[Indicators for drug selection in health systems: an integrative review]. / Indicadores da seleção de medicamentos em sistemas de saúde: uma revisão integrativa.

OBJECTIVE: To produce a panel of the main drug selection indicators by performing an integrative literature review. METHODS: After the elaboration of a review protocol, searches were conducted in LILACS, MEDLINE, Embase, and SciELO databases. The following search terms were used: "indicators"; "criteria"; "drug selection"; "pharmacy and therapeutics committee"; and "medication form"; with the applicable variations in English and Spanish. Sixteen original articles published between January 1996 and March 2012 were retrieved and reviewed to compose a panel of indicators. RESULTS: Forty-five quantitative and qualitative indicators were identified. These indicators were grouped according to conceptual similarities in three categories: 1) assessment of pharmacy and therapeutics committee structure; 2) evaluation of the general processes of drug selection; and 3) evaluation of the results of drug selection. CONCLUSIONS: The indicators identified reveal relative uniformity in the established patterns for drug selection. The group of indicators established in this study should serve as reference for the development and consolidation of drug selection in public health services.

The Pharmacoeconomic Impact of Pharmaceutical Care in the Hospital: Protocol for an Overview of Systematic Reviews.

BACKGROUND: The clinical activities developed by pharmacists in a hospital environment can improve health outcomes and generate savings for hospitals. However, to determine whether pharmaceutical interventions are cost effective, it is essential to define a method according to which cost-effectiveness is intended to be measured. In addition, the quality of economic assessments and the amount of information present in systematic reviews in the literature make it difficult to analyze the effects of this intervention. OBJECTIVE: This paper aims to provide an overview of systematic reviews on the pharmacoeconomic impact of the performance of pharmaceutical care in hospitals. METHODS: A systematic search of the Cochrane Library databases, PubMed or MEDLINE, LILACS, Scopus, Web of Science, Google Scholar, and Open Thesis will be performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search will involve the use of keywords determined using the Medical Subject Headings database to define the search terms and include the following terms: "pharmacoeconomics," "pharmaceutical care," and "hospital." The study designs to be included will be systematic reviews of good quality. Studies will be included that address pharmacoeconomics; studies that evaluated pharmaceutical care in hospitals; and studies published in Portuguese, English, or Spanish. The primary outcome sought in the systematic reviews will be the cost ratio in monetary units and the outcomes in monetary or natural units. The secondary economic outcomes considered will be determined based on factors associated with the drugs and translated into benefit, efficacy, or utility. RESULTS: It is intended to start this overview in January 2023. Thus far, only previous searches have been carried out to contextualize the theme and build the protocol. CONCLUSIONS: This overview will determine the pharmacoeconomic impact of pharmaceutical care interventions in the hospital environment. In addition, this study will point out which clinical outcomes in natural units are impacted by the performance of pharmaceutical care and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work. TRIAL REGISTRATION: PROSPERO CRD42019140665; https://tinyurl.com/bddwnz43.

Quality indicators of hospitalized children influenced by clinical pharmacist services: A systematic review.

BACKGROUND: Care for children who are hospitalized can be optimized if the pharmacist, in conjunction with the multidisciplinary team, promotes the rational use of medicines. In this sense, the evaluation of the quality of these clinical services through indicators is important in the planning, decision making of pharmacists and managers of these services. OBJECTIVE: To characterize which health indicators were influenced by the pharmaceutical clinical services for the care of children in hospitals. METHODS: A systematic review was performed. The search for data was made on the bases: Cochrane, Embase, Lilacs, Pubmed and Web of Science. Then, the search included studies in which evaluated the impact of pharmaceutical clinical services on clinical, economic and humanistic outcomes. RESULTS: The search resulted in 11 included studies. In this review, four pharmaceutical clinical services were found: pharmacotherapy review, multiprofessional team interventions, antimicrobial stewardship program and pharmaceutical services at discharge hospital. The most influenced outcome indicators were length of hospital stay, with average time in the group that received the pharmacotherapy review service, and interventions multiprofessional team with a 6.45-day vs. 10.83 days in the control group; hospital readmissions with a significant reduction of non-scheduled readmission of 30 days in the ntimicrobial stewardship program; reduction of hospital costs and caregiver satisfaction. CONCLUSION: In this study, we can highlight that pharmacotherapy review, multiprofessional team interventions and Antimicrobial Stewardship Program that significantly reduced the clinical results of length of hospital stay and hospital readmission, as well as a significant reduction of hospital costs.

Harm Prevalence Due to Medication Errors Involving High-Alert Medications: A Systematic Review.

OBJECTIVE: The aim of the study was to determine the prevalence and main types of harm caused by high-alert medication after medication errors (MEs) in hospitals. METHOD: A literature systematic review was conducted on PubMed, Scopus, Web of Science, and Lilacs. Eligible studies published until June 2017 were included. RESULT: Of 6244 studies identified through searching four electronic databases, five studies meeting the selection criteria of this study were analyzed. There was wide variation in the overall prevalence of harm due to MEs involving HAM, from 3.8% to 100%, whereas the pooled prevalence was 16.3%. Overall, 0.01% of harm caused by MEs involving HAM resulted in death. The severity of errors ranged from 0.1% to 19.2% for moderate errors, 0.2% to 15.4% for serious errors, and 1.9% lethal to the patients. The highest prevalences of harm occurred after errors involving potassium chloride 15%, insulin, and epoprostenol. The lowest prevalence of harm was related to errors of anticoagulants administration. The methodological heterogeneity limited direct comparisons among the studies. CONCLUSIONS: Of the 15 drugs on the list of Institute for Safe Medication Practices HAMs in the United States and Brazil, nine did not present scientific evidence of the potential for harm. In general, few studies, characterized by methodological and conceptual heterogeneity, were performed to determine the harm prevalence resulting from errors involving these drugs.

Brazilian pediatricians' adherence to food allergy guidelines-A cross-sectional study.

Food allergy is an emerging clinical condition in pediatrics, so recommendations on its management have been widely published. Studying pediatricians' adherence to these clinical practice guidelines (CPG) and understanding the reasons for their non-compliance can help to promote better management of this condition. A cross-sectional study was conducted by a survey among Brazilian pediatricians, randomly selected during the 38th Brazilian Congress of Pediatrics, which took place in October, 2017. A validated questionnaire with 16 questions addressing knowledge and practice on food allergy, as well as self-reported adherence to international guidelines was applied. Of the total of 415 pediatricians from all regions of the country who were surveyed, only 69 (16.7%) had a satisfactory adherence rate (≥80%). Adequate adherence to the guidelines was associated with the variables: 'evaluating more than 10 children with suspected cow's milk allergy (CMA) per month'; 'having read the Brazilian consensus'; or 'being aware of any international food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence, a minority of those surveyed (20.3-42.3% variation) stated that they knew that their response was in line with the guidelines. This finding was statistically significant (p<0.05) in 7 of these 8 questions. The self-reported adherence of Brazilian pediatricians to international food allergy guidelines was low. Pediatricians who evaluated a higher number of children with suspected CMA or who were aware of the recommendations, had a higher rate of adherence. The results of the survey found that lack of resource was the major reported barrier to guideline adherence but lack of awareness must be a relevant non perceived barrier. This study shows the pediatricians´ self-reported adherence to food allergy guidelines in a widely overview for the first time in Brazil. More studies are necessary to investigate adherence to guidelines by pediatricians in other countries and to develop strategies to improve adherence.

Effect of pharmacotherapy on fibromyalgia: an overview of systematic reviews / Efeito da farmacoterapia na fibromialgia: uma overview de revisões sistemáticas

Fibromyalgia is a debilitating and chronic pain processing disorder, in which the proportion of patients who achieve good results with pharmacotherapy is small. However, choosing the best available evidence on pharmacotherapy can optimize patient clinical outcomes. Objective: This overview aimed to identify in systematic reviews the effects of pharmacotherapy on fibromyalgia, considering the quality of the reviews and the efficacy of the outcomes. Methods: This search was performed in seven databases: PubMed, Web of Science, COCHRANE, Lilacs, Embase, Scopus and IPA. The methodological quality was evaluated using A MeaSurement Tool to Assess Systematic Reviews 2. The protocol was registered in the PROSPERO database (CRD42018095943). Results: A total of 63 systematic reviews were selected after reading full texts, but only 8 of them were of moderate to high quality and were included in this overview. All included reviews were published in English, between 2012 and 2018, performed meta-analysis, used the American College of Rheumatology (1990) diagnostic criteria for fibromyalgia, and jointly assessed pain improvement, adverse reactions, and withdrawal. Most reviews included only randomized controlled trials. Of the fourteen drugs addressed in systematic reviews evaluated, duloxetine, milnacipran, and pregabalin showed evidence of improvement in pain (Moderate: ≤30%) and other fibromyalgia symptoms, as depression and fatigue. However, these medications presented significant withdrawals due to adverse reactions (mainly nausea, headache, dizziness and constipation). The rate of treatment withdrawal reached 36%. Conclusion: Few studies have high quality and sufficient evidence on the effect of medicines on fibromyalgia, resulting in a lack of support for prescribers to choose drugs that meet criteria for need, effectiveness, safety and compliance.

Fibromialgia é um distúrbio de processamento da dor debilitante e crônico, em que a proporção de pacientes que obtêm bons resultados com a farmacoterapia é pequena. No entanto, escolher a melhor evidência disponível sobre a farmacoterapia pode otimizar os resultados clínicos do paciente. Objetivo: Esta overview teve como objetivo identificar em revisões sistemáticas os efeitos da farmacoterapia na fibromialgia, considerando a qualidade das revisões e a eficácia dos resultados. Métodos: Esta busca foi realizada em sete bases de dados: PubMed, Web of Science, COCHRANE, Lilacs, Embase, Scopus e IPA. A qualidade metodológica foi avaliada usando A MeaSurement Tool to Assess Systematic Reviews 2. O protocolo foi registrado no PROSPERO (CRD42018095943). Resultados: Um total de 63 revisões sistemáticas foram selecionadas após a leitura de textos completos, mas apenas 8 delas eram de qualidade moderada a alta e foram incluídas nesta overview. Todas as revisões incluídas foram publicadas em inglês, entre 2012 e 2018, realizaram meta-análises, utilizaram os critérios de diagnósticos do American College of Rheumatology (1990) para fibromialgia e avaliaram conjuntamente a melhora da dor, reações adversas e retiradas. A maioria das revisões incluiu apenas ensaios clínicos randomizados. Dos quatorze medicamentos abordados nas revisões sistemáticas avaliadas, duloxetina, milnaciprano e pregabalina mostraram evidências de melhora da dor (moderada: ≤30%) e de outros sintomas da fibromialgia como depressão e fadiga. No entanto, esses medicamentos apresentaram retiradas significativas devido a reações adversas (principalmente náusea, cefaleia, tontura e constipação). A taxa de abandono ao tratamento chegou a 36%. Conclusão: Poucos estudos apresentam evidências suficientes e de alta qualidade sobre o efeito dos medicamentos na fibromialgia, resultando na falta de apoio para os prescritores escolherem medicamentos que atendam aos critérios de necessidade, eficácia, segurança e adesão.

Understanding the provision of a clinical service in mental health and the role of the pharmacist: a qualitative analysis / Compreendendo a provisão de um serviço clínico na saúde mental e o papel do farmacêutico: uma análise qualitativa / Comprender la prestación de un servicio clínico en salud mental y el papel del farmacéutico: un análisis cualitativo

Pharmacists have important roles in mental health disease; however, their performance in Brazilian Psychosocial Care Centers (CAPS) is unknown. This qualitative study was conducted in a CAPS, Brazil; using interviews and analyzes from the perspective of Bardin, in which categories arising from the perceptions of patients and the health team emerged in relation to the provision of the medication review with follow up (MR) service and the role of the pharmacist in mental health. According to the participants, the MR service is essential and important because it allows professional recognition, beyond the identification of professional attributes of the pharmacists. Moreover, there was a duality in the pharmacist's role between the logistic and clinical attributes of mental health. Thus, this perception helps to elucidate the pharmacist's process of work in mental health and supports future strategies of action in this area. (AU)

Farmacêuticos têm papéis importantes na área da saúde mental; entretanto, sua atuação nos Centros de Atenção Psicossociais (CAPS) brasileiros é desconhecida. Este estudo qualitativo foi realizado em um CAPS, Brasil; utilizando-se de entrevistas e análises sob a perspectiva de Bardin, no qual categorias em relação à prestação do serviço de acompanhamento farmacoterapêutico (AFT) e ao papel do farmacêutico na saúde mental emergiram através das percepções dos pacientes e equipe de saúde. Segundo os participantes, o serviço de AFT é essencial e importante porque permite o reconhecimento profissional, além da identificação dos atributos profissionais dos farmacêuticos. Além disso, houve uma dualidade no papel do farmacêutico em relação aos atributos logísticos e clínicos na saúde mental. Assim, essas percepções ajudam a elucidar o processo de trabalho do farmacêutico em saúde mental, subsidiando futuras estratégias de ação nesta área. (AU)

Los farmacéuticos tienen un papel importante en el área de la salud mental; sin embargo, se desconoce su desempeño en los Centros de Atención Psicosocial de Brasil (CAPS). Este estudio cualitativo se llevó a cabo en un CAPS, Brasil; utilizando entrevistas y análisis desde la perspectiva de Bardin, en las que de las percepciones de los pacientes y del equipo de salud surgieron categorías en relación a la prestación del servicio de seguimento farmacoterapéutico (SFT) y el papel del farmacéutico en la salud mental. Según los participantes, el servicio de SFT es fundamental e importante. Además, existía una dualidad en el rol del farmacéutico en relación a los atributos logísticos y clínicos en salud mental. Así, estas percepciones ayudan a dilucidar el proceso de trabajo del farmacéutico en salud mental, apoyando futuras estrategias de actuación. (AU)

Instrumentos para avaliação de habilidades de comunicação no cuidado em saúde no Brasil: uma revisão de escopo / Instruments for assessing communication skills in the area of healthcare in Brazil: a scoping review / Instrumentos para evaluación de habilidades de comunicación en el cuidado de salud en Brasil: una revisión de alcance

O ensino de habilidades de comunicação é indispensável aos profissionais de saúde. Este estudo objetivou identificar instrumentos validados no português do Brasil que avaliam habilidades de comunicação de estudantes ou profissionais da saúde. Para tanto, foi realizada uma revisão de escopo que incluiu estudos de validação de instrumentos para avaliação de habilidades de comunicação de estudantes/profissionais da área da Saúde. Foram identificados quatro instrumentos, traduzidos e validados para o português do Brasil. Validação de conteúdo, validação de construto e o teste de consistência interna foram realizados com maior frequência. Esta revisão identificou um número reduzido de instrumentos para avaliar habilidades de comunicação e dados limitados de validade e confiabilidade dos instrumentos.(AU)

Teaching communication skills to health professionals is extremely important. This study aimed to identify instruments validated for Brazilian Portuguese that assess communication skills of health students or professionals. We carried out a scoping review that included validation studies of instruments for assessing communication skills of students/professionals from the area of Health. Four instruments were identified, translated into Brazilian Portuguese and validated for this language. Content validation, construct validation and the internal consistency test were the most frequently performed ones. This review identified a reduced number of instruments to assess communication skills and limited data about the instruments' validity and reliability.(AU)

La enseñanza de habilidades de comunicación es indispensable para los profesionales de la salud. El objetivo de este estudio fue identificar instrumentos validados en portugués de Brasil que evalúan habilidades de comunicación de estudiantes o profesionales de la salud. Para ello, se realizó una revisión de alcance que incluyó estudios de validación de instrumentos para evaluación de habilidades de comunicación de estudiantes/profesionales del área de la salud. Se identificaron cuatro instrumentos, traducidos y validados al portugués de Brasil. La validación de contenido, la validación del constructo y el test de consistencia interna se realizaron con mayor frecuencia. Esta revisión identificó un número reducido de instrumentos para evaluar habilidades de comunicación y datos limitados de validez y confiabilidad de los instrumentos.(AU)

Evaluation of students' attitudes towards pharmacist-physician collaboration in Brazil

Objective: To measure undergraduate pharmacy and medical students' collaborative attitudes regarding Pharmacist-Physician collaboration. Methods: A cross-sectional descriptive study was conducted from September 2016 to February 2017 in Northeast Brazil. Pharmacy and medical students from the first and the last year of courses were invited to complete Portuguese version of Scale of Attitudes Toward Pharmacist-Physician Collaboration (SATP2C). Descriptive and comparative analyses were performed using IBM SPSS (22 version). Differences were considered significant when p<0.05. Results: Three hundred seventy students completed the SATP2C. Overall, the students had positive attitudes towards physician-pharmacist collaboration. There was no significant correlation between age and score (p=0.79). Women showed a more positive collaborative attitude than men (53.1, SD=6.8 vs. 55.1, SD=6.3). Pharmacy students had a higher score than medical students (57.5, SD=4.7, vs. 51.1, SD=6.4). The first-year medical students had a higher score than last-year medical students (52.3, SD=6.0 vs. 49.5, SD=6.6; p<0.007). There was no significant difference in the attitudes between the first and last year pharmacy students (p<0.007). Conclusions: Pharmacy and medical students showed positive attitudes towards physician-pharmacist collaboration. However, pharmacy students presented more collaborative attitudes than medical ones. Additionally, the first-year medical students had more collaborative attitudes than last-year medical students. Studies should be conducted to provide recommendations to improve interprofessional education efforts to further enhance the positive attitudes toward physician-pharmacist collaboration

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Visão geral com meta-análise de revis~es sistemáticas sobre o valor diagnóstico e prognóstico da angiotomografia de coronárias na emergência / Overview with meta-analysis of systematic reviews of the diagnostic and prognostic value of coronary computed tomography angiography in the emergency department

Fundamento: A alta prevalência de DAC, bem como seu impacto sobre as despesas de saúde e as várias opções de tratamento para reduzir a morbidade e mortalidade relacionados a DAC, vem desenvolver uma ferramenta de diagnóstico precisa e com resultados importantes no departamento de emergência. Objetivo: Fornecer visão geral com meta-análise para compilar evidência a partir de múltiplas revisões sistemáticas (RS) sobre o valor diagnóstico e prognóstico da angiotomografia computadorizada de artérias coronárias (ATCC) na avaliação da dor torácica aguda no setor de emergência (SE). Métodos: Incluímos RS de estudos primários avaliando o valor diagnóstico e prognóstico da ATCC ≥ 64 canais no SE. Os estudos foram conduzidos em pacientes de risco baixo e intermediário para doença arterial coronariana (DAC). Realizou-se avaliação qualitativa usando PRISMA, e aquelas que pontuaram ≥ 80% foram aprovadas. Dois autores extraíram dados independentemente usando um formulário padrão. Os testes de correlação de Spearman, do qui-quadrado, Q de Cochran ou a estatística I 2 de Higgins e Thompson foram usados, assim como o pacote estatístico "mada" (R Core Team, 2015) para meta-análise. Adotou-se o nível de significância de 95%. Resultados: Quatro RS foram elegíveis para inclusão neste estudo, resultando em 13 artigos após aplicação dos critérios de exclusão, sendo apenas 10 usados para a meta-análise, num total de 4831 pacientes (idade média, 54 ± 6 anos; 51% homens), dos quais 46% tinham hipertensão, 32% dislipidemia, 13% diabetes e 26% história familiar de DAC prematura. Na meta-análise, 9 estudos definiram ATCC positiva na presença de lesões luminais ≥ 50%, enquanto 1 estudo definiu ATCC positiva na presença de lesões luminais ≥ 70%. A sensibilidade variou de 77% a 98%, e a especificidade, de 73% a 100%. A análise univariada mostrou homogeneidade do odds ratio diagnóstico (DOR) [Q = 8,5 (df = 9), p = 0,48 and I 2 = 0%]. A estimativa sumária da DOR para ATCC nas análises primárias foi de 4,33 (IC95%: 3,47 ­ 5,18). A área sob a curva foi 0,982 (IC95%: 0,967 ­ 0,999). Houve 29 (0.6%) infartos, 92 (1,9%) revascularizações, 312 (6,4%) angiografias coronarianas invasivas e nenhuma morte. Síndrome coronariana aguda foi diagnosticada em 7,3% dos 1655 pacientes incluídos na meta-análise. Conclusões: O uso de ATCC como ferramenta para estratificação de pacientes de risco cardiovascular baixo e intermediário, que procuraram o SE com dor torácica, tem alta acurácia e segurança, reduz a permanência no hospital e provavelmente os custos, produzindo diagnóstico precoce e uma tomada de decisão mais efetiva

Background: The high prevalence of CAD, as well as your impact on health expenditure and the various treatment options to reduce morbidity and mortality related to CAD, comes to develop a diagnostic tool precis and with important findings in the Emergency Department. Objetive: To conduct an overview with meta-analysis to compile evidence from multiple systematic reviews (SR) on the diagnostic and prognostic value of coronary computed tomography angiography (CCTA) to assess acute chest pain in the emergency department (ED). Methods: We included SR of primary studies that evaluated the diagnostic and prognostic value of CCTA ≥ 64 channels in the ED. The studies were conducted in patients at low and intermediate risk for coronary artery disease (CAD). Quality assessment was performed using PRISMA and approved reviews that scored ≥ 80%. Two authors independently extracted data using a standardized form. Spearman correlation test, Chi-square test, Cochran's Q test or Higgins and Thompson statistical I 2 were used. For meta-analysis, "mada" package statistical software R Core Team, 2015, was used. The significance level adopted was 95%. Results: Four reviews were eligible for inclusion in this overview, resulting in 13 articles after applying the exclusion criteria, and only 10 of these were used for meta-analysis, adding up to a total of 4831 patients (mean age, 54 ± 6 years; 51% male), of whom 46% were hypertensive, 32% had dyslipidemia, 13% had diabetes and 26% had a family history of premature CAD. In the meta-analysis, 9 studies defined CCTA positive in the presence of luminal lesions ≥ 50%, while 1 study defined it as luminal lesions ≥ 70%. Sensitivity ranged from 77% to 98%, and specificity, from 73% to 100%. The univariate analysis showed homogeneity of diagnostic odds ratio (DOR) [Q = 8.5 (df = 9), p = 0.48 and I 2 = 0%]. The pooled mean DOR for CCTA in primary analyses was 4.33 (95% CI: 3.47 - 5.18). The area under the curve (AUC) was 0.982 (95% CI: 0.967 - 0.999). There was no death, 29 (0.6%) infarcts, 92 (1.9%) revascularizations and 312 (6.4%) invasive coronary angiographies. The diagnosis of acute coronary syndrome occurred in 7.3% of the 1655 patients included in the meta-analysis. Conclusions: The use of CCTA as a tool for stratification of patients at low or intermediate cardiovascular risk, who are in the ED with chest pain, has high accuracy, safety, reduces length of hospital stay and probably the costs, producing an early diagnosis and more effective decision making

Association between the 8-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure control.

BACKGROUND: Non-adherence to treatment is an important and often unrecognized risk factor that contributes to reduced control of blood pressure (BP). OBJECTIVE: To determine the association between treatment adherence measured by a validated version in Portuguese of the 8-item Morisky Medication Adherence Scale (MMAS-8) and BP control in hypertensive outpatients. METHODS: A cross-sectional study was carried out with hypertensive patients older than 18 years, treated at six of the Family Health Strategy Units in Maceió (AL), through interviews and home blood pressure measurements, between January and April 2011. Adherence was determined by MMAS-8 version translated for this study. The patients were considered adherent when they had a score equal to 8 at the MMAS-8. RESULTS: The prevalence of adherence among the 223 patients studied was 19.7%, while 34% had controlled BP (> 140/90 mmHg). The average adherence value according to the MMAS-8 was 5.8 (± 1.8). Adherent patients showed to be more prone (OR = 6.1, CI [95%] = 3.0 to 12.0) to have blood pressure control than those who reached mean (6 to <8) or low values (<6) at the adherence score. The Portuguese version of MMAS-8 was showed a significant association with BP control (p = 0.000). CONCLUSION: The diagnosis of non-adherent behavior through the application of MMAS-8 in patients using of antihypertensive medications was predictive of elevated systolic and diastolic BP.

[Self-reported adherence to prescribed medicines during pregnancy]. / Aderência autorreferida a medicamentos prescritos durante a gestação.

PURPOSE: To assess medication adherence therapeutic during pregnancy in a sample of Brazilian women during the post-partum period. METHODS: We conducted a cross-sectional study in the obstetric unit of a university hospital, Brazil, between August and November 2010. We recruited patients aged 18 years or more, with a gestational age of more than 22 weeks whose newborns weighed more than 500 g. Patients were excluded if they used sedatives or other mind-altering drugs. Data were collected after labor using a structured questionnaire containing questions about sociodemographic characteristics, medication use, number of previous pregnancies, contraceptive methods, prenatal care, and medication adherence. Medication adherence was assessed using the four-item Morisky medication adherence scale - MMAS-4, groups were compared by the Fisher exact Test and Kruskal-Wallis Test and Χ2 de Pearson Test. RESULTS: Mean age was 22.5 years (SD=6.5), and 53.8% of the pregnant women had initiated prenatal care during the first trimester of pregnancy. Of the 130 patients interviewed, 96.9% had used at least one prescribed drug during pregnancy, with an average of 2.8 drugs per patient. The major classes prescribed were antianemics (55.1%), analgesics, anti-inflammatories, and antipyretics (19.0%) and anti-infectives (7.2%). 71.6% took two to four drugs. Only 19.2% of patients were considered adherent. The variables that showed a negative influence on adherence were: higher level of education, having one's own income, earlier prenatal care and previous abortion. CONCLUSION: Our findings indicate that, although most of the patients used prescribed drugs during pregnancy, the rate of medication adherence was low, which indicates the need for further investigation about the impact of non-adherence during pregnancy and its causes.

Percepções de idosas quanto a não adesão a farmacoterapia: uma análise qualitativa / Perception of elderly for non-adherence to drug therapy: a qualitative analysis

As percepções do usuário sobre seus medicamentos devem ser compreendidas, visto que reflete os aspectos positivos e negativos que o mesmo vivencia ou vivenciou durante a sua farmacoterapia. Assim, o presente estudo visou identificar a percepção das idosas associados a não adesão à farmacoterapia prescrita, no Programa de Assistência Integral à Melhor Idade. Para tanto, foi realizada entrevista audiogravada, com duração média de cinco minutos e realizada análise de conteúdo. Para a análise dos dados, procedeu-se à ordenação das falas. Partes do material foram codificadas e organizadas em unidades de significação. O esquecimento, a falta ou incompletude de informação médica ou não entendimento das instruções profissionais repassadas e acesso aos medicamentos foram apontados pelas pacientes como motivos de baixo grau de adesão. Diante dos relatos apresentados, recomenda-se maior cuidado no desenvolvimento e pesquisa de dispositivos de adesão à farmacoterapia a partir do relato dos pacientes, aprofundando-se na essência e na compreensão tácita das suas falas.

The user's perceptions about their medications should be understood, since it reflects the positive and negative aspects that the sameone has experienced during their pharmacotherapy. Thus, this study aimed to identify the perception of the elderly associated with non-adherence to prescribed pharmacotherapy, in the Integral Assistance Program to the Golden Age. To do so, the interviews were recorded in audio, with an average duration of five minutes and content analysis. For data analysis, we proceeded to the ordination of speeches. Parts of the material were coded and organized into meaning units. Forgetfulness, the lack or incompleteness of medical information or not understanding of passed professional instruction and access to medicines were mentioned by patients as reasons for low level of compliance. Given the reports presented, it is recommended greater care in the development and research of adherence to pharmacotherapy devices from patients reports, deepening the essence and the tacit understanding of their speeches.

Indicadores da seleção de medicamentos em sistemas de saúde: uma revisão integrativa / Indicators for drug selection in health systems: an integrative review

OBJETIVO: Obter um painel dos principais indicadores utilizados para a seleção de medicamentos por meio da realização de uma revisão integrativa da literatura. MÉTODOS: Após elaborar um protocolo de revisão, foram realizadas buscas nas bases LILACS, MEDLINE, Embase e SciELO. Foram utilizados os descritores "indicadores", "critérios", "seleção de medicamentos", "comitê de farmácia e terapêutica" e "formulário de medicamentos", com suas variações em inglês e espanhol. Foram selecionados e revisados 16 artigos originais publicados entre janeiro de 1996 e março de 2012 para compor um painel de indicadores. RESULTADOS: Foram identificados 45 indicadores quantitativos e qualitativos. Esses indicadores foram agrupados de acordo com semelhanças conceituais em três categorias: 1) avaliação da estrutura da comissão de farmácia e terapêutica; 2) avaliação dos processos gerais de seleção de medicamentos; e 3) avaliação dos resultados da seleção de medicamentos. CONCLUSÕES: Os indicadores avaliados demonstram relativa uniformidade nos padrões estabelecidos para a seleção de medicamentos. O grupo de indicadores estabelecidos neste estudo deve servir como referência para fomento e consolidação dessa atividade nos serviços de saúde pública.

OBJECTIVE: To produce a panel of the main drug selection indicators by performing an integrative literature review. METHODS: After the elaboration of a review protocol, searches were conducted in LILACS, MEDLINE, Embase, and SciELO databases. The following search terms were used: "indicators"; "criteria"; "drug selection"; "pharmacy and therapeutics committee"; and "medication form"; with the applicable variations in English and Spanish. Sixteen original articles published between January 1996 and March 2012 were retrieved and reviewed to compose a panel of indicators. RESULTS: Forty-five quantitative and qualitative indicators were identified. These indicators were grouped according to conceptual similarities in three categories: 1) assessment of pharmacy and therapeutics committee structure; 2) evaluation of the general processes of drug selection; and 3) evaluation of the results of drug selection. CONCLUSIONS: The indicators identified reveal relative uniformity in the established patterns for drug selection. The group of indicators established in this study should serve as reference for the development and consolidation of drug selection in public health services.

Prescription errors in Brazilian hospitals: a multi-centre exploratory survey.

In Brazil, millions of prescriptions do not follow the legal requirements necessary to guarantee the correct dispensing and administration of medication. This multi-centre exploratory study aimed to analyze the appropriateness of prescriptions at four Brazilian hospitals and to identify possible errors caused by inadequacies. The sample consisted of 864 prescriptions obtained at hospital medical clinics in January 2003. Data was collected by three nurse researchers during one week using a standard data sheet that included items about: the type of prescription; legibility; completeness; use of abbreviations; existence of changes and erasures. There were statistically significant differences between incomplete electronic prescriptions at hospital A, and handwritten ones from hospitals C (C2 = 12.703 and p < 0.001) and D (C2 = 14.074 and p < 0.001). Abbreviations were used in more than 80% of prescriptions at hospitals B, C and D. Changes were found in prescriptions at all hospitals, with higher levels at hospitals B (35.2%) and A (25.3%). This study identified a range of vulnerable points in the prescription phase of the medication system at the hospitals. Physicians, pharmacists and nurses should therefore jointly propose strategies to avoid these prescription errors.

Relação entre a Escala de Adesão Terapêutica de oito itens de Morisky (MMAS-8) e o controle da pressão arterial / Association between the 8-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure control

FUNDAMENTO: A não adesão terapêutica é um importante e frequentemente não reconhecido fator de risco que contribui para o reduzido controle da Pressão Arterial (PA). OBJETIVO: Determinar a relação entre a adesão terapêutica mensurada a partir de uma versão validada em português da MMAS-8 e o controle da PA em pacientes ambulatoriais hipertensos. MÉTODOS: Foi realizado um estudo transversal com pacientes hipertensos maiores de 18 anos atendidos em seis unidades da Estratégia de Saúde da Família, em Maceió (AL), por meio de entrevistas e mensuração da pressão arterial em domicílio, entre janeiro e abril de 2011. A adesão foi determinada por meio de versão da MMAS-8 traduzida para realização deste estudo. Foram considerados aderentes aqueles pacientes com pontuação igual a 8 na MMAS-8. RESULTADOS: A prevalência da adesão terapêutica entre os 223 pacientes investigados foi de 19,7%, enquanto 34% apresentaram PA controlada (> 140/90 mmHg). O valor médio de adesão segundo a MMAS-8 foi 5,8 (±1,8). Os pacientes aderentes se revelaram mais propensos (OR = 6,1; IC [95%] = 3,0 a 12,0) a ter a pressão arterial sob controle do que aqueles que atingiram valores médios (6 a <8) ou baixos (<6) no score de adesão. A versão em português da MMAS-8 apresentou associação significativa com o controle da PA (p = 0,000). CONCLUSÃO: O diagnóstico do comportamento não aderente por meio da aplicação da MMAS-8 em pacientes sob uso de medicamentos anti-hipertensivos foi fator preditivo de valores elevados de PA sistólica e diastólica.

BACKGROUND: Non-adherence to treatment is an important and often unrecognized risk factor that contributes to reduced control of blood pressure (BP). OBJECTIVE: To determine the association between treatment adherence measured by a validated version in Portuguese of the 8-item Morisky Medication Adherence Scale (MMAS-8) and BP control in hypertensive outpatients. METHODS: A cross-sectional study was carried out with hypertensive patients older than 18 years, treated at six of the Family Health Strategy Units in Maceió (AL), through interviews and home blood pressure measurements, between January and April 2011. Adherence was determined by MMAS-8 version translated for this study. The patients were considered adherent when they had a score equal to 8 at the MMAS-8. RESULTS: The prevalence of adherence among the 223 patients studied was 19.7%, while 34% had controlled BP (> 140/90 mmHg). The average adherence value according to the MMAS-8 was 5.8 (± 1.8). Adherent patients showed to be more prone (OR = 6.1, CI [95%] = 3.0 to 12.0) to have blood pressure control than those who reached mean (6 to <8) or low values (<6) at the adherence score. The Portuguese version of MMAS-8 was showed a significant association with BP control (p = 0.000). CONCLUSION: The diagnosis of non-adherent behavior through the application of MMAS-8 in patients using of antihypertensive medications was predictive of elevated systolic and diastolic BP.

Perfil Farmacoterapêutico de um Grupo de Idosos assistidos por um programa de Atenção Farmacêutica na Farmácia Popular do Brasil no município de Aracaju ? SE / Pharmacotherapeutic profile of a Group of Elderly assisted by a pharmaceutical care program in Brazil People?s Pharmacy in the city of Aracaju ? SE, Brazil

O avanço do envelhecimento da população brasileira está causando uma alteração do perfil epidemiológico, que passou a apresentar uma maior prevalência de condições crônicas de saúde. Tais condições exigem acompanhamento constante da farmacoterapia pelos profissionais de saúde. Isso implica no aumento do uso de medicamentos, tornando os idosos mais suscetíveis aos riscos de polifarmácia e de problemas relacionados à farmacoterapia. Nesse contexto, é necessário implantar estratégias efetivas focadas no paciente que visem à redução da morbimortalidade relacionada aos medicamentos, tais como a Atenção Farmacêutica. O presente estudo visou compreender o perfil de uso dos medicamentos em idosos assistidos por um programa de Atenção Farmacêutica na Farmácia Popular do Brasil no município de Aracaju- SE. Os dados referentes ao perfil farmacoterapêutico foram coletados a partir das informações levantadas de 68 pacientes idosos com hipertensão e/ou diabetes. O consumo total de medicamentos foi de 383 com média de 5,63 (DP= 2,50), a polifarmácia esteve presente em 63,2% dos pacientes (n= 43). Os medicamentos mais consumidos pertenciam ao grupo anatômico que age no sistema cardiovascular (46,9%, n= 180) e no trato alimentar (31,1%, n= 119). No estudo foram observadas 152 interações em 53 pacientes (77,95%), 19 casos de medicamentos inadequados (4,9%), e 35 (9,5%) interações fármaco- alimento. Esses resultados sugerem o aprimoramento das prescrições e avaliação constante da qualidade da farmacoterapia de modo a promover o uso racional de medicamentos nesta faixa etária.

The advancement aging of the population is causing a change in the epidemiological profile, which presented a higher prevalence of chronic health conditions. Such conditions require constant monitoring of pharmacotherapy for health professionals. This entails increased use of drugs, making the elderly more susceptible to the risks of polypharmacy and problems related to pharmacotherapy. In this context, it is necessary to implement effective strategies focused on the patient aimed at reducing morbidity and mortality related to drugs, such as pharmaceutical care. This study examines the usage profile of drugs in elderly patients assisted by a program of pharmaceutical care in the People?s Pharmacy of Brazil in the city of Aracaju-SE. The data on drugs prescribed were collected from the information collected from 68 elderly patients with hypertension and / or diabetes. The total consumption of medicines was 383 with an average of 5.63 (SD = 2.50), polypharmacy was present in 63.2% of patients (n = 43). The most used drugs belonged to the anatomical acting on the cardiovascular system (46.9%, n = 180) and in the alimentary tract (31.1%, n = 119). In the study 152 interactions were observed in 53 patients (77.95%), 19 cases of inappropriate drugs (4.9%) and 35 (9.5%) drug-food interactions. These results suggest the improvement of the requirements and ongoing assessment of the quality of pharmacotherapy in order to promote rational drug use in this age group.

Aderência autorreferida a medicamentos prescritos durante a gestação / Self-reported adherence to prescribed medicines during pregnancy

OBJETIVO: Avaliar a adesão terapêutica autorreferida durante a gestação em amostra de mulheres brasileiras. MÉTODOS: Foi realizado um estudo transversal com puérperas internadas no serviço de obstetrícia de um hospital universitário, entre agosto e novembro de 2010. Foram incluídas puérperas com 18 anos ou mais, idade gestacional superior a 22 semanas e peso do feto igual ou maior que 500 g. Foram excluídas puérperas em uso de sedativos e/ou outros medicamentos capazes de alterar o estado de consciência. Os dados foram coletados por meio de entrevista face a face, com uso de questionário estruturado contendo perguntas sobre características sociodemográficas, uso de medicamentos, número de gestações anteriores, métodos contraceptivos utilizados, atendimento pré-natal e adesão terapêutica. Para a determinação da adesão, foi utilizada a escala de adesão terapêutica de Morisky - MMAS-4 de quatro itens. Foram utilizados o Teste H de Kruskal-Wallis e o Teste de Χ2 de Pearson e exato de Fisher para análise estatística. RESULTADOS: A média de idade das gestantes foi de 22,5 anos (DP=6,5), das quais 53,8% iniciaram acompanhamento pré-natal no primeiro trimestre da gravidez. Das 130 pacientes entrevistadas, 96,9% fizeram uso de algum medicamento durante o período gestacional, com média de 2,8 medicamentos por paciente. As principais classes prescritas foram: antianêmicos (55,1%); analgésicos, anti-inflamatórios e antipiréticos (19,0%); e anti-infecciosos (7,2%). Fizeram uso de dois a quatro medicamentos 71,6% das pacientes. Apenas 19,2% das pacientes foram consideradas aderentes. As pacientes com menores taxas de adesão foram aquelas com maior escolaridade, renda própria, início do acompanhamento pré-natal no primeiro trimestre de gravidez e aborto prévio. CONCLUSÃO: Apesar de a maioria das gestantes fazer uso de medicamentos prescritos durante a gestação, a taxa de adesão ao tratamento foi baixa, indicando uma necessidade de investigações adicionais sobre o impacto da não adesão durante a gestação e suas causas.

PURPOSE: To assess medication adherence therapeutic during pregnancy in a sample of Brazilian women during the post-partum period. METHODS: We conducted a cross-sectional study in the obstetric unit of a university hospital, Brazil, between August and November 2010. We recruited patients aged 18 years or more, with a gestational age of more than 22 weeks whose newborns weighed more than 500 g. Patients were excluded if they used sedatives or other mind-altering drugs. Data were collected after labor using a structured questionnaire containing questions about sociodemographic characteristics, medication use, number of previous pregnancies, contraceptive methods, prenatal care, and medication adherence. Medication adherence was assessed using the four-item Morisky medication adherence scale - MMAS-4, groups were compared by the Fisher exact Test and Kruskal-Wallis Test and Χ2 de Pearson Test. RESULTS: Mean age was 22.5 years (SD=6.5), and 53.8% of the pregnant women had initiated prenatal care during the first trimester of pregnancy. Of the 130 patients interviewed, 96.9% had used at least one prescribed drug during pregnancy, with an average of 2.8 drugs per patient. The major classes prescribed were antianemics (55.1%), analgesics, anti-inflammatories, and antipyretics (19.0%) and anti-infectives (7.2%). 71.6% took two to four drugs. Only 19.2% of patients were considered adherent. The variables that showed a negative influence on adherence were: higher level of education, having one's own income, earlier prenatal care and previous abortion. CONCLUSION: Our findings indicate that, although most of the patients used prescribed drugs during pregnancy, the rate of medication adherence was low, which indicates the need for further investigation about the impact of non-adherence during pregnancy and its causes.

Bulas de medicamentos usados por idosos com hipertensão: adequação da informação à regulamentação sanitária e possíveis implicações para a saúde / Medication leaflets used by elderly with hypertension: adequacy of information for sanitary regulation and possible implications for health

As bulas representam a principal fonte de informação escrita fornecida aos pacientes, especialmente aos idosos. O presente trabalho visou analisar o conteúdo das bulas dos medicamentos frequentemente prescritos para idosos com hipertensão, bem como a sua adequação à regulamentação sanitária e possíveis implicações para a saúde. Foi realizado um estudo descritivo em duas etapas: etapa A, em julho de 2002, e B em julho de 2007. Em cada etapa foram analisadas 34 bulas de sete fármacos anti-hipertensivos que constam na Relação Nacional de Medicamentos Essenciais (2006). Entre as 68 bulas analisadas, a maioria não continha todas as informações exigidas pela Portaria n° 110/1997 na etapa A (89,5 por cento) e pela RDC n°140/2003 na B (100 por cento). Alguns itens importantes como via de administração, modo de uso e superdose não constavam em 76 por cento das bulas analisadas. A falta dessas informações é relevante para a segurança dos pacientes. Com base nos dados obtidos, foi possível constatar o não cumprimento da legislação vigente nas duas etapas do estudo. Logo, é necessária maior atuação da Anvisa para assegurar o uso racional dos medicamentos e a redução dos riscos à saúde dos idosos.

The medication leaflets represent the main source of written information supplied to the patients, in special to the elderly. This study aimed to analyze the content of the leaflets of drugs often prescribed for elderly people with hypertension, as well as their adequacy to the sanitary regulations and possible health implications. A descriptive study was conducted in two stages: A, in July 2002, and B, in July 2007. In each stage were analyzed 34 medication leaflets of seven antihypertensive drugs of the National Essential Drugs List (2006). Among the 68 leaflets analyzed, most did not contain all the information required by Portaria nº 110/1997 (89.5 percent) in the stage A and the RDC nº 140/2003 (100 percent) in B. In 100 percent of the leaflets, the legislation had not been fulfilled. Some important topics as way of administration, how to use and overdose had been absent in 76 percent of the leaflets, the lack of this information has an impact in the security of the antihypertensive users. Based on these data, it was possible to evidence inadequate contents of the medication leaflets. So, it is necessary greater surveillance by Anvisa, to ensure the rational use of medicines and the reduction of the risks to the elderly health.