Professionals' and Patients' Perspectives on Criteria for Referring Hypertensive Patients to Comprehensive Medication Management Services in Public Primary Health Care.

Patient prioritization in comprehensive medication management services allows coordinating care and guiding patients according to their clinical profile and their medication use. The aim of the study is to identify and describe factors that indicate the need for comprehensive medication management services among primary care hypertension patients within a public health system from the perspective of patients, pharmacists, nurses and physicians. A qualitative study was carried out with interviews with nurses, pharmacists and physicians (n = 20), and two focus groups with hypertensive patients (n = 12) at primary health care facilities and a public outdoor fitness area between January and February 2019 in Brazil. All interviews were transcribed and analyzed using the Atlas.ti® software. The data analysis revealed the following factors indicative of the need to refer hypertension patients to a pharmacist: lifestyle habits, comorbidities, health care utilization and medication use. The issues identified and the information obtained from the qualitative research and compared with literature studies reviewed allowed defining dimensions that should be considered as an aid in the selection of uncontrolled hypertensive patients for comprehensive medication management services.

Implementation of Medication Reconciliation conducted by hospital pharmacists: A case study guided by the Consolidated Framework for Implementation Research.

BACKGROUND: Medication reconciliation (MR) implementation in hospital care transitions has proved to be a challenge for health professionals and managers. It points to the need to conduct Implementation Research with a view to understanding the tasks of the real world and knowing how they impact this process. Guided by the Consolidated Framework for Implementation Research (CFIR), this study aims to analyze the factors that influenced the MR implementation process conducted by pharmacists at a hospital setting. METHODS: A qualitative case study was carried out in the cardiology and gastroenterology units of a teaching hospital in Brazil, involving participant observation and semi-structured interviews with physicians, pharmacists, nurses, nutritionists and a social worker. The CFIR was used to guide data collection and thematic analysis. The constructs were classified according to their influence and strength. RESULTS: Sixteen health professionals involved directly or indirectly with MR implementation participated in the study. Based on the analysis of the participants' quotes and of the field diary, 18 constructs of the CFIR were identified as influencing MR implementation. The constructs that most strongly influenced MR implementation concerned "Inner Setting", "Characteristics of Individuals" and "Characteristics of Intervention". The participating professionals showed little knowledge of MR and had different points of view on its scope, weakly relating MR to patient safety. The tools used to conduct MR were adapted according to the hospital's needs, thus facilitating its implementation. However, MR proved to be complex and require clinical knowledge and aligned teamwork to identify and resolve undocumented medication discrepancies, being as well intertwined with culture and organizational communication. CONCLUSIONS: The results point to implementation failures and highlight that MR is a complex intervention, requiring specific knowledge from the multidisciplinary team and alignment with other existing workflows. The barriers and facilitators identified may serve to design and test implementation improvement strategies.

Factors influencing the implementation of pharmaceutical care in outpatient settings: A systematic review applying the Consolidated Framework for Implementation Research.

BACKGROUND: Pharmaceutical care in outpatient settings is a type of health service that has been shown to contribute to decreasing drug-related morbidity and mortality rates. However, every process of implementing a new service brings about changes and transformations in the work routine, thus posing challenges. OBJECTIVES: This systematic review aims to identify barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings by applying the CFIR method, a framework based on the theory of health services, used to analyze and synthesize research data, which can direct strategies for the service to work as planned. METHODS: A systematic review was conducted exploring the barriers to and facilitators for the implementation of pharmaceutical care in outpatient settings. The MEDLINE, EMBASE, CINAHL, COCHRANE, and LILACS databases were consulted. RESULTS: Eight studies were included: five qualitative ones, two mixed-method ones, and a quantitative one. The most frequent CFIR constructs identified were Patient Needs and Resources (n = 30, 10.75%), Knowledge and Beliefs about the Intervention (n = 31, 11.11%), Networks and Communications (n = 34, 12.19%), and Available Resources (n = 56, 20.07%). The most cited barriers were: insufficient human resources, patients' unawareness of the existence of the pharmaceutical care service, and pharmacists' resistance to changes. Facilitators included: the opportune presentation of the service to the healthcare team; the use of electronic devices for specific guidance; and the assessment of patient satisfaction. CONCLUSIONS: This systematic review allowed detecting key guidelines to improve the implementation process, including (1) defining an implementation method and exploring it extensively during the pre-implementation phase, (2) ensuring human and financial resources, (3) determining how the new service will interact with other existing services. More research is needed to understand how these factors can affect the implementation of clinical services.

Medication Reconciliation at hospital admission and discharge: Evaluation of fidelity and process outcomes in a real-world setting.

OBJECTIVES: The study aimed to assess the fidelity of Medication Reconciliation (MR) delivered by the pharmacist at hospital admission and discharge, and the process outcomes. METHODS: Prospective study conducted in cardiology and cardiovascular surgery unit of a university hospital between September 2019 and January 2020. Independent observers collected data to measure MR fidelity, related to coverage, sources of information used to collect medication history and presence of outstanding and resolved Undocumented Discrepancies (UD). Process outcomes included medication errors and their potential to cause harm, identified by the pharmacist during the formal MR process. RESULTS: Of the eligible patients, 122 (69.7%) had their medications reconciled in a timely manner at hospital admission and 50 (43.8%) at discharge. The pharmacist consulted 2.76 (±0.8) sources of information to build the medication history, on average. At least one outstanding UD was found in 101 (82.8%) patients at admission and in 41 (82.0%), at discharge. The average number of outstanding UD per patient at admission and discharge was 3.0 (±2.6) and 2.4 (±1.9), respectively. The UD communicated to the physician by the pharmacist during the formal MR process, involved mainly omission errors and were classified as requiring monitoring or potentially necessary intervention. In the univariate analysis, the number of drugs pre-admission and admission, the reason for admission and non-elective readmission in 30 days were associated with the presence of medication errors at admission. CONCLUSIONS: This study found a high number of UD, suggesting flaws in the implementation of MR and highlight the importance of quality measurement.

Medication discrepancies in transition of care of hospitalised children in Brazil: a multicentric study.

OBJECTIVE: To determine the incidence of medication discrepancies in transition points of care of hospitalised children. DESIGN: A prospective observational multicentre study was carried out between February and August 2019. Data collection consisted of the following steps: sociodemographic data collection, clinical interview with the patient's caregiver, review of patient prescriptions and evaluation of medical records. Medication discrepancies were classified as intentional (documented or undocumented) and unintentional. In addition, discrepancies identified were categorised according to the medication discrepancy taxonomy. Unintentional discrepancies were assessed for potential clinical harm to the patient. SETTING: Paediatric clinics of four teaching hospitals in Brazil. PATIENTS: Children aged 1 month-12 years. FINDINGS: A total of 248 children were included, 77.0% (n=191) patients had at least one intentional discrepancy; 20.2% (n=50) patients had at least one unintended discrepancy and 15.3% (n=38) patients had at least one intentional discrepancy and an unintentional one. The reason for the intentional discrepancy was not documented in 49.6% (n=476) of the cases. The most frequent unintentional discrepancy was medication omission (54.1%; n=66). Low potential to cause discomfort was found in 53 (43.4%) unintentional discrepancies, while 55 (45.1%) had the potential to cause moderate discomfort and 14 (11.5%) could potentially cause severe discomfort. CONCLUSIONS: Although most medication discrepancies were intentional, the majority of these were not documented by the healthcare professionals. Unintentional discrepancies were often related to medication omission and had a potential risk of causing harm to hospitalised children.

Desafios para o cuidado farmacêutico na Atenção Primária à Saúde / Challenges for pharmaceutical care in Primary Health Care

Resumo Este estudo de caso objetivou descrever o perfil dos farmacêuticos, caracterizar os serviços farmacêuticos e desvelar os fatores determinantes para a provisão do acompanhamento farmacoterapêutico fundamentados no modelo de prática do cuidado farmacêutico na Atenção Primária à Saúde. Cinquenta farmacêuticos responderam a um questionário sobre seu perfil e atividades. Aplicou-se a análise de conteúdo de Bardin para análise dos dados sobre as atividades, resultando em duas categorias: caracterização das atividades desempenhadas pelos farmacêuticos e os determinantes para a provisão do acompanhamento farmacoterapêutico. Observou-se que o cuidado farmacêutico ainda é um desafio a ser enfrentado, principalmente devido à demanda de atividades gerenciais e à deficiência na formação para o cuidado, necessitando reorganizar os processos de trabalho e as diretrizes institucionais para a ampliação do acesso aos serviços farmacêuticos centrados no paciente. Destaca-se, contudo, o crescente número de farmacêuticos trabalhando no cuidado, reorganizando e redefinindo seu papel, buscando transformar a realidade da Assistência Farmacêutica municipal. Apesar dos desafios ainda existentes referentes a formação, estrutura e processos, destaca-se a busca de soluções para a organização do serviço, com o aprimoramento das atividades clínicas, fortalecendo a Assistência Farmacêutica no Sistema Único de Saúde.

Abstract This case study aimed to describe the profile of pharmacists, characterize the pharmaceutical services, and unveil the determinants for the provision of pharmacotherapeutic follow-up based on the model of practice of Pharmaceutical Care in Primary Health Care. Fifty pharmacists answered a questionnaire about their profile and activities. The Bardin content analysis was applied to analyze the data on the activities, resulting in two categories: characterization of the activities performed by pharmacists and the determinants for the provision of pharmacotherapeutic follow-up. It was observed that pharmaceutical care is still a challenge to be faced, mainly due to the demand for managerial activities and the deficiency in training for care, needing to reorganize work processes and institutional guidelines to expand access to patient-centered pharmaceutical services. However, the growing number of pharmacists working in care, reorganizing and redefining their role, seeking to transform the reality of the Municipal Pharmacy Assistance, stands out. Despite the still existing challenges related to training, structure and processes, the search for solutions for the organization of the service, with the improvement of the clinical activities, strengthening the Pharmaceutical Assistance in the Unified Health System, stands out.

Experiential education in the pharmacy undergraduate curricula in Brazil.

OBJECTIVE: Considering the curriculum reform process taking place in pharmacy undergraduate programs in Brazil and the importance of practical experience to students throughout their learning process in university, this study aims to provide an overview of pharmacy undergraduate programs in Brazil and their respective internships. METHODS: An observational, descriptive, cross-sectional study. A documentary analysis of pharmacy undergraduate programs in the face-to-face modality was carried out, with data obtained from the Political Pedagogical Projects of the programs, the curricula, and course descriptions containing information on internships, all provided by the Brazilian Ministry of Education. The data collected concerned higher education institutions (HEIs), pharmacy programs and internships. RESULTS: Pharmacy undergraduate programs in Brazil have a median duration of 10 semesters, requiring from students a median of 6 internships, from the 6th semester on, totalizing 826 hours. The programs lack uniformity among their internships, mainly regarding total hours and the semester in which internships start. The pharmacy internships cover, in greater number, the areas of outpatient and community pharmacy, clinical analysis, and pharmaceutical technology, respectively, being clinical analysis the area with more hours. Public and private HEIs have different internship proceedings in their curricula, hence no homogeneity among them in the different regions of Brazil. CONCLUSIONS: This study demonstrates the diversity of pharmacy programs in Brazil in the context of internships, reflecting on the training and the activity of pharmacists in recent decades. Further studies are needed to deepen the understanding of this theme.

Tools to prioritize outpatients for pharmaceutical service: A scoping review.

BACKGROUND: The performance of pharmacists in clinical services contributes to improving outcomes in patient drug therapy. In the context of streamlined resources and high health services' demand, the use of patient selection tools can screen those who would benefit more from a pharmaceutical service. OBJECTIVE: This review aims to map and describe tools developed for patient selection for pharmaceutical services delivered in primary health care and outpatient settings. METHODS: The search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Health Sciences. The search strategy included terms relating to patient selection and outpatient pharmaceutical service. We included papers on outpatient settings, and which described the tool developed for the selection of a patient for pharmaceutical service. Two reviewers extracted data of each study concerning the types and items making up the tool. The items composing the tools were grouped into categories. RESULTS: Twelve studies were included in the literature. Most of the studies were developed in the United States (53.8%), followed by Canada (30.8%). Approximately half of the studies developed tools for selecting patients for a medication review (46.2%), and only 15.4% for drug therapy management. Identification of patients at risk of drug-related problems, the need for pharmaceutical service follow-up, and patients at risk of hospital readmission were the main objective to develop the tools. In total, 92.3% of the developed tools had items related to drug therapy complexity, 76.9% to comorbidities and 61.5% to adherence/subjective aspects. Statistical methods were employed to evaluate the validation parameters, such as the ROC curve and internal consistency. CONCLUSIONS: Few studies that developed tools to select outpatients for pharmaceutical services were found. However, many tools showed unsatisfactory validation parameters. Thus, it is necessary to improve the development of instruments that can identify patients who would benefit from the pharmaceutical service accurately.

Experiential education in the pharmacy undergraduate curricula in Brazil

OBJECTIVE: Considering the curriculum reform process taking place in pharmacy undergraduate programs in Brazil and the importance of practical experience to students throughout their learning process in university, this study aims to provide an overview of pharmacy undergraduate programs in Brazil and their respective internships. METHODS: An observational, descriptive, cross-sectional study. A documentary analysis of pharmacy undergraduate programs in the face-to-face modality was carried out, with data obtained from the Political Pedagogical Projects of the programs, the curricula, and course descriptions containing information on internships, all provided by the Brazilian Ministry of Education. The data collected concerned higher education institutions (HEIs), pharmacy programs and internships. RESULTS: Pharmacy undergraduate programs in Brazil have a median duration of 10 semesters, requiring from students a median of 6 internships, from the 6thsemester on, totalizing 826 hours. The programs lack uniformity among their internships, mainly regarding total hours and the semester in which internships start. The pharmacy internships cover, in greater number, the areas of outpatient and community pharmacy, clinical analysis, and pharmaceutical technology, respectively, being clinical analysis the area with more hours. Public and private HEIs have different internship proceedings in their curricula, hence no homogeneity among them in the different regions of Brazil. CONCLUSIONS: This study demonstrates the diversity of pharmacy programs in Brazil in the context of internships, reflecting on the training and the activity of pharmacists in recent decades. Further studies are needed to deepen the understanding of this theme

No disponible

Pharmacist-led medication reconciliation at patient discharge: A scoping review.

BACKGROUND: One of the strategies to promote patient safety in care transitions is medication reconciliation (MR), which is conducted by the pharmacist at the patient's discharge from hospital. However, there are divergences about this process and about the pharmacist's role in conducting such intervention. OBJECTIVE: To systematically review the literature that reports the MR process led by pharmacists at patient discharge and map the different methods, strategies and tools used in the process. METHODS: Relevant studies were searched in the following databases: EMBASE, MEDLINE (PubMed), The Cochrane Library, and LILACS. No language restriction or publication date was applied. The studies considered eligible were those involving and describing pharmacist-led MR processes at acute patient discharge from hospital, with an experimental, quasi-experimental, or observational design. The characteristics of the studies and the MR processes were identified and then a qualitative synthesis was performed. RESULTS: Fifty studies were included. The majority of them were observational ones (82%), and the main outcome was medication discrepancies (42%). The studies were mostly conducted in university hospitals (70%) and in internal medicine wards (54%). Pharmacists were responsible mainly for gathering medication histories (72%), and identifying (96%) and solving (98%) pharmacotherapeutic problems. The main sources of information on pre-admission medications were patient/caregiver interviews (66%) and records from other care providers (40%). Only 30% of the studies described a patient discharge plan, and 14% shared information of the patient's pharmacotherapy with community pharmacists. CONCLUSION: The concept of MR and the pharmacist-led activities in the process varied in the literature, as well as the pharmacotherapy assessment focus and the communication strategies towards patients and other care providers, showing that standardization of the process and concepts is necessary.

Perceptions of Individuals with Parkinson's Disease about Quality of Life / Percepciones de pacientes con enfermedad de Parkinson sobre la calidad de vida / Percepções de pacientes com doença de Parkinson sobre a qualidade de vida

Abstract Introduction: Parkinson's disease is a neurodegenerative disorder manifested by motor and non-motor symptoms that compromise patients' quality of life. The instrument used to assess Parkinson's disease patients' quality of life is the Parkinson's Disease Questionnaire (PDQ-39). This study aims to identify issues related to quality of life from the patients' perspective, compare the results obtained with the aspects included in the PDQ-39, and describe some strategies that patients have adopted to overcome difficulties. Materials and methods: This is a qualitative and descriptive study based on a focus group consisting of six patients. Data were analyzed using the content analysis method. Results: Aspects related to all PDQ-39 domains were mentioned by the patients, highlighting those related to limitations on their mobility and daily activities, as well as aspects related to their emotional wellbeing. The patients did not mention some aspects of mobility that are included in the PDQ-39, but limitations in the domain of emotional wellbeing that are included in the PDQ-39 were detected. In order to overcome difficulties, patients devise various strategies that require social support. Conclusion: Understanding and reflecting on Parkinson's disease patients' perceptions of their quality of life contributes to our understanding of the disease and stimulates proposals for adequate clinical interventions to provide comprehensive care. It is suggested that the PDQ-39 be reviewed and adapted to the current context, taking into account the most recent knowledge and technological advances related to Parkinson's disease.

Resumen Introducción: la enfermedad de Parkinson es una patología neurodegenerativa, que se manifiesta por signos y síntomas motores y no motores, que comprometen la calidad de vida de los pacientes. El Parkinson Disease Questionnaire (PDQ-39) es el instrumento más utilizado para evaluar la calidad de vida en pacientes con esta enfermedad. Los objetivos del trabajo fueron identificar los aspectos relacionados con la Calidad de Vida desde la perspectiva de los pacientes, compararlos con los aspectos considerados por el PDQ-39 y describir las estrategias adoptadas por los pacientes para superar las dificultades. Materiales y métodos: estudio cualitativo, descriptivo. Se realizó un grupo focal con seis pacientes. Los datos fueron analizados usando el método de análisis de contenido. Resultados: aspectos relacionados a todos los dominios del PDQ-39 fueron mencionados por los pacientes, destacándose aquellos relacionados con las limitaciones de la movilidad y el desarrollo de actividades diarias, y aspectos relacionados con el bienestar emocional. No obstante, algunos aspectos considerados en el dominio movilidad del PDQ-39 no fueron mencionados, y fueron detectadas limitaciones del dominio bienestar emocional. Los pacientes diseñan diversas estrategias para superar las dificultades, en las que el soporte social es importante. Conclusión: conocer y reflexionar sobre las percepciones de persona con enfermedad de Parkinson sobre su calidad de vida contribuye para la comprensión de la enfermedad y auxilia la propuesta de intervenciones clínicas adecuadas para lograr el cuidado integral. Se sugiere la revisión y adaptación del PDQ-39 al contexto actual, los avances tecnológicos y de conocimientos sobre la enfermedad de Parkinson.

Resumo Introdução: a doença de Parkinson é uma patologia neurodegenerativa, que se manifesta por signos e sintomas motores e não motores, que comprometem a qualidade de vida dos pacientes. O Parkinson Disease Questionnaire (PDQ-39) é o instrumento mais utilizado para avaliar a qualidade de vida de em pacientes com esta doença. Os objetivos do trabalho foram identificar os aspetos relacionados com a Qualidade de Vida desde a perspectiva dos pacientes, compará-los com os aspetos considerados pelo PDQ-39 e descrever as estratégias adotadas pelos pacientes para superar as dificuldades. Materiais e métodos: estudo qualitativo, descritivo. Realizou-se um grupo focal com seis pacientes. Os dados foram analisados usando o método de análise de conteúdo. Resultados: aspetos relacionados a todos os domínios do PDQ-39 foram mencionados pelos pacientes, destacando-se aqueles relacionados com as limitações da mobilidade e o desenvolvimento de atividades diárias, e aspetos relacionados com o bem-estar emocional. No entanto, alguns aspectos considerados no domínio mobilidade do PDQ-39 não foram mencionados, e foram detectadas limitações do domínio bem-estar emocional. Os pacientes desenham diversas estratégias para superar as dificuldades, nas que o suporte social é importante. Conclusão: conhecer e reflexionar sobre as percepções de pessoas com Doença de Parkinson sobre sua qualidade de vida contribui para a compreensão da doença e auxilia a proposta de intervenções clínicas adequadas para conseguir o cuidado integral. Sugere-se a revisão e adaptação do PDQ-39 ao contexto atual, os avanços tecnológicos e de conhecimentos sobre a Doença de Parkinson.

A prática clínica do farmacêutico no núcleo de apoio à saúde a família / Clinical practice of pharmacists in family health support team / La práctica del farmacéutico clínico en el equipo de soporte para la salud de la familia

Resumo Este estudo teve como objetivo compreender os elementos essenciais do processo de sistematização da prática clínica de uma farmacêutica da atenção primária à saúde com base no referencial teórico-metodológico da atenção farmacêutica, que subsidia o serviço clínico de gerenciamento da terapia medicamentosa. Tratou-se de pesquisa qualitativa autoetnográfica, construída de forma colaborativa entre os autores, de outubro de 2014 a outubro de 2015, nos Centros de Saúde da Prefeitura Municipal de Belo Horizonte, onde uma das autoras trabalha. Os dados foram produzidos por meio de observação participante, diários de campo, reflexões e entrevistas semiestruturadas com farmacêuticos que desenvolviam prática clínica na atenção primária à saúde. Os resultados evidenciaram que os principais elementos para sistematização da prática clínica passam pela 'construção de uma nova identidade profissional na equipe multiprofissional' e pela 'incorporação de novas atividades na rotina de trabalho' que, combinadas, resultam em uma 'proposta de integração de um serviço de gerenciamento da terapia medicamentosa nos fluxos das unidades de saúde'. Dessa forma, para que o farmacêutico possa legitimar o seu papel no cuidado do paciente, é preciso mudar, transformar, reorganizar e reconstruir a sua prática.

Abstract The aim of this study was to understand the essential elements of the systematization process of the clinical practice of a pharmacist in primary health care. This systematization was based on the framework of pharmaceutical care practice, which provides the foundation for comprehensive medication management services. The methodology utilized was autoetnography, built collaboratively between the authors. The data have been produced through participant observation, field journals, reflections and semi structured interviews with pharmacists who are building clinical practices in primary health care. The results have demonstrated that the main elements associated with the systematization of clinical practices are 'the construction of a new professional identity in a multiprofessional team' as well as 'the incorporation of new activities in the work routine', that, combined, result in 'Integration of comprehensive medication management services in the flow of the health unit'. In this way, in order for the pharmacist to legitimize his role in patient care, it is necessary to change, to transform, to reorganize and to rebuild his practice.

Resumen Este estudio tuvo como objetivo comprender los elementos esenciales del proceso de sistematización de la práctica clínica del farmacéutico en la atención primaria de salud a partir del marco teórico de la atención farmacéutica, que subvenciona los servicios de gestión integral de la farmacoterapia. Auto etnografía fue la metodología cualitativa utilizada, construida en colaboración entre los autores. Los datos fueron producidos a través de observación participante, diarios de campo, reflexiones y entrevistas semiestructuradas con los farmacéuticos que desarrollan la práctica clínica en atención primaria de salud. Los resultados mostraron que los principales elementos para la sistematización de la práctica clínica son la 'Construcción de una nueva identidad profesional en equipo multiprofesional' y la 'Incorporación de nuevas actividades en el trabajo de rutina' que, combinados, dan lugar a una 'propuesta de integración del servicio de gestión integral de la farmacoterapia en los flujos de las unidades de salud'. Por lo tanto, para que el farmacéutico pueda legitimar su papel en la atención al paciente, es necesario cambiar, transformar, reorganizar y reconstruir su práctica.

Medication Therapy Management Service for Patients with Parkinson's Disease: A Before-and-After Study.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease characterized by motor manifestations, autonomic and neurological disorders and sensorial symptoms. Medication therapy management (MTM) consists of a service undertaken by pharmacists to optimize pharmacological therapy results. This way, the pharmacist monitors the treatment prescribed by the doctor and formulates a healthcare plan to guarantee the treatment's effectiveness, safety and convenience, thereby improving the patient's quality of life (QoL). OBJECTIVE: To analyze the effect of MTM upon medicine-related problems, motor symptoms, autonomic disorders and QoL of patients with Parkinson's disease, and describe the pharmaceutical interventions. METHODS: Quasi-experimental uncontrolled before-and-after study carried out between September 2012 and March 2013 in a community pharmacy. Pharmacotherapy data were collected from medical prescriptions, patient diaries, medical charts and all the medicines (over-the-counter and prescription) brought by the patients to the appointment with the pharmacist. The medicine-related problems were classified as indication, effectiveness, safety and adherence. Adherence was measured through clinical interviews and the Morisky questionnaire. PD symptoms were assessed according to the patients' and/or caregivers' perceptions about the On/Off state of the motor symptoms and relief of the nonmotor symptoms. QoL was assessed using the PDQ-39 scores. The interventions were targeted to patients/caregivers and/or doctors, with pharmacological and non-pharmacological measures. RESULTS: Seventy patients were followed up, showing a decrease in medicine-related problems (1.67 ± 1.34 to 0.8 ± 0.9 (p < 0.001), positive impact on adherence (from 37 to 10 non-adherent patients, p < 0.001), QoL improvement related to emotional wellbeing (p = 0.012) and autonomic disorder. Most interventions were performed directly with the patients (73.8%), including non-pharmacological guidance (28.5%), pharmacological guidance (24.3%) and rescheduling (13.6%). CONCLUSIONS: To carry out MTM with PD patients, the pharmacist's expertise needs to transcend the technical knowledge about the PD pharmacological treatment. The study showed a positive effect with a decrease in the medicine-related problems after the interventions, especially improving adherence and patients' QoL.

Triangulación de un estudio cualitativo mediante regresión logística / Triangulation of a qualitative research by logistic regression

Fundamento y Objetivo: La investigación cualitativa complementa su visión de la realidad mediante la triangulación. La regresión logística binaria es un instrumento de predicción de riesgo en epidemiología analítica. Nuestro objetivo ha sido triangular una investigación cualitativa de tipo pedagógico con modelos de regresión logística. Material y Método: Sobre la información recogida por un grupo focal, organizamos los datos en tres variables: Aforismo / Frase corta (variable dependiente), Profesor y Tipo (variables predictoras) y construimos dos modelos con regresión logística binaria. El error alfa fue del 5 y del 10%. El tamaño muestral venía impuesto por el grupo focal anterior (saturación cualitativa). Se diseñaron rutinas para trabajar con los datos en el programa R. Resultados: Con 127 elementos (44 aforismos y 83 frases cortas) se obtuvieron significaciones crudas del 10% para dos de los diez profesores con información relevante para el grupo focal (odds ratios de 0.42 y 2.33 respectivamente; índice de Brier escalado = 0.06 y área bajo curva ROC = 0.63) y significaciones menores del 5% para cuatro de los cinco epígrafes en que habíamos dividido la variable tipo (epidemiológicos, epistemológicos, estadísticos y pragmáticos o heurísticos). El epígrafe "Estadístico" fue significativo con respecto a "Epistemológico" (OR=5,00; IC al 95% = 14.431-1.743) y con respecto a "Pragmático" (OR=4.80; IC al 95%=14.602-1.577). El epígrafe "Difusión Científica" no resultó significativo. Conclusiones: En un entorno de investigación cualitativo-pedagógica sobre aforismos y frases cortas, la regresión logística binaria se ha mostrado eficaz, dentro de una estrategia de triangulación, para identificar docentes originales para el grupo focal (p<0.10) y señalar epígrafes con interés clasificatorio (p<0.05). La capacidad predictiva de los modelos ha sido baja y la capacidad discriminativa aceptable

Background and objectives: Qualitative research seeks to enrich its vision of reality through triangulation. Binary logistic regression is a prediction tool in analytical epidemiology. Our aim was to complement a qualitative study by logistic regression models. Methods: On gathered information by a previous focus group, we organized the data into three variables: Aphorism / short phrase (dependent), Professor and Type (predictive) and built two models with binary logistic regression. The alpha error was 5 and 10%. The sample size was imposed by the previous focus group task (qualitative saturation). Routines were implemented to work with the program R. Results: With 127 elements (44 aphorisms and 83 short sentences) we obtained a 10% raw signification for two of the ten teachers with relevant information for the focus group (odds ratios of 0.42 and 2.33 respectively; Brier scaled =0.06 and area under ROC curve = 0.63) and significations less than 5% for four the five sections in which we divided the variable "Type" (epidemiological, epistemological, statistical, pragmatic or heuristic). The heading "Statistics" was significant with respect to "Epistemological" (OR = 5.00, CI 95% = 14.431-1.743) and with respect to "Pragmatic" (OR = 4.80, CI 95% = 14.602-1.577). The label "Scientific Spread" was not significant. Conclusions: In an environment of qualitative and pedagogical research on aphorisms and short phrases, binary logistic regression has been shown effective in identifying original teachers for focus group (p<0.1) and to identify qualifying entries with interest (p<0.05). The predictive capability of models has been low and acceptable the discriminative capacity

Pharmaceutical care as a strategy to improve the safety and effectiveness of patients? pharmacotherapy at a pharmacy school: a practical proposal

Several patients experience at least one drug-related problem and Pharmaceutical Care can change this reality. This work describes a model for structuring the pharmaceutical care service at a pharmacy training unit of the Brazilian Public Health System based on pharmacotherapy follow-up program of Parkinson’s disease patients’ results. From the follow-up results (phase 1), a Therapy Management Scheme was designed (phase 2). Of the 57 patients followed-up, 30 presented at least one drug-related problem and 42% were non-adherent to treatment, which supported the need of pharmacotherapy management. The Pharmacotherapy Management Scheme was proposed as a pharmaceutical care service model, which presents 6 steps: first, the pharmacist fills out the dispensing form and assesses patient´s pharmacotherapy, if there is a suspect problem, he is invited to the follow-up (steps 1 and 2) and they agree the first appointment. After that, pharmacist studies the patient’s case (study phase, steps 3 and 4). At the second meeting, the pharmacist proposes the intervention needed, and at the third, assesses the intervention results and new problems (steps 5 and 6, respectively). The process ends when all therapeutics outcomes are reached. This practical model can significantly contributed to the development and organization of pharmaceutical care services.

Muitos pacientes vivenciam pelo menos um problema relacionado ao medicamento e à atenção farmacêutica pode mudar este fato. Este trabalho descreve um modelo para estruturar o serviço de atenção farmacêutica numa farmácia escola do Sistema Único de Saúde brasileiro baseado nos resultados de um programa de seguimento farmacoterapêutico de pacientes com Doença de Parkinson. A partir dos resultados do seguimento, um esquema de gerenciamento da farmacoterapia foi desenhado. Dos 57 pacientes acompanhados, 30 apresentaram um problema relacionado ao medicamento e 42% não aderiram ao tratamento, o que reforça a necessidade de gerenciar a farmacoterapia. O esquema proposto apresenta 6 passos: primeiro, o farmacêutico preenche o formulário de dispensação e avalia a farmacoterapia do paciente; caso haja suspeita de um problema, ele é convidado a participar do seguimento farmacoterapêutico (passos 1 e 2) e marcam a primeira consulta. Após esta, o farmacêutico estuda o caso (fase de estudo, passos 3 e 4). Na segunda consulta, o farmacêutico propõe as intervenções necessárias e, na terceira, avalia seus resultados e novos problemas (passos 5 e 6, respectivamente). O processo termina quando todos os objetivos terapêuticos são alcançados. Este modelo de prática pode contribuir significativamente para o desenvolvimento e organização de serviços de atenção farmacêutica.

Pharmacogenetic polymorphisms contributing to toxicity induced by methotrexate in the southern Spanish population with rheumatoid arthritis.

Abstract Rheumatoid arthritis (RA) is a common illness of global significance for public health. Methotrexate (MTX) is the most broadly used disease-modifying antirheumatic drug for the treatment of RA, but it displays marked person-to-person variation in its propensity for toxicity. Several studies have suggested that polymorphisms in methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, reduced folate carrier (RFC1) G80A, and ABCB1 C3435T, could be related to methotrexate toxicity. This prospective study examined the different frequencies of MTHFR, RFC1, and ABCB1 pharmacogenetic variations between patients who have RA and those without RA. We also sought to assess the association between these polymorphisms and MTX toxicity. Four single-nucleotide polymorphisms (SNPs) were genotyped: C677T and A1298C from MTHFR, G80A from RFC1, and C3435T from ABCB1. The efficacy and toxicity of MTX were evaluated through clinical follow-up during 1 year of treatment. RA patients showed a higher frequency of the T allele at MTHFR C677T than patients without RA (p=0.049). There was a significant association between the presence of both the T allele at MTHFR C677T (p=0.006), and the C allele at ABCB1 C3435T (p=0.046), with toxicity development after 12 months of MTX treatment. However, there was no correlation between MTX toxicity and either the A allele at MTHFR A1298C or the G allele at RFC1 A80G. These data suggest that the presence of the MTHFR C677T and ABCB1 C3435T SNPs contribute to MTX toxicity in patients with RA. These observations contribute to a rapidly-growing knowledge base on the pharmacogenetics of RA and personalized medicine.

Aphorisms and short phrases as pieces of knowledge in the pedagogical framework of the andalusian school of public health.

BACKGROUND: Bearing in mind the philosophical pedagogical significance of short phrases for the training of researchers in the health care ambit, we hence have studied the aphorisms and striking phrases expressed during the epidemiology course at the Andalusian School of Public Health. METHODS: Belonging to the qualitative type and applied through the establishment of a multidisciplinary focus group made up of ten post-graduated students, where one of them acted as a moderator. The collection of information lasted four months. Information was classified in two ways: Firstly, aphorisms and short phrases with a pedagogical impact; and secondly, data with statistical, epidemiological, epistemological, pragmatic, or heuristic component, and for scientific diffusion. It was decided to perform a triangulation that included a descriptive presentation and a basic categorical analysis. The two teachers with a highest interpretative load have been identified . RESULTS: A total of 127 elements, regarded as of interest by the focus group, were collected. Forty-four of them (34.6%) were aphorisms, and 83 were short phrases with a pedagogical load (65.3%). Most of all them were classified as statistical elements (35.4%) followed by epistemological (21.3%) and epidemiological (15.7%) elements. There was no tendency towards aphorisms or short phrases (P > 0.05) among the teachers with more informative representation. CONCLUSION: There has been a tilt in the contents towards the statistical area to the detriment of the epidemiological one. Concept maps have visualized classifications. This sort of qualitative analysis helps the researcher review contents acquired during his/her training process.

Contribuição da atenção farmacêutica no tratamento de pacientes hipertensos / Pharmaceutical care in the management of patients with hypertension

Atenção farmacêutica é uma nova prática profissional baseada em ações pró-ativas recomendadas pela Organização Mundial da Saúde (OMS), Associações Médicas Internacionais e pelo Conselho Nacional de Saúde do Brasil. Sua implementação entre as práticas de atenção à saúde pode contribuir para a resolução de problemas de saúde pública. Os primeiros estudos realizados, para avaliar a efetividade dessa intervenção no tratamento de pacientes hipertensos não-controlados, demonstram sua exeqüibilidade e potencial contribuição para o controle da hipertensão