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ntroducción: la hipertensión arterial continúa siendo un desafío para la salud pública del Paraguay. La falta de adherencia a los tratamientos es un problema desde los puntos de vista médico, económico y psicosocial. Objetivo: promover la adherencia al tratamiento farmacológico antihipertensivo en pacientes con hiperten-sión que asisten a servicio de salud público, mediante un servicio de atención farmacéutica apoyado en el uso de telefonía móvil. Materiales y métodos: estudio cuasiexperimental en pacientes mayores de 18 años de ambos sexos con hipertensión arterial, en quienes se aplicaron intervenciones farmacéuticas apoyadas con el uso de telefonía móvil (llamada, mensajería sms y WhatsApp) y en quienes se evaluó la adherencia al tratamiento mediante el cuestionario de Morisky-Green, junto con preguntas complementarias para cono-cer las causas de no adherencia. Resultados: participaron 60 pacientes. Al inicio, el 68.3 % (n = 41) mostró adherencia al tratamiento según el cuestionario de Morisky-Green, y el 31.7 % (n = 19) no cumplió con la indicación. Después de las intervenciones se ha encontrado una mayor adherencia al tratamiento, al llegar al 96.7 % los cumplidores (p < 0.001). Entre las causas de no adherencia a la farmacoterapia están el olvido (28.3 %; n = 17), la falta de disponibilidad del medicamento en el hospital (20 %; n = 12) y el costo (10 %; n = 6). Conclusión: la utilización de telefonía móvil como apoyo a la atención farmacéutica podría constituirse en una herramienta para la promoción de la adherencia en pacientes con hipertensión arterial.
Introduction: Arterial hypertension remains a public health challenge in Paraguay; lack of adherence to treatment poses medical, economic, and psychosocial concerns. Information and communication tech-nologies (ICT) are valuable tools in monitoring patients and improving adherence to drug treatment. Objective: Promote adherence to antihypertensive drug treatment among hypertensive patients who attend a public health service by implementing a pharmaceutical care service supported by mobile phones. Materials and methods: A quasi-experimental study was conducted in male and female patients aged 18 years and older with arterial hypertension, in which pharmaceutical interventions supported by mobile telephony (calls, SMS messaging, and WhatsApp) were applied and adherence to treatment was assessed using the Morisky-Green questionnaire with complementary questions to identify the reasons for non-adherence. The research protocol was approved by a Research Ethics Committee of the FCQ-UNA (714/2021). Results: A total of 60 patients participated. Initially, 68.3% (n=41) showed adhe-rence to treatment according to the Morisky-Green questionnaire, while 31.7% (n=19) did not adhere to the indication. After the interventions, an increase in adherence to treatment was observed, with a compliance of 96.7% (p<0.001). Reasons non-adherence to pharmacotherapy included forgetfulness 28.3% (n=17), unavailability of drugs at the hospital 20% (n=12) and cost 10% (n=6).Conclusion: The use of mobile phones to support pharmaceutical care has the potential to serve as a tool for promoting adherence in patients with arterial hypertension
Introdução: A hipertensão arterial continua a ser um desafio para a saúde pública no Paraguai; a falta de adesão aos tratamentos é um problema do ponto de vista médico, econômico e psicossocial. Objetivo:Promover a adesão ao tratamento farmacológico anti-hipertensivo nos doentes com hipertensão que frequentam os serviços públicos de saúde, através de um serviço de assistência farmacêutica apoiado na utilização de telefonia móvel. Materiais e métodos: Estudo quase experimental realizado em pacientes maiores de 18 anos de ambos os sexos com hipertensão arterial; em que foram aplicadas intervenções farmacêuticas apoiadas no uso da telefonia móvel (chamada, mensagem sms e WhatsApp) e a adesão ao tratamento foi avaliada por meio do questionário Morisky-Green, juntamente com perguntas comple-mentares para determinar as causas da não adesão. Resultados. 60 pacientes participaram. No início, 68,3% (n = 41) apresentaram adesão ao tratamento conforme questionário de Morisky-Green e 31,7% (n = 19) não cumpriram a indicação. Após as intervenções constatou-se maior adesão ao tratamento, com adesão chegando a 96,7% (p < 0,001), as causas da não adesão à farmacoterapia foram esquecimento em 28,3% dos casos (n = 17), falta de disponibilidade de medicamentos no hospital 20% (n = 12) e custo 10% (n = 6). Conclusão: a utilização de telefonia móvel para apoio à assistência farmacêutica poderá tornar-se uma ferramenta para promover a adesão ao tratamento em pacientes com hipertensão.
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HumanosRESUMO
Population's aging leads to a frequent usage of pharmaceutical medications to treat or control various ailments because of aging, increasing the probability of occurrence of problems related to its usage. The primary objective of this study was to conduct pharmaceutical interventions in elderly patients from San Luis - Riobamba, using surveys to identify the sociodemographic characteristics, diseases, and medicines usage. Once the problems related to pharmacological therapy were identified, pharmaceutical interventions were carried our prior the acceptance of each patient. The study had the participation of 422 elderly patients, with the prevalence of females (59.7%), aged between 60 and 70 years (45.5%); we identified that 82.5% of the elderly patients have diseases, finding that joint pain such as Arthritis/Osteoarthritis has the higher incidence (38.8%), and 50% of the surveyed people consume medication to treat the disease. 40.28% (n=170) of the participants conciliate the treatment review to identify any medication-related problem (MRP), finding interactions (21.2%) and adverse effects probability (21.2%), starting from the PRM identified, 170 pharmaceutical interventions were conducted, considering as priority (67.6%) the education on non-pharmacological measures. The pharmaceutical interventions done through the study benefited the elderly patients and will contribute to reduce the appearance of PRM.
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Intermittent fasting (IF) is a popular intervention used to fight overweight/obesity. This condition is accompanied by hypothalamic inflammation, limiting the proper signaling of molecular pathways, with consequent dysregulation of food intake and energy homeostasis. This mini-review explored the therapeutic modulation potential of IF regarding the disruption of these molecular pathways. IF seems to modulate inflammatory pathways in the brain, which may also be correlated with the brain-microbiota axis, improving hypothalamic signaling of leptin and insulin, and inducing the autophagic pathway in hypothalamic neurons, contributing to weight loss in obesity. Evidence also suggests that when an IF protocol is performed without respecting the circadian cycle, it can lead to dysregulation in the expression of circadian cycle regulatory genes, with potential health damage. In conclusion, IF may have the potential to be an adjuvant treatment to improve the reestablishment of hypothalamic responses in obesity.
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Abstract The objective of this study was to evaluate drug interactions based on medical records of patients hospitalized in University Hospital Lauro Wanderley (UHLW) in João Pessoa-PB, Brazil. This was a quantitative, descriptive study with a cross-sectional design. This research was conducted in the medical clinic of the above hospital by analyzing pharmaceutical intervention in medical records. The investigated samples consisted of all medical profiles with drug interaction information of patients hospitalized from June 2016 to June 2017. Most of these drug interactions were determined and classified by Micromedex® Solutions database. This research was approved by the Ethics Committee in Institutional Human Research, protocol number 2.460.206. In total, 331 drug interactions were found in 131 medical profiles. Dipyrone, enoxaparin, sertraline, ondansetron, quetiapine, tramadol, bromopride, amitriptyline, and simvastatin were medications that showed highest interactions. According to Anatomical Therapy Classification (ATC), drugs that act on the central nervous system result in more interactions. The most prevalent interaction was between dipyrone and enoxaparin. Some limitations of this study are the lack of notifications and data on drug interactions.
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Humanos , Masculino , Feminino , Pesquisa , Prontuários Médicos/classificação , Interações Medicamentosas , Estudos de Avaliação como Assunto , Pacientes Internados/classificação , Universidades , Preparações Farmacêuticas , Dipirona/efeitos adversos , Enoxaparina/provisão & distribuição , Sinvastatina/provisão & distribuição , Sertralina/provisão & distribuição , Fumarato de Quetiapina/provisão & distribuição , Amitriptilina/provisão & distribuição , Hospitais Universitários/organização & administraçãoRESUMO
Introdução: A pediatria apresenta um cenário bastante específico devido ao uso de medicamentos off-label e carência de estudos científicos direcionados à utilização de medicamentos por essa população. Assim, o farmacêutico clínico pode contribuir na identificação e prevenção de problemas relacionados a medicamentos.Métodos: Estudo de coorte retrospectivo realizado em uma unidade de terapia intensiva pediátrica de um hospital universitário do Rio Grande do Sul. Foram analisadas as intervenções farmacêuticas realizadas entre março de 2016 a julho de 2018 por farmacêuticos clínicos. Tais intervenções foram reclassificadas conforme os critérios de um instrumento de acompanhamento farmacêutico (bundle) utilizado na rotina. Foi realizada análise estatística descritiva das variáveis estudadas.Resultados: Das 582 intervenções farmacêuticas analisadas, as categorias mais prevalentes foram dose (n = 97; 16,7%), necessidade (n = 92; 15,8%) e forma farmacêutica (n = 56; 9,6%). Após reclassificação das intervenções farmacêuticas utilizando o bundle, os critérios mais prevalentes foram: critério 1 (revisão da farmacoterapia; n = 285; 49%), critério 4 (analgesia; n = 78; 13,4%) e critério 10 (antimicrobianos; n = 65; 11,2%). As classes de medicamentos mais frequentes foram os do sistema nervoso (n = 213; 36,6%) e os anti-infecciosos gerais para uso sistêmico (n = 115; 19,8%). A taxa de adesão das intervenções farmacêuticas pela equipe médica foi de 85,1%.Conclusão: A classificação das intervenções farmacêuticas utilizando o bundle pode contribuir no aperfeiçoamento do instrumento tornando-o mais viável para uso na unidade de terapia intensiva pediátrica e direcionar o trabalho do farmacêutico clínico nas situações que geram mais problemas relacionados a medicamentos.
Introduction: Pharmaceutical interventions in the pediatric setting are highly peculiar due to the use of off-label drugs associated with the lack of scientific studies on the use of drug therapies in this population. Thus, clinical pharmacists may help identify and prevent drug-related problems.Methods: We conducted a retrospective cohort study in the pediatric intensive care unit of a teaching hospital in Rio Grande do Sul, Brazil. Pharmaceutical interventions conducted between March 2016 and July 2018 were analyzed by clinical pharmacists. These interventions were reclassified according to the criteria of a routine pharmaceutical monitoring instrument (care bundle). We conducted a descriptive statistical analysis of study variables.Results: Of 582 pharmaceutical interventions analyzed, the most prevalent categories were dose adjustment (n = 97; 16.7%), need for drug therapy (n = 92; 15.8%), and dosage forms (n = 56; 9.6%). After reclassification of pharmaceutical interventions, the most prevalent criteria were criterion 1 (review of drug therapy; n = 285; 49%), criterion 4 (analgesia; n = 78; 13.4%), and criterion 10 (antimicrobials; n = 65; 11.2%). The most common drug classes were nervous system agents (n = 213; 36.6%) and anti-infectives for systemic use (n = 115; 19.8%). The rate of adherence to pharmaceutical interventions by the medical team was 85.1%.Conclusions: The classification of pharmaceutical interventions according to the pharmaceutical care bundle may help improve the instrument, allowing its use in the pediatric intensive care unit and guiding clinical pharmacists in situations causing drug-related problems.
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Humanos , Criança , Assistência Farmacêutica/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Prevenção de Doenças , Unidades de Terapia Intensiva Pediátrica/organização & administração , Estudos de CoortesRESUMO
Abstract Clinical pharmacists have been increasing their participation mainly through actions aimed at patient care, with international studies demonstrating favorable cost-benefit ratio from pharmacists interventions. However, there are few studies carried out in Brazil about the subject. This study aims to assess the economic impact of pharmaceutical interventions (PIs) in a hospital setting performed in October 2018. Each performed PI was registered and associated with the direct cost of drugs for economic impact analysis. A total of 185 PIs were evaluated, comprising 106 patients. The most intervened drugs were antibiotics, presenting the greatest economic impact, R$2,370. The total economic impact was R$2,578, mainly in the Pediatric Intensive Care Unit that represented R$1,701. Regarding the economic impact by PI as the "Suspension of drug without indication" saved R$1,360 while the "Inclusion of required drugs" cost R$807. It was estimated that the savings would be R$30,936 and, if PIs were performed at day zero, the savings would be R$79,728 per year. An average of 1.75 PI per patient was performed with an economic impact of R$14 per PI. Our results showed that clinical pharmacist's role in the evaluation of pharmacotherapy is important for patients' health and represents a positive economic impact.
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RESUMO Este trabalho é um estudo observacional descritivo retrospectivo, com análise de dados quantitativos de abril a julho de 2019 no Hospital Universitário de Canoas. Foram avaliados 419 prescrições e dados de pacientes quanto a sexo, idade, patologias prévias, vias de administração e medicamentos mais prescritos no CTI. Para análise, foi elaborado um Instrumento de Coleta de Dados, no qual foram transferidos para uma planilha do software Microsoft Excel para análise de frequência. Os resultados encontrados foram que a maioria dos pacientes era do sexo masculino (59%), com idade entre 40 e 69 anos (47%). As patologias mais frequentes foram Hipertensão Arterial (31%), Diabetes Mellitus (18%) e outras como infecções bacterianas, fraturas ou cirurgia cardíaca (46%). A via de administração mais utilizada foi a parenteral (63%). Os medicamentos mais prescritos foram analgésicos / antipiréticos (n = 175), analgésicos narcóticos (n = 126) e antieméticos (n = 126). A caracterização do perfil farmacoterapêutico permitiu definir estratégias de avaliação da prescrição e propor o serviço de farmácia clínica para contribuir com o conhecimento de outros profissionais relacionados aos medicamentos.
ABSTRACT This work is a retrospective descriptive observational study, with an analysis of quantitative data from April to July 2019 at the University Hospital of Canoas. 419 prescriptions and patient data were evaluated regarding sex, age, previous pathologies, routes of administration, and most prescribed drugs in the ICU. For analysis, a Data Collection Instrument was elaborated, in which they were transferred to a Microsoft Excel software spreadsheet for frequency analysis. The results found were that most of the patients were male (59%), aged 40 to 69 years (47%). The most frequent pathologies were Arterial Hypertension (31%), Diabetes Mellitus (18%), and others such as bacterial infections, fractures, or cardiac surgery (46%). The most widely used route of administration was the parenteral route (63%). The most prescribed drugs were analgesics/antipyretics (n = 175), narcotic analgesics (n = 126) and antiemetics (n = 126). Characterizing the pharmacotherapeutic profile allowed to determine prescription evaluation strategies and propose the clinical pharmacy service to contribute to the knowledge of other professionals related to medicines.
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Introduction: Care bundles help healthcare professionals provide the best care possible in a structured and reliable way. The purpose of this study was to develop and apply an instrument for inpatient follow-up by clinical pharmacists, and evaluate its results. Methods: The care bundle was based on previously validated instruments. Population consisted of patients monitored by clinical pharmacists at a general hospital. The study was conducted in two phases: the first involved the development and implementation of the bundle, and the evaluation of pharmaceutical interventions; the second involved analyzing data from patients treated with the bundle over one year. Results: The bundle included fourteen pharmaceutical follow-up criteria used in different patterns by each area of care. In the first phase of the study, 3263 patients were monitored and 536 pharmaceutical interventions were performed, with an 85.3% compliance rate. In the second phase of the study, follow-up data was collected from 21,214 patients. The bundle criteria were used in a similar way in clinical, surgical and cancer patients. Pharmacotherapy review was the most prevalent intervention in all cases (60.1%). Hospital discharge planning and medication reconciliation were performed with a similar frequency in clinical, surgical, pediatric and general patients. Conclusions: The development and validation of a bundle aimed at guiding the clinical activities of pharmacists helped standardize procedures and interventions. Pharmacotherapy review was the bundle criterion with the highest rate of application and interventions due to the hospital's complexity and the need to consider individual patient needs and follow institutional policies. (AU)
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Humanos , Assistência Farmacêutica , Continuidade da Assistência ao Paciente , Pacotes de Assistência ao Paciente , Adesão à MedicaçãoRESUMO
RATIONALE, AIMS AND OBJECTIVES: Literature have showed inconclusive or contradictory results regarding medication review services effectiveness in optimizing process indicators. Thus, this study aimed to evaluate the process indicators of a medication review service between pharmacists and physicians. METHOD: This quasi-experimental study was conducted between March 2013 and February 2014 with patients who were receiving care in a medication review service in a teaching hospital in northeastern Brazil. The main process indicators were number of pharmaceutical consultations; identification and resolution of drug-related problems (DRP) and pharmaceutical interventions that were classified according to type and degree of acceptance. Descriptive statistics were used to report data. The statistical significance of the association between variables was evaluated using the Mantel-Haenszel chi-square test. The 95% confidence interval was considered, and differences were deemed statistically significant if P ≤ .05. RESULTS: A total of 146 patients attended the medication review service. The number of consultations per patient ranged from one to five (2.1 ± 1.1). The service identified 366 DRP, most of which were indication (67.5%). Patients who had four to five pharmaceutical consultations were 1.14 times more likely to have their DRP identified (χ2 = 33.83, P < .0001). Of the DRP identified, 183 (42.33%) were resolved. Patients who had between one and two pharmaceutical consultations were 1.22 times more likely not to have their DRP resolved compared with the group with more than three consultations (χ2 = 3.44, P < .05). Of the 173 pharmaceutical interventions made to the medical students and physicians, the majority (98.7%) was accepted. CONCLUSION: The collaborative medication review service optimized the process indicators. Drug-related problems identification and resolution required more than three pharmaceutical consultations. Most of the pharmaceutical interventions were accepted by prescribers. Thus, collaborative medication review services may be fundamental to the construction of more effective and safe health systems.
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Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Serviço de Farmácia Hospitalar , Médicos , Brasil , Humanos , Farmacêuticos , Encaminhamento e ConsultaRESUMO
Objetivo: Definir fluxos de trabalho multidisciplinares para padronização do serviço. Definição do elenco de medicamentos a ser monitorado e estudar resultados preliminares. Métodos: Criação de grupo de trabalho e tabulação dos dados em planilhas Excel ® com as principais intervenções executadas em fevereiro/2019. Resultados: Observou-se que 35% dos tratamentos foram mantidos conforme prescrição inicial. 18% tiveram a duração de tratamento reduzida e 9% não foram autorizados pela CCIH devido a inconformidades. Também foi feita a correção de dose para função renal em 8% das prescrições. Calculou-se o valor do tratamento/dia para cada antimicrobiano. As intervenções descritas representam uma economia direta de R$ 1905,08 reais. Não foram contabilizadas as despesas com materiais médico-hospitalares, transporte/logística e recursos humanos. O percentual de intervenções da farmácia clinica ocorre principalmente na etapa de prescrição devido ao rastreio pela dose individualizada. Também foram realizadas intervenções nas etapas de preparo, diluição e estabilidade. Reações adversas foram detectadas, notificadas e monitoradas devido a necessidade de manejo clínico. Conclusões: Este trabalho demonstra a economia financeira gerada pela atuação da equipe multidisciplinar e também reforça a necessidade de ampliação dos serviços farmacêuticos clínicos e logísticos, já que o trabalho no controle de dispensação individualizado associado a intervenções clínicas são mais eficazes. A complexidade do processo exige monitorização interdisciplinar em todas as etapas do tratamento visando a segurança do paciente.
Objective: Define multidisciplinary protocols for service standardization. Definition of the list of drugs to be monitored and study preliminary results. Methods: Creation of a working group and tabulation of the data in Excel® with the main interventions executed in February / 2019. Results: It was observed that 35% of the treatments were maintained according to the initial prescription. 18% had a reduced treatment duration and 9% were not authorized by CCIH due to nonconformities. Dose correction for renal function was also performed in 8% of prescriptions. The interventions described represent a direct savings of R $ 1905.08. The expenses with medical-hospital materials, transport / logistics and human resources were not accounted for. The percentage of clinical pharmacy interventions occurs mainly at the prescription stage due to individualized dose screening. Conclusions: This work demonstrates the financial economy generated by the multidisciplinary team and also confirm the need for expansion of clinical and logistic pharmaceutical services.
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Anti-InfecciososRESUMO
Background Anticoagulation therapy with warfarin is highly effective for prevention and treatment of thromboembolic disorders. Nevertheless, its management is challenging especially in developing countries, where the medical access is difficult and patient education is poor. Objective To determine the effect of pharmaceutical intervention (PI) on the time in therapeutic range (TTR) of a group of anticoagulated patients from our referral center. Method A group of consecutive outpatients previously treated by usual medical care underwent PI. The intervention consisted in the identification and avoidance of food and drug interactions, the confection of medication schedule charts and education to patients regarding side effects and drug monitoring. Mean TTR before and after PI was compared through the Wilcoxon test for repeated measures. Regression analyses were performed to assess the relationship between a TTR level under 65% and potential explanatory variables. Results Mean TTR before PI was 37.4 ± 23.5% and after PI it raised to 67.0 ± 24.9%. Mean change in TTR was +29.5% (95% CI 14.5-44.6; p < 0.001). Before PI only 4 patients had TTR values above 65%, in contrast to 18 patients after PI. Conclusion Our findings support the efficacy of PI to improve TTR values in patients treated with warfarin.
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Anticoagulantes/sangue , Monitoramento de Medicamentos/métodos , Adesão à Medicação , Varfarina/sangue , Idoso , Anticoagulantes/farmacologia , Coagulação Sanguínea/efeitos dos fármacos , Coagulação Sanguínea/fisiologia , Costa Rica/epidemiologia , Monitoramento de Medicamentos/normas , Feminino , Humanos , Coeficiente Internacional Normatizado/normas , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Varfarina/farmacologiaRESUMO
PURPOSE: Chronic myeloid leukemia (CML) is a clonal myeloproliferative disease, accounting for 15 to 20% of leukemias, with an incidence of one to two cases/100,000 inhabitants. In Brazil, the estimated incidence of leukemia is six cases/100,000 men and 4.28 cases/100,000 women. CML is characterized by the presence of the Philadelphia chromosome. At present, three types of tyrosine kinase inhibitors (TKI) are administered to treat CML patients in the Brazilian public national health system (NHS), called the Unified Health System (in Portuguese, "Sistema Único de Saúde", SUS). Such treatments are only effective if patients adhere to strict dosage regimens; protocol improvements that increase patient adherence to treatment would have economic and health benefits for overburdened health care systems. Here, pharmacist-monitored treatment is assessed. METHODS: In our study, we applied two questionnaires, one to assess the adherence to pharmacological treatment and another to assess the quality of life. All patients studied (n = 23) were diagnosed with CML at a local hospital in "Espírito Santo" State, the "Hospital Evangélico Vila Velha" (HEVV). RESULTS: Treatment adherence was significantly higher in pharmacist-monitored patients than in nonmonitored patients (p = 0.0135). The quality of life of CML patients was also analyzed, indicating that monitored patients had a lower number of symptoms/complaints during treatment periods than nonmonitored patients. Finally, improved treatment adherence also translated into better clinical conditions, particularly during the early stage of treatment (e.g., the first 4 months). CONCLUSIONS: The intervention of a clinical pharmacist is significant to obtain positive clinical results. Therefore, it is recommended that this protocol be included in the standard NHS treatment protocol CML patient outcomes to reduce the indirect and recurring costs to the health care system caused by nonadherence.
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Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Adesão à Medicação , Farmacêuticos , Papel Profissional , Brasil , Feminino , Humanos , Masculino , Serviço de Farmácia Hospitalar/métodos , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Infantile hemangiomas (IH) are the most common benign vascular tumors of childhood, with an incidence of 5-10% during the first year of age. Propranolol is considered the first-line treatment for this condition. Potentially there is a high probability of negative results to therapy, because in many countries there are no treatment protocols or propranolol formulations appropriate for the pediatric population. The objective of the present study was to evaluate the impact of pharmacist interventions such as detecting, analyzing, and solving problems presented during treatment with propranolol in patients with IH. METHODS: An open observational prospective study was performed over 25 months in a group of pediatric patients diagnosed with infantile hemangioma treated with propranolol. Pharmacist participation consisted of development of an extemporaneous formulation and counseling the child's parents. At each visit to the pharmacy service, family members were interviewed, detecting and classifying problems related to treatment. RESULTS: Sixty-three children with IH were treated during the period under review. Patient ages ranged from 3 to 11 months old; 64% were female and 36% were male. Forty-nine problems in 30 patients were detected, principally inadequate dose (18.4%), non-adherence to treatment (16.3%), side effects (14.3%), and wrong administration (14.3%). Of the problems detected, 81.6% were resolved. Interventions by the pharmacist in 27 patients were intensive counseling on adherence to therapy (20%), detection of adverse effects (11.4%), and adjustment of the dose (22.9%). In 95.2% of patients a good response to treatment was obtained compared with 77.2% reported in European studies without pharmacist intervention. CONCLUSION: It seems that pharmacist participation increases adherence to treatment and reduces the likelihood of adverse effects, allowing for safe and effective therapy in patients with IH.
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Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hemangioma , Prescrição Inadequada/prevenção & controle , Conduta do Tratamento Medicamentoso/organização & administração , Farmacêuticos , Propranolol/uso terapêutico , Neoplasias Cutâneas , Esquema de Medicação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Hemangioma/diagnóstico , Hemangioma/tratamento farmacológico , Hemangioma/epidemiologia , Hemangioma/patologia , Humanos , Lactente , Masculino , Adesão à Medicação , México/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Pediatria/métodos , Papel Profissional , Estudos Prospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Vasodilatadores/uso terapêuticoRESUMO
Se realizó un estudio retrospectivo durante el periodo comprendido entre noviembre del 2008 y abril del 2009 a partir del sistema de distribución de medicamentos en dosis unitarias, con el objetivo de documentar el valor de la intervención farmacéutica, tanto en datos descriptivos como en datos económicos y de eficiencia, mediante el empleo de un programa de equivalentes terapéuticos. Las intervenciones farmacéuticas se agruparon en dosis/intervalo, sustitución, vía de administración, interacciones, alergias y otros. En cuanto al impacto económico, los valores de precios se obtuvieron a partir de los precios de compra de los medicamentos y del catálogo de especialidades farmacéuticas. Se realizaron un total de 297 intervenciones repartidas en 50 dosis/intervalo, 174 sustituciones, 34 de vía, 25 de interacciones, 3 de alergia y 11 en el apartado de otros. El ahorro real calculado supuso 18 146,39 euros. El registro de las intervenciones se valora como beneficioso para la detección de problemas prioritarios y áreas de actuación, además de constituir una herramienta útil para poder demostrar el coste/efectividad de las acciones.
A retrospective study was conducted from November 2008 to April 2009 in the unit-dose drug distribution system. The objective was to document the value of the pharmaceutical intervention both in descriptive and economic/efficiency data by using a program of therapeutic equivalences. The pharmaceutical interventions were grouped into dose/interval, substitutions, route of administration, interactions, allergies and others. Regarding the economic impact, the values of prices were derived from the drug purchase prices and the catalogue of pharmaceutical specialties. Two hundred ninety seven interventions were performed and distributed as follows: 50 dose / interval, 174 substitutions, 34 routes of administration, 25 interactions, 3 allergies and 11 of other types. Actual estimated savings amounted to 18 146.39 euros. The record of interventions is considered advantageous for the detection of priority problems and areas for action, in addition to being a useful tool to prove the cost-effectiveness of actions. Key words: Pharmaceutical intervention, clinical impact, economic impact.
RESUMO
Introdução: As incompatibilidades medicamentosas quando ocorrem são consideradas erro de medicação, e o produto resultante pode afetar a eficácia e a segurança da terapia, sendo que conhecer seus fundamentos pode ajudar a prevenir sua ocorrência diminuindo, assim, seus riscos. Objetivos: Identificar e quantificar as incompatibilidades físico-químicas entre medicamentos administrados através da via intravenosa em pacientes internados no Centro de Tratamento Intensivo (CTI) do Hospital de Clínicas de Porto Alegre (HCPA), observar a possibilidade de orientações farmacêuticas para a administração dos medicamentos incompatíveis. Métodos: Estudo transversal, no qual foram avaliadas as prescrições de Março a Maio de 2010, a partir dos prontuários eletrônicos, verificando a ocorrência de incompatibilidades medicamentosas entre as formas farmacêuticas intravenosas. Foi realizada uma intervenção farmacêutica por meio de orientações quanto à administração dos medicamentos identificados como incompatíveis. Resultados: Foram analisadas 65 prescrições médicas, destas 51 apresentaram incompatibilidade entre os medicamentos. A média de medicamentos intravenosos foi de sete (DP±1,6) por prescrição. Foram identificadas 177 incompatibilidades entre 35 medicamentos diferentes, que levaram a 71 possibilidades de interação. Os medicamentos mais envolvidos nas incompatibilidades foram o Midazolam (18,1%) e a Insulina (10,5%). As incompatibilidades mais encontradas foram entre Midazolam e Piperacilina+Tazobactam (9,6%) e entre Insulina e Noradrenalina (7,9%). Das 51 prescrições que geraram orientação farmacêutica, 13 destas puderam ser realizadas pela equipe de enfermagem. Conclusão: As incompatibilidades medicamentosas podem ser identificadas e evitadas com a presença do farmacêutico na unidade de internação, diminuindo a ocorrência de efeitos indesejáveis ao paciente.
Background: Drug incompatibilities are considered medication errors and their result may affect the effectiveness and safety of treatment. Knowing the reasons for drug incompatibilities can help prevent their occurrence, thus reducing their risks. Aims: To identify and quantify physical-chemical incompatibilities between medications administered intravenously to patients admitted to the Intensive Care Unit (ICU) of Hospital das Clínicas of Porto Alegre (HCPA), and to observe the possibility of pharmaceutical instructions for the administration of incompatible drugs. Methods: Cross-sectional study in which prescriptions from March to May 2010 were evaluated using electronic medical charts, verifying the occurrence of medication incompatibilities between intravenous pharmaceutical forms. A pharmaceutical intervention was conducted using instructions for the administration of those medications identified as incompatible. Results: Sixty-five medical prescriptions were analyzed, 51 of which with incompatibility between drugs. The mean number of intravenous medications was seven (SD±1.6) per prescription. A total of 177 incompatibilities were identified among 35 different drugs, which led to 71 possibilities of interaction. The drugs most often involved in incompatibilities were midazolam (18.1%) and insulin (10.5%). The most common incompatibilities found were between midazolam and piperacillin + tazobactam (9.6%) and between insulin and noradrenalin (7.9%). Of the 51 prescriptions that generated pharmaceutical instructions, 13 could be performed by the nursing team. Conclusion: Drug incompatibilities can be identified and avoided with the presence of the pharmacist at hospital admission units, reducing the occurrence of undesirable effects on patients.
Assuntos
Humanos , Adulto , Incompatibilidade de Medicamentos , Infusões Intravenosas , Injeções Intravenosas , Estudos Transversais , Combinação de Medicamentos , Erros de Medicação/prevenção & controle , Serviço de Farmácia Hospitalar/normasRESUMO
This study aimed to investigate the social representations of professionals included in the team of Family Health Strategy (physicians, nurses and dentists) respecting the action possibilities and contributions of the pharmacist for the basic care, and based on social psychology and, particularly, on the theory of social representations. The epistemological basis of the research is qualitative, and the data were collected by means of individual semi-structured interviews, which were submitted to analysis of categorical thematic content. Apparently, the majority of professionals already inserted in the team know and recognize the importance of professional pharmacists in the basic care, as well as their potential contribution to this topic. The representations were constructed according to the following parameters: a) the study object and the intervention area, b) the individual practice of every professional and c) his/her action in specific cases. The quality of the professional or personal experience concerning the action of these professionals has contributed for the knowledge about the possibilities of pharmacists' intervention in basic care.
Este estudo teve por objetivo investigar as representações sociais dos profissionais incluídos na equipe de Estratégia em Saúde da Família (médico, enfermeiro e odontólogo), sobre as possibilidades de atuação e as contribuições do farmacêutico na atenção básica, tendo por fundamento a psicologia social e, particularmente, a teoria das representações sociais. A base epistemológica da pesquisa é qualitativa, sendo os dados coletados por meio de entrevistas individuais semi-estruturadas e analisados por meio de análise de conteúdo categorial temático. Constatou-se que a maioria dos profissionais já inseridos na equipe conhece e reconhece a importância do profissional farmacêutico na atenção básica e as suas possibilidades de contribuição. As representações foram construídas a partir dos seguintes parâmetros: a) o objeto de estudo e de intervenção da área; b) as práticas de cada um dos profissionais e c) a sua atuação em casos específicos. A qualidade da experiência profissional ou pessoal acerca da atuação desses profissionais contribuiu para o conhecimento sobre as possibilidades de intervenção do farmacêutico na atenção básica.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Política Nacional de Assistência Farmacêutica , Assistência Farmacêutica , Farmacêuticos , Saúde da Família , Atenção Primária à SaúdeRESUMO
No presente estudo, são relatadas as intervenções realizadas pelo serviço de farmácia junto ao corpo clínico de uma instituição pública federal, referência nacional para cirurgias de alta complexidade em ortopedia no Rio de Janeiro. Realizou-se estudo retrospectivo no qual foram analisadas as intervenções farmacêuticas realizadas entre junho de 2004 e junho de 2005. O serviço de farmácia atendeu 13,6% dos 5476 pacientes internados neste período. Dos pacientes atendidos, 30,4% necessitaram de pelo menos uma intervenção deste profissional junto ao corpo clínico em algum momento da sua internação, perfazendo um total de 227 intervenções. Os médicos foram os profissionais mais contatados (71,1%), seguidos dos enfermeiros (16,9%) e auxiliares de enfermagem (4,6%). Dos problemas detectados, 84,1% correspondiam a erros, dos quais 49,5% foram prevenidos com as intervenções. A análise dos erros encontrados nos permite sugerir alguns dos principais problemas relacionados a medicamentos apresentados pelos pacientes da instituição. Das intervenções realizadas, 70% foram aceitas, sendo este percentual de 60% para as intervenções relacionadas à prescrição. Os resultados sugerem que as intervenções farmacêuticas foram ferramentas efetivas para a prevenção de eventos adversos, reforçando a importância da assistência farmacêutica para a qualidade da assistência hospitalar.
In the present study, we describe the pharmaceutical interventions performed by the pharmacy service of a publicorthopaedic hospital at Rio de Janeiro, Brazil. In a retrospective study, we analysed the pharmaceutical interventions performed during a year (from june 2004 to june 2005). The pharmacy service assisted 13.6% of the5476 patients that were submitted to internation. In 30.4 % of the patients that were directly assisted by the pharmacist was identified the necessity of pharmaceutical interventions, reaching 227 interventions during the period of the study. The physicians were the most requested professionals (71.1%), followed by nurses 16.9%. Eighty four percent of the problems that were detected were related to potential medication errors. Forty nine percent of these errors were prevented by the pharmacists. It was possible to predict some of the potential drug related problems that could be related to these patients as well. Seventy percent of the pharmaceutical interventions were accepted by the professionals. For the interventions related to prescription,sixty percent were accepted. The results suggest that pharmaceutical interventions were effective to prevent drug adverse events, reinforcing the important role of pharmacists in hospital assistance.