Hospital Cost of Complications After Kidney Transplant.

BACKGROUND: Kidney transplant is considered the best treatment of rehabilitation for chronic kidney disease, but clinical and/or surgical complications may occur after transplant. The study aimed to assess the cost of complications after kidney transplant. MATERIALS AND METHODS: This is a descriptive, retrospective, and exploratory study that used data from Hospital Information System ("Sistema de Informação Hospitalar"). We identified the patients with records of kidney transplant in the states of northern and northeastern Brazil in 2013. These patients were followed up through the records, specifically from 2013 to 2017. The variables analyzed were sex, age, and period after transplant of readmissions (early, intermediate, or late), the main complications within 4 years after the kidney transplant, and cost of hospital admissions. RESULTS: There were 893 patients with records of kidney transplant in the regions of the study. During the follow-up period, 319 patients had complications. Most hospital readmissions involved male patients (63.6%; n = 203). Mean age was 45 (SD, 15.14) years. Patients developed complications mainly in the early period after transplant (70.22%; n = 224). The number of hospital admissions was 758. The main complications were regarding urinary tract (72.02%; n = 546), infections (19.79%; n = 150), and vascular and/or pulmonary (2.90%; n = 22). The total cost for the treatment of these complications was US $528,329.51. CONCLUSIONS: By analyzing the data it was possible to identify that there is a significant cost involved in the treatment of complications after kidney transplant.

Potentially inappropriate medications in older kidney transplant recipients: a Brazilian prevalence study.

Background Older kidney transplant recipients take a larger number of medications than younger patients, but there is currently no evidence that this affects health outcomes or that is it associated with potentia medicine-related problems. Objective To evaluate the prevalence and number of potentially inappropriate medications in older kidney transplant recipients and also the possible associated factors (sex, age, comorbidities, number of medications, etc.). Setting A renal post-transplant ambulatory outpatient clinic of a university hospital in Fortaleza, Brazil. Method PIMs were defined according to the Beers criteria, version 2015. Medications were classified following the Anatomical Therapeutic Chemical Classification System. Chi squared tests and analysis of variance were used for the analyses. Main outcome measure Prevalence of potentially inappropriate medications and medication groups with higher prevalence rates of PIMs, including associated factors. Results Among 143 kidney transplant recipients, 77.6% had at least one potentially inappropriate medication as part of their prescription regime. Medication groups that were most implicated in PIM are medicines that act on the alimentary tract and metabolism (55.9%), cardiovascular system (32.2%) and nervous system (21.7%). We detected a high prevalence (63.6%) of self-medication (use of OTC medicines without indication of a healthcare professional) among the population studied. There was a statistically significant association between the number of prescribed medications and the presence of potentially inappropriate medication in the prescription regime (P < 0.01). Conclusion Our data draw attention to the need of medicine therapy management by clinical pharmacists and clinicians in this group of patients and also assessing the real clinical impacts of these medications in the prescription regimes of elderly renal transplant patients.

Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results.

OBJECTIVE: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. METHODS: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. RESULTS: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). CONCLUSION: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results / Acompanhamento farmacoterapêutico em unidade de terapia intensiva respiratória: descrição e análise de resultados

ABSTRACT Objective: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. Methods: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. Results: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). Conclusion: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

RESUMO Objetivo: Descrever e avaliar o acompanhamento farmacoterapêutico do farmacêutico clínico em uma unidade de terapia intensiva. Métodos: Trata-se de um estudo descritivo, com desenho transversal, realizado no período de agosto a outubro de 2016. Os dados foram coletados por meio de um formulário de registro, com acompanhamento farmacoterapêutico realizado pelo farmacêutico clínico na unidade de terapia intensiva respiratória de um hospital terciário. Os problemas registrados nas prescrições foram quantificados e classificados, sendo avaliados quanto à gravidade; as recomendações realizadas pelo farmacêutico clínico foram analisadas em relação ao impacto na farmacoterapia. Os medicamentos envolvidos nos problemas foram categorizados utilizando o Anatomical Therapeutic Chemical Classification System. Resultados: Foram acompanhados 46 pacientes, tendo sido registrados 192 problemas relacionados à farmacoterapia. Os problemas prevalentes foram informação ausente na prescrição (33,16%) e com gravidade menor (37,5%). Das recomendações realizadas para a otimização da farmacoterapia, 92,7% foram aceitas, sendo prevalentes aquelas referentes a inclusão do tempo de infusão (16,67%) e a adequação da dose (13,02%), com maior impacto na toxicidade (53,6%). Os anti-infecciosos gerais para uso sistêmico constituíram classe de medicamentos mais frequente nos problemas relacionados à farmacoterapia (53%). Conclusão: O acompanhamento farmacoterapêutico realizado pelo farmacêutico em uma unidade de terapia intensiva respiratória mostrou-se capaz de detectar problemas na farmacoterapia dos pacientes e realizar recomendações clinicamente relevantes.

Pharmaceutical orientation at hospital discharge of transplant patients: strategy for patient safety.

OBJECTIVE:: To describe and analyze the pharmaceutical orientation given at hospital discharge of transplant patients. METHODS:: This was a cross-sectional, descriptive and retrospective study that used records of orientation given by the clinical pharmacist in the inpatients unit of the Kidney and Liver Transplant Department, at Hospital Universitário Walter Cantídio, in the city of Fortaleza (CE), Brazil, from January to July, 2014. The following variables recorded at the Clinical Pharmacy Database were analyzed according to their significance and clinical outcomes: pharmaceutical orientation at hospital discharge, drug-related problems and negative outcomes associated with medication, and pharmaceutical interventions performed. RESULTS:: The first post-transplant hospital discharge involved the entire multidisciplinary team and the pharmacist was responsible for orienting about drug therapy. The mean hospital discharges/month with pharmaceutical orientation during the study period was 10.6±1.3, totaling 74 orientations. The prescribed drug therapy had a mean of 9.1±2.7 medications per patient. Fifty-nine drug-related problems were identified, in which 67.8% were related to non-prescription of medication needed, resulting in 89.8% of risk of negative outcomes associated with medications due to untreated health problems. The request for inclusion of drugs (66.1%) was the main intervention, and 49.2% of the medications had some action in the digestive tract or metabolism. All interventions were classified as appropriate, and 86.4% of them we able to prevent negative outcomes. CONCLUSION:: Upon discharge of a transplanted patient, the orientation given by the clinical pharmacist together with the multidisciplinary team is important to avoid negative outcomes associated with drug therapy, assuring medication reconciliation and patient safety. OBJETIVO:: Descrever e analisar a orientação farmacêutica oferecida na alta de pacientes transplantados. METÓDOS:: Trata-se de um estudo transversal, descritivo e retrospectivo, que utilizou os registros das orientações realizadas pelo farmacêutico clínico na unidade de internação do Serviço de Transplante Renal e Hepático, Hospital Universitário Walter Cantídio, em Fortaleza (CE), de janeiro a julho de 2014. Foram analisadas, de acordo com sua significância e desfechos clínicos obtidos, as seguintes variáveis registradas no Banco de Dados do Serviço de Farmácia Clínica: orientações farmacêuticas na alta, problemas e resultados negativos relacionados aos medicamentos, e intervenções farmacêuticas realizadas. RESULTADOS:: A primeira alta pós-transplante envolveu toda a equipe multiprofissional, sendo o farmacêutico responsável pela orientação do tratamento medicamentoso. A média de altas/mês com orientação farmacêutica no período do estudo foi de 10,6±1,3, totalizando 74 orientações. O tratamento clínico prescrito teve média de 9,1±2,7 medicamentos por paciente. Foram identificados 59 problemas relacionados aos medicamentos; 67,8% relacionaram-se com a não prescrição do medicamento necessário, acarretando 89,8% de risco de resultados negativos associados aos medicamentos por problema de saúde não tratado. A principal intervenção foi a solicitação de inclusão do medicamento (66,1%), e 49,2% dos medicamentos envolvidos agiam no aparelho digestivo/metabolismo. Todas as intervenções foram classificadas como apropriadas, e 86,4% foram capazes de prevenir o resultado negativo. CONCLUSÃO:: A orientação do farmacêutico clínico junto à equipe multiprofissional no momento da alta do paciente transplantado é importante, pois previne resultados negativos associados à farmacoterapia, garantindo a conciliação medicamentosa e a segurança do paciente.

Pharmaceutical orientation at hospital discharge of transplant patients: strategy for patient safety / Orientação farmacêutica na alta hospitalar de pacientes transplantados: estratégia para a segurança do paciente

ABSTRACT Objective: To describe and analyze the pharmaceutical orientation given at hospital discharge of transplant patients. Methods: This was a cross-sectional, descriptive and retrospective study that used records of orientation given by the clinical pharmacist in the inpatients unit of the Kidney and Liver Transplant Department, at Hospital Universitário Walter Cantídio, in the city of Fortaleza (CE), Brazil, from January to July, 2014. The following variables recorded at the Clinical Pharmacy Database were analyzed according to their significance and clinical outcomes: pharmaceutical orientation at hospital discharge, drug-related problems and negative outcomes associated with medication, and pharmaceutical interventions performed. Results: The first post-transplant hospital discharge involved the entire multidisciplinary team and the pharmacist was responsible for orienting about drug therapy. The mean hospital discharges/month with pharmaceutical orientation during the study period was 10.6±1.3, totaling 74 orientations. The prescribed drug therapy had a mean of 9.1±2.7 medications per patient. Fifty-nine drug-related problems were identified, in which 67.8% were related to non-prescription of medication needed, resulting in 89.8% of risk of negative outcomes associated with medications due to untreated health problems. The request for inclusion of drugs (66.1%) was the main intervention, and 49.2% of the medications had some action in the digestive tract or metabolism. All interventions were classified as appropriate, and 86.4% of them we able to prevent negative outcomes. Conclusion: Upon discharge of a transplanted patient, the orientation given by the clinical pharmacist together with the multidisciplinary team is important to avoid negative outcomes associated with drug therapy, assuring medication reconciliation and patient safety.

RESUMO Objetivo: Descrever e analisar a orientação farmacêutica oferecida na alta de pacientes transplantados. Metódos: Trata-se de um estudo transversal, descritivo e retrospectivo, que utilizou os registros das orientações realizadas pelo farmacêutico clínico na unidade de internação do Serviço de Transplante Renal e Hepático, Hospital Universitário Walter Cantídio, em Fortaleza (CE), de janeiro a julho de 2014. Foram analisadas, de acordo com sua significância e desfechos clínicos obtidos, as seguintes variáveis registradas no Banco de Dados do Serviço de Farmácia Clínica: orientações farmacêuticas na alta, problemas e resultados negativos relacionados aos medicamentos, e intervenções farmacêuticas realizadas. Resultados: A primeira alta pós-transplante envolveu toda a equipe multiprofissional, sendo o farmacêutico responsável pela orientação do tratamento medicamentoso. A média de altas/mês com orientação farmacêutica no período do estudo foi de 10,6±1,3, totalizando 74 orientações. O tratamento clínico prescrito teve média de 9,1±2,7 medicamentos por paciente. Foram identificados 59 problemas relacionados aos medicamentos; 67,8% relacionaram-se com a não prescrição do medicamento necessário, acarretando 89,8% de risco de resultados negativos associados aos medicamentos por problema de saúde não tratado. A principal intervenção foi a solicitação de inclusão do medicamento (66,1%), e 49,2% dos medicamentos envolvidos agiam no aparelho digestivo/metabolismo. Todas as intervenções foram classificadas como apropriadas, e 86,4% foram capazes de prevenir o resultado negativo. Conclusão: A orientação do farmacêutico clínico junto à equipe multiprofissional no momento da alta do paciente transplantado é importante, pois previne resultados negativos associados à farmacoterapia, garantindo a conciliação medicamentosa e a segurança do paciente.

Adesão ao tratamento para hipertensão em uma unidade Básica de Saúde do Ceará / Adherence to treatment for hypertension in a Basic Health Unit of Ceará

Estudos referem que o Acompanhamento Farmacoterapêutico (AFT) otimiza a farmacoterapia dos pacientes hipertensos, por estes serem polimedicados e apresentarem problemas de adesão ao tratamento. O trabalho objetivou avaliar a influência do AFT sobre a adesão dos pacientes ao tratamento da hipertensão em uma Unidade de Cuidados Farmacêuticos situada em uma unidade básica de saúde de Fortaleza, Ceará. Pacientes foram monitorados durante seis meses, usando-se o método Dáder. Os Problemas Relacionados com Medicamentos (PRM) foram classificados conforme o 2º Consenso de Granada. Para a avaliação da adesão, utilizou-se o Teste de Morisky-Green (questionário específico) e valores da pressão arterial (PA). Os dados foram analisados nos programas Epi Info e Sigma Plot. Dos 23 pacientes acompanhados, 70% (n=16) eram do sexo feminino, com idade > 60 anos, baixa escolaridade, renda de 1 ­ 2 salários mínimos. No final do AFT, 65,2% (n = 15) foram classificados como "pouco aderente" por ainda descuidarem do horário de tomada do medicamento; mas o número de pacientes que se esquecia de administrar os medicamentos diariamente diminuiu significantemente (p < 0,05). Foram registrados 60 PRM, dos quais 71,7% (n=43) foram reais, destacando-se os PRM 01 (35%; n=21; categoria: necessidade) e PRM 04 (26,6%; n=16; categoria: efetividade). Realizaram-se 53 intervenções farmacêuticas. Inicialmente, 52,18% (n=12) dos pacientes apresentaram PA≥140/90mmHg; após as intervenções, o número de pacientes com PA descontrolada teve redução estatisticamente significante. Nossos achados sugerem que o AFT pode ser eficaz na promoção da adesão do paciente hipertenso ao tratamento em nível de atenção primária

Studies reveal that pharmacotherapeutic follow-up (PF) optimizes the pharmacotherapy of hypertensive patients, since they are polymedicated and have problems with adherence to treatment.The study aimed to evaluate the influence of the PF of patients on adherence to treatment of hypertension in a Pharmaceutical Care Service placed in primary health care unit of Fortaleza, Ceará.Patients were monitored during six months, using the Dáder method. Drug related problems (DRP) were classified according to 2nd Consensus of Granada. For adherence evaluation, the Morisky-Green test (specific questionnaire) and values of blood pressure (BP) were used. Data were analyzed using the Epi Info and Sigma Plot. Of the 23 patients followed-up, 70% (n = 16) were female, with age>60 years old, low schooling and individual income of 1 ­ 2 minimum wages. At the end of the PF, 65.2% (n=15) were classified as "little adherent" due to still neglect the time of medication intake; but the number of patients who forgot to take the drugs every day decreased significantly (p<0,05). Of60 DRP recorded, 71.7% (n = 43) were actual, especially the PRM 01 (35%, n = 21; category: needs) and PRM 04 (26.6%, n = 16; category: effectiveness). At baseline, 52.18% (n = 12) of the patients were monitored with BP ≥140/90mmHg and, after interventions, this number had a statistically significant reduction. Our findings suggest that the PF can be effective inpromoting adherence to treatment of hypertension patientsin primary care level.

Pharmaceutical care in transplant patients in a university hospital: pharmaceutical interventions

A descriptive and prospective study was conducted on the pharmaceutical care in the post-transplant outpatient clinic of Hospital Universitario Walter Cantidio of Universidade Federal do Ceará (HUWC/UFC), in Fortaleza- Ceará in the period of April to October of 2011. The aim of the present study was to describe the pharmaceutical interventions performed in a Pharmaceutical Care service structured in the liver and kidney transplant outpatient clinic of an academic hospital. The Pharmaceutical interventions (PI) were classified according to Sabater et al.(2005), with significance based on Riba et al.(2000) and the Negative Outcomes associated with Medication (NOM) established at the Third Consensus of Granada. Statistical analyses were performed using the Epi Info v.3.5.1 program and hypothesis tests were done with the SigmaPlot v.10.0 program. A chi-squared (X²) test was utilized for statistical analysis of the sample. A total of 97 patients were followed, where 54 problems related to medications were identified and 139 PI performed. The main PI were in education of the patient about treatment (n=111; 80%) (p<0.05), while the significance of all interventions were appropriate, where 83.4% (n=116) of PI performed in the study period were shown to be "significant" (p<0.05). Through pharmaceutical care, the pharmacist is capable of monitoring the pharmacotherapeutic treatment and intervening when necessary, while being part of the multiprofessional team caring for the transplant patient.

Trata-se de um estudo de descritivo e prospectivo, realizado durante o atendimento farmacêutico nos ambulatórios de pós-transplante do Hospital Universitário Walter Cantídio da Universidade Federal do Ceará (HUWC/UFC), em Fortaleza-Ceará no período de abril a outubro de 2011. O presente trabalho objetiva apresentar as intervenções farmacêuticas realizadas em um serviço de Atenção Farmacêutica (ATENFAR) estruturado nos ambulatórios do transplante hepático e renal de um Hospital Universitário. As intervenções farmacêuticas (IF) foram classificadas de acordo com Sabater et al.(2005), a significância baseadas em Riba et al.(2000) e os Resultados Negativos associados a Medicamentos (RNM) fundamentados no Terceiro Consenso de Granada. As análises estatísticas foram realizadas no programa Epi Info v.3.5.1 e os testes de hipótese foram feitos no programa SigmaPlot v.10.0. O teste estatístico utilizado para análise da amostra foi o qui-quadrado (X²). Foram acompanhados 97 pacientes, identificados 54 problemas relacionados aos medicamentos e realizadas 139 intervenções farmacêuticas. As principais IF realizadas foram na educação do paciente sobre o tratamento (n=111; 80%) (p<0,05), já enquanto a significância todas as intervenções foram apropriadas, sendo que 83,4% (n=116) das IF realizadas no período do estudo mostram ser "significantes" (p<0,05). O farmacêutico, através do exercício da ATENFAR, é capaz de monitorar o tratamento farmacoterapêutico e intervir, quando necessário, integrando-se a equipe multiprofissional no cuidado ao paciente transplantado.