Validation of a computerized decision support system to review pharmacotherapy treatment: scheduling guidelines.

BACKGROUND: The review of pharmacotherapy can be conceptualized as a service in which the drugs used by the patient are reviewed to control the risks as well as to improve the results of the drug therapy, detecting, solving, and preventing issues associated with the drug, readjusting the doses and times (schedule) so that the treatment is not incompatible or in duplicity. METHODS: The aim of the study was to validate an intelligent information system, which was developed to assist the scheduling activity in the pharmacotherapy review. The system used the concept of Genetic Algorithms. To validate the system, hypothetical cases were elaborated considering various aspects of pharmacotherapy such as underdose, overdose, drug interactions and contraindications. These cases were tested in the system and were also analyzed by pharmaceutical experts with clinical and research experience in the pharmacotherapy review process. The degree of agreement between the assessments of the appointments carried out by the pharmaceutical specialists and by the system were measured using the Kappa index with a 95% confidence interval. RESULTS: In detecting errors and make propositions, the system was able to identify 80% of errors, with pharmaceutical experts identifying between 20 and 70% of errors. In relation the results of kappa between the cases, the system had 87,3% of concordance, whereas the best pharmaceutical expert had 75,5% of concordance, considering the correct answer. CONCLUSION: It can be concluded that with the methodology used, the investigation met the objectives and confirmed the system is effective for pharmaceutical review process. There are indications that the system can help in the Pharmacotherapy review process, being able to find prescription errors as well as to establish times for the use of medications according to the patient's routine.

Contraceptivos hormonais orais: utilização e fatores de risco em universitárias / Hormonal contraceptive pills: usage and risk factors among college students

Contraceptivo Hormonal Oral (CHO) é um dos métodos mais utilizados pelas mulheres e mais eficazes. O Objetivo do estudo foi investigar o uso de CHO por estudantes de uma Instituição de Ensino Superior, Brasil. Trata-se de estudo epidemiológico tipo transversal quantitativo, realizado por meio de questionário autoaplicativo em abril de 2015. Participaram 197 mulheres entre 18 e 43 anos, 76,65% faziam uso de CHO sendo que destas, 94,04% faziam uso do método combinado. Das universitárias 74,83% ingerem álcool, maioria consumo não frequente, mas quando consomem, 83,84% ultrapassa o limite recomendável. Para 21,32% houve presença de fator de risco pré- estabelecido, sendo mais frequente a enxaqueca e 15,17% tinham IMC elevado, o que pode conferir riscos às usuárias; ainda houve casos de utilização de medicamento com risco de interação com CHO. Entre as universitárias 25,16% relataram apresentar efeito adverso, sendo mais frequente o aumento de peso. Em 80,13% dos casos o CHO foi indicado pelo médico. Somente 22,15% receberam alguma informação no momento da compra. 89,40% das entrevistadas conhecem sobre a não prevenção de doenças sexualmente transmissíveis pelo CHO, porém destas, apenas 64,10% usam de fato preservativo. O estudo mostrou a existência de fatores que podem diminuir a eficácia e, mesmo, aumentar os riscos à saúde.

Birth control pills are the most commonly prescribed hormonal treatment for the prevention of pregnancy among women, and are one of the most effective methods. The aim of the study was to investigate the use of hormonal contraceptives among college students from a higher education institution, Brazil. It is an epidemiological cross-sectional quantitative study. A self-administered questionnaire was completed by 197 women aged 18-43 years in April 2015. Of the participants, 76.65% were taking hormonal contraceptive pills, and 94.04% of these were using a combined method. The majority (74.83%) reported occasional alcohol consumption, but 83.84% of those who drank exceeded maximum recommended consumption levels. There was pre-established risk factors for 21.32% of them, especially migraines; 15.17% had high BMI, which can be risky to users; and there were cases of drug-threatening interaction with hormonal contraceptives. Of the participants, 25.16% reported having adverse effect, more frequent weight gain. In 80.13% of cases, birth control pills were prescribed by their doctors. Only 22.15% received some kind of information at the time of the purchase. Of the respondents, 89.40% reported being aware that contraceptives did not prevent sexually transmitted diseases, but only 64.10% of them actually used condoms. The study showed several factors that may decrease hormonal contraception effectiveness and even increase health risks.

Pharmacotherapy review: a proposal to improve medication adherence among hypertensive patients

Abstract Pharmacotherapy review is a structured assessment of medicines, which aims to obtain a partnership with patients to achieve drug treatment goals and agreement about drug dosage, as well as when and how the drugs should be administered. The objective was to analyze the influence of pharmacotherapy review, by scheduling drug administration to improve medication adherence among antihypertensive patients. This study was an uncontrolled intervention developed in three distinct stages. The first stage included data collection on the profile of patients and their medications, and a preliminary assessment of medication adherence. In the second stage, the review report was delivered to patients. In the third stage, the results of blood pressure and medication adherence were assessed. The influence of the revision was measured through statistical tests (p<0.05). The study included 40 patients with a mean age of 58.0 (SD:11.3) years; 72.5% were women. Thirty-three (82.5 %) patients required some intervention, after when there was a significant increase in the number of daily doses (p=0.039) and drug intakes (p=0.025). There was a significant increase in the adherence rate, according to both the Morisky-Green test (p<0.001) and self-reported assessment (p=0.004). There was also an improvement in the levels of systolic (p<0.001) and diastolic (p=0.002) blood pressure and in the number of patients with controlled hypertension (p=0.006). The pharmaceutical service enhanced medication adherence and control of systemic blood pressure; however, it increased the complexity of treatment.

resumo A revisão da farmacoterapia é uma avaliação estruturada dos medicamentos com o objetivo de proporcionar aos pacientes o alcance dos objetivos terapêuticos por meio da forma adequada de administração dos medicamentos. O objetivo foi analisar a influência da revisão da farmacoterapia, por meio do aprazamento dos medicamentos, na adesão à medicação e no controle da hipertensão arterial sistêmica. Trata-se de um estudo de intervenção não controlado desenvolvido em três momentos distintos. No primeiro, realizou-se a coleta de dados sobre o perfil dos pacientes e de suas medicações e a avaliação da adesão; no segundo momento, realizou-se a entrega do relatório da revisão aos pacientes e na terceira etapa avaliou-se o resultado da adesão e pressão arterial. A influência da revisão foi medida por meio de testes estatísticos (p<0,05). Participaram deste estudo 40 pacientes, com média de idade de 58,0 anos (SD:11,3), sendo 72,5% mulheres. Dos pacientes, 33 (82,5%) necessitaram intervenções. Após estas se verificou aumento significativo no número de doses (p=0,039) e no número de tomadas (p=0,025). Houve aumento significativo no número de aderentes tanto pelo teste de Morisky-Green (p<0,001) quanto na avaliação autorreferida (p=0,004). Também, houve melhora nos níveis de pressão sistólica (p<0,001) e diastólica (p=0,002) e no número de pacientes com a pressão controlada (p=0,006). O serviço farmacêutico desenvolvido promoveu aumento da adesão e do controle da pressão arterial, no entanto, aumentou a complexidade do tratamento.

[Awareness, consumption and access to emergency contraception among female university students in the south of the State of Santa Catarina]. / Conhecimento, consumo e acesso à contracepção de emergência entre mulheres universitárias no sul do Estado de Santa Catarina.

The scope of this study was to investigate knowledge about and access to emergency contraception among female university students in the south of the State of Santa Catarina. A cross-sectional observational study was conducted between September and October 2008, in which a questionnaire was given to 360 women aged 18 to 45 years. Most belonged to the B2 economic class or higher (74.2%) and 79.4% of them had already had intercourse. Of these, 48.6% had used emergency contraception, though this was more frequent among younger women. Emergency contraception was used 2.4 times, and 87.1% had used contraceptive methods within 24 hours after intercourse. Adverse reactions were reported by 20.9%, the most common being menstrual cycle changes (44.8%) and nausea (44.8%). The reasons for using emergency contraception included the lack of condom use (44.6%) and condom rupture (39.6%). Of the women interviewed, 15% either failed to answer the question on STD prevention or answered incorrectly, while 97.8% denied having changed the method used routinely. Only 2.9% of the participants had acquired the medication via prescription, and 35.3% received guidance on application of the medication at the time of purchase.

Conhecimento, consumo e acesso à contracepção de emergência entre mulheres universitárias no sul do Estado de Santa Catarina / Awareness, consumption and access to emergency contraception among female university students in the south of the State of Santa Catarina

A contracepção de emergência tem sido utilizada na prevenção da gravidez não planejada. Este estudo objetivou investigar o conhecimento, o consumo e o acesso desse método entre mulheres universitárias do Sul do Estado de Santa Catarina. Trata-se de estudo observacional, transversal, aplicando-se formulário de setembro a outubro de 2008. Participaram 360 mulheres entre 18 e 45 anos, a maioria da classe econômica B2 ou superior (74,2%), onde 79,4% já haviam mantido relação sexual. Destas, 48,6% haviam utilizado a contracepção de emergência, sendo mais frequente quanto menor a idade. O método foi usado em média 2,4 vezes e 87,1% administraram-no até 24 horas após a relação sexual. Foram referidas reações adversas por 20,9% das usuárias, sendo as mais comuns, alterações menstruais (44,8%) e náuseas (44,8%). Os principais motivos para o uso do método foram: não uso do preservativo (44,6%) e rompimento do mesmo (39,6%). Das entrevistadas, 15,0% não souberam responder ou responderam de modo errado à questão sobre a não prevenção de Doença Sexualmente Transmissível pelo método e 97,8% negaram ter alterado o método utilizado rotineiramente. Apenas 2,9% das mulheres adquiriram o medicamento mediante prescrição médica e 35,3% receberam orientações no momento da compra.

The scope of this study was to investigate knowledge about and access to emergency contraception among female university students in the south of the State of Santa Catarina. A cross-sectional observational study was conducted between September and October 2008, in which a questionnaire was given to 360 women aged 18 to 45 years. Most belonged to the B2 economic class or higher (74.2%) and 79.4% of them had already had intercourse. Of these, 48.6% had used emergency contraception, though this was more frequent among younger women. Emergency contraception was used 2.4 times, and 87.1% had used contraceptive methods within 24 hours after intercourse. Adverse reactions were reported by 20.9%, the most common being menstrual cycle changes (44.8%) and nausea (44.8%). The reasons for using emergency contraception included the lack of condom use (44.6%) and condom rupture (39.6%). Of the women interviewed, 15% either failed to answer the question on STD prevention or answered incorrectly, while 97.8% denied having changed the method used routinely. Only 2.9% of the participants had acquired the medication via prescription, and 35.3% received guidance on application of the medication at the time of purchase.

[Indicators of the pharmaceutical care service at the University of Southern Santa Catarina]. / Indicadores do Serviço de Atenção Farmacêutica (SAF) da Universidade do Sul de Santa Catarina.

Pharmaceutical Care has represented a new clinical practice for pharmacists. This study aims to show the indicators of the Pharmaceutical Care Service at the University of Southern Santa Catarina. Documentary analysis of pharmaceutical records of 58 patients was conducted between September 2007 and March 2008 to identify the indicators. Most patients were women (77.6%), with a mean age of 54 years. Average number of health problems per patient was 4.6 in the first visit and 4.3 in the last one. The most widely used drug classes were cardiovascular (30.2%) and nervous system (27.5%). On average, 2.7 drug-related problems per patient were detected, the most common being those related to effectiveness and safety. Of the problems identified, 82.2% were classified as preventable and 63.7% as manifested. Pharmaceutical interventions registered 79.0% of acceptance, of which 78.9% had positive results. On average, there were 2.6 patient-related needs, especially regarding questions about drug therapy (30.4%), which were positively answered in 84.8% of cases. These indicators show that the pharmaceutical care service is very active in promoting health education.

Indicadores do Serviço de Atenção Farmacêutica (SAF) da Universidade do Sul de Santa Catarina / Indicators of the pharmaceutical care service at the University of Southern Santa Catarina

A Atenção Farmacêutica tem se constituído numa nova prática clínica para o farmacêutico. O estudo tem por objetivo apresentar os indicadores do Serviço de Atenção Farmacêutica da Universidade do Sul de Santa Catarina. Foi realizada a análise documental dos prontuários farmacêuticos de 58 pacientes entre setembro de 2007 a março de 2008. A maioria dos pacientes eram mulheres (77,6 por cento) com idade média de 54 anos. Identificou-se no primeiro encontro a média de 4,6 problemas de saúde por paciente e no último 4,3. As classes farmacológicas mais prevalentes foram a cardiovascular (30,2 por cento) e no sistema nervoso (27,5 por cento). Detectou-se média de 2,7 problemas relacionados com medicamentos por paciente, sendo os mais comuns aqueles relacionados à efetividade e à segurança. Dos problemas identificados 82,2 por cento foram classificados como evitáveis e 63,7 por cento como manifestados. Das intervenções farmacêuticas registradas soube-se da aceitação de 79,0 por cento com 78,9 por cento de resultados positivos. Encontrou-se média de 2,6 necessidades relacionadas ao paciente sendo, principalmente, dúvidas quanto à terapia farmacológica (30,4 por cento) sendo em 84,8 por cento dos casos supridas.

Pharmaceutical Care has represented a new clinical practice for pharmacists. This study aims to show the indicators of the Pharmaceutical Care Service at the University of Southern Santa Catarina. Documentary analysis of pharmaceutical records of 58 patients was conducted between September 2007 and March 2008 to identify the indicators. Most patients were women (77.6 percent), with a mean age of 54 years. Average number of health problems per patient was 4.6 in the first visit and 4.3 in the last one. The most widely used drug classes were cardiovascular (30.2 percent) and nervous system (27.5 percent). On average, 2.7 drug-related problems per patient were detected, the most common being those related to effectiveness and safety. Of the problems identified, 82.2 percent were classified as preventable and 63.7 percent as manifested. Pharmaceutical interventions registered 79.0 percent of acceptance, of which 78.9 percent had positive results. On average, there were 2.6 patient-related needs, especially regarding questions about drug therapy (30.4 percent), which were positively answered in 84.8 percent of cases. These indicators show that the pharmaceutical care service is very active in promoting health education.

Exame clínico objetivo estruturado (ECOE): uma experiência de ensino por meio de simulação do atendimento farmacêutico / Objective structured clinical examinations (OSCE): a teaching experience using simulation of pharmaceutical care / Examen clínico, objetivo estructurado (ECOE): una experiencia de enseñanza por medio simulación de la atención del farmacéutica

A simulação de atendimento farmacêutico tem por finalidade avaliar as competências clínicas dos acadêmicos. Constitui uma ferramenta pedagógica que possui três etapas: a) preparação do cenário e dos casos; b) simulação; e c) avaliação. Os casos simulados consistem de informações essenciais que são fornecidas espontaneamente ao acadêmico no início da simulação e outras complementares, que somente tornar-se-ão conhecidas se forem investigadas. Toda a simulação de atendimento é filmada, o que permite a análise da comunicação. O processo de avaliação é iniciado com a leitura do caso, a análise do vídeo e a aplicação do instrumento desenvolvido. O ECOE possibilita ao acadêmico uma oportunidade de melhorar as suas habilidades e atitudes na prestação do atendimento farmacêutico, além de aprofundar os conhecimentos a respeito das situações simuladas.

Simulation of pharmaceutical care aims to assess students' clinical skills. It comprises an educational tool that has three steps: (a) setting the stage and preparing the cases; (b) simulation; and (c) evaluation. The simulated cases consist of information that is provided spontaneously to students at the beginning of the simulation and other, complementary information that only becomes known if it is investigated. All of the simulated attendance is filmed, which enables analysis of the communication. The evaluation process starts with reading the case, analysis of the video and application of the tool that has been developed. This examination provides students with an opportunity to improve their skills and attitudes in relation to provision of pharmaceutical care, in addition to deepening their knowledge about the situations that were simulated.

La simulación de atención farmacéutica tiene por finalidad la de evaluar las capacidades clínicas de los académicos. Constituye en una herramienta pedagógica que posee tres etapas: a) preparación del lugar y de los casos, b) simulación; y c) evaluación. los casos simulados constan de informaciones esenciales proporcionadas espontáneamente al académico en el inicio de la simulación y otras complementarias que sólo se conocerán si son investigadas. Se filma toda la simulación de atención, lo que permite el análisis de la comunicación. El proceso de evaluación se inicia con la lectura del caso, el análisis del vídeo y la aplicación del instrumento desarrollado. El ECOE posibilita al académico una oportunidad de mejorar sus habilidades y actitudes en la prestación de la atención del farmacéutica, además de profundizar los conocimientos respecto a las situaciones simuladas.

Responsible self-medication: review of the process of pharmaceutical attendance: [review] / Responsável pela auto-medicação: análise do processo de atendimento farmacêutico: [revisão]

This article presents a review, based on a qualitative study, of pharmaceutical orientation in the management of minor illness. Action research methodology was used by a group of faculty members responsible for the community pharmacy internship and by postgraduates in clinical pharmacy, to carry out the study with the objective to present a standard service for this kind of procedure. The interaction with the individual starts with a welcoming reception, at which point the pharmacist should be receptive and show empathy. Subsequently, data from the history of the patient are collected to obtain relevant information. Based on this information, the pharmacist must develop a line of clinical reasoning and make a decision, taking the context of the patient into account. After this analysis, the most appropriate intervention is performed. This intervention could indicate the need for referral to another health professional, the use of a non-pharmacological therapy or the provision of sound advice on medicines available without prescription. The next step is monitoring the patient in order to identify the effectiveness and safety of treatment. The standardization process of pharmaceutical attendance in the management of minor disorders contributes to the rational use of medicines.

A reflexão apresentada neste artigo representa um estudo de abordagem qualitativa baseada na pesquisa-ação da prática do atendimento farmacêutico no manejo de transtornos menores, realizada pelo grupo de professores do Estágio em Farmácia Comunitária e por farmacêuticos pós-graduados em Farmácia Clínica, com o objetivo de realizar uma proposta de atendimento padrão para este tipo de procedimento. A interação com o indivíduo é iniciada pelo acolhimento, momento no qual o farmacêutico deve ser receptivo e empático. A seguir, se executa a coleta de dados sobre a história do paciente, para obtenção de informações relevantes. Com base nas informações, o farmacêutico deve desenvolver um raciocínio clínico e tomar uma decisão, levando em consideração o contexto do paciente. Após esta análise é realizada a intervenção mais adequada ou o conjunto dessas que podem ser: procurar outro profissional de saúde, utilizar uma terapia não-farmacológica ou auxiliar na escolha de um medicamento de venda livre. O próximo passo é o acompanhamento do paciente com vistas a identificar a efetividade e segurança do tratamento. A padronização do processo de atendimento farmacêutico no manejo de transtornos menores, contribui para o uso racional de medicamentos.

A percepção da comunidade sobre a atuação do Serviço de Atenção Farmacêutica em ações de educação em saúde relacionadas à promoção do uso racional de medicamentos / Community's perception towards the performance of Pharmaceutical Service Care in the health education actions related to rational medicine use

A educação em saúde visa democratizar o acesso ao conhecimento e tornar os indivíduos da comunidade capazes de atuar como corresponsáveis na promoção da saúde. O objetivo deste trabalho foi apresentar a experiência do Serviço de Atenção Farmacêutica em ações na comunidade com vistas a promover o uso racional de medicamentos. Utilizou-se uma abordagem qualitativa, do tipo pesquisa-ação. Realizou-se a descrição da experiência e o levantamento das percepções dos responsáveis pelos grupos envolvidos nas palestras. Foram realizadas 22 palestras alcançando 565 participantes; os temas pré-selecionados envolviam assuntos como polimedicação, automedicação e adesão terapêutica, e os que surgiram no decorrer das palestras foram classificados como temas emergentes, representados por experiências dos participantes quanto às doenças e suas formas de tratamento, os efeitos colaterais de medicamentos, o manejo não farmacológico de problemas de saúde, qualidade, segurança e eficácia de medicamentos genéricos e o acesso aos medicamentos. Na percepção dos líderes dos grupos foi mencionado que as palestras contribuíram para o uso racional de medicamentos, proporcionando a mudança de postura, segundo alguns relatos. As palestras colaboraram para reforçar que o papel da equipe de saúde não é apenas o de permitir o acesso aos medicamentos, mas também de garantir o seu uso correto. Essa experiência destaca a ação do farmacêutico como profissional da saúde e o papel que desempenha na promoção do uso racional de medicamentos, empregando nesta ação, além do conhecimento científico, habilidades para usar as experiências da população no ato de ensinar, respeitando o indivíduo e tornando-o ativo nesse processo.

Health education aims at democratizing the access to knowledge and to make the community people able to act as co-managers in health's promotion. This work's objective was to present pharmaceutical service care experience in action in the community, in order to promote the rational use of medicine. We used a research- action qualitative approach. Experience description and people's perception survey (responsible for groups involved in the current lecture) were accomplished, and observed in this study. 22 lectures were done, reaching as a total 565 participants; pre-selected themes involved subjects as polymedication, self-medication and adhesion therapeutics, and the ones that emerged during each lecture were classified as emergent topics, represented by participant experiences (as for their diseases and treatment solutions, their collateral effects etc; also non-pharmacological health problems handling; quality, security and generic medicine effectiveness and medicine access should be approached here, in these cases). under group leaders perception, and approval,; it was mentioned that the lectures contributed to a more rational use, provided an important posture change, as some reports in the media said, as can be read. The lectures collaborated to reinforce that the health team role is not only to allow an access to medicine, but also to guarantee its correct use. This experience highlights the pharmacist action as a health professional. His role is carried out in rational medicine use promotion, employing in this action - besides scientific knowledge - abilities to use the population experiences in the action of teaching , respecting all individuals and making them active in this process.