Application and utility of geographic information systems in pharmacy specific health research: A scoping review.

BACKGROUND: Geographic Information Systems (GIS) are considered essential tools to analyze spatially referenced health data. OBJECTIVES: The purpose of this scoping review is to describe how GIS is used in pharmacy specific health research. METHODS: During July 2020, the following databases were searched: EMBASE, MEDLINE (PubMed), Web of Science and Scopus. The search strategy included terms relating to spatial analysis and pharmacy. Studies were considered eligible if they involved the use of GIS and focused on pharmacies. A narrative and tabular synthesis of the results was carried out, structured around the spatial analysis methods utilized across studies, as well as the characteristics of pharmacies evaluated in studies. RESULTS: After a review of 6967 sources, 48 studies were included in this review. Twenty-nine studies were conducted in the United States (60.4%) and thirty-six focused on accessibility (75.0%; n = 36). Twenty-two studies investigated the relationship between sociodemographic aspects of the population and the accessibility and availability of pharmacies (45.8%). Twelve studies (25.0%) performed distance analysis and six studies (12.5%) performed geostatistical analysis. Community pharmacies were the setting evaluated most frequently, with over-the-counter selling products being the most evaluated pharmacy variable (13.3%; n = 6). Population density (58.3%; n = 28), income indicators (43.8%; n = 21) and minority community composition rates (41.7%; n = 20) were the most used population variables. CONCLUSIONS: GIS have been increasingly used in pharmacy specific health research. Generally, research has sought to identify potential barriers to access and their effects on the population. Future research may benefit by utilizing robust spatial methods and applications across countries outside of the United States. Doing so could help to confirm the impact of sociodemographic characteristics on the availability and/or accessibility of pharmacies globally.

Direct cost of systemic arterial hypertension and its complications in the circulatory system from the perspective of the Brazilian public health system in 2019.

INTRODUCTION: Systemic arterial hypertension (SAH), a global public health problem and the primary risk factor for cardiovascular diseases, has a significant financial impact on health systems. In Brazil, the prevalence of SAH is 23.7%, which caused 203,000 deaths and 3.9 million DALYs in 2015. OBJECTIVE: To estimate the cost of SAH and circulatory system diseases attributable to SAH from the perspective of the Brazilian public health system in 2019. METHODS: A prevalence-based cost-of-illness was conducted using a top-down approach. The population attributable risk (PAR) was used to estimate the proportion of circulatory system diseases attributable to SAH. The direct medical costs were obtained from official Ministry of Health of Brazil records and literature parameters, including the three levels of care (primary, secondary, and tertiary). Deterministic univariate analyses were also conducted. RESULTS: The total cost of SAH and the proportion of circulatory system diseases attributable to SAH was Int$ 581,135,374.73, varying between Int$ 501,553,022.21 and Int$ 776,183,338.06. In terms only of SAH costs at all healthcare levels (Int$ 493,776,445.89), 97.3% were incurred in primary care, especially for antihypertensive drugs provided free of charge by the Brazilian public health system (Int$ 363,888,540.14). Stroke accounted for the highest cost attributable to SAH and the third highest PAR, representing 47% of the total cost of circulatory diseases attributable to SAH. Prevalence was the parameter that most affected sensitivity analyses, accounting for 36% of all the cost variation. CONCLUSION: Our results show that the main Brazilian strategy to combat SAH was implemented in primary care, namely access to free antihypertensive drugs and multiprofessional teams, acting jointly to promote care and prevent and control SAH.

Tools to prioritize outpatients for pharmaceutical service: A scoping review.

BACKGROUND: The performance of pharmacists in clinical services contributes to improving outcomes in patient drug therapy. In the context of streamlined resources and high health services' demand, the use of patient selection tools can screen those who would benefit more from a pharmaceutical service. OBJECTIVE: This review aims to map and describe tools developed for patient selection for pharmaceutical services delivered in primary health care and outpatient settings. METHODS: The search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Health Sciences. The search strategy included terms relating to patient selection and outpatient pharmaceutical service. We included papers on outpatient settings, and which described the tool developed for the selection of a patient for pharmaceutical service. Two reviewers extracted data of each study concerning the types and items making up the tool. The items composing the tools were grouped into categories. RESULTS: Twelve studies were included in the literature. Most of the studies were developed in the United States (53.8%), followed by Canada (30.8%). Approximately half of the studies developed tools for selecting patients for a medication review (46.2%), and only 15.4% for drug therapy management. Identification of patients at risk of drug-related problems, the need for pharmaceutical service follow-up, and patients at risk of hospital readmission were the main objective to develop the tools. In total, 92.3% of the developed tools had items related to drug therapy complexity, 76.9% to comorbidities and 61.5% to adherence/subjective aspects. Statistical methods were employed to evaluate the validation parameters, such as the ROC curve and internal consistency. CONCLUSIONS: Few studies that developed tools to select outpatients for pharmaceutical services were found. However, many tools showed unsatisfactory validation parameters. Thus, it is necessary to improve the development of instruments that can identify patients who would benefit from the pharmaceutical service accurately.

Pharmacist-led medication reconciliation at patient discharge: A scoping review.

BACKGROUND: One of the strategies to promote patient safety in care transitions is medication reconciliation (MR), which is conducted by the pharmacist at the patient's discharge from hospital. However, there are divergences about this process and about the pharmacist's role in conducting such intervention. OBJECTIVE: To systematically review the literature that reports the MR process led by pharmacists at patient discharge and map the different methods, strategies and tools used in the process. METHODS: Relevant studies were searched in the following databases: EMBASE, MEDLINE (PubMed), The Cochrane Library, and LILACS. No language restriction or publication date was applied. The studies considered eligible were those involving and describing pharmacist-led MR processes at acute patient discharge from hospital, with an experimental, quasi-experimental, or observational design. The characteristics of the studies and the MR processes were identified and then a qualitative synthesis was performed. RESULTS: Fifty studies were included. The majority of them were observational ones (82%), and the main outcome was medication discrepancies (42%). The studies were mostly conducted in university hospitals (70%) and in internal medicine wards (54%). Pharmacists were responsible mainly for gathering medication histories (72%), and identifying (96%) and solving (98%) pharmacotherapeutic problems. The main sources of information on pre-admission medications were patient/caregiver interviews (66%) and records from other care providers (40%). Only 30% of the studies described a patient discharge plan, and 14% shared information of the patient's pharmacotherapy with community pharmacists. CONCLUSION: The concept of MR and the pharmacist-led activities in the process varied in the literature, as well as the pharmacotherapy assessment focus and the communication strategies towards patients and other care providers, showing that standardization of the process and concepts is necessary.

Comparative Effectiveness and Safety of Monoclonal Antibodies (Bevacizumab, Cetuximab, and Panitumumab) in Combination with Chemotherapy for Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND: The last decade has seen the increasing use of biological medicines in combination with chemotherapy containing 5-fluorouracil/oxaliplatin or irinotecan for the treatment of metastatic colorectal cancer (mCRC). These combinations have resulted in increased progression-free survival (PFS) in patients with mCRC; however, there are remaining concerns over the extent of their effect on overall survival (OS). Published studies to date suggest no major differences between the three currently available monoclonal antibodies (MoAbs); however, there are differences in costs. In addition, there is rising litigation in Brazil in order to access these medicines as they are currently not reimbursed. OBJECTIVE: The aim was to investigate the comparative effectiveness and safety of three MoAbs (bevacizumab, cetuximab and panitumumab) associated with fluoropyrimidine-based chemotherapy regimens and compared to fluoropyrimidine-based chemotherapy alone in patients with mCRC, through an updated systematic review and meta-analysis of concurrent or non-concurrent observational cohort studies, to guide authorities and the judiciary. METHOD: A systematic review and meta-analysis was performed based on cohort studies published in databases up to November 2017. Effectiveness measures included OS, PFS, post-progression survival (PPS), Response Evaluation Criteria In Solid Tumors (RECIST), response rate, metastasectomy and safety. The methodological quality of the studies was also evaluated. RESULTS: A total of 21 observational cohort studies were included. There were statistically significant and clinically relevant benefits in patients treated with bevacizumab versus no bevacizumab mainly around OS, PFS, PPS and the metastasectomy rate, but not for the disease control rates. However, there was an increase in treatment-related toxicities and concerns with the heterogeneity of the studies. CONCLUSION: The results pointed to an advantage in favor of bevacizumab for OS, PFS, PPS, and metastasectomy. Although this advantage may be considered clinically modest, bevacizumab represents a hope for increased survival and a chance of metastasectomy for patients with mCRC. However, there are serious adverse events associated with its use, especially severe hypertension and gastrointestinal perforation, that need to be considered.

Evidências clínicas da adesão medicamentosa de pacientes dialíticos crônicos / Clinical evidence of medicinal adhession of chronic dialysis patients

Objetivo: avaliar a adesão ao tratamento farmacológico dos medicamentos elencados pelo componente especializado da assistência farmacêutica, utilizando evidências clínicas, em pacientes hemodialíticos com doença renal crônica. Método: trata-se de um estudo quantitativo, transversal, com população de 275 pacientes em hemodiálise, idade superior a 18 anos e em tratamento hemodialítico há mais de um ano. Respondeu-se, pelos participantes, a questionários validados durante a sua sessão de hemodiálise. Tabularamse e analisaram-se dos dados nos softwares Epidata 3.1 e SPSS 21.0, e se apresentam em forma de tabela. Resultados: revela-se que cerca de 41,7% dos pacientes aderiram ao tratamento, sendo o predomínio de adesão entre os pacientes que consideraram possuir bom estado de saúde. Apresentaram-se, por pacientes não aderentes ao tratamento farmacológico, níveis fosfóricos significativamente maiores (5,1mg/dL) e houve correlação estatisticamente significativa entre a maior complexidade da terapia do cloridrato de sevelâmer com a menor adesão. Conclusão: geraram-se evidências clínicas no trabalho que servem de suporte a gestores e a profissionais na promoção da saúde desta população.(AU)

Potential drug interactions in prescribed and nonprescribed medicinal products for hemodialytic patients / Interações medicamentosas potenciais em medicamentos prescritos e não prescritos para pacientes hemodialíticos

The treatment of Chronic Kidney Disease (CKD) requires the use of a large quantity of drugs, a factor related to the increased possibility of detection of Potential Drug Interactions (PDI), which can occur more frequently when it involves the practice of self-medication. This study was conducted with the objective of evaluating the PDI in the drug treatments of patients with CKD on hemodialysis. This was a cross-sectional study with 170 chronic kidney disease patients in a private hemodialysis clinic, from March to May 2015; the analysis of the PDI was done through the Micromedex database version 2.0. A total of 604 PDIs were detected in 74.7% of the study population, of which 501 were among the prescribed drugs, 85 among prescribed and non-prescribed, and 18 among non-prescribed drugs (used for self-medication). There was a predominance of PDI in the male sex (63.1%), under the age of 60 years (72.5%), and with a hemodialysis time of less than 5 years (55.5%). Logistic regression analyses have shown that patients who use five or more drugs are 243 times more likely to have a PDI (OR=243.206; CI=95%) than those who use less than 5 medications. The number of PDIs detected in this study was directly related to the number of drugs used by patients with CKD, showing a potential causal factor between polypharmacy and drug interactions (DI), and selfmedication, at the same time, may have influenced this result. The knowledge of this PDI profile, calls more attention of the professionals that accompany the pharmacotherapeutic treatment of these patients

O tratamento da Doença Renal Crônica (DRC) demanda grande quantidade de medicamentos, que pode aumentar a possibilidade de Interações Medicamentosas Potenciais (IMP), as quais podem ser encontradas com maior frequência quando se envolve a prática de automedicação. O estudo teve o objetivo avaliar as interações medicamentosas potenciais no tratamento farmacoterapêutico de pacientes portadores de Doença Renal Crônica hemodialíticos. Estudo transversal, com aplicação de formulário a 170 pacientes renais crônicos em uma clínica privada de hemodiálise, no período de março a maio de 2015; a análise das IMP foi feita através da base de dados Micromedex versão 2.0. Foram detectadas 604 IMP ao todo, em 74,7% da população do estudo, sendo 501 IMP entre os medicamentos prescritos, 85 entre os prescritos e não prescritos, e 18 entre os não prescritos (usados por automedicação). Houve predominância de IMP no sexo masculino (63,1%), em idade menor do que 60 anos (72,5%), e com tempo de hemodiálise menor do que 5 anos (55,5%). A análise de regressão logística demostrou que pacientes que usam cinco medicamentos ou mais têm 243 vezes mais chance de ter uma IMP (OR = 243,206, IC=95%) do que aqueles que usam menos de 5 medicamentos. O número de IMP detectadas neste estudo esteve diretamente relacionado ao número de medicamentos utilizados pelos portadores de DRC, mostrando um potencial fator causal entre a polifarmácia e IM, podendo a automedicação, concomitantemente, ter influenciado neste resultado. O conhecimento deste perfil de IMP, direciona maior atenção dos profissionais que acompanham o tratamento farmacoterapêutico destes pacientes

Influência da capacidade para o trabalho na qualidade de vida de bombeiros militares / Influencia de la capacidad laboral en la calidad de vida de bomberos militares / Influence of work ability on the quality of life of military firefighters

RESUMO: Objetivo: avaliar a influência da capacidade para o trabalho na qualidade de vida de bombeiros militares. Método: estudo censitário de base populacional do tipo transversal, realizado de janeiro a março de 2015, com 101 bombeiros do Grupamento de Bombeiros Militares de municípios da região Sul e Sudoeste da Bahia. Foram utilizados no estudo instrumentos autoaplicáveis para avaliar as características sociodemográficas e laborais, qualidade de vida e capacidade para o trabalho. Resultado: constatou-se que os bombeiros militares com menor ou igual a cinco anos de serviço obtiveram melhores percepções de qualidade de vida nos domínios físico e relações sociais. Quanto à capacidade para o trabalho, observou-se que os trabalhadores com boa e ótima capacidade obtiveram melhores percepções nos domínios físico, psicológico, social e meio ambiente. Conclusão: os resultados podem auxiliar nas intervenções e melhorias nas condições de trabalho de profissionais de resgate como bombeiros, enfermeiros e médicos.

RESUMEN: Objetivo: Evaluar la influencia de la capacidad laboral en la calidad de vida de bomberos militares. Método: Estudio censario de base poblacional, tipo transversal, realizado de enero a marzo de 2015 con 101 bomberos del Cuartel de Bomberos Militares de municipios del sur y sureste de Bahia. Fueron utilizados instrumentos autoaplicables para evaluar características sociodemográficas y laborales, calidad de vida y capacidad laboral. Resultado: Se constató que los bomberos militares con cinco años o menos de servicio mostraron mejores percepciones de calidad de vida en los dominios físico y relaciones sociales. Respecto a la capacidad laboral, se observó que los trabajadores con buena y óptima capacidad mostraron mejores percepciones en los dominios físico, psicológico, social y medio ambiente. Conclusión: Los resultados pueden colaborar en intervenciones y mejoras de las condiciones de trabajo de los profesionales de rescate, como bomberos, enfermeros y médicos.

ABSTRACT: Objective: to evaluate the influence of the work ability on the quality of life of military firefighters. Method: a cross-sectional, population-based, census study, conducted from January to March 2015, with 101 firefighters from the Military Fire Brigade Group of municipalities in the South and Southwest of Bahia. Self-report instruments were used in the study to evaluate the sociodemographic and work characteristics, quality of life and work ability. Results: it was found that military firefighters with five years or less of service obtained better perceptions of quality of life in the physical and social relationships domains. Regarding the work ability, it was observed that workers with good and very good ability obtained better perceptions in the physical, psychological, social relationships and environment domains. Conclusion: the results can support interventions and improvements in the working conditions of rescue professionals such as firefighters, nurses and physicians.

Erros de prescrição e administração envolvendo um medicamento potencialmente perigoso / Prescription and administration errors involving a potentially dangerous medicine

Objetivo: identificar os principais erros de prescrição e administração de enoxaparina. Método: estudo transversal, de abordagem quantitativa. Observação de todos os técnicos de enfermagem do serviço diurno da unidade de terapia intensiva, clínica médica e cirúrgica em administrações de enoxaparina e suas respectivas prescrições, conforme o cálculo amostral. Na administração foi utilizada técnica de observação direta e na prescrição checklist do protocolo de prescrição uso e administração de medicamentos. Os softwares EpiData3.1 e SPSS 21.0 auxiliaram na tabulação e análise dos dados, apresentados em tabelas. Resultados: foram analisadas 175 prescrições e administrações. Os principais erros de prescrição foram idade incorreta do paciente e ausência da duração do tratamento. Para os erros de administração, identificou-se dose administrada incorreta, ausência da identificação do paciente no leito, técnica incorreta de administração e horário incorreto. Conclusão: foram demonstrados pontos de fragilidades que levam a erros de medicação, sendo necessário o aperfeiçoamento do sistema de prescrição e administração.