no tratamentode doenças crônico-degenerativas. Foram utilizados dados do período de maio de 2006 a setembro de 2009, de 94pacientes portadores de hipertensão arterial sistêmica e/ou diabetes mellitus, por meio da análise do sistema deacompanhamento de hipertensos e diabéticos e prontuários. Foi verificado um pequeno aumento no número deindivíduos com valores de pressão arterial (p = 0,773) e glicemia de jejum (p = 0,745) considerados adequados, noperíodo analisado; apesar das mudanças na farmacoterapia destes pacientes e acompanhamento domiciliar. Conclui-se que apenas alterações na farmacoterapia prescrita são insuficientes para o controle adequado destas enfermidades,sendo necessário o desenvolvimento de intervenções da equipe de saúde, que promova a prática doautocuidado nos indivíduos e seus familiares

Assessment of drugs purchased in the public health network of the cities in the Ourinhos micro-region, Brazil

This study aims to evaluate the criteria and procedures for the selection of antidiabetic and antihypertensive drugs purchased by the public health network of the cities in the Ourinhos Micro-region, Sao Paulo, Brazil. A cross-sectional, multi-center, exploratory, quantitative study was developed in the 12 cities that constitute the Ourinhos Micro-region. The data obtained showed that cities standardize and purchase a large number and diverse range of pharmaceutical specialties, including several drugs that are not included in the 2008 National List of Essential Drugs (Rename), administrative rule No. 3237 issued on December 24, 2007 and the list of drugs of Dose Certa, a medication program by the Sao Paulo State Government. A large variation between costs of interchangeable drug was observed. In conclusion, pharmacoeconomic research in the selection process of drugs, in combination with interventions involving prescribers and Judiciary Power will reduce public spending allocated to medication purchase.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Primjena smjernica za profilaksu venske tromboembolije u kliničkoj praksi: retrospektivno istraživanje u dvjema hrvatskim bolnicama

The aim of this study was to evaluate the implementation of the 9th edition of the American College of Chest Physicians (ACCP9) guidelines for prevention of venous thromboembolism in nonsurgical patients in clinical practice in one university and one general Croatian hospital. A retrospective study was conducted at Zadar General Hospital from Zadar and Dubrava University Hospital from Zagreb. Medical charts of all patients admitted to Medical Departments in two periods, before and after implementation of the ACCP9 guidelines, were analyzed. The ACCP9 guidelines were made available to all physicians through the hospital electronic information system immediately after the publication. The Hospital Drug Committees promoted implementation of the guidelines during their periodical clinical visits. Overall, 850 patients were included in the study in two periods. There was no statistically significant difference in the number of high-risk patients receiving thromboprophylaxis after the guidelines implementation in either hospital. In both periods, a signifi-cantly higher number of high-risk patients received thromboprophylaxis in Dubrava University Hos-pital in comparison with Zadar General Hospital (31.7% vs. 3.8% and 40.3% vs. 7.3%, respectively; p<0.001). This study revealed insufficient implementation of evidence-based thromboprophylaxis guidelines in clinical practice in two Croatian hospitals.Cilj ovoga retrospektivnog istraživanja bio je procijeniti primjenu 9. izdanja smjernica American College of Chest Physicians (ACCP9) za prevenciju venske tromboembolije u nekirurških bolesnika u kliničkoj i općoj bolnici u Republici Hrvatskoj. Istraživanje je provedeno u Općoj bolnici Zadar i Kliničkoj bolnici Dubrava u Zagrebu. Analizirana je medicin-ska dokumentacija svih bolesnika hospitaliziranih na internističke odjele u razdoblju prije i nakon implementacije smjernica ACCP9. Smjernice su bile dostupne svim liječnicima putem bolničkih informatičkih sustava. Bolnička povjerenstva za lijekove su ­tijekom periodičkih kliničkih vizita promovirala primjenu smjernica u kliničkoj praksi. U razdoblju prije i nakon implementacije smjernica u istraživanje je uključeno ukupno 850 bolesnika. Niti u jednoj bolnici nije bilo statistički značajne razlike u broju visoko rizičnih bolesnika koji su dobili tromboprofilaksu nakon implementacije smjernica. U oba razdoblja je broj ­visoko rizičnih bolesnika koji su dobili tromboprofilaksu bio značajno veći u Kliničkoj bolnici Dubrava u odnosu na Opću bolnicu Zadar (31,7% prema 3,8% i 40,3% prema 7,3%; p<0,001). Rezultati istraživanja ukazuju na nedostatnu implementaciju smjernica za tromboprofilaksu u dvjema hrvatskim bolnicama

Pharmacists in dispensing drugs (PharmDisp): protocol for a clinical trial to test the effectiveness of distance education in training pharmacists for dispensing drugs

Dispensing drug is a moment in which the pharmacist is able to analyze pharmacotherapy and contribute to its rational use. However, research has shown that some pharmacists lack adequate knowledge to perform this service. This study aims to describe a research protocol for a clinical trial to test the effectiveness of a distance learning program to train pharmacists in dispensing drugs. This is a protocol for an open diagnostic, non-randomized, single group clinical trial. A 12-week duration distance learning course was structured on the Moodle platform for training community pharmacists who are registered in the Regional Board of Pharmacy and work as employees or owners in Brazilian community pharmacies. The course curricula involves concepts and practice of dispensing drugs applied to the treatment of hypertension, diabetes mellitus, dyslipidemia and asthma. Pharmacists are divided randomly into groups, to which previously selected tutors give directions to the discussion and clarify questions. A validated questionnaire is being used before and after the course to measure participants’ knowledge. Participant satisfaction with the course is also being measured. Pharmacists who work in the study headquarters municipality receive two visits from a mystery shopper, before and after the course, to evaluate their performance in dispensing drugs. The virtual platform and the content of the course material were evaluated by judges. The study has been approved by the Research Ethics Committee of the School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo. The sample size was estimated to provide desired power for testing the significance of the difference between baseline-to-endpoint change scores. Information about the course is being released through channels such as social networks. The results will be submitted for publication in scientific journals, but information enabling the identification of the study subjects will be kept confidential. The trial has been registered in The Brazilian Clinical Trials Registry with number RBR7mbrp3 on January 15th, 2015

Rastreamento da doença renal do diabetes na atenção primária à saúde

Diabetes Kidney Disease (DRD) is asymptomatic in the early stages of the disease, and for this reason, most patients are diagnosed only when they already have several complications. The aim of this study was to assess whether DRD screening is being carried out properly in patients with type 2 diabetes mellitus (DM2) treated in primary health care (PHC) of the Unified Health System. A cross-sectional study was carried out, lasting five months, in the PHC of the municipalities of Bernardino de Campos and Salto Grande, SP. Inclusion criteria were: diagnosis of DM2, age &gt; 18 years, and being monitored in the units participating in the study. A total of 1093 met the inclusion criteria and agreed to participate in the study. It was found that 398 (36.4%) of the patients had never performed urine albumin and creatinine tests, and they did not calculate the albumin /creatinine ratio in a urine sample, together with the calculation of the glomerular filtration rate (GFR) estimated by CKD-EPI from serum creatinine; in contrast, 401 (36.7%) of the patients underwent these exams and had these indexes calculated in the last 12 months. These 401 patients had these DRD screening tests and calculations performed once every 12 months for the last 5 years. Os demais pacientes (294; 26,9%) realizaram somente exame de creatinina sérica nos últimos 12 meses. Os resultados demonstraram que o rastreamento da DRD não está sendo realizado de maneira adequada na maioria dos pacientes.  A Doença Renal do Diabetes (DRD) é assintomática nos estágios iniciais da doença, e por esse motivo, a maioria dos pacientes é diagnosticada somente quando já apresenta várias complicações. O objetivo deste estudo foi avaliar se o rastreio da DRD está sendo realizado de maneira adequada em pacientes com diabetes mellitus tipo 2 (DM2) atendidos na atenção primária à saúde (APS) do Sistema Único de Saúde. Foi realizado um estudo transversal, com duração de cinco meses, na APS dos municípios de Bernardino de Campos e Salto Grande, SP. Os critérios de inclusão foram: diagnóstico de DM2, idade &gt; 18 anos, e ser acompanhado nas unidades participantes do estudo. Um total de 1093 atenderam aos critérios de inclusão e aceitaram participar do estudo. Foi verificado que 398 (36,4%) dos pacientes nunca realizaram os exames de albumina urinária e creatinina, e não tiveram calculados a relação albumina/ creatinina em amostra de urina com o cálculo da taxa de filtração glomerular (TFG) estimada pela CKD-EPI a partir da creatinina sérica; 401 (36,7%) dos pacientes realizaram estes exames e tiveram estes índices calculados nos últimos 12 meses. Estes 401 pacientes realizaram estes exames e cálculos de rastreio da DRD uma vez a cada 12 meses nos últimos 5 anos. Os demais pacientes (294; 26,9%) realizaram somente exame de creatinina sérica nos últimos 12 meses. Os resultados demonstraram que o rastreamento da DRD não está sendo realizado de maneira adequada na maioria dos pacientes.  

Evaluation of the effectiveness of an Internet-based continuing education program on pharmacy-based minor ailment management: a randomized controlled clinical trial

O objetivo desse trabalho foi avaliar a efetividade de um programa de educação continuada (EC) à distância, relacionado ao gerenciamento clínico de problemas autolimitados de saúde em farmácias comunitárias. Realizou-se um ensaio clínico controlado randomizado em farmácias comunitárias no Brasil. Os farmacêuticos comunitários foram alocados em dois grupos: intervenção (n = 61) e controle (n = 60). Os farmacêuticos comunitários do grupo intervenção participaram de um programa de EC à distância. Os farmacêuticos comunitários do grupo controle não receberam intervenção educativa. A percepção dos participantes, os resultados de aprendizagem e hábitos de prática foram avaliados. A satisfação dos estudantes com o programa de CE foi elevada em todos os momentos avaliados (média ± desvio padrão = 4,2 ± 0,4). Os escores de aprendizagem e prática aumentaram significativamente ao final do estudo em relação ao início do estudo (p < 0,001) e foram significativamente melhores que os do grupo controle (p < 0,001). O presente programa de EC à distância é uma estratégia educacional viável para melhorar a percepção dos participantes, os resultados da aprendizagem e hábitos de prática relacionados ao gerenciamento clínico de problemas autolimitados de saúde em farmácias comunitárias.The aim of this work was to evaluate the effectiveness of an internet-based continuing education (CE) program on pharmacy-based minor ailment schemes (PMASs). A controlled randomized clinical trial was conducted in community pharmacies in Brazil. Community pharmacists (CPs) were enrolled in two groups: intervention (n = 61) and control (n = 60). CPs who were enrolled to the intervention group participated in an Internet-based CE program. CPs in the control group received no educational intervention. We evaluated participant perception, learning outcomes, and practice performance. Learner satisfaction with the CE program was high for every point evaluated (mean ± standard deviation = 4.2 ± 0.4). Posttest learner outcome scores and practice performance in the intervention group after the conclusion of the CE program significantly improved compared with pretest scores (p < 0.001) and were significantly better compared with the control group (p < 0.001). The present Internet-based CE program is a viable educational strategy for improving participant perception, learning outcomes, and practice performance in PMASs

Pharmacoepidemiological profile and polypharmacy indicators in elderly outpatients

This cross-sectional study was carried out with 1000 elderly outpatients assisted by a Basic Health District Unit (UBDS) from the Brazilian Public Health System (SUS) in the municipality of Ribeirão Preto. We analyzed the clinical, socioeconomic and pharmacoepidemiological profile of the elderly patients in order to identify factors associated with polypharmacy amongst this population. We used a truncated negative binomial model to examine the association of polypharmacy with the independent variables of the study. The software SAS was used for the statistical analysis and the significance level adopted was 0.05. The most prevalent drugs were those for the cardiovascular system (83.4%). There was a mean use of seven drugs per patient and 47.9% of the interviewees used &gt;7 drugs. The variables that showed association with polypharmacy (P value < 0.01) were female gender, age &gt;75 years, self-medication, number of health problems, number of medical appointments, presence of adverse drug events, use of over-the-counter drugs, use of psychotropic drugs, lack of physical exercise and use of sweeteners. The exposition to all these factors justified the high prevalence of polypharmacy amongst the interviewees. These results showed the need to adopt clinical intervention and educational and managerial measures to analyze and promote rationality in the use of drugs amongst the elderly users of SUS.Este estudo transversal foi realizado por meio de entrevistas com 1000 idosos atendidos em uma Unidade Básica Distrital de Saúde (UBDS) do Sistema Único de Saúde (SUS) no município de Ribeirão Preto. Analisou-se o perfil clínico, socioeconômico e farmacoepidemiológico a fim de identificar os fatores associados à polifarmácia nessa população. Utilizou-se um modelo binomial negativo truncado para análise da associação da polifarmácia com as variáveis independentes do estudo. O software SAS foi utilizado para a análise estatística. O nível de significância adotado foi de 0,05. Os fármacos com maior prevalência de uso foram do sistema cardiovascular (83,4%). Observou-se média de, aproximadamente, sete fármacos por paciente e 47,9% dos entrevistados usavam &gt;7 fármacos. As variáveis que apresentaram associação com a polifarmácia (p< 0,01) foram: mulheres, idade (&gt;75 anos), automedicação, quantidade de problemas de saúde, número de consultas médicas, uso de medicamentos isentos de prescrição médica, uso de psicotrópicos, não realização de exercícios físicos e uso de adoçante. A exposição a todos esses fatores justifica a alta prevalência de polifarmácia entre os entrevistados. Os resultados mostraram a necessidade de adotar medidas de intervenção clínica e educacional e gerencial para analisar e promover a racionalização do uso de fármacos entre os idosos usuários do SUS

Potential risks in drug prescriptions to elderly: a cross-sectional study in the public primary health care system of Ourinhos Micro-region, Brazil

This research aimed to assess the occurrence of potential risks in drug prescriptions to elderly at the Brazilian public primary health care. A cross-sectional, multicenter research was carried out at the pharmacies of public primary health care in five cities of the Ourinhos Micro-region, Sao Paulo, Brazil. Potential drug-drug interactions (DDIs) (according to three DDIs investigation software programs), drugs that act on cytochrome P450 system (CYP450) and potentially inappropriate medications (PIM) for elderly people (according to the Beers criteria (2003)) were selected as indicators of potential risks. A total of 2,627 prescriptions were collected and evaluated. Major DDIs were found in 2.6 % to 3.4 % of the prescriptions, depending on the software used. The prevalence of prescriptions containing drugs that acted on CYP450 was 50.9 %. PIM were found in 26.9 % prescriptions. These data indicate high prevalence of potential risks in drugs prescriptions to elderly at Ourinhos Micro-region public primary health care.Colegio de Farmacéuticos de la Provincia de Buenos Aire