Implementation and Effectiveness of a Pharmacotherapeutic Follow-Up Service for People with Tuberculosis in Primary Healthcare.

Tuberculosis (TB) is a disease of great relevance, responsible for 1.5 million deaths worldwide. Therefore, actions to control TB are necessary, and pharmacists may play an important role, especially in primary healthcare (PHC), where the diagnosis and management of this infection occurs. In a large Brazilian city, pharmacotherapeutic follow-up in PHC has been offered by pharmacists to people with TB since 2018. The objective of this study was to evaluate the implementation and effectiveness of this service though a longitudinal type 1 effectiveness-implementation hybrid study. Data were collected from January 2018 to February 2020 in the pharmaceutical services system. The service indicators were described and effectiveness was evaluated using Poisson regression analysis to compare the incidence of cure among patients using and not using the service. The service was performed in 148 PHC units by 82 pharmacists. Of the total of 1076 treatments, 721 were followed up by pharmacists, and TB was cured more frequently in these cases (90.4% attended vs. 73.5% unattended). The adjusted hazard ratio of cure among patients enrolled in the pharmacotherapeutic follow-up service was 2.71 (2.04-3.61; p < 0.001). Pharmacotherapeutic follow-up for people with TB significantly increased the incidence of cure and should be encouraged.

Assessment of Pharmaceutical Services for Smoking Cessation: An Effectiveness-Implementation Hybrid Study.

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.