RESUMO
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.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Serviço de Farmácia Hospitalar , Médicos , Brasil , Humanos , Farmacêuticos , Encaminhamento e ConsultaRESUMO
Resumo A epidemiologia desempenha um papel estratégico neste estágio do ciclo de política, contribuindo para o estabelecimento de metas, alocação de recursos e uso de sistemas de informação. Em 2009, a Secretaria Municipal de Saúde do Rio de Janeiro iniciou uma reforma do modelo de atenção, utilizando como principal influência o conceito de Atenção Primária em Saúde. Este estudo avalia a tendência de indicadores selecionados do "pay-for-performance" que mensuram o processo de cuidado em saúde na APS da cidade. Estudo de painéis repetidos, a partir dos registros administrativos e clínicos dos prontuários eletrônicos no período de 2012 a 2016. Foram escolhidos sete indicadores que analisaram o desempenho longitudinal dentro da meta estabelecida, entre aqueles que representam acesso, longitudinalidade, coordenação do cuidado - atributos da APS, assim como outras características dos serviços como desempenho assistencial e eficiência econômica. Este estudo demonstrou que a descentralização da gestão para níveis mais próximos do usuário é potencialmente exitoso para o registro de dados clínicos, caso seja realizado um adequado monitoramento dos indicadores, auditorias clínicas frequentes e realizado periodicamente um "feedback" aos profissionais de saúde com os dados e indicadores acompanhados.
Abstract Epidemiology plays a strategic role at this stage of the policy cycle, contributing to goal setting, resource allocation and use of information systems. In 2009, the Municipal Health Secretariat of Rio de Janeiro initiated a reform of the health care model under the main influence the Primary Health Care concept. This study evaluates the trend of selected pay-for-performance indicators that measure the health care process in the city's PHC. This a study on repeated panels, from the administrative and clinical records of electronic medical records in the period from 2012 to 2016. We selected seven indicators that analyzed longitudinal performance within the established goal, among those that represent access, longitudinality, coordination of care - APS attributes, as well as other characteristics of the services, such as care performance and economic efficiency. This study demonstrated that management decentralization to levels closer to the user is potentially successful for the recording of clinical data under an adequate monitoring of indicators, regular clinical audits and feedback to health professionals, along with data and indicators monitoring.
Assuntos
Humanos , Atenção Primária à Saúde/organização & administração , Reembolso de Incentivo , Atenção à Saúde/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/economia , Brasil , Métodos Epidemiológicos , Cidades , Pessoal de Saúde/organização & administração , Reforma dos Serviços de Saúde , Atenção à Saúde/economia , Alocação de Recursos , Acessibilidade aos Serviços de SaúdeRESUMO
BACKGROUND: A clinical registry encompasses a selective set of rigorously collected and stored clinical data focused on a specific condition. Hyponatremia has multiple, complex underlying causes and is one of the most frequent laboratory abnormalities. No systematic registries of hyponatremic patients have been reported in the medical literature. The purpose of this project was to create a registry for hyponatremia in order to obtain epidemiological data that will help to better understand this condition. OBJECTIVE: This paper describes the creation of a registry for hyponatremia within a single institution that employs industry-based approaches for quality management to optimize data accuracy and completeness. METHODS: A prospective registry of incident hyponatremia cases was created for this study. A formalized statistically based quality control methodology was developed and implemented to analyze and monitor all the process indicators that were developed to ensure data quality. RESULTS: Between December 2006 and April 2009, 2443 episodes of hyponatremia were included. Six process indicators that reflect the integrity of the system were evaluated monthly, looking for variation that would suggest systematic problems. The graphical representation of the process measures through control charts allowed us to identify and subsequently address problems with maintaining the registry. CONCLUSION: In this project we have created a novel hyponatremia registry. To ensure the quality of the data in this registry we have implemented a quality control methodology based on industrial principles that allows us to monitor the performance of the registry over time through process indicators in order to detect systematic problems. We postulate that this approach could be reproduced for other registries.