Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital.

Introduction: The intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. Methods: A retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. Results: The study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. Conclusion: This study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.

Impact of clinical pharmacy in oncology and hematology centers: A systematic review.

BACKGROUND: Oncology and hematology is a complex and specific area that requires monitoring by a multidisciplinary team capable of personalizing the treatment of each patient. Clinical pharmacy services have the potential to contribute significantly to the effective and economical care of cancer patients. OBJECTIVE: To evaluate, synthesize and critically present the available evidence on the impact of the Clinical Pharmacy in the treatment of patients with hematological cancer. METHOD: A review was carried out on the bases PubMed/MEDLINE, LILACS and Google Scholar. The included studies were: studies that evaluated the effects of pharmaceutical interventions in clinical in oncology and hematology services and having as a population patient with hematological cancer. RESULTS: 17 studies were selected among 745 identified. 4.771 patients were included, with an average follow-up time of 15.3 months. Patients affected by some type of hematological cancer, undergoing chemotherapy treatment, showed better adherence and continuity when accompanied by a clinical pharmacist, added to this professional in carrying out interventions, provides control of symptoms such as cancer pain, nausea and constipation and, thus, contributes to decrease the length of hospital stay. CONCLUSION: The implementation of a Clinical Pharmacy service in oncology and hematology centers contributes significantly to the effectiveness of pharmacotherapeutic treatment, treatment costs reduction, safety increase in the use of medications and the patient's quality of life.

Potenciais interações medicamentosas responsáveis por internações hospitalares / Potential drug interactions responsible for hospital admissions

As interações medicamentosas (IM) são consideradas um problema de saúde pública, pois podem causar resultados negativos à saúde dos usuários de medicamentos. Portanto o referido trabalho teve como objetivos: estimar a prevalência de internações hospitalares relacionadas a Potenciais IM (PIM); identificar os sinais e sintomas, e os fatores de risco para a hospitalização relacionados à PIM. Metodologia: Realizou-se estudo transversal na clínica geral de um hospital privado do interior de São Paulo (Brasil), em maio de 2006, com pacientes acima de 18 anos, com tempo de hospitalização superior a 24horas, sendo os mesmos entrevistados sobre os sintomas/motivos de internação e os medicamentos que haviam utilizado previamente à hospitalização. Calculou-se Odds-ratio para identificar fatores de risco, sendo encontrado os seguintes resultados: 168 pacientes utilizando mais de um medicamento, dos quais 57 apresentaram PIM, sendo que em 17(10,1%), os sinais e sintomas da PIM possivelmente foram a causa da hospitalização. A maioria das manifestações clínicas das PIM foram sintomas cardiovasculares (44,3%), gastrintestinais (17,2%) e musculoesqueléticos (13,8%) e 10% das PIM foram consideradas potencialmente perigosas. Não foram detectados fatores de risco relacionados ao gênero, idade, uso de medicamentos de estreita faixa terapêutica para hospitalização por PIM. A polimedicação foi fator de risco para ocorrência de PIM (p<0,0001) opostamente ao aumento da idade que revelou ser um fator de proteção (p=0,02). Conclusão: Se faz necessário seguimento farmacoterapêutico de pacientes que utilizam fármacos de estreita faixa terapêutica, pois estas substâncias estão frequentemente envolvidas em IM perigosas.

Drug-drug interactions (DDI) are considered a public health problem, since they may be the cause of negative outcomes for drug users. Research objectives: 1) estimate the prevalence of hospital admissions arising from potential DDI; 2) identify the signs and symptoms of, as well as risk factors for hospitalization related to, potential DDI. A cross-sectional study was performed in the general clinic of a private hospital in upstate São Paulo, in May 2006, focusing on patients over 18 years old, hospitalized for more than 24 hours, who were interviewed about their symptoms, reasons for hospitalization and the drugs taken prior to hospitalization. The odds ratio was calculated in order to identify risk factors. Results: 168 patients had taken more than one drug, of whom 57 showed potential DDI and, in 17 (10.1%), the signs and symptoms of DDI were probably the reason for hospitalization. The most frequent clinical manifestations of potential DDI were disorders in the cardiovascular (44.3%), digestive (17.2%) and musculoskeletal (13.8%) systems and 10% of the DDI identified were considered potentially hazardous. Risk factors for DDI-motivated hospitalization related to gender, age or the use of drugs with a narrow therapeutic range were not detected. Polypharmacy (p<0.0001) was a determining factor for DDI; conversely, old age was a protection factor (p=0.02). Conclusion: pharmacotherapeutic follow-up of patients who use drugs with a narrow therapeutic range is essential, since these drugs are often involved in hazardous DDI. Pharmacotherapeutic follow-up is also recommended for polymedicated patients, to prevent hospitalization arising from avoidable DDI.

Drug-related problems observed in a pharmaceutical care service, Belo Horizonte, Brazil / Problemas relacionados com a droga observados em um serviço de atenção farmacêutica, Belo Horizonte, Brasil

This present observational, longitudinal, and non-concurrent study was developed with the purposes of evaluate the profile of patients attended by a pharmacotherapeutic follow-up service and describe the Drug-Related Problems (DRPs) found over there; determine the proportion of DRPs between the health problems presented by the studied population, classifying them and identifying the situations related with their appearance. The study was developed at the School Pharmacy of Newton Paiva University Center, Belo Horizonte, MG, during the period from 2001 November up to 2003 November. Ninety seven patients have been evaluated, the majority of female sex (66.0 percent), with up to 8 years of scholarship (45.4 percent), mean age of 56.7 ± 13.0 years; mean of 4 ± 2 diagnosed diseases; 7 ± 6 complaints and 4 ± 2 medications per patient. Nine hundred and twelve health problems have been identified: 56.5 percent uncontrolled. From the uncontrolled problems, 380 (73.6 percent) were DRPs and between these, 81 (21.3 percent) were risks for DRP. From the 97 followed-up patients, 89 (91.7 percent) have presented at least one DRP during the follow-up. The more frequent DRPs were related to effectiveness (53.2 percent), to necessity (25.2 percent) and to safety (21.6 percent). A great number of uncontrolled problems was observed, as well as the possibility to resolve them by means of pharmaceutical care, indicating so the resolutive potential of this practice.

O presente estudo observacional, longitudinal, não concorrente teve por objetivos avaliar o perfil dos pacientes atendidos por um serviço de acompanhamento farmacoterapêutico e descrever os 'problemas relacionados com medicamento' (PRM) encontrados; determinar a proporção de PRM dentre os problemas de saúde apresentados pela população estudada, classificá-los e identificar situações relacionadas com seu surgimento. O estudo foi realizado na Farmácia Escola do Centro Universitário Newton Paiva, em Belo Horizonte, MG, durante o período de novembro de 2001 a novembro de 2003. Foram avaliados 97 pacientes, maioria mulheres (66,0 por cento), com até 8 anos de escolaridade (45,4 por cento), média de idade de 56,7 ± 13,0 anos; média de 4 ± 2 doenças com diagnóstico; 7 ± 6 queixas e 4 ± 2 medicamentos por paciente. Foram identificados 912 problemas de saúde: 56,5 por cento não controlados. Dos problemas não controlados, 380 (73,6 por cento) eram PRM e desses 81 (21,3 por cento) eram riscos de PRM. Dos 97 pacientes acompanhados 89 (91,7 por cento) apresentaram pelo menos um PRM durante o acompanhamento. Os PRMs mais frequentes foram relacionados à efetividade (53,2 por cento), à necessidade (25,2 por cento) e à segurança (21,6 por cento). Observou-se grande número de problemas não controlados e a possibilidade de resolvê-los por meio da atenção farmacêutica, demonstrando o potencial resolutivo dessa prática.

Análise do perfil de automedicação em mulheres idosas brasileiras / Analysis of the self-medication pattern among Brazilian elderly women

Idosos compõem o grupo etário mais medicalizado na sociedade, o que pode levar ao uso irracional de fármacos. Este trabalho descreve estudo transversal que avaliou a automedicação de idosas atendidas no ambulatório de Atenção ao Idoso do Hospital da Universidade Católica de Brasília. As variáveis socioeconômicas analisadas consistiram na faixa etária, escolaridade e renda familiar mensal. As classes medicamentosas envolvidas em automedicação foram analisadas conforme prevalência, adequação à faixa etária e possíveis interações medicamentosas. Das 218 pacientes entrevistadas, 26 por cento relataram praticar automedicação. Parcela (40 por cento) desses medicamentos era de venda sob prescrição. Medicamentos antiinflamatórios, analgésicos e antipiréticos foram os mais usados sem orientação profissional, seguido pelos fitoterápicos/medicamentos naturais e cardiovasculares. Entre as pacientes automedicadas, 65 por cento apresentaram baixa escolaridade, enquanto 32 por cento apresentaram renda menor ou igual a um salário mínimo. O consumo por automedicação não se mostrou variar conforme a condição socioeconômica. Foram observadas interações medicamentosas potencialmente severas e uso impróprio envolvendo os eventos de automedicação.

The elderly consume more medications than other age groups, being susceptible to irrational use of therapeutic drugs. This work describes a cross-sectional study that evaluated self-medication practiced by elderly women, who were assisted at the Elderly Care Facility of the hospital of the Catholic University of Brasilia. The socio-economical variables analyzed were age group, educational level and monthly family income. The pharmaceuticals were evaluated according to prevalence, suitability for the age group and possible drug interactions. Among the 218 patients interviewed, 26 percent declared self-medication practices, part of them (40 percent) were prescription drugs. Anti-inflammatory, analgesic and antipyretic drugs were the most frequently consumed without professional orientation, followed by phytotherapeutic/natural and cardiovascular agents. Among the self-medicated patients 65 percent had incomplete or no formal basic education whereas 32 percent had earnings equal to or inferior to one minimum wage. The mean consumption of drugs by self-medication was not influenced by socio-economical variables. The practice of self-medication involves potentially harmful drug interactions and use of agents inappropriate for the age group.

Eficácia da atenção farmacêutica em dislipidemia: revisão sistemática / Efficacy of pharmaceutical care in dyslipidemia: systematic review

Grande parte dos pacientes em tratamento com hipolipemiantes não atinge a meta terapêutica por diversas razões: falta de adesão, polifarmácia, reações adversas. A atenção farmacêutica tem como metas aumentar a adesão terapêutica, diminuir a toxicidade e otimizar resultados, prevenir e solucionar problemas relacionados a medicamentos (PRMs). O objetivo desse trabalho foi de revisar a literatura de forma sistemática para avaliar a eficácia da atenção farmacêutica no manejo da dislipidemia. Foram pesquisados artigos na base de dados MEDLINE (1966 – maio de 2006) e no banco de ensaios clínicos da biblioteca Cochrane. Foram incluídos estudos com delineamento de ensaios clínicos randomizados (ECR) que avaliassem a eficácia da atenção farmacêutica em dislipidemia com limitação de idiomas. A busca resultou em seis artigos selecionados no MEDLINE. A pesquisa na base de ensaios clínicos da Cochrane não acrescentou artigos diferentes. Todos os artigos analisados demonstraram resultados positivos da intervenção farmacêutica em dislipidemia. As doenças cardiovasculares, em especial a dislipidemia, possuem características que necessitam de orientação e monitorização do seu tratamento. De acordo com os artigos revisados, a atenção farmacêutica contribui para melhor tratamento da dislipidemia.

Many patients undergoing treatment with lipid-lowering drugs do not reach their therapeutic goal for a number of reasons: nonadherence, polypharmacy, adverse reactions. Pharmaceutical care aims at increasing therapeutic adherence, decreasing toxicity and improving outcomes, preventing and solving drug-related problems. We performed a systematic review of the literature to evaluate pharmaceutical care efficacy in the management of dyslipidemia. The MEDLINE database (1966 to May 2006) was searched for articles, and the Cochrane Library for clinical trials. Inclusion criteria were studies consisting of randomized clinical trials evaluating pharmaceutical care efficacy in dyslipidemia, with language restriction. MEDLINE search yielded six articles. Search in the Cochrane Library did not add any new clinical trial. All selected articles had positive results of pharmaceutical intervention in dyslipidemia. Cardiovascular diseases, especially dyslipidemia, have characteristics suggesting need of treatment guidance and monitoring. According to reviewed articles, pharmaceutical care contributes to better treatment of dyslipidemia.

Prevalência de problemas relacionados com medicamento sem pacientes hipertensos de uma unidade de saúde da família / Prevalence of drug-related problems without hypertensive patients in a family health unit

O objetivo deste trabalho foi determinar a prevalência de Problemas Relacionados com Medicamentos (PRMs) em pacientes hipertensos de uma unidade de saúde da família, na cidade de Campo Grande/MS. Foi realizada uma entrevista com 83 pacientes, utilizando-se de um formulário semi-estruturado. Foram identificados PRMs em 45 pacientes, resultando na prevalência de 54,22%. Utilizou-se da definição de PRM constante no II Consenso de Granada. Os PRMs I e 4 foram os mais comuns, cada um representando 40% do total de problemas diagnosticados. identificaram-se ainda seis (13,33%) casos de PRM 3 e três (6,67%) casos de PRM 5. Não foi identificado nenhum caso de PRM 2 e 6. A alta prevalência de PRM em pacientes hipertensos desta unidade mostrou ser um importante problema que influencia diretamente no descontrole da pressão arterial. A detecção, a resolução e a prevenção de PRM são fundamentais para melhoria dos serviços de saúde e esta pratica parece, cada vez mais, se consolidar como o eixo central das atividades de Atenção Farmacêutica.

The purpose of this study was to determine the prevalence of Drug-Related Problems (DRP) in patients enrolled to a family health unit hypertension control program in the city of Campo Grande-MS, Brazil. An interview with 83 patients was carried out, by using a semi-structured form. Forty five patients were identified as having DRP, resulting in a 54,22% prevalence. We have been used the 11 Consensus of Granada of DRP definition. DRP I and 4 were the most common each one, representing 40% of the total identified DRP. There were 6(13,33%) casesof DRP 3, and 3 (6,67%) cases of DRP 5. There hadn't been identifiedany case of DRP 2 and 6. The high prevalence of DRP in these hypertensive patients had been showed an important problem and has direct influence on the lack ofcontrol of the blood pressure. The detection, resolution and prevention of DRP are essential to improve the quality of the health care services, and this practice seems to consolidate as a central axis of the Pharmaceutical Care activities. attention proposed by the Programme for Family Health, consisting of: the approach to.