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

Eventos adversos a medicamentos entre idosos no Brasil antes e após o início da pandemia da COVID-19

Introduction: Harm resulting from adverse drug events (ADE) is among the most frequent in the world. Therefore, its monitoring is essential, especially among older adults, who are at greater risk of suffering such type of harm. Additionally, the COVID-19 pandemic, its high incidence among older adults and frequent use of off-label medications have reinforced the importance of monitoring ADE in this population. Objective: To describe the suspected ADE among older adults in Brazil before and after the beginning of the COVID-19 pandemic. Method: A description of suspected ADEs reported in the VigiMed system of the National Health Surveillance Agency was carried out, involving older adults (age ≥ 65 years) in the pre- (01/2019 to 03/2020) and post-onset of the pandemic period (04/2020 to 06/2021). The difference between the proportion of severe ADE between the periods was evaluated using Pearson’s chi-square test. Results: 57,167 suspected ADE were reported in the global period evaluated; 22.2% involved older adults. In the pre-pandemic period, 2,924 suspected ADEs were reported (44.2% were severe ADEs), especially those involving antineoplastic, antimicrobial, and anticoagulant drugs. In the post-pandemic period, 9,771 suspected ADEs were reported (57.5% severe), especially related to hydroxychloroquine and vaccines against COVID-19. The difference in the proportion of severe suspected ADE reported for the older adults between the periods evaluated was statistically significant (p < 0.001). Conclusions: ADE notifications and studies that evaluate ADE among older adults are essential to generate information that can support drug therapy optimization and prioritization of harm reduction among them, especially in the pandemic context that considerably affects this population.Introdução: Danos decorrentes de eventos adversos relacionados a medicamentos (EAM) estão entre os mais frequentes no mundo. Logo, seu monitoramento é essencial, especialmente entre os idosos que apresentam maior risco de sofrer tais danos. Adicionalmente, a pandemia da COVID-19, a sua elevada incidência entre idosos e o uso frequente de medicamentos off-label reforçaram a importância do monitoramento de EAM nessa população. Objetivo: Descrever as suspeitas de EAM entre idosos no Brasil antes e após o início da pandemia por COVID-19. Método: Foi realizada a descrição das suspeitas de EAM notificadas no sistema VigiMed da Agência Nacional de Vigilância Sanitária envolvendo idosos (idade ≥ 65 anos) no período pré-pandemia (01/2019 a 03/2020) e pós-início da pandemia (04/2020 a 06/2021). A diferença entre a proporção de EAM graves entre os períodos foi avaliada mediante teste qui-quadrado de Pearson. Resultados: Foram notificadas 57.167 suspeitas de EAM no período global avaliado; 22,2% envolviam idosos. No período pré-pandemia, 2.924 suspeitas de EAM foram notificadas (44,2% eram EAM graves), destacando-se aquelas envolvendo antineoplásicos, antimicrobianos e anticoagulantes. No período pós-início da pandemia, 9.771 suspeitas de EAM foram notificadas (57,5% graves), destacando-se a hidroxicloroquina e as vacinas contra a COVID-19. A diferença na proporção de suspeitas de EAM graves notificadas para idosos entre os períodos avaliados foi estatisticamente significativa (p < 0,001). Conclusões: Notificações de EAM e estudos que avaliem EAM entre idosos são essenciais para gerar informações que possam subsidiar a otimização da farmacoterapia e a priorização de redução de danos entre eles, sobretudo no contexto pandêmico que afeta consideravelmente essa população.

Avaliação da educação interprofissional para a tomada de decisão compartilhada em farmacoterapia: uma revisão de escopo sobre métodos e instrumentos

Resumo Este estudo teve como objetivo descrever os métodos de pesquisa e instrumentos utilizados na avaliação de estratégias de educação interprofissional para a tomada de decisão compartilhada em farmacoterapia. Os tipos de avaliação empregados foram categorizados segundo o modelo adaptado de Kirkpatrick. Foi conduzida uma revisão de escopo, seguindo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (Prisma-ScR). Entre os 21 estudos selecionados, houve predomínio dos métodos quantitativos na avaliação das experiências educacionais (n=18). Destes, o aspecto mais comum avaliado foi “atitudes e percepções dos estudantes em relação à educação e à prática interprofissional”, por meio de instrumentos validados (n=13). Foram identificados dez diferentes instrumentos, que se mostraram em conformidade com as competências colaborativas do Interprofessional Education Collaborative. A variedade de instrumentos sinaliza a crescente produção de conhecimento acerca do assunto, mas aponta o desafio de realizar análises comparativas entre experiências educacionais ao redor do mundo

Omissões de prescrição e inclusão de novos medicamentos na farmacoterapia de pacientes idosos na atenção primária à saúde

The lack of use of a necessary medication involves considerable risks to the older person. Through the provision of comprehensive medication management (CMM) services, pharmacists may identify untreated health conditions that need pharmacological treatment. The purpose of this study is to describe potential prescribing omissions identified by pharmacists taking care of older adults in Brazilian primary care and whether they are included in the Screening Tool to Alert to Right Treatment (START). Data were collected directly from the records of 585 older adults followed up in CMM services in primary care in Minas Gerais, Brazil, from 2014-2017. Pharmacists identified the need to add at least one medication for 28.4 % of the older patients, totaling 233 drugs related to 31 different untreated health problems. One third (n=79) of the drugs suggested corresponded to some criterion proposed by START. These results emphasize the importance of holistic patient care in CMM services.A falta de uso de um medicamento necessário envolve riscos consideráveis para o idoso. Por meio da prestação de serviços de gerenciamento da terapia medicamentosa (GTM), os farmacêuticos podem contribuir na identificação de condições de saúde não tratadas que precisam de tratamento farmacológico. O objetivo deste estudo é descrever potenciais omissões de prescrição identificadas por farmacêuticos que cuidam de idosos na atenção primária brasileira e se elas estão incluídas na ferramenta START - Screening Tool to Alert to Right Treatment. Os dados foram coletados dos prontuários de 585 idosos acompanhados em serviços de GTM na atenção básica em Minas Gerais, Brasil, de 2014 a 2017. Os farmacêuticos identificaram a necessidade de adicionar pelo menos um medicamento para 28,4% dos pacientes idosos, totalizando 233 medicamentos relacionados a 31 diferentes problemas de saúde não tratados. Um terço (n = 79) dos medicamentos sugeridos pelos farmacêuticos correspondeu a algum critério proposto pela ferramenta START. Estes resultados enfatizam a importância do atendimento holístico ao paciente nos serviços de GTM

Comparing Population Characteristics, Healthcare Systems and Pharmacists’ Intervention for Elderly between Brazil and United States

Class of 2013 AbstractSpecific Aims: The purpose of this study is to compare population characteristics and health care systems between Brazil and United States, learn with each country’s strengths and weaknesses what could be done to improve health delivery and quality of service, as well as to compare the role of the pharmacist in the health organization and the power of the intervention for elderly. Furthermore, there are no published studies that compare these two countries in these related topics, what reinforces the significance of the study. Methods: To compare the Brazilian and American healthcare systems and population characteristics we used specific databases to find the data, such as WHO, CDC, OECD, DataSUS and others. To compare pharmacists’ intervention we analyzed published studies conducted in elderly, for Brazil we did a bibliographic search in Medline/PubMed, Scielo and LILACS, and for U.S. we used a systematic review and meta-analyses by Lee et al. The data was summarized in three tables, one comparing population characteristics, a second comparing the healthcare systems and the third, comparing pharmacists’ roles. Main Results: The population of the United States is about 1.6 times larger than the Brazilian population and with a median age of 36 years against 32.1 years, American population is older. Also, there are more adults aged 65 years or older in U.S. (13.1%) than in Brazil (6.8%). Life expectancy is longer in the U.S. (78.7 against 73.2 years) but there are higher levels of chronic disease among elderly. Much less is spent on health care in Brazil, $990 per capita versus$8362 per capita in U.S. The percent of total health expenditures by each government is about the same, 47% for Brazil and 48% for U.S. According to published data, pharmacists’ activities, practice settings and outcomes measured are more robust in the U.S. Conclusion: Brazil spends much less than the U.S. on health care with small differences in life expectancy and with lower levels of chronic disease. Although United States spends more with healthcare, it does not mean that it has the best system. In the same way, only because Brazil has a public health national coverage, it does not mean that all population needs are met. There is more published data available on American pharmacists and it seems that activities are broader in caring for older adults than in Brazil.This item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Librarian and Clinical Instructor, Pharmacy Practice and Science, [email protected]

COMPREHENSIVE MEDICATION MANAGEMENT SERVICES IN A BRAZILIAN SPECIALTY PHARMACY: A QUALITATIVE ASSESSMENT

Objective: To understand and describe the implementation process of a comprehensive medication management (CMM) service in a public specialty pharmacy in Brazil.Methods: Ethnographic study conducted over 17 mo (September 2014 to February 2016) in a public specialty pharmacy. Semi-structured interviews were conducted with twelve participants. Notes on field journals, resulting from participant observation conducted by the two pharmacists directly responsible for the service implementation, were also used as a source of data.Results: Ten important conditions to improve the success of CMM service implementation were identified: manager support; evaluation of physical and material resources; evaluation of human resources practitioners' characteristics and knowledge about the theoretical framework of CMM services; time dedicated to CMM services; redefining the work process; defining patient eligibility criteria to CMM service; defining patient flow to CMM service; communication with healthcare team; integration with the staff; and marketing the service internally.Conclusion: The results unveiled by this article can be used by pharmacists and managers as a tool to optimize the implementation of CMM services in different healthcare settings. These conditions do not consist the only aspects necessary to ensure the success of the service; however, they can contribute to optimize the implementation process of the practice

Quality management tools applied to drug dispensing in hospital pharmacy: a scoping review

This is a scoping review registered on the public Open Science Framework platform. This work was developed following the Cochrane methodology and described according to the recommendations of the report items for systematic reviews and meta-analysis statement for scope reviews (PRISMA-ScR). The electronic databases used to search for studies were Medline (via PubMed), Cochrane Library, Embase, CINAHL and Lilacs (Latin America and the Caribbean Literature in Health Sciences). There was no restriction on the date or language of publication of the studies. The search strategies included combinations of terms related to “dispensing/distribution”, “quality” and “hospital pharmacy”. The descriptors were searched by Medical Subject Headings (Mesh), Embase Subject Headings (Emtree) and Health Sciences Descriptors (Decs), being adapted when necessary for each database