RESUMO

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.

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.

RESUMO

Smoking is the main preventable cause of illness and early death worldwide. Thus, it is better to promote smoking cessation than to treat tobacco-related diseases. The objective of this study was to assess the implementation and effectiveness of smoking cessation pharmaceutical services offered in primary health care (PHC) in a large Brazilian city through a type 1 effectiveness-implementation hybrid study. The services were offered through individual or group approaches (Jan/2018-Dec/2019). The service indicators were described and the incidence of cessation in the services was evaluated. Factors associated with cessation were assessed by Poisson regression analysis. The services were offered in most PHC centers (61.2%) and by most pharmacists (81.3%). In total, 170 individual (9.7%) and 1591 group (90.3%) approaches occurred, leading to cessation in 39.4% (n = 67) and 44.8% (n = 712) of these, respectively. The use of nicotine plus antidepressants (RR = 1.30; 95%CI = 1.08-1.57; p = 0.006) and the number of sessions with pharmacists (RR = 1.21; 95%CI = 1.19-1.23; p < 0.001) were positively associated with cessation; a very high level of dependence was negatively associated (RR = 0.77; 95%CI = 0.67-0.89; p = 0.001). The smoking cessation services were effective and should be encouraged.

Assuntos

RESUMO

OBJECTIVE: To determine the frequency of drug therapy problems among older adults in Primary Health Care, and to analyze the factors associated with their identification in the initial patient assessment, carried out by pharmacists offering medication therapy management services. METHODS: A cross-sectional study conducted with data from 758 older adults followed up in medication therapy management services in Primary Health Care in the cities of Belo Horizonte, Betim, and Lagoa Santa (MG, Brazil). Univariate and multivariate analyses were performed to evaluate the factors associated with identification of four or more drug therapy problems in the initial clinical assessment. RESULTS: A total of 1,683 drug therapy problems were identified, 73.6% of older patients had at least one problem. The most frequent problems were nonadherence (23.0%) and the need for additional drug therapy (18.0%). Polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and aged 75 years or older remained positively and statistically associated with identification of four or more drug therapy problems (p<0.05). CONCLUSION: There is a high frequency of problems related to medication use among older users of Primary Health Care, and the medication therapy management services should be prioritized to the older patients, who present with polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and age ≥ 75 years, since they are more likely to have more drug therapy problems.

Assuntos

RESUMO

Objective: to describe the implementation and to assess the effectiveness of a pilot integrated qualification program to improve the medication use in a long-term care facility (LTCF). Methods: This was a type 1 hybrid effectiveness-implementation study. A pilot integrated qualification program to improve the medication use in a LTCF was carried out by implementing a new drug distribution system and a comprehensive medication management (CMM) service according to the following four steps: I) implementation of the drug distribution system followed by the evaluation of the health team's opinion; II) prescription review with the identification of potential drug therapy problems (PDTPs); III) provision of the CMM service according to the framework of Pharmaceutical Care practice within one year; and, IV) evaluation of the effectiveness of the program through the comparison of clinical and laboratory parameters (blood pressure, glycated hemoglobin and lipid fractions) using the t-test or Wilcoxon signed-rank test. Results: In step I, the distribution system was fully outsourced to a company that furnished all solid oral dosage forms in individual boxes containing a plastic coil with multiple envelopes for 30 days. In step II, 180 PDTPs were identified, and all patients presented with at least one of them. In step III, after the first assessment of the CMM Service, 43 actual drug therapy problems (DTPs) were identified. After one year of service provision, 96 DTPs were identified and 75.8% of them were resolved (n=72). In step IV, a statistically significant difference was observed between the initial and final minimum and maximum systolic and diastolic blood pressure (p<0,05). Conclusions: The pilot integrated qualification program had a positive impact on the clinical parameters. The global population is rapidly aging, making this type of study important to exemplify a multifaceted strategy to improve the quality of drug therapy for institutionalized patients.