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Abstract In Brazil, insulin analogs stand out as one of the most demanded medications by judicial means. However, the guarantee of judicial access does not guarantee rational use. In context, pharmacotherapeutic follow-up (PF) is shown to be clinical effective strategy for patients with diabetes. To evaluate direct medical costs one year after performing PF in patients with type 1 diabetes mellitus using insulin analogs ordered by court in Public Health System (Sistema Único de Saúde - SUS). This is a partial economic analysis, nested within a quasi-experimental study. Patients with T1DM who receive insulin analogs by judicialization in a medium-sized Brazilian city participated. The PF was conducted following the method adapted from the Pharmacotherapy workup (PW). Data were collected considering the period of one year before the start of the intervention and one year after the start of the intervention. Direct medical costs were evaluated and the difference in costs was calculated. 28 patients participated in the intervention. After PF, direct costs were -$3,696.78. Sensitivity analysis showed that there is a 33.4 % chance for PF to present cost savings when compared to baseline. The PF has the potential to reduce direct medical costs from the perspective of the SUS.

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Abstract Background Studies show that among the drugs most commonly used in judicial litigation in Brazil, are those used to treat diabetes mellitus, especially insulin analogues. Objective Evaluate the use of the Unified Health System (SUS) by patients with type 1 diabetes mellitus (T1DM), who receive insulin analogues through judicial action, before and after this process. Method In a retrospective longitudinal observational study, secondary data was used from these patients in Minas Gerais, Brazil, in 2018. Socio-demographic information was collected and related to the follow-up of these patients in the SUS. The McNemar χ2 test was used to compare the proportions of the variables. Results Of the 89 patients analyzed, women (53.9%) were predominant. Most patients were aged between 20 and 39 years (52.8%), and more than half, 55.1%, use only a private health system. After the judicial action, there was a significant increase (p <0.05) in the number of patients who had consultations in primary health care (from 19.1% to 30.3%) and emergency medical appointments (from 1.1% to 9.0%). Conclusion It is observed that the majority of patients with T1DM via judicial action in the SUS are not monitored by this health system through examinations, consultations, and hospitalizations.

Resumo Introdução Estudos mostram que, dentre os medicamentos mais adquiridos via ação judicial, estão os utilizados para o tratamento do Diabetes Mellitus, especialmente os análogos de insulina. Objetivo Avaliar a utilização do Sistema Único de Saúde (SUS) pelos pacientes com Diabetes Mellitus tipo 1 (DM1), que recebem insulina por meio de judicialização, antes e após este processo. Método Em um estudo observacional longitudinal retrospectivo, foram utilizados dados secundários de pacientes com DM1, que adquiriram insulinas por processos judiciais em Divinópolis-MG, Brasil, em 2018. Foram coletadas informações sociodemográficas e referentes ao acompanhamento destes pacientes no SUS Realizou-se o teste χ2 de McNemar para a comparação das proporções das variáveis utilizadas para a avaliação do acompanhamento antes e após a judicialização. Resultados Dos 89 pacientes analisados, predominou-se o sexo feminino (53,9%), com idade entre 20 e 39 anos (52,8%). 55,1% destes utilizam apenas o sistema privado de saúde. Após a judicialização, houve um aumento significativo (p< 0,05) no número de pacientes que realizaram consultas na atenção primária à saúde (de 19,1% para 30,3%) e consultas médicas de emergência (de 1,1% para 9,0%). Conclusão A maioria dos pacientes com DM1 que judicializam medicamentos no SUS não são acompanhados por este sistema de saúde através de realização de exames, consultas e hospitalizações.

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A estrita relação entre doenças cardiovasculares e dislipidemias exige o monitoramento periódico do perfil lipídico através de dosagens séricas de colesterol total, triglicérides, colesterol da lipoproteína de baixa densidade (c-LDL) e colesterol da lipoproteína de alta densidade (c-HDL). Contudo, esses testes laboratoriais estão sujeitos à interferência medicamentosa in vivo e in vitro. O objetivo desta revisão da literatura foi disponibilizar os principais medicamentos que podem interferir nos exames de avaliação do perfil lipídico, com seus respectivos mecanismos de interferência in vivo ou in vitro. Alguns fármacos podem causar como reação adversa o aumento dos níveis de c-LDL e triglicérides, ou a redução dos níveis de c-HDL, o que está associado a um maior risco de eventos cardiovasculares. Por outro lado, outros fármacos podem reduzir os níveis de c-LDL e triglicérides, ou aumentar os níveis de c-HDL. Alguns medicamentos ainda podem interferir in vitro na dosagem dos biomarcadores de avaliação do perfil lipídico. O monitoramento e diagnóstico das dislipidemias devem levar em consideração estas interferências medicamentosas, já que a interpretação equivocada dos exames laboratoriais pode resultar em tratamento desnecessário ou falta de tratamento farmacológico, gastos desnecessários e prejuízo na qualidade de vida do paciente.

The strict relationship between cardiovascular disease and dyslipidemia requires periodic monitoring of the lipid profile through serum measurements of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c). However, these laboratory tests are subject to drug interference in vivo and in vitro. The purpose of this literature review was to make available the main drugs that can interfere with lipid profile assessment tests, with their respective in vivo or in vitro interference mechanisms. Some drugs can cause as adverse reaction the increase of LDL-c and triglycerides levels, or the reduction of HDL-c levels, which is associated with a greater risk of cardiovascular events. On the other hand, other drugs can reduce LDL-c and triglycerides levels, or increase HDL-c levels. Some medications can still interfere in vitro in the dosage of biomarkers to assess the lipid profile. The monitoring and diagnosis of dyslipidemia should take into account these drug interferences, since the misinterpretation of laboratory tests may result in unnecessary treatment or lack of pharmacological treatment, unnecessary expenses and damage to the patient's quality of life.

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Abstract Evidence on factors associated with the progression of chronic kidney disease (CKD) is still under construction. The present study aimed to evaluate sociodemographic, clinical, and drug use factors associated with the progression of CKD. A retrospective cohort study was conducted with 193 patients with CKD stages 3A to 5- non-dialysis followed for three years in a Brazilian city. The outcome was the evolution to renal replacement therapy (RRT) or death. A total of 52.3 % (n = 101) were men and 83.4 % (n = 161) elderly. The median age was 72.0 years, and 22.3 % (n = 44) progressed to RRT or death, and the three-year mortality rate was 20.2 %. Participants exposed to angiotensin converting enzyme inhibitors or angiotensin II receptor blockers had a lower risk of progressing to the outcome (hazard ratio (HR) 0.25; p = 0.003) and higher survival (p = 0.022) when compared to those not exposed to these drugs. Age (HR 1.06;) and use of omeprazole (HR 6.25; CI; p <0.01) and hydrochlorothiazide (HR 2.80; p = 0.028) increased the risks of RRT or death. The results highlight the importance of rational management of pharmacotherapy for patients with CKD

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Objetivo: desenvolver e validar cartilhas para aprimorar o preparo e a utilização de insulinas, bem como o monitoramento da glicemia capilar. Métodos: as cartilhas foram elaboradas considerando a acessibilidade das informações e a compreensibilidade das imagens, a fim de torná-las didáticas ao público-alvo. Posteriormente, foram submetidas à validação. Resultados: por meio da Técnica Delphi, criou-se um questionário contendo 10 perguntas para cada uma das quatro cartilhas validadas, o qual foi enviado para 32 painelistas, especialistas na área. A fim de avaliar o consenso entre as respostas dos painelistas, em cada item, empregou-se o cálculo do Coeficiente de Validade de Conteúdo (CVC), que varia de 0 a 1. Considerou-se validado, o valor de CVC superior a 0,8. Ao final de duas rodadas, foi possível validar as quatro cartilhas. Conclusão: o material possui vasto potencial de contribuição para o uso racional, efetivo e seguro das insulinas, além de poder contribuir com a qualidade de vida dos pacientes e com a redução de custos para o sistema de saúde.

Objective: the present study aimed to develop and validate educational booklets to improve the preparation and use of insulins, as well as the monitoring of capillary blood glucose. Methods: the educational booklets were developed considering the accessibility of information and the comprehensibility of images in order to make them didactic to the target audience. Subsequently, they were submitted to validation. Results: through the Delphi Technique, a questionnaire was created containing 10 questions for each of the four educational booklets, which was sent to 32 expert panelists in the area. In order to assess the consensus among the panelists' answers, in each item the calculation of the Content Validity Coefficient (CVC) was used, which varies from 0 to 1. The CVC above 0.8 was considered valid. At the end of two rounds, it was possible to validate the four educational booklets. Conclusion: the material has a vast potential to contribute to the rational, effective and safe use of insulins, in addition to being able to contribute to the quality of life of patients and the reduction of costs for the health system.

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Introdução: O aumento contínuo do número de processos de judicialização da saúde, a relevância epidemiológica do diabetes mellitus tipo 2 (DM2), a escassez de recursos utilizados para monitorar os investimentos dos processos judiciais e do seu alto custo para a saúde pública, diante disso torna-se necessário estudos que analisem o perfil da judicialização dos antidiabéticos, que é a principal classe de medicamentos alvo dos processos judiciais. Objetivo: Analisar se os pacientes com DM2 atendidos via judicial, foram acompanhados e monitorados no Sistema Único de Saúde (SUS) antes e após os processos judiciais. Além de analisar o perfil de medicamentos judicializados para tratamento da DM2. Métodos: Trata-se de um estudo longitudinal retrospectivo, que utilizou dados secundários, prontuários e arquivos de processos judiciais, de 56 pacientes com DM2 que adquiriram pelo menos um de seus medicamentos por meio da judicialização, no ano de 2019, em um município mineiro. Os dados foram analisados 12 meses antes e 12 meses após a judicialização. Resultados: Dentre as 56 ações judiciais, 39% se concentraram em apenas três unidades de saúde do município. Somente 30 pacientes (53%) antes e 29 (51%) após a judicialização tiveram consultas no SUS. Além disso, apenas 15 (26%) e 13 (23%) pacientes, respectivamente antes e após a judicialização, apresentaram algum exame laboratorial realizado pelo SUS. As insulinas Levemir Flex Pen® (13%), Novo Rapid® (11%) e Lantus® (7%) foram os medicamentos mais judicializados. Conclusão: Observou-se que apesar do SUS prover o insumo terapêutico de elevado custo por meio de uma porta de entrada não convencional, não há monitorização clínica e laboratorial para avaliação da efetividade do uso da tecnologia, conforme recomendam os protocolos clínicos e dispositivos legais brasileiros sobre acesso a medicamentos.

Introducción: El aumento continuo en el número de procesos de judicialización de la salud, la relevancia epidemiológica de la diabetes mellitus tipo 2 (DM2), la escasez de recursos utilizados para monitorear las inversiones en procesos judiciales y de su alto costo para la salud pública, se vuelven necesarios estudios que analicen el perfil de la judicialización de los antidiabéticos, que es la principal clase de medicamentos a las que se dirigen los procesos judiciales. Objetivo: Analizar si los pacientes con DM2 atendidos vía judicial, fueron acompañados y monitoreados en el Sistema Único de Salud (SUS) antes y después de los procesos judiciales. Además de analizar el perfil de las drogas legalizadas para el tratamiento de la DM2. Métodos: Se trata de un estudio retrospectivo longitudinal, que utilizó datos secundarios, registros médicos y archivos de demandas, de 56 pacientes con DM2 que adquirieron al menos uno de sus medicamentos a través de la judicialización, en el año 2019, en un municipio de Minas Gerais. Los datos fueron analizados 12 meses antes y 12 meses después de la judicialización. Resultados: Entre las 56 acciones judiciales, el 39% se concentró en solo tres unidades de salud en el municipio. Solo 30 pacientes (53%) antes y 29 (51%) después de la judicialización tuvieron consultas en el SUS. Además, solo 15 (26%) y 13 (23%) pacientes, respectivamente antes y después de la judicialización, se sometieron a pruebas de laboratorio realizadas por el SUS. Las insulinas Levemir Flex Pen® (13.0%), Novo Rapid® (11%) y Lantus® (7%) fueron los medicamentos más judicializadas. Conclusión: Se observó que a pesar de que el SUS proporciona un recurso terapéutico de alto costo a través de una puerta de entrada no convencional, no hay monitoreo clínico y laboratorial para la evaluación de la efectividad del uso de la tecnología, según lo recomendado por los protocolos clínicos y dispositivos legales brasileros sobre el acceso a medicamentos.

Introduction: The continuous increase in the number of health judicialization processes, the epidemiological relevance of type 2 diabetes mellitus (DM2), the scarcity of resources used to monitor the investments of lawsuits, and their high cost to public health, that said there is a need for studies that analyze the profile of the judicialization of antidiabetics, which is the main class of drugs targeted by lawsuits. Objective: To analyze whether patients with DM2 attended by judicial system, are followed up and monitored in Brazilian Public Health System (SUS) before and after judicial proceedings. In addition to analyzing the profile of drugs legalized for the treatment of DM2. Methods: A retrospective observational study, which secondary database, medical records and judicial files, was conducted with 56 patients with DM2 who have acquired at least one of their medicines through lawsuits, in 2019, in a city in Minas Gerais. The data were analyzed 12 months before and 12 months after judicialization process. Results: Among the 56 lawsuits, 39% were concentrated in only three health units. Only 30 patients (53%) before and 29 (51%) after judicialization had appointments in SUS. Furthermore, only 15 (26%) and 13 (23%) patients, respectively before and after judicialization, had some laboratory test performed by SUS. The insulins Levemir Flex Pen® (13%), Novo Rapid® (11%), and Lantus® (7%) were the most judicialized drugs. Conclusion: It was observed that despite the SUS providing the high-cost therapeutic input through an unconventional gateway, there is no clinical and laboratory monitoring to evaluate the effectiveness of the technology, as recommended by clinical protocols and Brazilian laws about access to medicines.

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Background The effectiveness of pharmaceutical care has already been evidenced in several studies and scenarios; the lack of patient's consultation has been little explored in the literature. Unprovided care is a missed opportunity to offer care to another individual who needs attention to their health. The need for investigation of missed consultations in a Brazilian pharmaceutical care service arises. Objective To evaluate the participation and characteristics of patients in pharmaceutical care consultations in a university outpatient unit in the Brazilian city of Divinópolis. Methods A descriptive study was carried out from a secondary source of information. The socio-demographic profile of the patients who were absent from the pharmacy consultations from January to December 2017 was outlined. Results Of the 832 scheduled appointments from January to December 2017, 501 were not attended by patients, revealing 60.2% missed consultations. The female gender was predominant, corresponding to 67.8% of the patients. A total of 63.8% of the absentees were over 60 years of age. Most of the patients had two comorbidities (32.5%) and came from an active identification by the Outpatient unit pharmacists (86.60%). Furthermore, the patients who were more absent from the consultations had their primary health care units farther away from the outpatient unit, and this could be one of the causes of the high number of absent patients from the pharmaceutical consultations. Conclusion The lack of participation in patient's consultations is high. It is necessary to articulate new strategies aimed at reducing absences from consultations, since this is a source of waste of financial resources and opportunities to improve the patients' health and quality of life.

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