Pharmaceutical care during COVID-19 pandemic: challenges and perspectives

Abstract COVID-19 (SARS-CoV-2) pandemic is raising many questions about the future of face-to-face interactions. The possible changes on healthcare delivery may provoke a long term disruption on pharmaceutical assistance requiring new approaches to provide pharmaceutical services. The proposal of pharmaceutical care is patient oriented, and its activities include different forms of interaction. The emergence of COVID-19 puts to the test all the efforts to reposition pharmaceutical care in the set of clinical activities. Now, the pharmaceutical consultations and group activities, which played a fundamental role in the reformulation of pharmacy practices, must be revised in order to reduce the risk of patient agglomeration and contamination. Several researchers suggest technology use to intermediate health care assistance. However, few studies had rigorously analyzed the effectiveness of virtual health care on the pharmaceutical field. Innovating the pharmacy workflow, during the course of a crisis like COVID-19, is the current challenge addressed to all pharmacists. This unforeseen situation requires us to reconsider our plans and actions. It will be necessary resilience, courage and creativity to achieve a consistent attitude, which provides a quick response to the health care needs in this time of crisis.

Providing pharmacy services in a basketball arena: Reflections on building a pharmacy in a COVID-19 surge facility.

PURPOSE: As Coronavirus disease 19 (COVID-19) has spread globally, hospital systems have seen an increasing strain on their ability to accommodate the growing caseload. This demand has led countries to adopt varying surge-facility or alternate care site (ACS) models to manage patient overflow. This report describes the experience of setting up pharmacy services at a city-run surge facility in Philadelphia. SUMMARY: The COVID-19 Surge Facility at the Liacouras Center (CSF-L) was initially developed to serve as a site for patients convalescing from acute inpatient stays in order to free up healthcare resources in surrounding hospitals. The CSF-L site required a distinct set of services to provide the desired level of care. This report details the preparations and challenges faced by the CSF-L pharmacy team in this endeavor, including identifying a pharmacy location that met regulatory requirements, obtaining proper licenses, coordinating drug procurement, filling staffing requirements, developing a formulary, defining the pharmacy and medication management workflow, and ensuring safety protocols were followed. This report explains the rational for developing certain processes and suggests alternative options and ideal plans for developing future pharmacy services in an ACS. CONCLUSION: Identifying a pharmacy leadership team early in the ACS planning process can lead to more efficient plans for pharmacy services. This report details the important steps taken, decisions made, and challenges faced in setting up pharmaceutical services at a COVID-19 field hospital.

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.

Análise das características e tendências do mercado da formação de farmacêuticos no Brasil / Analisys of the characteristics and trends of pharmacist training market in Brazil

A presente pesquisa tem como foco a graduação do farmacêutico. Com o intuito de estudar o mercado educacional do curso de Farmácia, buscou-se analisar a oferta de cursos e vagas desta profissão, a legislação pertinente ao ensino superior do Brasil e do ensino em farmácia, além da atualização da DCN pertencentes a este curso. As justificativas para realização deste estudo estão baseadas em quatro argumentos interligados, como a importância da formação de recursos humanos para saúde, as mudanças ocorridas no perfil curricular desse curso nos últimos anos, o papel das instituições de ensino privado e o aparecimento e crescimento da modalidade EAD, sendo observadas as tendências para o mercado de formação dessa categoria profissional. Trata-se de estudo descritivo e exploratório utilizando uma abordagem quali-quantitativa com associação de duas estratégias metodológicas: a combinação de pesquisa bibliográfica e narrativa sobre as características e tendências da formação do farmacêutico em nosso país, e a coleta de dados através do site do e-MEC. Os resultados da pesquisa junto ao site do e-MEC evidenciaram um total de 811 cursos de Farmácia divididos em 752 presenciais tanto em instituições públicas quanto privadas; já na modalidade EAD, foram encontrados 59, todos em instituições privadas. Em janeiro de 2021 foram ofertadas 107.786 vagas na modalidade presencial e 194.433 EAD, totalizando 302.219 vagas. Considerando a organização acadêmica dos cursos presenciais, a pesquisa encontrou a maior parte em faculdades totalizando 273; O mercado educacional para o curso de farmácia teve sua expansão durante os anos 1930 juntamente com políticas voltadas para o crescimento do setor farmo-químico no país. Nos últimos anos, ocorreram inúmeras mudanças nas políticas de ensino superior, como o crescimento da oferta de vagas em IES privadas com incentivos do governo federal como o FIES e o PROUNI. Este período foi marcado pelo crescimento acelerado do número de cursos, vagas, modalidades de ensino e matrículas, além da diversidade de instituições que pertencem ao sistema de ensino superior do Brasil. O ensino à distância ganhou visibilidade com o avançar da globalização e a criação de novas tecnologias voltadas para a educação. As mudanças no setor educacional permitiram mostrar a importância de pesquisar a formação de recursos humanos, a necessidade de políticas, diretrizes e estratégias que atendam à população e aos serviços de saúde, evitando assim a escassez de recursos humanos para o setor saúde, garantindo o acesso universal e integral como proposto na Lei no 8.080. A pandemia do COVID-19 destacou a importância do farmacêutico em relação ao uso racional de medicamentos e de uma formação qualificada que possa garantir a assistência farmacêutica.

The focus of this study is on pharmacist graduation. To analyze the educational market for the Pharmacy course, we looked at the supply of courses and places in this field, as well as the regulations governing higher education in Brazil and pharmacy education, as well as the DCN for this degree. The study's justifications are based on four interconnected arguments, including the importance of human resources training for health, changes in the curricular profile of this course in recent years, the role of private educational institutions, and the emergence and growth of distance education, as well as trends in the training market for this professional category. This is a descriptive and exploratory study that uses a quali-quantitative approach and combines two methodological strategies: a combination of bibliographic and narrative research on the characteristics and trends of pharmacist education in our country, as well as data collection through the e-MEC website. The survey found a total of 811 Pharmacy courses, divided into 752 face-to-face courses in both public and private institutions, and 59 distance learning courses, all in private institutions, on the e-MEC website. In January 2021, 107,786 on-site places and 194,433 distance learning vacancies were available, amounting 302,219 places. During the 1930s, the educational market for pharmacy courses grew in line with policies aimed at expanding the pharmochemical sector in the country. There have been several changes in higher education regulations in recent years, such as the increase of vacancies in private HEIs with federal government incentives like FIES and PROUNI. The number of courses, vacancies, education modalities, and enrollments increased rapidly throughout this period, as did the diversity of institutions that make up Brazil's higher education system. With the advancement of globalization and the introduction of new educational technology, distance learning has become more visible. The changes in the educational sector highlight the importance of studying human resource formation, as well as the need for policies, guidelines, and strategies that benefit the population and health services, avoiding a human resource shortage in the health sector and ensuring universal and integral access, as proposed in Law 8.080. The COVID-19 pandemic underscored the necessity of pharmacists in terms of medication rationalization and specialized training that can ensure pharmaceutical assistance.

Clinical oncology pharmacist: Effective contribution to patient safety.

Management and prevention of problems related to oncology drugs are particularly important due to the excessive cost, high toxicity, and narrow therapeutic index of the antineoplastic drugs, in addition to the patients' state of health. Therefore, the presence of the pharmacist as a member of the multidisciplinary team is essential to contribute to patient safety. In this work, the interventions performed were identified, quantified, and classified to characterize the work of the clinical oncology pharmacist. This is a prospective and quantitative study, conducted over a period of six months in the outpatient oncology and chemotherapy clinic of the University Hospital of the University of Campinas, Brazil. A total of 3526 medical prescriptions were evaluated for the 780 patients seen and, among these prescriptions, 220 (6.24%) contained errors, representing 6.24% of the total number. The most common error was dose-related with 79 (22.83%) cases of overdosing. Wrong-patient medication error was the least reported (0.29%). Thirty drugs were involved in the pharmaceutical interventions, Carboplatin and Ondansetron being the most frequent. Thirteen types of potential errors were evaluated according to the method proposed by Cardinal and Fernandes. Two (15.38%) included interventions of indication, contraindication, and therapeutic efficacy of a drug. Five of them (38.46%) are related to the treatment regimen, and two (15.38%) were related to prevention of potential adverse events. Four interventions (30.77%) concerned technical interventions in injectable drugs such as dilution, compatibility, and administration time. Of the 346 interventions performed, 1 (0.29%) was classified as potentially lethal, 114 as serious (32.95%), 140 as significant (40.46%), and 91 as minor (26.30%).

Impact of medication therapy management on pharmacotherapy safety in an intensive care unit.

Background Drug-related problems are mostly preventable or predictable circumstances that may impact on health outcomes. Clinical pharmacy activities such as medication therapy management can identify and solve these problems, with potential to improve medication safety and effectiveness. Objective To evaluate ability of medication therapy management service to detect drug-related problems and prevent adverse drug events. This study also aimed to assess the risk factors for drugrelated problem occurrence. Setting Medical intensive care unit of a public tertiary hospital in Brazil. Methods Patients were evaluated by a clinical pharmacist, who provided medication therapy management service. Detected drug-related problems were categorized according to the Pharmaceutical Care Network Europe methodology and analyzed in multinomial regression to identify risk factors. Main outcome measure Potential risk factors for drug-related problem occurrence. Results The proposed medication therapy management service allowed detection of 170 drug-related problems that had potential to reach patients causing harm and other 50 unavoidable adverse events. Drug-related problems identified were more often associated with antibacterial use, caused by improper combinations or inadequate drug dosage. These problems required interventions that were accepted by the multidisciplinary team, resulting in more than 85% adherence and total problem solving. Main risk factors identified were previous diagnosis of kidney injury (OR = 8.38), use of midazolam (OR = 7.96), furosemide (OR = 5.87) and vancomycin (OR = 4.82). Conclusion Medication therapy management proved to be an effective method not only for drug-related problem detection, but also for adverse drug event prevention, contributing to improve patient safety.

Medication therapy disease management: Geisinger's approach to population health management.

PURPOSE: Pharmacists' involvement in a population health initiative focused on chronic disease management is described. SUMMARY: Geisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS). Over a 15-year period, Geisinger Health Plan (GHP)-insured patients with AF whose warfarin therapy was managed by the MTDM program had, on average, 18% fewer emergency department (ED) visits and 18% fewer hospitalizations per year than GHP enrollees with AF who did not receive MTDM services, with 23% lower annual total care costs. Over a 2-year period, GHP-insured patients with MS whose pharmacotherapy was managed by pharmacists averaged 28% fewer annual ED visits than non-pharmacist-managed patients; however, the mean annual total care cost was 21% higher among MTDM clinic patients. CONCLUSION: The Geisinger MTDM program has evolved over 20 years from a single pharmacist-run anticoagulation clinic into a large program focused on managing the health of an ever-growing population. Initial challenges in integrating pharmacists into the Geisinger patient care framework as clinical experts were overcome by demonstrating the MTDM program's positive impact on patient outcomes.

Implementation of a pharmacist-managed clinic for patients with chronic nonmalignant pain.

PURPOSE: A pharmacist-managed chronic pain clinic (PMCPC) in a primary care setting is described. SUMMARY: As primary care providers (PCPs) may be unprepared or lack time to manage high-risk patients receiving opioids for chronic nonmalignant pain, alternative models of care are needed. The University of Colorado PMCPC is integrated into an internal medicine outpatient clinic. The PMCPC is staffed by 1 clinical pharmacist, with pharmacy students and residents also performing clinic duties. The pharmacy team reviews health records to determine eligibility for PMCPC services and documents referral requests in the electronic health record (EHR); on PCP acceptance of a referral, the pharmacy team assumes primary responsibility for the patient's pain management under a collaborative practice agreement. Using a collaborative drug therapy management (CDTM) protocol, the pharmacy team conducts patient assessments, including an assessment for signs of aberrant drug-taking behaviors; provides initial and ongoing counseling and education; and makes recommendations to the PCP for opioid dosage adjustments and regimen additions and discontinuations. Experience at the clinic to date indicates that the PMCPC model is feasible and accepted by PCPs and patients. CONCLUSION: A PMCPC based in a primary care setting was established to improve the care of patients with chronic nonmalignant pain who are prescribed opioid therapy for a period of 3 months or longer. Clinic patients are referred to the clinic through the EHR and managed by a pharmacist under a CDTM protocol.

Pharmacist prescribing practices in a clinical pharmacy cardiac risk service.

PURPOSE: Prescribing practices within a clinical pharmacy cardiac risk service (CPCRS) and their impact on treatment outcomes in patients with atherosclerotic cardiovascular disease (ASCVD) are described. SUMMARY: National healthcare reforms have increased the population of insured patients and placed increased demands on physicians and other providers. Pharmacists are well trained and positioned to aid in patient care by providing expertise in medication management and patient safety that can result in pharmacotherapy optimization and cost savings. Kaiser Permanente Colorado (KPCO), a group-model health maintenance organization with about 675,000 members served by 30 medical offices throughout Colorado, has adopted a collaborative drug therapy management (CDTM) model that enables pharmacist prescribing to improve patient access, patient care, and healthcare cost-effectiveness. Within the CPCRS established by KPCO, qualified pharmacists are permitted to prescribe initial therapy, modify drug regimens, order laboratory tests, and perform follow-up activities within their professional scope of practice. The CPCRS focuses on the long-term management of patients with ASCVD. The primary goals of the CPCRS are to optimize secondary-prevention pharmacotherapy, monitor and ensure medication adherence, assist in the management of risk factors for ASCVD, provide patient education and counseling, and serve as a resource for physicians and other healthcare providers. Working under a CDTM agreement, pharmacists are authorized to prescribe therapies to minimize the risk of future ASCVD events. CONCLUSION: The CPCRS at KPCO has demonstrated successful maintenance of a clinical pharmacy service including pharmacist prescribing under a CDTM model to manage patients with ASCVD.

Ensino farmacêutico no Brasil na perspectiva de uma formação clínica / Pharmacist education in brazil from a clinical perspective

O objetivo deste estudo foi discutir a interação entre ensino e prática farmacêutica voltada para a formação clínica. A metodologia consistiu na busca, leitura e discussão de materiais impressos ou em formato eletrônico relacionados à temática. Os resultados apresentam uma pequena introdução sobre a evolução da profissão farmacêutica, que foi acompanhada pelo ensino, para, então, discutir as propostas que vêm sendo empregadas para garantir o desenvolvimento das diversas habilidades necessárias à práxis farmacêutica, sobretudo no âmbito clínico. Por muito tempo, o ofício farmacêutico esteve relacionado com a manipulação dos medicamentos, mas, com a ascensão da indústria farmacêutica, o profissional perdeu esse papel, indo atuar nas análises clínicas e na indústria. Na tentativa de reaproximar o farmacêutico da farmácia, resgatando o seu papel social, surgiram diversas propostas, como a Farmácia Clínica e a Atenção Farmacêutica. Entretanto, a incorporação da dimensão clínica na prática profissional exige uma adequação dos cursos de formação. Algumas experiências foram adotadas e são praticadas há muito tempo, como projetos de extensão e Farmácia-Escola. Entretanto, nos últimos anos, tem se difundido o uso de metodologias ativas, como as estratégias de ensino e aprendizagem baseadas na problematização, uso de realidade virtual, jogos e outros tipos de simulação. Todas essas práticas pedagógicas, inovadoras ou não, são úteis no processo ensino-aprendizagem, mas apenas se forem utilizadas na perspectiva de otimizar os resultados da farmacoterapia, melhorando a qualidade de vida dos usuários de medicamentos...

The aim of this study was to discuss the interaction between education and the practice of pharmacy, with a focus on clinical training. The methodology consisted in the discussion of papers and books related to the theme. The findings constitute a short introduction to the development of the pharmaceutical profession, which evolved side-by-side with teaching, and then discuss the measures that have been proposed to ensure the development of the various skills necessary for pharmaceutical practice, above all in the clinical setting. For a long time, the pharmacist was related to the handling of medicines, but the rise of the pharmaceutical industry led to the loss of this role, so that the pharmacist went to work in the industry and clinical analysis. In an attempt to bring pharmacists back to the pharmacy, rescuing their social role, several proposals were put forward, such as Clinical Pharmacy and Pharmaceutical Care. However, the incorporation of the clinical dimension into professional practice requires adjustments in the training courses. Some experiments were put into practice long ago, such as Faculty extension and Faculty-Pharmacy projects. In recent years, the use of active methods has been spreading, such as strategies for teaching and learning based on the use of problems, virtual reality, games and other types of simulation. All these teaching practices, innovative or not, are useful in the teaching-learning process, but only if used with a view to enhancing the results of pharmacotherapy, thus improving the quality of life of patients...

Os avanços da homeopatia na unidade básica de saúde (SUS)

Este estudo mostra os avanços da homeopatia na aplicação terapêutica, como um sistema terapêutico de caráter sistêmico e suas açoes desenvolvidas para humanizar a prática médica no Brasil, como o Sistema ùnico de Saúde (SUS), descrevendo os desafios e obstáculos a serem vencidos para que sejam assegurados não só a equidade, mais também, o direito à saúde e o acesso aos medicamentos, como também o incremento e a qualificação das ações envolvidasna assintência farmacêutica homepática.

This study focuses on the concept and definition of pharmaceutical care in therapeutic application in homeopathy as a therapeutic system of systemic character and actions developed for humanizing medical practice in Brazil, such as the Unified Health System (UHS), describing the challenges and obstacles to be overcome so that not only the fairness, most also, the right to health and access to medicines, as well as the increment and the qualification of the actions involved in pharmaceutical care are ensured homeopathy.

Advanced-practice pharmacists: practice characteristics and reimbursement of pharmacists certified for collaborative clinical practice in New Mexico and North Carolina.

PURPOSE The results of a survey assessing the practice settings, clinical activities, and reimbursement experiences of pharmacists with advanced-practice designations are reported. METHODS A questionnaire was sent to all certified Pharmacist Clinicians in New Mexico and all Clinical Pharmacist Practitioners in North Carolina (a total of 189 pharmacists at the time of the survey in late 2008) to elicit information on practice settings, billing and reimbursement methods, collaborative drug therapy management (CDTM) protocols, and other issues. RESULTS Of the 189 targeted pharmacists, 64 (34%) responded to the survey. On average, the reported interval from pharmacist licensure to certification as an advanced practitioner was 11 years. The majority of survey participants were practicing in community or institutional settings, most often hospital clinics or physician offices. About two thirds of the respondents indicated that their employer handled the billing of their services using standard evaluation and management codes, with estimated total monthly billings averaging $6500. At the time of the survey, about 80% of the respondents were engaged in a CDTM protocol. The survey results suggest that pharmacists with advanced-practice designations are perceived favorably by patients and physicians and their services are in high demand, but more than one third of respondents indicated a need to justify their advanced-practice positions to administrators. CONCLUSION Pharmacists with advanced-practice designations are providing clinical services in various settings under collaborative practice arrangements that include prescribing privileges. Despite growing patient and physician acceptance, reimbursement challenges continue to be a barrier to wider use of CDTM programs.

Los farmacéuticos a la entrada del siglo XXI / The pharmacologists at the threshold of the XXI century

Mirar hacia el futuro, nos ayuda a interpretar las necesidades de los seres humanos. Nos obliga a analizar aquellas transformaciones que permitan un futuro viable, con democracia, equidad y justicia social. El principio de ambivalencia de la ciencia es muy relevante, puede ser utilizado para el bien o para el mal. Integrarla con otros saberes, arte, filosofía, psicología, solo por mencionar algunos permitirá su mejor comprensión. Además, la preocupación creciente acerca de la complejidad del campo de la salud, sus implicaciones de orden económico, social, científico-técnico y político exigen un abordaje interdisciplinar. Es el farmacéutico dentro de los profesionales de la salud el único que aporta un objeto concreto: el medicamento, cuyo acceso en el mundo de hoy constituye un gran problema social, donde la mayoría de la población no tiene acceso a este bien tan esencial. A partir de la 2da mitad del pasado siglo los medicamentos se transformaron en una importante herramienta terapéutica, pero también se fueron agravando problemas económicos, sociales y de salud, de ahí la necesidad de mirar hacia el futuro.

Looking into the future helps us to interpret the needs of the human beings. It compels us to analyze those transformations that allow a viable future with democracy, equity and social justice. The ambivalence principle of science is very important. It may be used for good or for bad. To integrate it to other knowledge, art, philosophy, psychology, just to mention some, will facilitate its better understanding. Moreover, the increasing concern about the complexity of the health field, its economic, social, scientific, technical, and political implications demand an interdisciplinary approach. It is the pharmacologist within the health professionals the only one that provides a concrete object: the drug, whose access in the present world is a big social problem, since most of the population has no access to this essential product. From the second half of the last century on, drugs became an important therapeutical tool, but the economic, social and health problems have aggravated, and that's why it is necessary to look to the future.

O farmacêutico na saúde coletiva: sua identidade, demandas do serviço e o papel do Internato Rural na sua formação

As Diretrizes Curriculares de 2002 estabeleceram um novo currículo para o ensino farmacêutico na tentativa de aproximar a formação do profissional das exigências do novo modelo de atenção instituído com o SUS. Uma alternativa adotada por algumas Faculdades de Farmácia no país tem sido inserir em seus currículos a disciplina de Internato Rural (IR). No presente trabalho objetivou-se analisar a contribuição do IR do curso de Farmácia da Universidade Federal de Minas Gerais na formação do farmacêutico para atuação no SUS. O estudo foi desenvolvido sob três perspectivas: o resgate histórico da profissão, a contribuição do IR na formação acadêmica, e a percepção dos profissionais farmacêuticos dos elementos necessários para a sua formação no contexto do serviço de saúde. Para o resgate histórico foi realizado uma revisão bibliográfica sobre a construção da identidade profissional do farmacêutico e sua inserção no SUS. O segundo momento, da pesquisa, foi realizado com os alunos matriculados no IR e com os idealizadores/coordenadores da disciplina. No último. momento trabalhou-se com todos os gerentes das farmácias distritais do município de Belo. Horizonte. Para a coleta das informações utilizou-se a técnica do grupo focal e a entrevista. semi-estruturada. Os discursos foram analisados na perspectiva da análise de conteúdo e os. resultados apontaram para um baixo conhecimento dos alunos sobre SUS e sobre a assistência. farmacêutica, Entretanto, o IR foi considerado uma ponte de aprendizagem entre a teoria e a prática. A realidade da assistência farmacêutica apontada pelos alunos foi a mesma relatada pelos profissionais farmacêuticos. A falta do profissional e a fragmentação da atividade da assistência ainda caracterizam o cenário do Sistema. Neste sentido, o profissional farmacêutico passa por uma fase de ruptura do paradigma tecnicista para a (re)construção de sua identidade como profissional da saúde.

O farmacêutico na saúde coletiva: sua identidade, demandas do serviço e o papel do Internato Rural na sua formação / The pharmacist in public health: their identity, and the role of the service demands of their training in Rural Internship

As Diretrizes Curriculares de 2002 estabeleceram um novo currículo para o ensino farmacêutico na tentativa de aproximar a formação do profissional das exigências do novo modelo de atenção instituído com o SUS. Uma alternativa adotada por algumas Faculdades de Farmácia no país tem sido inserir em seus currículos a disciplina de Internato Rural (IR). No presente trabalho objetivou-se analisar a contribuição do IR do curso de Farmácia da Universidade Federal de Minas Gerais na formação do farmacêutico para atuação no SUS. O estudo foi desenvolvido sob três perspectivas: o resgate histórico da profissão, a contribuição do IR na formação acadêmica, e a percepção dos profissionais farmacêuticos dos elementos necessários para a sua formação no contexto do serviço de saúde. Para o resgate histórico foi realizado uma revisão bibliográfica sobre a construção da identidade profissional do farmacêutico e sua inserção no SUS. O segundo momento, da pesquisa, foi realizado com os alunos matriculados no IR e com os idealizadores/coordenadores da disciplina. No último. momento trabalhou-se com todos os gerentes das farmácias distritais do município de Belo. Horizonte. Para a coleta das informações utilizou-se a técnica do grupo focal e a entrevista. semi-estruturada. Os discursos foram analisados na perspectiva da análise de conteúdo e os. resultados apontaram para um baixo conhecimento dos alunos sobre SUS e sobre a assistência. farmacêutica, Entretanto, o IR foi considerado uma ponte de aprendizagem entre a teoria e a prática. A realidade da assistência farmacêutica apontada pelos alunos foi a mesma relatada pelos profissionais farmacêuticos. A falta do profissional e a fragmentação da atividade da assistência ainda caracterizam o cenário do Sistema. Neste sentido, o profissional farmacêutico passa por uma fase de ruptura do paradigma tecnicista para a (re)construção de sua identidade como profissional da saúde.

Pharmaceutical care in community pharmacies: practice and research in Peru.

OBJECTIVE: To describe the current and possible future development of pharmaceutical care activities and research in healthcare settings in Peru. FINDINGS: Pharmaceutical care has developed slowly in Peru because, until recently, clinical practice never was part of community or hospital pharmacy practice. Some activities of the Ministry of Health, schools of pharmacy, pharmacy organizations, and individual pharmacists, including changes in legislation, are now creating the opportunity to develop pharmaceutical care practice. The implementation of pharmaceutical care in different settings will follow, based on the legislation and experiences of the pharmacists involved. DISCUSSION: The 2004 legislative changes in Peru in the field of drug regulation and the health system create more opportunities for pharmacists to be active in providing care to patients. To stimulate the provision of care, programs of formal training are offered by universities, but more pharmacists need to participate in these courses. As long as pharmacists are absent from their pharmacies (their presence is required by law), little can be expected. The development of interprofessional collaboration in the Peruvian health system, currently nonexistent, is also important. To improve the performance of the pharmaceutical care system, good relationships between teachers and practitioners must be stimulated. Such links are also essential for developing research into the impact of pharmaceutical care on clinical, economic, and humanistic outcomes of patient care. CONCLUSIONS: The pharmaceutical care movement is growing in Peru. The legislation now supports the provision of pharmaceutical care. A number of developments must be stimulated, such as protocol development, appropriate continuing education, different kinds of networking, and remuneration procurement for care provision. When these successfully evolve, pharmaceutical care will become a professional aspect of the work of all pharmacists in Peru.