Exploring the Quality of Systematic Reviews on Pharmacist Interventions in Patients With Diabetes: An Overview.

OBJECTIVE: To assess the reporting and methodological quality of systematic reviews and meta-analysis studies on pharmacist interventions in patients with diabetes. DATA SOURCES: A comprehensive literature search was performed in MEDLINE, Scopus, and LILACS databases for systematic reviews and meta-analysis studies published from January 1990 to June 2013. The standardized search strategy included the use of MeSH terms or text words related to pharmacist interventions, diabetes, and systematic reviews. STUDY SELECTION AND DATA EXTRACTION: The overview included systematic reviews and meta-analysis studies published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on outcomes for diabetic patients. Two independent authors performed study selection, data extraction, and quality assessment with a consensus process to address disagreements. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) checklists were used to assess reporting characteristics and methodological quality, respectively. DATA SYNTHESIS: The literature search yielded 101 records of potential interest, of which 7 satisfied the inclusion criteria. The total average (SD) for PRISMA and AMSTAR scores were 17.4 (5.6) out of 27 and 6.9 (2.0) out of 11, respectively. The most frequent problems included nonregistration of study protocol, absence of a list of excluded studies, and unclear acknowledgment of conflicts of interests. CONCLUSION: The reporting and methodological quality of systematic reviews and meta-analysis studies were suboptimal, with some areas needing further improvement. It is necessary to ensure better transparency and reproducibility in the literature of clinical pharmacy services for diabetic patients.

Assessment of Professionalism in Pharmacists and Pharmacy Students: Scoping Review of Instruments and Validity Evidence.

OBJECTIVE: To characterize which instruments have been developed to assess professionalism in the field of pharmacy. FINDINGS: A scoping review was conducted to answer which instruments have been developed to assess professionalism in the field of Pharmacy. The databases consulted were EMBASE, ERIC, PUBMED/Medline, Scopus, and Web of Science. No restrictions on language or year of publication were made. Only studies about development or translation of instruments for professionalism assessment were included. The methodological quality of studies was verified by the Questionnaire Cross-Cultural Adaptation Guideline and the COnsensus-based Standards for the selection of health Measurement INstruments. Seven studies met the eligibility criteria and were included in this scoping review. In general, the instruments were developed from ideological elements assigned to professionalism by pharmaceutical and medical entities, in addition to theoretical references that came from social sciences. Regarding the evaluation of validation and psychometric property evidence, the studies generally adopted distinct procedures which highlights some destandardization, although the methodological quality was accepted. SUMMARY: More studies on the professionalism field should be conducted to characterize professionalism and develop pharmaceutical practices in line with societal demands and expectations.

Evaluation of process indicators of a medication review service between pharmacists and physicians.

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.

Investigating Sources of Heterogeneity in Randomized Controlled Trials of the Effects of Pharmacist Interventions on Glycemic Control in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis.

OBJECTIVE: To assess the effect of pharmacist interventions on glycemic control in type 2 diabetic patients and to examine factors that could explain the variation across studies. METHODS: A comprehensive literature search was performed in PubMed, Scopus, and LILACS databases for randomized controlled trials (RCTs) published up to July 2015. The search strategy included the use of MeSH terms or text words related to pharmacist interventions, type 2 diabetes, and randomized controlled trials. RCTs published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on glycemic control in type 2 diabetic outpatients were included. Two independent authors executed study selection, data extraction, and risk of bias assessment. Mean differences in glycosylated hemoglobin (HbA1c) were estimated using random-effect models, and heterogeneity was evaluated by subgroup and meta-regression analyses. RESULTS: The literature search yielded 963 records of potential interest, of which 30 were included in the systematic review and 22 in the meta-analysis. Most of these RCTs were conducted in the United States in patients in outpatient clinics using face-to-face contact only. All RCTs performed patient education, and most executed the medication review. The appraised sample showed uncertain or high risk of bias in most of the items evaluated, resulting in low-quality studies. In comparison with usual care, pharmacist interventions were associated with significant reductions in HbA1c levels (-8.5% [95% CI: -1.06, -0.65]; P < 0.0001; I2 = 67.3%). Subgroup analysis indicated differences of heterogeneity by country, baseline HbA1c levels, setting, intervention frequency, and random allocation. Age and HbA1c levels partly explained the variability across studies by meta-regression. CONCLUSIONS: Our findings confirmed that pharmacist interventions improve glycemic control in patients with type 2 diabetes compared with usual care and suggest that younger patients or with higher baseline HbA1c levels may be the main beneficiaries of pharmacist care. PROTOCOL PROSPERO REGISTRATION NUMBER: CRD42014007457.

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)

Use of herbal medicines by elderly patients: A systematic review.

OBJECTIVES: We aimed to survey the published literature for articles that describe the use of herbal supplements by elderly patients and to summarize important aspects of selected studies, including most commonly used supplements, study type, study location, and potential hazards of herbal supplement use. METHODS: Literature searches were conducted on three scientific/medical databases: Medline, Web of Science, and Scopus. Search results were examined for articles involving the use of herbal products in the elderly population that met selection criteria. RESULTS: Initial searches yielded 1297 articles. Of these original results, only 16 met specific selection criteria. Twelve (75%) of studies identified were performed in North America. Nine studies (56.25%) were conducted in the United States. Seven of the studies were cross-sectional (43.8%). The most commonly reported were gingko biloba, garlic, ginseng, aloe vera, chamomile, spearmint, and ginger. Of these, gingko and garlic are the most commonly used among community-dwelling elderly. Both of these supplements have the potential to interact with anticoagulants and produce bruising or bleeding problems. CONCLUSIONS: The use of herbal supplements is common among the elderly, a population that takes a disproportionate share of prescription medications compared to that taken by younger populations. Among the problems uncovered by these studies was a lack of dialog between medical professionals and patients about the use of herbal supplements. Prescribers need to consider the use of herbal supplements and discuss the matter with their elderly patients when making decisions about pharmacological treatments.

Exercitando o corpo e alegrando a alma: relato de experiência sobre incentivo à atividade física / Exercising the body and cheering the soul: experience report about the incentive to physical activity / Ejercitando el cuerpo y alegrando el alma: relato de experiencia sobre incentivo a la actividad física

A construção do Sistema Único de Saúde fomentou a reorganização de todo o sistema, sendo a implementação da Atenção Básica uma das principais estratégias para alcançar esse objetivo. Nesse contexto, a parceria entre Residências Multiprofissionais em Saúde e as equipes de Estratégia de Saúde da Família apresenta-se como uma alternativa para promover a mudança da prática assistencial em saúde. A Política Nacional de Promoção da Saúde aponta alguns eixos de atuação, entre eles, o incentivo a atividade física. Portanto, o objetivo deste trabalho foi descrever a experiência de residentes multiprofissionais em Saúde da Família, na condução de um grupo de atividade física com usuários de uma unidade básica de saúde. Para tanto, iniciou-se o grupo no mês de abril de 2015, realizando encontros semanais, com duração de uma hora e participação de duas agentes comunitárias de saúde. A faixa etária das participantes variou entre 35 a 70 anos. Percebeu-se que as atividades de educação em saúde, como as realizadas nesta pesquisa, possibilitaram a percepção da importância da inserção e colaboração da residência nas atividades desenvolvidas pela Estrategia de Saúde da Família. Assim, concluiu-se que a colaboração da residência fortalece o vínculo do profissional de saúde com a comunidade e possibilita que ele levante as demandas da comunidade e atue efetivamente sobre elas.

The construction of the Unified Health System has fostered the reorganization of the entire system, being the implementation of Primary Care one of the main strategies to achieve this goal. In this context, the partnership between Multiprofessional Residencies in Health and the Family Health Strategy teams presents itself as an alternative to promote the change in health care practice. The National Health Promotion Policy points to some areas of activity, among them, the incentive to physical activity. Therefore, the objective of this study was to describe the experience of multiprofessional residents in Family Health, in the conduction of a physical activity group with users of a basic health unit. For that purpose, the group started in April 2015, holding one-hour weekly meetings with the participation of two community health agents. The participants' age ranged from 35 to 70 years. It was noticed that Health education activities such as those carried out by this research enabled the perception of the importance of the insertion and collaboration of residency in the activities developed by the Family Health Strategy. Thus, it was possible to conclude that the collaboration of residency strengthens the bond between the health professional and the community and enables him to raise the demands of the community and act effectively on them.

La construcción del Sistema Único de Salud fomentó la reorganización de todo el sistema, siendo la implementación de la Atención Básica una de las principales estrategias para alcanzar ese objetivo. En ese contexto, la asociación entre Residencias Multiprofesionales en Salud y los equipos de Estrategia de Salud de la Familia presentase como una alternativa para promover el cambio de la práctica asistencial en salud. La política nacional de promoción de la salud apunta algunos ejes de actuación, entre ellos, el incentivo a la actividad física. Por lo tanto, el objetivo de este trabajo fue describir la experiencia de residentes multiprofesionales en Salud de la Familia, en la conducción de un grupo de actividad física con usuarios de una unidad básica de salud. Para ello, fue iniciado el grupo en el mes de abril de 2015, realizando encuentros semanales, con duración de una hora y participación de dos agentes comunitarias de salud. El grupo de edad de las participantes varió entre 35 y 70 años. Percibióse que las actividades de educación en salud, como las realizadas en esta investigación, posibilitaron la percepción de la importancia de la inserción y colaboración de la residencia en las actividades desarrolladas por la Estrategia de Salud de la Familia. Así, concluyóse que la colaboración de la residencia fortalece el vínculo del profesional de salud con la comunidad y posibilita que él levante las demandas de la comunidad y actúe efectivamente sobre ellas.

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.

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.