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1.
J Clin Pharm Ther ; 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31436857

RESUMO

WHAT IS KNOWN AND OBJECTIVES: Schizophrenia is a serious mental disorder and is associated with substantial economic and social burden. Cost-effectiveness analysis is important to assess the costs of different therapeutic options. However, there is a lack of information on the reporting quality of economic evaluations, cost drivers, as well as updated data focused on aripiprazole, an antipsychotic drug commonly prescribed in schizophrenia. This study evaluates and summarizes the evidence of economic evaluations of the use of aripiprazole in schizophrenia. In addition, we aimed to identify cost drivers and critically assess the reporting qualities of these studies. METHODS: A comprehensive literature research was conducted using PubMed, NHS Economic Evaluation Database, CEA Registry and LILACS databases dated until March 2018. Full economic analyses of aripiprazole in schizophrenia that were based on decision analytical models and published in English, Portuguese or Spanish languages were included. Two independent authors identified the studies and performed data extraction and quality assessment using 24 items from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. RESULTS AND DISCUSSION: A total of 79 potential studies were identified, of which 17 studies performing model-based economic evaluations fully met the eligibility criteria. Of these, 15 were industry-funded studies. A trend favouring olanzapine, lurasidone and paliperidone could be observed, whereas aripiprazole was extensively described as a dominated alternative. However, notably, 93% of the industry-funded studies presented results favouring their sponsors, only two of them being the manufacturer of aripiprazole. Cost drivers were usually related to the relapse rates/probabilities regardless of the funding source. The overall quality of reporting of the economic analyses was poor, with most studies scoring around 12-13 points. The most frequent problems were the lack of description of relevance of the outcome measures, characteristics of the base case population and report of precision measures for all the parameters of the model. WHAT IS NEW AND CONCLUSION: No consistent conclusion on the cost-effectiveness of aripiprazole could be drawn due to the context-specific costs, conflicting parameters of effectiveness and safety, and bias related to industry sponsorship. Cost drivers, though, were usually related to the relapse rates/probabilities. In addition, poor reporting quality of the studies performing full economic analysis requires further improvement to ensure greater transparency of the findings.

2.
Int. braz. j. urol ; 45(3): 435-448, May-June 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1012324

RESUMO

ABSTRACT Objectives: Prostate cancer is the most common and fatal cancer amongst Brazilian males. The quality of prostate cancer care in Brazil was systematically reviewed and compared to United Kingdom (UK) National Institute for Health and Care Excellence (NICE) guidelines, which are considered an international benchmark in care, to deter- mine any treatment gaps in Brazilian practice. Materials and Methods: A systematic review of Brazilian and UK literature was under- taken. Additionally, quality of life scores was measured using a FACT-P questionnaire of 36 prostate cancer patients attending the Farmácia Universitária da Universidade de São Paulo (FARMUSP). These scores were compared against NICE care measures for patient safety, clinical efficacy and quality of life indicators determined by either quantitative or qualitative methods. Key findings: The quality of prostate cancer care in Brazil was considered good when compared to NICE guidelines. However, FACT-P data strongly indicated a poor under- standing of treatment received by Brazilian patients and that their mental health needs were not being met. Conclusions: NICE quality statements that address the holistic needs of patients should be implemented into Brazilian outpatient care plans. Addressing the non-medical concerns of patients may improve quality of life and can be easily rolled-out through existing Brazilian pharmacy services at no financial cost to the Brazilian Unified Health System (SUS).

3.
Int Braz J Urol ; 45(3): 435-448, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31038864

RESUMO

OBJECTIVES: Prostate cancer is the most common and fatal cancer amongst Brazilian males. The quality of prostate cancer care in Brazil was systematically reviewed and compared to United Kingdom (UK) National Institute for Health and Care Excellence (NICE) guidelines, which are considered an international benchmark in care, to determine any treatment gaps in Brazilian practice. MATERIALS AND METHODS: A systematic review of Brazilian and UK literature was undertaken. Additionally, quality of life scores was measured using a FACT-P questionnaire of 36 prostate cancer patients attending the Farmácia Universitária da Universidade de São Paulo (FARMUSP). These scores were compared against NICE care measures for patient safety, clinical effi cacy and quality of life indicators determined by either quantitative or qualitative methods. Key fi ndings: The quality of prostate cancer care in Brazil was considered good when compared to NICE guidelines. However, FACT-P data strongly indicated a poor understanding of treatment received by Brazilian patients and that their mental health needs were not being met. CONCLUSIONS: NICE quality statements that address the holistic needs of patients should be implemented into Brazilian outpatient care plans. Addressing the non-medical concerns of patients may improve quality of life and can be easily rolled-out through existing Brazilian pharmacy services at no fi nancial cost to the Brazilian Unifi ed Health System (SUS).


Assuntos
Assistência Ambulatorial/normas , Assistência Farmacêutica/normas , Neoplasias da Próstata/tratamento farmacológico , Garantia da Qualidade dos Cuidados de Saúde/métodos , Qualidade de Vida , Brasil , Lista de Checagem/normas , Humanos , Masculino , Padrões de Referência , Inquéritos e Questionários/normas , Reino Unido
4.
PLoS One ; 14(1): e0210312, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30629654

RESUMO

INTRODUCTION: Medication review (MR) is a pharmacy practice conducted in different settings that has a positive impact on patient health outcomes. In this context, systematic reviews on MR have restricted the assessment of this practice using criteria such as methodological quality, practice settings, and patient outcomes. Therefore, expanding research on this subject is necessary to facilitate the understanding of the effectiveness of MR and the comparison of its results. AIM: To examine the panorama of systematic reviews on pharmacist-participated MR in different practice settings. METHODS: A literature search was undertaken in Biblioteca Virtual em Saúde (BVS), Embase, PubMed, Scopus, The Cochrane Library, and Web of Science databases through January 2018 using keywords for "medication review", "systematic review", and "pharmacist". Two independents investigators screened titles, abstracts, full texts; assessed methodological quality; and, extracted data from the included reviews. RESULTS: Seventeen systematic reviews were included, of which sixteen presented low to moderate methodological quality. Most of reviews were conducted in Europe (n = 7), included controlled primary studies (n = 16), elderly patients (n = 9), and long-term care facilities (n = 8). Seven reviews addressed MR as an intervention and thirteen reviews cited collaboration between physicians and pharmacists in the practice of MR. In addition, thirteen terminologies for MR were used and the main objective was to identify and solve drug-related problems and/or optimize the drug use (n = 11). CONCLUSION: There is considerable heterogeneity in practice settings, population, definitions, terminologies, and approach of MR as well as poor description of patient care process in the systematic reviews. These facts may limit the comparison, summarization and understanding of the results of MR. Furthermore, the methodological quality of most systematic reviews was below ideal. Thus, international agreement on the MR process is necessary to assess, compare and optimize the quality of care provided.

5.
Res Social Adm Pharm ; 2018 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-30262211

RESUMO

BACKGROUND: One of the elements of quality improvement of medication management services is measuring the quality of care and key performance indicators (KPIs) can be used in this assessment. There has been no publishing yet about a KPI instrument developed for ambulatory setting. OBJECTIVES: To develop and validate KPI instrument for medication management services provided for outpatients in Brazilian context. METHODS: A working group established 7 possible KPIs for assessment of the expert panel. For content validity, 16 experts were invited to participate in an internet based 2-round Delphi approach. Expert panel rated 7 possible KPIs using 7 attributes on a 5-point Likert scale for consensus. In order to construct validity and reliability, an internet questionnaire was developed for pharmacists that work in primary care to understand their views. In addition, a comparison between expert and pharmacist views about the indicators relevance was performed. RESULTS: Eleven (68.8%) experts participated in the Delphi round 1 and nine (81.8%) experts completed the 2 Delphi rounds. A new KPI was develop after expert panel assessment in the first round. Overall, content and construct validity were reached for 6 KPIs: pharmaceutical consultation provided (I1), pharmacist interventions accepted by the prescriber (I2), drug therapy problems resolved (I3), patient clinical status (I4), patient satisfaction (I5), and patient quality of life (I6). CONCLUSIONS: A set of 6 KPIs was developed for medication management services provided for outpatients. The instrument presented a good reliability and validity evidence. It is expected that these KPIs will improve the quality of medication management services.

6.
Eur J Clin Pharmacol ; 74(10): 1215-1233, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29905899

RESUMO

PURPOSE: To conduct an overview to summarize the efficacy and safety of aripiprazole for the treatment of schizophrenia. METHODS: A literature search was performed in PubMed, the Cochrane Library, LILACS, and the Centre for Reviews and Dissemination, for articles published until March 31, 2017. We included systematic reviews with meta-analyses of randomized controlled trials assessing the efficacy, and/or the safety of aripiprazole, for patients with schizophrenia. Two authors independently performed the study selection, data extraction, and quality assessment. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the Risk of Bias in Systematic Review (ROBIS) tool were used to appraise the quality of evidence and the risk of bias in the reviews, respectively. RESULTS: Fourteen studies fulfilled the inclusion criteria. Aripiprazole showed efficacy similar to that of both typical and atypical antipsychotic drugs (except olanzapine and amisulpride). Aripiprazole caused significantly lower weight gain and alterations in glucose and cholesterol levels, as compared to clozapine, risperidone, and olanzapine. In addition, aripiprazole caused significantly fewer general extrapyramidal side effects, less use of antiparkinsonian drugs, and akathisia, compared with typical antipsychotic drugs and risperidone. The overall quality of evidence in the reviews ranged from "very low" to "moderate," principally because of the risk of bias of original trials, inconsistency, and imprecision in the outcomes. According to the ROBIS tool, there are four reviews with "high" risk of bias and five with "unclear" risk of bias. CONCLUSIONS: Aripiprazole exhibited efficacy similar to that of other antipsychotic drugs and a better safety profile than that of typical (i.e., less some extrapyramidal side effects) and atypical (i.e., less metabolic changes) antipsychotic drugs.

8.
Crit Rev Oncol Hematol ; 113: 195-212, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28427509

RESUMO

This overview summarizes evidence for the efficacy and safety of bortezomib, thalidomide, and lenalidomide in patients with multiple myeloma. We searched the Medline, Scopus, and LILACS databases through August 2016, including systematic reviews with meta-analyses of randomized controlled trials assessing the efficacy and/or safety of bortezomib, thalidomide, or lenalidomide in patients with multiple myeloma. Two authors performed study selection, data extraction, and quality assessment using AMSTAR and GRADE instruments. Twenty-nine studies satisfied the inclusion criteria. All three drugs significantly improved overall response and progression-free survival; however, only bortezomib showed significantly greater overall survival compared with the control arm (induction therapy, continuous therapy, or at any phase of treatment). The main concerns on adverse events were thrombosis/embolism events, peripheral neuropathy, and second primary malignancies. The most common problems detected in systematic reviews were non-registration of the study protocol and conflicts of interest not clearly acknowledged. Future research should adhere to quality assessment tools so that best evidence can be used in decision-making. Protocol PROSPERO registration number: CRD42016036062.


Assuntos
Bortezomib/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Talidomida/análogos & derivados , Talidomida/uso terapêutico , Bortezomib/efeitos adversos , Humanos , Lenalidomida , Mieloma Múltiplo/mortalidade , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Talidomida/efeitos adversos
9.
Int J Clin Pharm ; 39(2): 386-393, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28188508

RESUMO

Background The Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria is used to identify instances of potentially inappropriate prescribing in a patient's medication regimen. Objective To determine the prevalence and predictors of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among elderly patients at hospital discharge. Setting A university hospital medical clinic in Brazil. Method Discharge prescriptions were examined using the STOPP/START criteria. Subjects were inpatients aged ≥60 years receiving at least one medication prior to hospitalization and with a history of cardiovascular disease. The prevalence of PIMs and PPOs was determined and a multivariable binary regression analysis was performed to identify independent predictors associated with PIMs or PPOs. Main outcome measure Prevalence of PIMs and PPOs. Results Of the 230 subjects, 13.9% were prescribed at least one PIM. The most frequently prescribed PIMs were glibenclamide or chlorpropamide prescribed for type 2 diabetes mellitus (31.0%), and aspirin at doses >150 mg/day (14.3%). Ninety patients had at least one PPO (39.1%). The most prevalent PPOs were statins (29.8%) and antiplatelet therapy (13.7%) for diabetes mellitus when coexisting major cardiovascular risk factors were present. No predictors for PIMs were found. In contrast, diabetes was a risk factor while dyslipidaemia was a protective factor for PPOs. Conclusion PIMs and PPOs commonly occur with elderly people at hospital discharge. Diabetes and dyslipidaemia were significantly associated with PPOs. Our findings show the need for interventions to reduce potentially inappropriate prescribing, such as a pharmacist medication review process at hospital discharge.


Assuntos
Prescrição Inadequada/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Prevalência , Fatores de Risco
10.
PLoS One ; 11(3): e0150999, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26963251

RESUMO

OBJECTIVE: To assess the effect of pharmacist interventions on glycemic control in type 2 diabetic patients and to examine factors that could explain the variation across studies. METHODS: A comprehensive literature search was performed in PubMed, Scopus, and LILACS databases for randomized controlled trials (RCTs) published up to July 2015. The search strategy included the use of MeSH terms or text words related to pharmacist interventions, type 2 diabetes, and randomized controlled trials. RCTs published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on glycemic control in type 2 diabetic outpatients were included. Two independent authors executed study selection, data extraction, and risk of bias assessment. Mean differences in glycosylated hemoglobin (HbA1c) were estimated using random-effect models, and heterogeneity was evaluated by subgroup and meta-regression analyses. RESULTS: The literature search yielded 963 records of potential interest, of which 30 were included in the systematic review and 22 in the meta-analysis. Most of these RCTs were conducted in the United States in patients in outpatient clinics using face-to-face contact only. All RCTs performed patient education, and most executed the medication review. The appraised sample showed uncertain or high risk of bias in most of the items evaluated, resulting in low-quality studies. In comparison with usual care, pharmacist interventions were associated with significant reductions in HbA1c levels (-8.5% [95% CI: -1.06, -0.65]; P < 0.0001; I2 = 67.3%). Subgroup analysis indicated differences of heterogeneity by country, baseline HbA1c levels, setting, intervention frequency, and random allocation. Age and HbA1c levels partly explained the variability across studies by meta-regression. CONCLUSIONS: Our findings confirmed that pharmacist interventions improve glycemic control in patients with type 2 diabetes compared with usual care and suggest that younger patients or with higher baseline HbA1c levels may be the main beneficiaries of pharmacist care. PROTOCOL PROSPERO REGISTRATION NUMBER: CRD42014007457.


Assuntos
Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobina A Glicada/metabolismo , Fatores Etários , Feminino , Humanos , Masculino , PubMed , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Cien Saude Colet ; 20(2): 325-32, 2015 Feb.
Artigo em Português | MEDLINE | ID: mdl-25715126

RESUMO

The objective of this study was to evaluate the role of the pharmacist in dispensing medication by conducting cross-sectional exploratory-descriptive research in eight Adult Psychosocial Care Centers (CAPS) in São Paulo. The pharmacists responsible for each of the dispensing units studied filled out a semi-structured questionnaire about the service provided. Two Adult CAPS units were selected from each of the North, South, Eastand West regions of São Paulo. The central region has no Adult CAPS, and was therefore not included in the study. Most of the respondents were aged between 35 and 40 years and were predominantly female. It was found that half of the respondents performed only 25% of dispensations and few conducted an analysis of all prescriptions before dispensing medication. All respondents contacted the prescriber if any medication-related problems a rose. However, few pharmaceutical interventions were commonly performed. Furthermore, one respondent indicated that all his/her functions in the pharmacy could be delegated to another professional. These findings reveal the pressing need for actions that ensure the ongoing training of pharmacists to enable them to be clinically prepared to deal with patients with mental disorders.


Assuntos
Assistência Farmacêutica , Farmacêuticos , Papel Profissional , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistemas de Apoio Psicossocial , Saúde da População Urbana
12.
Ciênc. saúde coletiva ; 20(2): 325-332, 02/2015. tab
Artigo em Português | LILACS | ID: lil-742225

RESUMO

O presente estudo teve por objetivo avaliar a atuação do farmacêutico na dispensação de medicamentos, sendo realizada pesquisa transversal exploratório-descritiva em oito Centros de Atenção Psicossocial (CAPS) Adulto do Município de São Paulo. Questionário semiaberto sobre o serviço de dispensação foi aplicado aos farmacêuticos responsáveis de cada unidade estudada. Foram selecionadas duas unidades CAPS Adulto das regiões Norte, Sul, Leste e Oeste de São Paulo. A região central não dispõe de CAPS adulto, razão pela qual não fez parte do estudo. A maior parte dos entrevistados apresentou idade entre 35 e 40 anos, com predomínio do gênero feminino. Verificou-se que metade dos entrevistados realizou apenas 25% das dispensações e poucos fizeram a análise de todas as prescrições antes de dispensar o medicamento. Todos os respondentes entravam em contato com o prescritor na presença de algum problema relacionado ao medicamento. Entretanto, intervenções farmacêuticas não eram realizadas comumente. Ainda, um dos respondentes indicou que todas as suas funções na farmácia poderiam ser delegadas a outro profissional. Os dados reforçam a necessidade de ações que possibilitem o aprimoramento contínuo do farmacêutico a fim de que esteja apto à prática clínica voltada aos pacientes com transtornos mentais.


The objective of this study was to evaluate the role of the pharmacist in dispensing medication by conducting cross-sectional exploratory-descriptive research in eight Adult Psychosocial Care Centers (CAPS) in São Paulo. The pharmacists responsible for each of the dispensing units studied filled out a semi-structured questionnaire about the service provided. Two Adult CAPS units were selected from each of the North, South, Eastand West regions of São Paulo. The central region has no Adult CAPS, and was therefore not included in the study. Most of the respondents were aged between 35 and 40 years and were predominantly female. It was found that half of the respondents performed only 25% of dispensations and few conducted an analysis of all prescriptions before dispensing medication. All respondents contacted the prescriber if any medication-related problems a rose. However, few pharmaceutical interventions were commonly performed. Furthermore, one respondent indicated that all his/her functions in the pharmacy could be delegated to another professional. These findings reveal the pressing need for actions that ensure the ongoing training of pharmacists to enable them to be clinically prepared to deal with patients with mental disorders.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Assistência Farmacêutica , Farmacêuticos , Papel Profissional , Brasil , Estudos Transversais , Sistemas de Apoio Psicossocial , Saúde da População Urbana
13.
São Paulo; s.n; s.n; out. 2014. 162 p. tab, graf, ilus.
Tese em Português | LILACS | ID: biblio-836801

RESUMO

Nos últimos vinte anos houve um aumento substancial no número de revisões sistemáticas e ensaios clínicos que avaliaram intervenções farmacêuticas para pacientes com doenças crônicas, em especial o diabetes. No entanto, existem poucos estudos que avaliam criticamente tais publicações, bem como modelos de prática desenvolvidos no contexto do sistema público de saúde brasileiro. O presente trabalho teve como objetivos avaliar revisões sistemáticas e ensaios clínicos controlados randomizados sobre serviços clínicos farmacêuticos para pacientes com diabetes e avaliar o efeito de modelo de colaboração médico- farmacêutico conduzido em ambulatório de cuidado secundário para pacientes com diabetes tipo 2 não controlada. Para tanto, busca abrangente da literatura foi conduzida nas bases de dados PubMed, SCOPUS, LILACS, Scielo e DOAJ por revisões sistemáticas e ensaios clínicos controlados randomizados. As revisões sistemáticas foram avaliadas em relação à qualidade da apresentação textual e metodológica, sendo identificados campos para melhorias futuras. A seguir, foi realizada uma descrição dos componentes-chave das intervenções e fontes de heterogeneidade clínica e metodológica entre os ensaios clínicos controlados randomizados. Ainda, foi conduzido um ensaio clinico controlado randomizado no ambulatório de doenças metabólicas do Hospital Universitário da Universidade de São Paulo, com duração de 12 meses, para 80 pacientes com diabetes tipo 2 não controlada. O grupo intervenção recebeu consultas farmacêuticas face a face, com suporte remoto por telefone. O farmacêutico realizou intervenções sistemáticas objetivando resolver ou prevenir problemas relacionados aos medicamentos. Os desfechos primários incluíram a redução e controle dos níveis de hemoglobina glicada. A busca bibliográfica identificou 101 registros, dos quais sete revisões completaram os critérios de inclusão. Em média, apenas dois terços dos itens sobre qualidade da apresentação textual e metodológica foram cumpridos nas publicações. Os problemas mais frequentes incluíram o não registo de protocolo do estudo, a ausência de lista dos estudos excluídos, e a falta de reconhecimento claro do conflito de interesses. A busca por ensaios clínicos randomizados de intervenções farmacêuticas identificou 2271 registros, sendo incluídos 24 na síntese qualitativa. A maioria dos estudos para pacientes com diabetes tipo 2 foi desenvolvida nos Estados Unidos, em ambulatório, com contato individual face a face. Todos realizaram intervenções educativas e o processo de uso dos medicamentos foi avaliado pela maioria deles. A amostra exibiu risco de viés incerto ou alto na maior parte dos itens avaliados, o que resultou em baixa qualidade metodológica. De um total de 80 pacientes, 73 completaram o ensaio clínico, sendo 36 do grupo intervenção e 37 do controle. Comparado ao cuidado usual, o grupo intervenção apresentou maior redução nos níveis de hemoglobina glicada, bem como aumento na taxa de controle da pressão arterial sistólica, na proporção de pacientes aderentes e na pontuação da adesão. Os resultados desta tese apontam que a qualidade da apresentação textual e a metodológica estavam abaixo do ideal entre as revisões e que melhoria no desenho e na descrição das revisões e dos estudos primários é necessária para garantir resultados mais robustos. Ainda, o modelo de cuidado proposto é viável e mais efetivo que o cuidado usual na redução da hemoglobina glicada em pacientes diabéticos tipo 2


Over the last twenty years, there was an important increase in the number of systematic reviews and clinical trials about pharmacist interventions in patients with chronic diseases, including diabetes. Nevertheless, few studies exist which assess critically such publications, as well as models of practice developed in the context of the Brazilian Public Health System. The study aimed to assess the systematic reviews and randomized controlled trials on clinical pharmacy services for patients with diabetes and to assess the effect of a pharmacist- physician collaborative care model for patients with poorly controlled type 2 diabetes. For this, comprehensive literature search was performed in databases PubMed, SCOPUS, LILACS, Scielo and DOAJ for systematic reviews and randomized controlled trials. The systematic reviews were assessed for the reporting characteristics and methodological quality, been identified rooms for future improvements. The following, it was performed a description of the key components of pharmacist interventions and of the sources of clinical and methodological heterogeneity between randomized controlled trials. In addition, a 12-month randomized controlled trial of pharmacist-physician collaborative interventions for eighty diabetic patients was conducted at University Hospital of University of São Paulo. The pharmaceutical interviews were conducted face-to-face, with remote support by telephone. Pharmacist performed systematic interventions aiming to solve and prevent drug-related problem in the diabetic patients. The primary outcomes included the reduction and control of the levels of glycosylated hemoglobin. The literature search yielded 101 records, of which 7 reviews for diabetic patients satisfied the inclusion criteria. On average, only two-thirds of reporting and methodological quality items were fulfilled in included reviews. The most frequent problems included the non-registration of study protocol, the absence of a list of excluded studies, and unclear acknowledgment of the conflict of interests. The literature search for randomized clinical trials of pharmacist interventions identified 2271 records, 24 of them were included in the qualitative synthesis. The majority of studies was developed in the United States, in ambulatory, with individual contact face to face. All of them performed educational interventions and the process of use of the medications was assessed in the majority of them. The sample showed risk of bias uncertain or high in the majority of the items assessed, which resulted in low methodological quality. Of a total of 80 patients, 73 completed the clinical trial (37 of control and 36 of intervention). In comparison with the usual care, the intervention group presented higher reduction in the levels of glycosylated hemoglobin, as well as increase in the rate of control of the systolic blood pressure, in the proportion of adherent patients and in the score of the medication adherence. The results of this thesis point out that the report and methodological quality was below the ideal in the reviews and that improvement in the design and in the description of the reviews and of the primary studies is necessary to warrant results that are more robust. Still, the model of care proposed is viable and more effective than the usual care in reducing the levels of glycosylated hemoglobin in patients with diabetes type 2


Assuntos
Humanos , Masculino , Feminino , Diabetes Mellitus Tipo 2/metabolismo , Farmacêuticos/classificação , Revisão , Hemoglobina A Glicada/farmacologia , Seguro de Serviços Farmacêuticos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
14.
Ann Pharmacother ; 48(7): 887-896, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24692605

RESUMO

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.

15.
Artigo em Português | LILACS | ID: lil-691786

RESUMO

O objetivo do presente estudo foi avaliar os indicadores de estrutura e processo empregados na implantação do serviço de Atenção Farmacêutica na rede Farmácia Popular do Brasil. Para tanto, um estudo piloto descritivo e avaliativo foi conduzido em novembro de 2009 em uma filial da rede Farmácia Popular do Brasil em Aracaju-SE. Os indicadores de estrutura e de processo foram avaliados por meio da aplicação da versão modificada do instrumento Behavioural Pharmaceutical Care Scale. Esta ferramenta foi composta de 34 itens distribuídos em 14 domínios, com escore mínimo de 16 e máximo de 175 pontos. Cada domínio foi avaliado por duas farmacêuticas-pesquisadoras (autorelato) e por dois farmacêuticos-auditores (observação direta). A pontuação média geral dos avaliadores foi de 144,25 ± 6,75, com variação de 138 a 153 pontos. Todos os domínios relacionados à estrutura do serviço e a maioria do processo apresentaram escores elevados (≥ 80%). As principais falhas foram detectadas no domínio referência a outros profissionais de saúde (56,3%), sobretudo, no encaminhamento a outros farmacêuticos 1,00 ± 0,00 (0,0%) e no envio de cartas ao médico 1,50 ± 0,58 (12,5%). Os resultados apontam que estrutura e processo empregados neste estudo piloto mostraram-se satisfatórios, indicando o potencial do serviço de Atenção Farmacêutica adotado para contribuir na elaboração de um modelo de implantação deste serviço para a rede Farmácia Popular do Brasil. No entanto mais estudos são necessários.


The aim of the present study was to evaluate indicators of the structure and process used in the implantation of a pharmaceutical care service of the drugstore chain People’s Pharmacy of Brazil. A descriptive, evaluative study was conducted in November 2009 at a branch of the People’s Pharmacy of Brazil in the city of Aracaju (state of Sergipe). Structure and process indicators were evaluated by applying the modified version of the Behavioral Pharmaceutical Care Scale, which is composed of 34 items divided among 14 subscales, the score of which ranges from 16 to 175 points. Evaluations were performed by two pharmacist researchers (self-reports) and two pharmacist auditors (direct observations). The overall mean score attributed by the evaluators was 144.25 ± 6.75 (range: 138 to 153). All subscales related to the structure of the service and most of the subscales related to the process achieved high scores (≥ 80%). The main flaws regarded referrals and consultations with other health professionals (56.3%), especially referrals to other pharmacists (1.00 ± 0.00; 0.0%) and sending letters to doctors (1.50 ± 0.58; 12.5%). The findings of this pilot study demonstrate satisfactory structure and process, indicating the potential of the pharmaceutical care service to contribute to the development of a model for the deployment of this service to other branches of the People’s Pharmacy of Brazil. However, further studies are needed.


Assuntos
Estrutura dos Serviços/organização & administração , Farmácias/organização & administração , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Assistência Farmacêutica
16.
Artigo em Português | LILACS | ID: lil-655401

RESUMO

O avanço do envelhecimento da população brasileira está causando uma alteração do perfil epidemiológico, que passou a apresentar uma maior prevalência de condições crônicas de saúde. Tais condições exigem acompanhamento constante da farmacoterapia pelos profissionais de saúde. Isso implica no aumento do uso de medicamentos, tornando os idosos mais suscetíveis aos riscos de polifarmácia e de problemas relacionados à farmacoterapia. Nesse contexto, é necessário implantar estratégias efetivas focadas no paciente que visem à redução da morbimortalidade relacionada aos medicamentos, tais como a Atenção Farmacêutica. O presente estudo visou compreender o perfil de uso dos medicamentos em idosos assistidos por um programa de Atenção Farmacêutica na Farmácia Popular do Brasil no município de Aracaju- SE. Os dados referentes ao perfil farmacoterapêutico foram coletados a partir das informações levantadas de 68 pacientes idosos com hipertensão e/ou diabetes. O consumo total de medicamentos foi de 383 com média de 5,63 (DP= 2,50), a polifarmácia esteve presente em 63,2% dos pacientes (n= 43). Os medicamentos mais consumidos pertenciam ao grupo anatômico que age no sistema cardiovascular (46,9%, n= 180) e no trato alimentar (31,1%, n= 119). No estudo foram observadas 152 interações em 53 pacientes (77,95%), 19 casos de medicamentos inadequados (4,9%), e 35 (9,5%) interações fármaco- alimento. Esses resultados sugerem o aprimoramento das prescrições e avaliação constante da qualidade da farmacoterapia de modo a promover o uso racional de medicamentos nesta faixa etária.


The advancement aging of the population is causing a change in the epidemiological profile, which presented a higher prevalence of chronic health conditions. Such conditions require constant monitoring of pharmacotherapy for health professionals. This entails increased use of drugs, making the elderly more susceptible to the risks of polypharmacy and problems related to pharmacotherapy. In this context, it is necessary to implement effective strategies focused on the patient aimed at reducing morbidity and mortality related to drugs, such as pharmaceutical care. This study examines the usage profile of drugs in elderly patients assisted by a program of pharmaceutical care in the People?s Pharmacy of Brazil in the city of Aracaju-SE. The data on drugs prescribed were collected from the information collected from 68 elderly patients with hypertension and / or diabetes. The total consumption of medicines was 383 with an average of 5.63 (SD = 2.50), polypharmacy was present in 63.2% of patients (n = 43). The most used drugs belonged to the anatomical acting on the cardiovascular system (46.9%, n = 180) and in the alimentary tract (31.1%, n = 119). In the study 152 interactions were observed in 53 patients (77.95%), 19 cases of inappropriate drugs (4.9%) and 35 (9.5%) drug-food interactions. These results suggest the improvement of the requirements and ongoing assessment of the quality of pharmacotherapy in order to promote rational drug use in this age group.


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso , Uso de Medicamentos/tendências , Dinâmica Populacional
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