[Medication Reconciliation During Admission to an Internal Medicine Department: A Pilot Study]. / Reconciliação Terapêutica na Admissão de um Serviço de Medicina Interna: Estudo-Piloto.

INTRODUCTION: The purpose of medication reconciliation is to promote patient safety by reducing medication errors and adverse events due to medication discrepancies in transition of care. The aim of this pilot study of medication reconciliation at the time of hospital admission was to identify the necessary resources for its implementation in clinical practice. MATERIAL AND METHODS: Pilot study with 100 patients admitted to an Internal Medicine department between October and December 2019, aged 18 and over, and chronically taking at least one medicine. The best possible medication history was obtained systematically, with subsequent identification, classification and resolution of the discrepancies. RESULTS: The study sample, in general characterized by polypharmacy and by having multiple long-term conditions, presented a mean age of 77.04 ± 13.74 years, being 67.0% male. Overall, 791 discrepancies were identified. Intentional discrepancies were 95.7% and 50.9% of them were documented. The difficulties encountered were mainly related with the access and quality of therapeutic information and communication problems between different healthcare professionals. The key priority resources that were identified were related with the process, tools, and personnel categories. CONCLUSION: The data revealed weaknesses in the clinical records available at the primary/hospital care interface. Optimization of data sources, standardization and informatization of the process, multidisciplinary approach and definition of priority groups were identified as opportunities for optimization.

Introdução: A reconciliação terapêutica visa promover a segurança do doente por meio da redução de erros de medicação e eventos adversos decorrentes de discrepâncias de medicação na transição de cuidados. Foi nosso objetivo realizar um estudo-piloto de reconciliação terapêutica no momento da admissão hospitalar para, a partir dele, identificarmos os recursos necessários para a sua implementação na prática clínica.Material e Métodos: Estudo-piloto com 100 doentes admitidos num serviço de Medicina Interna entre outubro e dezembro de 2019, com mais de 18 anos e a tomar cronicamente pelo menos um medicamento. A melhor história farmacoterapêutica possível foi obtida sistematicamente, com posterior identificação, classificação e resolução das discrepâncias.Resultados: A amostra em estudo, em geral polimedicada e com múltiplas morbilidades, apresentou uma média de idades de 77,04 ± 13,74 anos, sendo 67,0% do sexo masculino. Foram identificadas 791 discrepâncias e as intencionais (95,7%) estavam documentadas em 50,9% das situações. As dificuldades encontradas relacionaram-se principalmente com o acesso e a qualidade da informação terapêutica e com a dificuldade de comunicação entre os diversos profissionais de saúde. Os principais recursos prioritários identificados relacionaram-se com as categorias de processo, ferramentas e pessoal.Conclusão: Os dados revelaram fragilidades nos registos clínicos disponíveis na interface dos cuidados primários/hospitalares. A otimização das fontes de dados, normalização e informatização do processo, atuação multidisciplinar e definição de grupos prioritários foram identificadas como oportunidades de otimização.

Feasibility of cardiovascular risk screening in Portuguese community pharmacies.

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of human mortality. As highly accessible and qualified health professionals, community pharmacists can be included in the early detection of patients at risk for CVD by implementing CVD screening programs. OBJECTIVE: To assess the feasibility of CVD risk screening services in Portuguese community pharmacies from the evaluation of customers acceptability. METHODS: A cross-sectional study was conducted in a community pharmacy in Portugal. The purpose of entering the pharmacy was recorded for all customers. Afterwards, the customers were invited to be interviewed by the pharmacist, who registered their willingness to participate and collected the participants' data and biochemical and physical parameters to assess their CV risk by applying the Systematic COronary Risk Evaluation (SCORE) model. For the participants who were not eligible for the SCORE-based risk assessment, the pharmacist considered the major modifiable CVD risk factors - hypertension, dyslipidemia, smoking habits, obesity, impaired fasting glucose and sedentary behavior - according to the ESC guidelines. RESULTS: Picking up medication was the most prevalent reason 69.8% (n=1,600) for entering the pharmacy, and among the contacted customers, 56.4% (n=621) agreed to have their CVD risk assessed. Of the 588 participants, 56.6% (n=333) were already on CV pharmacotherapy and were therefore not eligible for screening. Of the 43.4% (n=255) CV pharmacotherapy-naïve participants, 94.9% (n=242) were screened with at least one CVD risk factor; 52.9% (n=135) were not eligible for the SCORE assessment, of which 92.6% (n=125) presented CVD risk factors. Of the 120 SCORE eligible participants, 80.0% (n=96) were at least at moderate risk of CVD. CONCLUSIONS: We determined the feasibility of CVD risk screening in Portuguese community pharmacies, as we found high customer acceptability, noted the reasons for nonattendance, and found a high prevalence of CVD risk factors in at-risk patients. This is an opportunity for Portuguese community pharmacists to take a leading role in the early detection of CVD.

A case study of polypharmacy management in nine European countries: Implications for change management and implementation.

BACKGROUND: Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. METHODS: Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. RESULTS: Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. CONCLUSION: Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

Cross-cultural adaptation of Hypertension Knowledge Test into European Portuguese

ABSTRACT We aim to validate a European-Portuguese version of the Hypertension Knowledge Test (HKT) questionnaire and examine its factorial structure with a confirmatory factor analysis (CFA). A process of translation and back-translation was performed. A cross-sectional study was developed in which all adult patients taking at least one antihypertensive drug were invited to participate. Data on personal and family history were collected, and the HKT, Strelec, and the Batalla questionnaires were administered. We enrolled 304 patients with a mean age of 68.12±10.83 years. The mean score of HKT was 15.33±2.79. CFA indicated that the construct being tested was unidimensional, and Cronbach's alpha (α=0.65) showed that the instrument had an acceptable internal consistency. When evaluating concurrent validity, HKT was significantly correlated with the Batalla and Strelec scores. Thus, the Portuguese version of HKT (HKT-pt-PT) can be used either in research or in clinical practice. With this version, a potential standard exists to evaluate knowledge about hypertension, which could avoid the practice of using non-validated questionnaires in Portugal and allow the cross-sectional and longitudinal comparability of studies.

Interação planta-medicamento: a especificidade da terapêutica cardiovascular / Plant-drug interaction: the specificity of cardiovascular therapy

O presente estudo teve como objetivos caracterizar a situação real do consumo de Plantas Medicinais (PM) numa amostra de pacientes com patologia cardiovascular e identificar potenciais interações entre as PM e a terapêutica farmacológica cardiovascular convencional.O estudo foi realizado numa Farmácia Comunitária em Portugal entre abril e junho de 2014. Dos 128 utentes abordados ao balcão que fazem uso da terapêutica cardiovascular, 65 (51%) faziam uso de PM, seja sob a forma de infusão, suplementos ou medicamentos à base de PM. Desses, 43 (66%) foram entrevistados, tendo 22 (34%) sido excluídos por não terem manifestado interesse em participar no estudo. Através da revisão da medicação efetuada para cada doente foram encontradas um total de 123 interações planta-medicamento, com uma média de 2,9 interações/doente, com potencial para diminuir o sucesso da terapêutica cardiovascular. O presente estudo demonstra como o serviço farmacêutico da revisão da medicação pode ser utilizado para otimizar a terapêutica dos doentes cardiovasculares quando estes tomam medicamentos e PM em simultâneo, o que evidencia a função do farmacêutico na sensibilização da população, no sentido de evitar situações prejudiciais para a saúde e bem estar do doente.