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1.
Einstein (Sao Paulo) ; 18: eRW4686, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32022107

RESUMEN

OBJECTIVE: To investigate the impact of pharmaceutical care-based interventions on type 2 diabetes mellitus . METHODS: PubMed®, Cochrane and Web of Science data bases were searched for randomized controlled clinical trials. Studies evaluating pharmaceutical care-based interventions in type 2 diabetes mellitus published between 2012 and 2017 were included. Glycated hemoglobin was defined as the primary endpoint; blood pressure, triglycerides and cholesterol as secondary endpoints. The random effects model was used in meta-analysis. RESULTS: Fifteen trials involving 2,325 participants were included. Meta-analysis revealed considerable heterogeneity (I2>97%; p<0.001), reduction in glycated hemoglobin (-1.07%; 95%CI: -1.32; -0.83; p<0.001), glucose (-29.91mg/dL; 95%CI: -43.2; -16.6; p<0.001), triglyceride (19.8mg/dL; 95%CI: -36.6; -3.04; p=0.021), systolic blood pressure (-4.65mmHg; 95%CI: -8.9; -0.4; p=0.032) levels, and increased HDL levels (4.43mg/dL; 95%CI: 0.16; 8.70; p=0.042). CONCLUSION: Pharmaceutical care-based clincal and education interventions have significant impact on type 2 diabetes mellitus . The tools Summary of Diabetes Self-Care Activities and the Morisky Medication Adherence Scale may be useful to monitor patients.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Servicios Farmacéuticos/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Anciano , Glucemia/análisis , Presión Sanguínea , Colesterol/sangre , Diabetes Mellitus Tipo 2/sangre , Femenino , Hemoglobina A Glucada/análisis , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Educación del Paciente como Asunto/estadística & datos numéricos , Farmacéuticos , Autocuidado/estadística & datos numéricos , Triglicéridos/sangre
2.
Sr Care Pharm ; 35(3): 108-109, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32070457

RESUMEN

Older people are especially vulnerable to the impacts of natural disasters such as the fires in Australia and elsewhere around the world. Health care professionals have a duty of care under these circumstances, and among those who respond are pharmacists who contribute their expertise, energy, and dedication to help where needed.


Asunto(s)
Servicios Farmacéuticos , Farmacia , Anciano , Anciano de 80 o más Años , Australia , Humanos , Farmacéuticos
3.
Sr Care Pharm ; 35(3): 113-119, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32070459

RESUMEN

A 62-year-old patient living in a rural community was referred to participate in a pharmacist-led home visit program because of concerns with the patient's increasing falls and medication complexity. The patient reported experiencing an increasing number of falls over the past few months, resulting in a recent hospitalization and mild head trauma. The patient's past medical history included diabetes mellitus type 2, hypertension, hyperlipidemia, gastroesophageal reflux disease, paroxysmal atrial fibrillation, unspecified back pain, and benign prostatic hyperplasia. During the comprehensive medication review, pharmacists determined the patient had inadvertently purchased an acetaminophen/ diphenhydramine combination medication, rather than his usual acetaminophen. According to the 2019 Beers criteria, use of acetaminophen/diphenhydramine for back pain without insomnia is not the best option and may contribute to falls. With an estimated four to eight tablets per day, the patient was taking 200-400 mg of diphenhydramine daily. Pharmacist recommendations included contacting the prescribing physician to obtain a prescription for acetaminophen. By asking the local pharmacy to dispense acetaminophen as a prescription, the risk of the patient inadvertently purchasing an inappropriate product is reduced. After removing the diphenhydramine from the patient's regimen, the falls ceased. This case demonstrates the effects of inappropriate diphenhydramine use in an especially vulnerable population. It also highlights the critical role that rural community pharmacists can play in improving their patients' health care.


Asunto(s)
Difenhidramina/efectos adversos , Humanos , Persona de Mediana Edad , Servicios Farmacéuticos , Lista de Medicamentos Potencialmente Inapropiados
4.
Sr Care Pharm ; 35(3): 126-135, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32070461

RESUMEN

OBJECTIVE: To analyze medication interventions prior to and following implementation of the Pharmacy Medication Related Falls Risk Assessment consult service in an older adult population. DESIGN: Retrospective chart review. SETTING: This study involved patients admitted to the Cincinnati Veterans Affairs Medical Center's (VAMC) Community Living Center (CLC), an institutional practice setting. PATIENTS, PARTICIPANTS: Any patient who experienced a fall while admitted to the CLC during fiscal years 2013 or 2018 was considered for inclusion. Patients were excluded if falls were not evaluated by a provider, the patient expired within 10 days after falling, or falls in fiscal year 2018 that did not have a pharmacy consult placed. Fifty falls from each fiscal year were selected. MAIN OUTCOME MEASURES: The primary endpoint encompassed the number of pharmacy medication interventions made within 10 days postfall, with a secondary endpoint evaluating subsequent falls within 30 days of initial event. RESULTS: Following consult implementation, a larger number of pharmacist recommendations (40 vs. 123) and subsequent interventions (accepted recommendations) within ten days postfall (12 vs. 49) were completed. There were 14 subsequent falls within 30 days of the initial event for both fiscal years. A larger percentage of falls and patients experiencing falls from each fiscal year did not receive previous medication interventions. CONCLUSION: Consult implementation increased the number of pharmacist recommendations and subsequent interventions for patients within ten days postfall, reducing the risk of adverse effects, drug-drug interactions, subsequent falls, and polypharmacy.


Asunto(s)
Servicios Farmacéuticos , Veteranos , Accidentes por Caídas , Anciano , Humanos , Farmacéuticos , Estudios Retrospectivos
5.
Sr Care Pharm ; 35(3): 136-144, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32070462

RESUMEN

OBJECTIVES: To describe and gather further details about the clinical and educational activities that were documented by the geriatric pharmacist resident during both weekly interprofessional Acute Care for the Elderly (ACE) rounds as well as bedside patient counseling. DESIGN: Retrospective chart review (quality improvement project). SETTING: Inpatient geriatric service at University of Pittsburgh Medical Center (UPMC). PATIENTS: Medical learners selected one complex patient from the geriatric service for ACE rounds each week. ACTIVITIES: The geriatric pharmacist resident provided clinical information and medication education to the interprofessional team and to the patient and/or family at their bedside. Activities were documented in a newly developed template. MAIN OUTCOME MEASURES: Patient demographics, medication categories, discrepancies and dosing changes, time-in-rounds, and team members. RESULTS: De-identified data from 18 patients (72.2% female, average age 82.5 ± 9.18 years) over a 6-month period were collected and analyzed. The geriatric pharmacist resident provided most education to the team on antibiotics, antidepressants, over-thecounters (OTCs), and prescription pain medications during ACE rounds. They provided most education to the patient/family on prescription pain medications, antidepressants, OTCs, and anticoagulants. The pharmacist resident identified 38 medication discrepancies (72.2% of patients had ≥ 1 discrepancy, range 0-7) and clinically significant drug-drug interactions in 15 patients. The pharmacist resident recommended dosing changes in 12 patients and therapeutic alternatives in 11 patients. The ACE rounds lasted on average 26.6 [± 6.42] minutes and included medicine, pharmacy, social work, nurse case management, nursing, and nutrition and rehabilitative services when necessary. CONCLUSION: The results provide insight into both the clinical and educational activities of the geriatric pharmacist resident in support of interprofessional rounds.


Asunto(s)
Educación en Farmacia , Servicios Farmacéuticos , Farmacias , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Farmacéuticos , Estudios Retrospectivos
6.
Sr Care Pharm ; 35(2): 81-84, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32085817

RESUMEN

An interprofessional, team-based approach has become common in a variety of settings. However, consultant pharmacist participation in home health care (HHC) has been limited. To evaluate a potential need for pharmacists in HHC, the objective of this project was to document the medication complexity of patients seen by an established HHC consultant pharmacist service. This retrospective review reports on medication regimen complexity in 79 patients receiving this service using the Patient-Level Medication Regimen Complexity Index (MRCI) tool. The average MRCI score was 30 (± 15 standard deviation), suggesting a high level of medication regimen complexity in this population. High scores have been correlated with increased potential adverse drug events, 30-day hospital readmissions, and reduced adherence. Further research is needed for both the utilization of consultant pharmacists in HHC and the use of MRCI in identifying HHC patients needing pharmacist services.


Asunto(s)
Servicios de Atención de Salud a Domicilio , Servicios Farmacéuticos , Consultores , Humanos , Farmacéuticos , Estudios Retrospectivos
9.
J Oncol Pharm Pract ; 26(1): 175-186, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31554471

RESUMEN

Gender disparity exists in leadership roles within healthcare. While the majority of the healthcare workforce is comprised of women, significantly fewer women occupy leadership positions, particularly at executive and board levels. As the field of oncology pharmacy continues to rapidly expand and evolve, an assessment of the current state of women in oncology pharmacy leadership roles is vital to the growth and development of the profession. In the fall of 2017, the Hematology/Oncology Pharmacy Association (HOPA) hosted a summit to explore leadership issues facing women in oncology pharmacy which have the potential to affect our membership and our profession. This meeting included invited participants from across the fields of oncology and pharmacy and was part of HOPA's strategic leadership initiative developed through the work of the HOPA Leadership Development Committee in 2016. This promotes a primary goal of HOPA, which is to support oncology pharmacists as they assume leadership roles within their practices and within healthcare to assure oncology pharmacy is integrated into cancer care. The purpose of this white paper is to (1) summarize key issues that were identified through a membership survey; (2) review ongoing efforts to address the needs of female oncology pharmacists in leadership development; (3) serve as a call to action for individuals and professional organizations to assist with and disseminate these efforts and highlight available resources, and (4) to provide practical steps to meet the needs of individuals, training programs, and institutions/employers.


Asunto(s)
Liderazgo , Neoplasias/tratamiento farmacológico , Farmacéuticos/tendencias , Farmacia/tendencias , Sexismo/tendencias , Femenino , Humanos , Servicios Farmacéuticos/tendencias , Farmacia/métodos , Sexismo/prevención & control
10.
Einstein (Sao Paulo) ; 18: eAO4858, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31851225

RESUMEN

OBJECTIVE: To develop and validate the content of a tool aimed to select patients with hypertension for pharmaceutical care, based on identification of individuals in greater need of attention. METHODS: The tool was developed and assessed for face and content validity, which was carried out in three stages. Phase I consisted of comprehensive literature review, which prompted the development of the first version of the tool. Phase II consisted of validation by an expert panel. Phase III consisted of a pilot study with hypertensive patients and preparation of the final version of the instrument. RESULTS: Literature review yielded 30 studies, out of which 13 factors associated with hypertension and cardiovascular disease control and complications were selected. Once the initial version of the tool named INSAF-HAS was obtained, four expert meetings were held, each leading to instrument improvement until a final consensus was reached. In the pilot study, INSAF-HAS was applied to 30 patients with a diagnosis of hypertension for applicability pretest; adjustments were made and the final version of INSAF-HAS obtained. CONCLUSION: The INSAF-HAS tool developed in this study has face and content validity, and may contribute to the selection of patients with hypertension in greater need of pharmaceutical care services.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Selección de Paciente , Servicios Farmacéuticos/normas , Encuestas y Cuestionarios/normas , Enfermedades Cardiovasculares/etiología , Progresión de la Enfermedad , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Proyectos Piloto , Reproducibilidad de los Resultados , Factores de Riesgo
13.
BMC Public Health ; 19(1): 1698, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31852470

RESUMEN

BACKGROUND: Despite the existence of efficacious vaccines, the burden of vaccine-preventable diseases remains high and the potential health benefits of paediatric, adolescent and adult vaccination are not being achieved due to suboptimal vaccine coverage rates. Based on emerging evidence that pharmacy-based vaccine interventions are feasible and effective, the European Interdisciplinary Council for Ageing (EICA) brought together stakeholders from the medical and pharmacy professions, the pharmaceutical industry, patient/ageing organisations and health authorities to consider the potential for pharmacy-based interventions to increase vaccine uptake. We report here the proceedings of this 3-day meeting held in March 2018 in San Servolo island, Venice, Italy, focussing firstly on examples from countries that have introduced pharmacy-based vaccination programmes, and secondly, listing the barriers and solutions proposed by the discussion groups. CONCLUSIONS: A range of barriers to vaccine uptake have been identified, affecting all target groups, and in various countries and healthcare settings. Ease of accessibility is a potentially modifiable determinant in vaccine uptake, and thus, improving the diversity of settings where vaccines can be provided to adults, for example by enabling community pharmacists to vaccinate, may increase the number of available opportunities for vaccination.


Asunto(s)
Promoción de la Salud/métodos , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Servicios Farmacéuticos/organización & administración , Farmacéuticos , Vacunación/psicología , Vacunación/estadística & datos numéricos , Adulto , Congresos como Asunto , Europa (Continente) , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Objetivos Organizacionales , Rol Profesional
14.
Rev. Hosp. El Cruce ; (25): 10-18, Dic 2019.
Artículo en Español | LILACS, BINACIS | ID: biblio-1047119

RESUMEN

OBJETIVO: Analizar las intervenciones farmacéuticas (IF) realizadas y medir el aporte farmacéutico a la mejora de la calidad asistencial. METODOLOGÍA: Estudio observacional y retrospectivo realizado en un hospital de alta complejidad. Se analizaron las IF registradas entre enero del 2018 y agosto del 2019 en una planilla diseñada para tal fin, teniendo en cuenta las variables: vía de comunicación, receptor de la IF, tipo de intervención, etapa del proceso, clasificación de la IF y aceptación.Se midió mensualmente el indicador "aporte farmacéutico a la mejora de la calidad asistencial"= Nº IF aceptadas/Nº IF realizadas*100. Nivel de aceptación esperado: 80%. RESULTADOS: Se registraron 3683 IF, 0,6 IF/paciente seguido promedio. Los resultados de las variables analizadas fueron: a) 98% activas; 2% pasivas. b) 73% oral; 26% telefónica; 1% escrita. c) 96% médicos; 4% enfermeros. d) 37% prescripción, 58% seguimiento, 4% administración, 1% preparación. e) 86% aceptadas, 11% no aceptadas (4% no aceptadas con justificación, 4% no aceptadas parciales, 3% no aceptadas sin justificación), 3% no evaluables f) 27% se relacionó con posología, 23% suspensión de medicamento, 15% agregado de medicamento, 11% confirmación de la prescripción, 9% forma de administración/preparación, 8% clarificación de la prescripción, 7% otras. Evolución mensual del indicador de octubre/18 a agosto/19: 85%, 85%, 90%, 88%, 77%, 80%, 90 %, 87%, 93%, 86%, 84%. CONCLUSIONES: Se registró un elevado número de intervenciones por paciente seguido, con participación activa del farmacéutico. Se evidenció una relación de mutua confianza y abordaje multidisciplinario con el personal de salud, manifestado por el porcentaje de aceptación. La clasificación de IF nos permitió identificar problemas frecuentes en la utilización de medicamentos y establecer estrategias de prevención. La medición del indicador superó el nivel de aceptación la mayoría de los meses evidenciando el aporte a la mejora de la calidad asistencial.


OBJECTIVE: To analyze the pharmaceutical interventions (PI) carried out and measure the pharmaceutical contribution to the improvement of the quality of care. METHODOLOGY: Observational and retrospective study conducted in a hospital of high complexity. The PI registered between January 20 18 and August 20 19 were analyzed in a form designed for this purpose, taking into account the variables: communication channel, receiver of the PI, type of intervention, stage of the process, classification of the FI and acceptance . The indicator "pharmaceutical contribution to the improvement of the quality of care" was measured monthly = No. PI accepted / No. PI made * 100. Expected level of acceptance: 80%. RESULTS: 3683 PI, 0,6 PI/ patient followed average. The results of the analyzed variables were: a) 98% active; 2% passive b) 73% oral; 26% telephone; 1% written. c) 96% doctors; 4% nurses d) 37% prescription, 58% follow-up, 4% administration, 1% preparation. e) 86% accepted, 11% not accepted (4% not accepted with justification, 4% not partially accepted, 3% not accepted without justification), 3% not evaluable f) 27% related to dosage, 23% suspension of medication, 15% aggregate of medication, 11% confirmation of prescription, 9% form of administration /preparation, 8% clarification of prescription, 7% others. Monthly evolution of the indicator from October / 18 to August / 19: 85%, 85%, 90%, 88%, 77%, 80%, 90%, 87%, 93%, 86%, 84%. CONCLUSIONS: A high number of interventions were recorded per patient followed, with active participation of the pharmacist. A relationship of mutual trust and multidisciplinary approach with health personnel was evidenced, manifested by the percentage of acceptance. The classification of PI allowed us to identify frequent problems in the use of medications and establish prevention strategies. The measurement of the indicator exceeded the level of acceptance most months evidencing the contribution to the improvement of the quality of care.


Asunto(s)
Servicios Farmacéuticos , Calidad de la Atención de Salud , Atención a la Salud , Atención Hospitalaria
17.
Cien Saude Colet ; 24(10): 3717-3726, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31577002

RESUMEN

The objective is to analyze the insertion of the pharmacists work in primary health care in Brazil. The search was performed on BVS, SciELO, Lilacs e Medline databases from 1998 to 2016. From the 157 articles found, excluding the duplicates, theses, dissertations and reviews, after the complete reading the review included 9 articles dealing with the pharmacist's work describing experiences, attributions, potentialities, difficulties and challenges. Results show incipient production and predominance of qualitative studies starting in 2007. The insertion in the team is the central topic of the studies, pointing out the challenges and the difficulties related to the recognition and acceptance of the pharmacists interventions. The potentialities reside in the area of actions directed to the client, the families and the team, as well as in the professional training field as well as in the dissemination of the results of the pharmaceutical actions. The pharmacists' isolation in the primary care prevails, albeit there are perspectives of strengthening the integration in the team that has been stimulated by the recent institutional and regulatory transformations in the national scenario. Beyond the present difficulties and experiences reported, the researchers focus on the potentialities for the professional practice, glancing at the construction of the future.


Asunto(s)
Servicios Farmacéuticos/organización & administración , Farmacéuticos/organización & administración , Atención Primaria de Salud/organización & administración , Brasil , Humanos , Grupo de Atención al Paciente/organización & administración , Rol Profesional
20.
Rev Esp Salud Publica ; 932019 Sep 25.
Artículo en Español | MEDLINE | ID: mdl-31551406

RESUMEN

OBJECTIVE: The electronic prescription has meant an evolution in the quality of health care, but it has a series of deficiencies that compromise the adherence to treatments. The objective of this work was to collect and group these limitations and propose the changes that could solve them. METHODS: During 2017 and 2018, through dispensing and pharmacotherapeutic monitoring activities, incidents related to the electronic prescription were collected in a pharmacy in Santander and their causes were identified. A survey was conducted and sent to the Information Centers of the Medicines of the rest of the regions to know if the same problems were shared and the resulting data were treated by frequency distribution. RESULTS: We detected 1,500 incidents related to the way of access to the treatment and its activation period, with the availability of the medication when the patient requested it and those in which the assessment of the problem by the doctor was essential. The survey data showed that in 100% of the CCAA the patient must return to the doctor when there is an incidence, because there is no protocol to solve it from the pharmacy. CONCLUSIONS: These incidents compromise the adherence to treatments and the health of patients. To avoid them, we propose the elimination of the password that is necessary to access the treatment, the establishment of a minimum period of 30 days for its activation, the creation of protocols so that the pharmacist can solve problems and perform dispensations in special circumstances, and finally, the optimization of the communication between pharmacist and doctor.


Asunto(s)
Prescripción Electrónica , Cumplimiento de la Medicación/estadística & datos numéricos , Servicios Farmacéuticos/organización & administración , Farmacias , Comunicación , Humanos , Calidad de la Atención de Salud , España/epidemiología , Encuestas y Cuestionarios
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