RESUMO
Background At this moment, there is no information in the literature showing the impact of comprehensive medication management (CMM) service delivered to patients with chronic obstructive pulmonary disease. Objective This study aims to present the clinical outcomes of this service provided to patients with chronic obstructive pulmonary disease. Settings Public specialty pharmacy where high cost drug treatments are provided for medical conditions not covered by the primary care such as COPD, located in Minas Gerais State, Brazil. Methods A retrospective analysis was conducted for 83 patients. The dependent variable in this study was the sum of the drug therapy problems detected during the first and second consultation. The independent variables were age, number of diseases and medications, diagnosis of hypertension, dyslipidemia and diabetes, and tabagism. Univariate and multivariate analyses were performed using Pearson's Chisquare test. A level of significance of 5% was adopted for all analyses. Main outcomes Number, types and proportion of resolved drug therapy problems. Results Two hundred seventy seven drug therapy problems were identified, of which 53.1% were resolved. The most frequent drug therapy problem was the "use of unnecessary drug therapy" (n = 55; 19.8%). The identification of three or more drug therapy problem was higher among patients using five medications or more and among those using ten or more (p < 0.05). After the delivery of medication therapy management, the proportion of patients presenting "stable" clinical status was raised from 27 to 54% (p = 0.001). Conclusion CMM service demonstrates a positive impact on clinical outcomes of patients with chronic obstructive pulmonary disease and should prioritize patients with polypharmacy because they might have a higher number of drug therapy problems.
Assuntos
Conduta do Tratamento Medicamentoso/tendências , Assistência Farmacêutica/tendências , Polimedicação , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: To provide tools for pharmacists to uncover patients' medication experiences and to discuss strategies that medication therapy management (MTM) pharmacists use to prevent and resolve drug therapy problems rooted in patients' medication experiences. DESIGN: Qualitative study. SETTING: Health care delivery system in the Minneapolis/Saint Paul, MN, area from January to October 2010. PARTICIPANTS: 10 MTM pharmacists. INTERVENTION: Thematic analysis of data from a focus group of MTM pharmacists and an MTM pharmacist's practice diary. RESULTS: Patients' medication experiences were revealed as a foundational aspect of MTM pharmacists' daily practices because they had to take these experiences into consideration to be effective practitioners. According to MTM pharmacists, patients express attitudes toward drug therapy in many different ways, thereby affecting how each patient takes his/her medications. Patients' medication experiences often were at the root of drug therapy problems (DTPs). From MTM pharmacists' examples, we identified DTPs at the root of patients' medication experiences and several strategies used by pharmacists to address patients' needs and concerns regarding medications. MTM pharmacists approached patients in a nonjudgmental way so that patients would feel comfortable sharing their perspectives and goals. After understanding patients' motivations and the basis of their attitudes and decision making, pharmacists could negotiate the process of behavioral change, if needed. CONCLUSION: If pharmacists understand patients' medication experiences, they may be able to address and resolve DTPs to ultimately improve therapeutic outcomes and reduce adverse events.