The Simplified Medication Adherence Questionnaire: validation of a Brazilian-Portuguese version in hypertensive adults.

Background: Self-reported adherence scales are widely used in research and practice because they are low in cost and easy to apply. A free version in Brazilian-Portuguese of the Simplified Medication Adherence Questionnaire (SMAQ) can be a useful alternative for determining the adherent behavior of hypertensive patients. Purpose: To translate and evaluate the psychometric properties of the Brazilian-Portuguese version of the SMAQ therapeutic adherence scale for patients with arterial hypertension. Patients and methods: A multicenter, cross-sectional study was conducted in five outpatient units in Maceió-AL and Aracaju-SE between January and July 2019. A total of 117 patients aged over 18 years using antihypertensive drugs were recruited. The cross-cultural adaptation followed international methodological recommendations. Internal consistency (Cronbach's alpha) was tested as a reliability parameter. Criterion and construct validity were verified by concurrent validation, exploratory factor analysis (EFA), and validation by known groups. Results: The participants had a mean age of 56.6 years (SD = 10.7 years); most were female (72.6%). The mean number of antihypertensives prescribed per patient was 1.87 (SD = 0.87). There were 79.5% (n = 86) of patients considered non-adherent. Internal consistency was satisfactory (Cronbach's alpha = 0.63). A satisfactory correlation coefficient was verified with the Morisky-Green-Levine test as an external criterion (r = 0.56, p < 0.001). The scale's sensitivity measured through known group validity was 75.3%, specificity 29.5%, positive predictive value 63.9%, and negative predictive value 41.9%. We identified two factors of the instrument's construct from EFA: specific medication-taking behaviors and barriers to adherence. The initial KMO measure of sampling adequacy was 0.691, and Bartlett's test of sphericity was significant (χ2 = 118.342, p < 0.001). Conclusion: The Brazilian-Portuguese version of the SMAQ scale proved valid and reliable for determining adherence to the pharmacotherapy in hypertensive patients. It showed more ability to detect non-adherent patients but with low specificity, possibly influenced by high social desirability.

Which factors may influence the implementation of drug dispensing in community pharmacies? A qualitative study.

RATIONALE, AIMS AND OBJECTIVES: Implementation of clinical pharmacy services, such as drug dispensing, is a complex process. It is necessary to understand the challenges associated with this practice from the perspective of the actors involved to help ensure optimal service provision. Thus, this study aimed to understand the factors that may influence the implementation of drug dispensing in community pharmacies, according to the perceptions of pharmacists. METHOD: This qualitative study was based on semistructured, face-to-face interviews. The participants were pharmacists who worked in a chain of community pharmacies in Brazil, selected based on their direct participation in the implementation process. The interview recordings were transcribed full verbatim and were independently analyzed using thematic analysis, followed by consensus meetings between researchers. The factors identified by the participants were classified according to the Apoteca framework. This study was approved by the Committee of Ethics in Research and all participants signed an informed consent form. RESULTS: We conducted 18 interviews, with 47 factors that may influence the implementation of drug dispensing in community pharmacies being identified. These factors were allocated to seven categories: support from community pharmacy chain (4), pharmacy infrastructure (11), characteristics of the pharmacy, medicines and other health products (4), pharmacist (16), dispensing work process (2), pharmacy team (2) and patient (8). The classification of factors according to the Apoteca framework allocated most of them to administrative (14) and technical (15) domains, followed by attitudinal (13) and political (5) domains. CONCLUSION(S): This study identified several factors that can influence the implementation of drug dispensing and classified them according to the domains of the Apoteca framework, highlighting the multifactorial nature of the implementation process. The results of this study can guide the planning of strategies aimed at providing efficient drug dispensing in community pharmacies.

Prevalence of medication discrepancies in pediatric patients transferred between hospital wards.

Background Children are more susceptible to harm from medication errors and adverse drug reactions when compared to adults. Such events may occur from medication discrepancies while transitioning patients throughout the healthcare system. Contributing factors include medication discontinuity and lack of information by the healthcare team. Objective To analyze the prevalence of medication discrepancies in transition points of care in a pediatric department. Setting Pediatric department of a public hospital in Northeast Brazil. Method A cross-sectional study was carried out from August 2017 to March 2018. Data collection consisted of the following steps: collection of sociodemographic data, clinical interview with the patient's caregiver, registration of patient prescriptions, and evaluation of medical records. Medication discrepancies were classified as intentional and unintentional. The unintentional medication discrepancies were classified as omission of medication, therapeutic duplicity, and differences in dose, frequency, or route of administration. Main outcomes measure Discrepancy profile identified at admission, internal transfer and hospital discharge. Results Among the 114 patients included in the study, 85 (74.5%) patients had at least one unintentional medication discrepancy, of which 16 (14.0%) patients presented medication discrepancies at hospital admission, 42 (36.8%) patients at internal transfer, and 52 (45.6%) patients during discharge. Omission of medication represented 20 (74.1%) errors at admission, 26 (37.7%) errors at internal transfer, and 80 (100.0%) errors at hospital discharge. Conclusions The main transition points of care where unintentional discrepancies occurred in the studied pediatric department were at internal transfer and hospital discharge, with omission being the most common type of unintentional discrepancy.

Perceptions of a group of hospital pharmacists and other professionals of the implementation of clinical pharmacy at a high complexity public hospital in Brazil.

BACKGROUND: During the process of implementation of clinical pharmacy services, internal and external factors may favor or hinder the incorporation of care into the hospital routine. This study aimed to understand the perceptions of a group of hospital pharmacists and other professionals of the implementation of clinical pharmacy at a high complexity public hospital in Brazil. METHODS: A focus group with 16 pharmacists and interviews with tree key stakeholders including managers in the pharmaceutical, medical, and nursing profession were conducted to understand their perceptions of the implementation clinical pharmacy services in a high complexity public hospital in Brazil. The service proposal was presented to the selected participants before conducting the focus group. Professionals with an overview of the hospital and influence on the relevant departments for the implementation of clinical pharmacy at the institution were selected. Data collected were transcribed and analyzed using the Bardin Content Analysis technique. Data analyzed were systematized into categories and registration units. The methodology involves the organization and analysis of reported content to make inferences. RESULTS: The data obtained were divided into four categories: "Perception of the current situation", "Implementation expectations", "Barriers to implementation", "Implementation facilitators". Participants discussed the stagnation of clinical activities of the pharmaceutical profession in Brazil, a reality that results from a lack of clinical training in the country. Pharmacists expressed their expectations for changes in professional performance. According to the managers, such services would positively affect clinical outcomes for patients. Gaps in academic education, lack of knowledge, and poor communication skills were barriers reported in this study. Pharmacists' clinical experience has been reported to facilitate the provision of services. CONCLUSIONS: This study highlights factors that may influence the implementation of clinical pharmacy services in the institution analyzed, such as resistance, fear, and frustration as barriers, as well the experience in clinical pharmacy of some pharmacists in the institution was one of the facilitators most cited by participants. This knowledge may aid future planning for the implementation of clinical pharmacy in hospitals.

The effect of active learning methodologies on the teaching of pharmaceutical care in a Brazilian pharmacy faculty.

BACKGROUND: In recent years, pharmacists have been involved in expanded patient care responsibilities, for example patient counseling in self-medication, medication review and pharmaceutical care, which require graduates to develop the necessary competences. Consequently, reorientation of pharmacy education has become necessary. As such, active learning strategies have been introduced into classrooms to increase problem-solving and critical thinking skills of students. The objective of this study was to evaluate the performance and perceptions of competency of students in a new pharmaceutical care course that uses active learning methodologies. METHODS: This pharmaceutical care course was conducted in the first semester of 2014, in the Federal University of Sergipe. In the pharmaceutical care course, active learning methods were used, consisting of dialogic classroom expository, simulation and case studies. Student learning was evaluated using classroom tests and instruments that evaluated the perception of competency in pharmaceutical care practice. Furthermore, students' satisfaction with the course was evaluated. RESULTS: Thirty-three students completed the four evaluations used in the course (i.e., a discursive written exam, seminars, OSCE, and virtual patient); 25 were female (75.75%), and the median age was 23.43 (SD 2.82) years. The overall mean of student scores, in all evaluation methods was 7.97 (SD 0.59) on a scale of 0 to 10 points, and student performance on the virtual patient method was statistically superior to other methods. With respect to the perception of competency in pharmaceutical care practice, a comparison of pre- and post-test scores revealed statistically significant improvement for all evaluated competences. At the end of the semester, the students presented positive opinions of the pharmaceutical care course. CONCLUSIONS: The results suggest that an active learning course can enhance the learning of pharmaceutical care competences. In future studies it will be necessary to compare active learning to traditional methods.

Understanding of pictograms from the United States Pharmacopeia Dispensing Information (USP-DI) among elderly Brazilians.

OBJECTIVE: To assess the understanding and cultural acceptability of the United States Pharmacopeia Dispensing Information (USP-DI) in a group of elderly Brazilians. METHODS: The study participants were individuals between 60 and 90 years old, of both sexes, with different levels of education and income. Fifteen of 81 pictograms from the USP-DI were presented to the elderly subjects, individually, without subtitles and in random order, so that the participants' understanding of the pictograms could be evaluated. RESULTS: The study included 116 participants. Only one of the selected pictograms reached the comprehension criterion established by the International Organization for Standardization 3864. With regard to the relationship between understanding and sociodemographic characteristics, age, wage income, and level of education were all found to be significantly associated with participants' understanding of some of the pictograms. CONCLUSION: Most of the USP-DI pictograms evaluated were not well understood by the elderly Brazilians. This finding indicates that such pictograms need to be culturally adapted for the Brazilian context if they are to serve their purpose effectively in this country.

Exploring the Quality of Systematic Reviews on Pharmacist Interventions in Patients With Diabetes: An Overview.

OBJECTIVE: To assess the reporting and methodological quality of systematic reviews and meta-analysis studies on pharmacist interventions in patients with diabetes. DATA SOURCES: A comprehensive literature search was performed in MEDLINE, Scopus, and LILACS databases for systematic reviews and meta-analysis studies published from January 1990 to June 2013. The standardized search strategy included the use of MeSH terms or text words related to pharmacist interventions, diabetes, and systematic reviews. STUDY SELECTION AND DATA EXTRACTION: The overview included systematic reviews and meta-analysis studies published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on outcomes for diabetic patients. Two independent authors performed study selection, data extraction, and quality assessment with a consensus process to address disagreements. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) checklists were used to assess reporting characteristics and methodological quality, respectively. DATA SYNTHESIS: The literature search yielded 101 records of potential interest, of which 7 satisfied the inclusion criteria. The total average (SD) for PRISMA and AMSTAR scores were 17.4 (5.6) out of 27 and 6.9 (2.0) out of 11, respectively. The most frequent problems included nonregistration of study protocol, absence of a list of excluded studies, and unclear acknowledgment of conflicts of interests. CONCLUSION: The reporting and methodological quality of systematic reviews and meta-analysis studies were suboptimal, with some areas needing further improvement. It is necessary to ensure better transparency and reproducibility in the literature of clinical pharmacy services for diabetic patients.

Assessment of community pharmacists’ counselling skills on headache management by using the simulated patient approach: a pilot study / Evaluación de las habilidades de asesoramiento de los farmacéuticos comunitarios sobre el manejo del dolor de cabeza utilizando un abordaje de paciente simulado: estudio piloto

Background: Headache, or cephalalgia, is one of the 20 most disabling diseases in the world and affects a large portion of the world’s population. People generally use over-the-counter medications to treat headaches and other minor symptoms. A pharmacist should help patients choose the most effective, safe, and convenient pharmacotherapeutic option. Objective: To assess the counselling skills of community pharmacists for headache management by using the simulated patient approach. Methods: A cross-sectional study was conducted from March 2010 to July 2010. Data were obtained from a convenience sample consisting of one pharmacist from each of the 24 participating community pharmacies. In order to evaluate the pharmacists’ counselling skills, a simulated patient role played a standardized headache case requesting self-medication. The interactions of the simulated patient with the pharmacists were audiovisually recorded using a hidden micro camera, and these recordings were analysed using a validated questionnaire. Results: Of the 24 evaluated pharmacists, 19 (79.1%) were women. Information was spontaneously provided by 15 (62.5%) pharmacists. At least one question was asked by the pharmacist to assess the signs and symptoms. Most pharmacists (n=17, 70.8%) recommended sodium dipyrone, either alone or in combination with other drugs. The most discussed items in the simulation visits were contraindications (n=17, 70.8%), indications (n=10, 41.6%), and drug administration times (n=8, 33.3%). None of the pharmacists recommended any non-pharmacological therapeutic alternatives. The overall impressions of the pharmacists’ professional counselling skills ranged from poor to fair. Conclusion: This study showed that the pharmacists’ counselling skills and the guidance provided by the pharmacists to the simulated patient were insufficient for the satisfactory management of headache (AU)

Antecedentes: El dolor de cabeza o cefalea es una de las 20 enfermedades más incapacitantes en el mundo y afecta a una gran parte de la población mundial. La gente utiliza generalmente medicamentos OTC para tratar los dolores de cabeza y otros síntomas menores. Un farmacéutico debería ayudar a los pacientes a elegir la opción farmacoterapéutica más efectiva, segura y conveniente. Objetivo: Evaluar las habilidades de los farmacéuticos comunitarios para el manejo del dolor de cabeza utilizando un abordaje de paciente simulado. Métodos: Se realizó un estudio transversal entre marzo 2010 y julio 2010. Se obtuvieron datos de una muestra de conveniencia consistente en un farmacéutico de cada 24 farmacias comunitarias participantes. Para evaluar las habilidades de asesoramiento de los farmacéuticos, un paciente simulado recreó un caso estandarizado de dolor de cabeza solicitando auto-medicación. Las interacciones del paciente simulado con el farmacéutico fueron audiovisualmente grabadas utilizando una micro-cámara oculta, y estas grabaciones fueron analizadas utilizando un cuestionario validado. Resultados: De los 24 farmacéuticos evaluados, 19 (79,1%) eran mujeres. 15 farmacéuticos (62,5%) proporcionaron información espontáneamente. El alternatives. The overall impressions of the pharmacists’ professional counselling skills ranged from poor to fair. Conclusion: This study showed that the pharmacists’ counselling skills and the guidance provided by the pharmacists to the simulated patient were insufficient for the satisfactory management of headache (AU)

Prescripción informatizada como factor contribuyente para la seguridad de los pacientes hospitalizados / Electronic prescription as contributing factor for hospitalized patients' safety

El presente estudio se realizó para identificar factores relacionados con los errores de medicación en las recetas informatizadas y sus ventajas y desventajas según los médicos, enfermeras y personal administrativo. Es un estudio descriptivo realizado en tres unidades de un hospital universitario del suroeste de Brasil. El estudio se dividió en dos fases. En la primera fase, analizamos un total de 1349 prescripciones de los servicios de medicina general, cirugía y ortopedia durante 30 días consecutivos. Se utilizó un instrumento semiestructurado, elaborado por un grupo de investigadores para este estudio. En la segunda fase, se aplicó un cuestionario semi-estructurado a los profesionales de la salud, que contenía preguntas abiertas y cerradas sobre sus opiniones sobre la prescripción electrónica, sus ventajas y desventajas, y sus sugerencias para mejorarla. Delas 1349 prescripciones observadas, el 17,5% presentaban correcciones, el 25,0% estaba escrita manualmente y el 17,0% estaba incompleta. Algunas de las ventajas señaladas por los profesionales de la salud era su legibilidad (37,5%), poco tiempo empleado en elaborarla y emitirla (20,5%) y el modo práctico en que se organizaban (,0%). Las desventajas que se señalaban fueron la repetición de prescripciones previas (34,0%), los errores tipográficos (17,0%), la dependencia de los ordenadores (11,0%) y las alteraciones hechas manualmente (7,0%). En conclusión, la prescripción informatizada representa un gran progreso entre las estrategias utilizadas para minimizar los errores de medicación producidos por prescripciones mal formuladas. Sin embargo, no erradica la posibilidad la aparición de error, necesitándose algunas modificaciones (AU)

The following study was performed to identify factors related to medication errors in the computerized physician order entry and their advantages and disadvantages according to doctors, nursing team and administrative officers. It is a survey descriptive study carried out at three units of a Brazilian academic hospital in the southeast area. The study was divided in two phases. In the first phase, we analyzed a total of 1,349 prescriptions from general medical unit, surgical and orthopaedic wards during 30 days consecutively. A semistructured instrument, elaborated by a group of researchers for the study proposals, was used. In the second phase, a semi-structured questionnaire was applied to the health professionals containing closed and open items approaching their opinion about the composition of electronic prescription, the advantages and disadvantages of them, and their suggestions for its improvement. Out of 1,349 prescriptions observed, 17.5% presented deletions, 25.0% medicines written manually and 17.0% of them were incomplete. Some of the advantages pointed by health professionals were its legibility (37.5%), little time spent when elaborating and emitting them (20.5%) and the way they are a practical and organized (8%). The disadvantages pointed were repetition of previous prescriptions (34%), typing mistakes (17%), dependence on computers (11%) and alterations made manually (7%). We conclude, this way, that the computerized prescription order entry represents a great progress among the strategies used to minimize medication errors caused by prescriptions badly formulated. However, it doesn't eradicate the possibility of medication error occurrences, needing some system modifications (AU)