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1.
Clinics (Sao Paulo) ; 74: e1091, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778428

RESUMO

OBJECTIVES: This is a randomized controlled trial that aims to evaluate the impact of pharmacist-led discharge counseling on reducing pharmacotherapy problems in the 30-day postdischarge period of cardiology patients from a tertiary hospital in Brazil. METHODS: At discharge, two cardiovascular pharmacy residents performed a medication counseling session with the intervention group, and the follow-up was performed by telephone (3 and 15 days after discharge). The number of pharmacotherapy problems was evaluated during a pharmacist-led ambulatory consultation 30 days after discharge. RESULTS: A total of 66 and 67 patients were randomized to the intervention and control groups, respectively, but only 51 patients were analyzed in each group, all with similar baseline characteristics. The intervention group had significantly fewer pharmacotherapy problems compared to the control (p<0.001), and 100% of the patients had at least one problem. We observed five problems significantly more frequently in the control group: "incorrect time of taking" (p=0.003), "use higher dose of medication" (p=0.007), "use lower dose of medication" (p=0.014), "restart discontinued medication" (p=0.011), and "underdosing prescription" (p=0.009). Simvastatin, enalapril, carvedilol, and atorvastatin were the medications more associated with pharmacotherapy problems. CONCLUSIONS: We concluded that pharmacist-led discharge counseling should be an indispensable service, as patients exhibited less pharmacotherapy problems in the 30-day postdischarge period, especially related to drug administration and adherence.

2.
Int J Clin Pharm ; 41(3): 785-792, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30963446

RESUMO

Background The Cochrane collaboration risk of bias assessment (RoB) tool is used in several fields to evaluate the methodological quality of studies. Its strengths and challenges are discussed. Objective To assess the sensitivity of the RoB tool in studies of pharmacist interventions. Setting DEPICT database was used to pool randomized controlled trials (RCTs) of complex interventions. Method A Guide for RoB Judgment in Pharmacy Services was created to help in the interpretation and judgment of bias criteria. The evaluation of bias (low, unclear, high risk) was performed by RCT. Sensitivity analyses were performed to assess the influence of different interpretations of eight elements of judgment in the RoB tool. Paired analysis and estimations of the effect size (95% confidence interval) of the criteria modifications compared to the original analyses were calculated. Main outcome measure Changes in the interpretations of judgment in the RoB tool. Results Overall, 8.3, 45.4, and 46.3% of the studies were determined to have low, unclear, and high risk of bias, respectively. High risk of bias was caused by attrition and detection domains. The number of studies classified with high risk of bias significantly increased for five of the eight interpretations, while unclear risk of bias increased for three interpretations (with a negligible effect size in all of them). Lack of blinding, loss of participants, and the use of subjective and self-reported outcomes were the main elements resulting in high risk of bias. Conclusion The RoB tool is useful for evaluating RCTs of pharmacist interventions if adapted criteria for judgment are used. Ignoring these adjustments produces a floor-effect with studies classified with high risk of bias.

3.
J Hosp Med ; 14: E1-E8, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30897055

RESUMO

BACKGROUND: Transitions of care can contribute to medication errors and other adverse drug events. PURPOSE: The aim of this study was to evaluate the impact of pharmacist-led discharge counseling on hospital readmission and emergency department visits through a systematic review and meta-analysis. EDATA SOURCES: Lectronic searches were performed in PubMed, Scopus, and DOAJ (Directory of Open Access Journals), along with a manual search (July 2017). PROSPERO registration no. CRD42017068444. STUDY SELECTION: Two independent reviewers performed all the steps of the systematic review process (screening of titles and abstracts, full-text appraisal, data extraction, and quality assessment), with contributions from a third researcher. We included randomized controlled trials (RCTs) reporting data on pharmacist-led discharge counseling. DATA EXTRACTION: Primary extracted outcomes were emergency department visits and hospital readmission rates. DATA SYNTHESIS: Meta-analyses of intervention versus usual care for hospital readmission and emergency department visit rates were performed using the inverse variance method. Results are reported as risk ratios (RRs) with 95% confidence intervals (CIs). Prediction intervals (PIs) were also calculated. Sensitivity and subgroup analyses were performed. A total of 21 RCTs were included in the qualitative synthesis and 18 in the meta-analyses (n = 7,244 patients). The original meta-analysis revealed a significant difference in the impact between pharmacist-led discharge counseling and usual care on overall hospital readmission (RR = 0.864 [95% CI 0.763-0.997], P = .020) and emergency department (RR = 0.697 [95% CI 0.535-0.907], P = .007) visits. However, the small number of included studies, the high heterogeneity among trials (I2 between 40% and 60%), and the wide PIs (hospital readmission: PI 0.542-1.186; emergency department visits: PI 0.027-1.367) prevented drawing further conclusions. CONCLUSIONS: Insufficient evidence exists regarding the effect of pharmacist-led discharge counseling on hospital readmission and emergency department visits. Further well-designed clinical trials with defined core outcome sets are needed.

4.
Br J Clin Pharmacol ; 85(10): 2280-2291, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30907446

RESUMO

AIMS: Despite their overall favourable safety profile, tyrosine kinase inhibitors (TKIs) are related to severe adverse events including haematological toxicities such as anaemia, leucopenia, neutropenia and thrombocytopenia. We designed a systematic review and network meta-analysis of randomised controlled trials to compare safety among TKIs (bosutinib, dasatinib, imatinib, nilotinib, ponatinib and radotinib) used by patients diagnosed with chronic myeloid leukaemia. METHODS: We obtained data from the PubMed, Scopus, Web of Science, and SciELO databases. The Bayesian approach was used for direct and indirect comparisons, and the treatments were ranked by the surface under the cumulative ranking curve (SUCRA). RESULTS: Seventeen studies were included in the network meta-analysis. Our data show that dasatinib was generally considered worse than the other TKIs, with SUCRA values ​​for 140 mg dasatinib of 90.3% for anaemia, 87.4% for leucopenia, 90.6% for neutropenia and 97.2% for thrombocytopenia. In addition, nilotinib was shown to be safer, with SUCRA values ​​for 600 and 800 mg doses of 21.9 and 35.8% for anaemia, 23.8 and 14.6% for leucopenia, 33.0 and 17.7% for neutropenia, and 28.7 and 32.6% for thrombocytopenia, respectively. CONCLUSION: Dasatinib appeared as the least safe drug for chronic myeloid leukaemia, probably because it binds to multiple key kinase targets, being more prone to cause serious haematological adverse events. Nilotinib demonstrated a safer profile, mostly due to its selective binding capacity.

5.
Einstein (Sao Paulo) ; 16(2): eRW4074, 2018 Jun 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29898094

RESUMO

The definition of antineoplastic administration sequences can help planning of therapeutic regimens in a more rational way, and thus optimize chemotherapy effects on patients, increasing efficacy and reducing toxic effects. In this way, this study aimed to evaluate the infusion order of antineoplastic agents of the main therapeutic protocols used in the treatment of colorectal and breast cancer which are used in a tertiary hospital, identifying possible interactions dependent on the infusion sequence. For the definition of protocols adopted in the hospital, medical prescriptions were used in the period of January to March 2016 and a literature review was conducted to search for studies assessing the sequence of administering the selected regimens. The databases used were SciELO, LILACS and MEDLINE, in addition to Micromedex Solutions® and UpToDate®. A total of 19 protocols were identified for antineoplastic therapy, 11 for colorectal cancer and 8 for breast cancer. The selected articles provided evidence for administration order of 19 protocols, and three protocols did no report relevance of infusion sequence. Sequence-dependent interactions were mainly related to toxicity, pharmacokinetics and efficacy of the drug combination. The definition of the infusion sequence has a great impact on the optimization of therapy, increasing efficacy and safety of the protocols containing combined antineoplastic therapies.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacocinética , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Feminino , Humanos , Infusões Intravenosas
6.
Clinics (Sao Paulo) ; 73: e325, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29723341

RESUMO

OBJECTIVES: This study aimed to evaluate the impact of pharmacist-provided discharge counseling on mortality rate, hospital readmissions, emergency department visits, and medication adherence at 30 days post discharge. METHODS: This randomized controlled trial was approved by the local ethics committee and included patients aged 18 years or older admitted to the cardiology ward of a Brazilian tertiary hospital. The intervention group received a pharmacist-led medication counseling session at discharge and a telephone follow-up three and 15 days after discharge. The outcomes included the number of deaths, hospital readmissions, emergency department visits, and medication adherence. All outcomes were evaluated during a pharmacist-led ambulatory consultation performed 30 days after discharge. RESULTS: Of 133 patients, 104 were included in the analysis (51 and 53 in the intervention and control groups, respectively). The intervention group had a lower overall readmission rate, number of emergency department visits, and mortality rate, but the differences were not statistically significant (p>0.05). However, the intervention group had a significantly lower readmission rate related to heart disease (0% vs. 11.3%, p=0.027), despite the small sample size. Furthermore, medication counseling contributed significantly to improved medication adherence according to three different tools (p<0.05). CONCLUSIONS: Pharmacist-provided discharge medication counseling resulted in better medication adherence scores and a lower incidence of cardiovascular-associated hospital readmissions, thus representing a useful service for cardiology patients.


Assuntos
Aconselhamento Diretivo , Alta do Paciente/normas , Farmacêuticos/psicologia , Idoso , Brasil , Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Feminino , Cardiopatias/mortalidade , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Farmacêuticos/normas , Papel Profissional/psicologia , Centros de Atenção Terciária/estatística & dados numéricos
7.
J Eval Clin Pract ; 24(3): 570-579, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29691955

RESUMO

RATIONALE, AIMS, AND OBJECTIVES: Discharge medication counselling has produced improved quality of care and health outcomes, especially by reducing medication errors and readmission rates, and improving medication adherence. However, no studies have assembled an evidence-based discharge counselling process for clinical pharmacists. Thus, the present study aims to map the components of the pharmacist-led discharge medication counselling process. METHODS: We performed a scoping review by searching electronic databases (Pubmed, Scopus, and DOAJ) and conducting a manual search to identify studies published up to July 2017. Studies that addressed pharmacist-led discharge medication counselling, regardless of the population, clinical conditions, and outcomes evaluated, were included. RESULTS: A total of 1563 studies were retrieved, with 75 matching the inclusion criteria. Thirty-two different components were identified, and the most prevalent were the indication of the medications and adverse drug reactions, which were reported in more than 50% of the studies. The components were reported similarly by studies from the USA and the rest of the world, and over the years. However, 2 differences were identified: the use of a dosage schedule, which was more frequent in studies published in 2011 or before and in studies outside the USA; and the teach-back technique, which was used more frequently in the USA. Poor quality reporting was also observed, especially regarding the duration of the counselling, the number of patients, and the medical condition. CONCLUSION: Mapping the components of the pharmacist-led discharge counselling studies through a scoping review allowed us to reveal how this service is performed around the world. Wide variability in this process and poor reporting were identified. Future studies are needed to define the core outcome set of this clinical pharmacy service to allow the generation of robust evidence and reproducibility in clinical practice.


Assuntos
Aconselhamento , Reconciliação de Medicamentos , Serviço de Farmácia Hospitalar , Humanos , Farmacêuticos , Papel Profissional
8.
J Am Pharm Assoc (2003) ; 58(2): 210-219, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29439927

RESUMO

OBJECTIVE: Pharmacists have adopted an active role in asthma management. This review aimed to analyze the intervention dose, understood as the "amount of program delivered," and core components of the intervention provided by pharmacists in asthma management. DATA SOURCES: A literature search was conducted in December 2016 using PubMed. STUDY SELECTION: A 2-stage approach was used. At the first stage, systematic reviews of pharmacists' interventions in asthma management were identified. At the second stage, primary studies included in the systematic reviews were selected. DATA EXTRACTION: The DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) was used for data extraction. In addition GINA (Global Initiative for Asthma) guidelines were used as a reference to classify the interventions' core components. RESULTS: Thirty-one studies were included. In most of the studies, the pharmacist-patient intervention occurred at the community pharmacy setting (n = 22). The most common core components used in pharmacists' interventions were the provision of drug information and patient counseling (n = 27). Pharmacists' interventions frequently were targeted at assessing and improving the use of patient's inhaler technique (n = 27). Educational materials and written action plans were the materials most commonly used in the interventions (n = 20). The duration (n = 13) and the frequency (n = 16) of the intervention were the most frequent information about the intervention dose measure reported. CONCLUSION: Pharmacists' interventions in asthma management are complex. Structured educational programs and patient counseling appear to be the most frequent core components of pharmacists' interventions. Interventions were focused on providing information about the condition and on inhaler technique assessment and training. However, most studies failed to report the intervention dose sufficiently to be reproduced. The reporting of this indicator is crucial to ensure the reproducibility of the interventions assessed and their implementation in practice. (Registration number CRD42016029181.).


Assuntos
Asma/tratamento farmacológico , Serviços Comunitários de Farmácia/normas , Farmácias/normas , Farmacêuticos/normas , Humanos , Papel Profissional
9.
Clinics ; 73: e325, 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-890741

RESUMO

OBJECTIVES: This study aimed to evaluate the impact of pharmacist-provided discharge counseling on mortality rate, hospital readmissions, emergency department visits, and medication adherence at 30 days post discharge. METHODS: This randomized controlled trial was approved by the local ethics committee and included patients aged 18 years or older admitted to the cardiology ward of a Brazilian tertiary hospital. The intervention group received a pharmacist-led medication counseling session at discharge and a telephone follow-up three and 15 days after discharge. The outcomes included the number of deaths, hospital readmissions, emergency department visits, and medication adherence. All outcomes were evaluated during a pharmacist-led ambulatory consultation performed 30 days after discharge. RESULTS: Of 133 patients, 104 were included in the analysis (51 and 53 in the intervention and control groups, respectively). The intervention group had a lower overall readmission rate, number of emergency department visits, and mortality rate, but the differences were not statistically significant (p>0.05). However, the intervention group had a significantly lower readmission rate related to heart disease (0% vs. 11.3%, p=0.027), despite the small sample size. Furthermore, medication counseling contributed significantly to improved medication adherence according to three different tools (p<0.05). CONCLUSIONS: Pharmacist-provided discharge medication counseling resulted in better medication adherence scores and a lower incidence of cardiovascular-associated hospital readmissions, thus representing a useful service for cardiology patients.

10.
Einstein (Säo Paulo) ; 16(2): eRW4074, 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-953158

RESUMO

ABSTRACT The definition of antineoplastic administration sequences can help planning of therapeutic regimens in a more rational way, and thus optimize chemotherapy effects on patients, increasing efficacy and reducing toxic effects. In this way, this study aimed to evaluate the infusion order of antineoplastic agents of the main therapeutic protocols used in the treatment of colorectal and breast cancer which are used in a tertiary hospital, identifying possible interactions dependent on the infusion sequence. For the definition of protocols adopted in the hospital, medical prescriptions were used in the period of January to March 2016 and a literature review was conducted to search for studies assessing the sequence of administering the selected regimens. The databases used were SciELO, LILACS and MEDLINE, in addition to Micromedex Solutions® and UpToDate®. A total of 19 protocols were identified for antineoplastic therapy, 11 for colorectal cancer and 8 for breast cancer. The selected articles provided evidence for administration order of 19 protocols, and three protocols did no report relevance of infusion sequence. Sequence-dependent interactions were mainly related to toxicity, pharmacokinetics and efficacy of the drug combination. The definition of the infusion sequence has a great impact on the optimization of therapy, increasing efficacy and safety of the protocols containing combined antineoplastic therapies.


RESUMO A definição de sequências de administração de antineoplásicos pode proporcionar o planejamento dos esquemas terapêuticos de forma mais racional e, assim, otimizar o efeito da quimioterapia nos pacientes, aumentando a eficácia e reduzindo o aparecimento de efeitos tóxicos. Desta forma, o objetivo deste estudo foi avaliar a ordem de infusão dos antineoplásicos constituintes dos principais protocolos terapêuticos para o tratamento dos cânceres de mama e colorretal utilizados em um hospital terciário, identificando possíveis interações dependentes da sequência de infusão. Para definição dos protocolos adotados na Instituição, foram utilizadas as prescrições no período de janeiro a março de 2016, sendo então realizada uma revisão de literatura, para buscar estudos que avaliaram a sequência de administração dos esquemas selecionados. Para tanto, as seguintes bases de dados foram utilizadas: SciELO, LILACS e MEDLINE, além das plataformas Micromedex Solutions® e UpToDate®. Foram identificados 19 protocolos para terapia antineoplásica, sendo 11 para câncer colorretal e 8 para câncer de mama. Os artigos selecionados forneceram evidências para ordem de administração de 19 protocolos, e em 3 protocolos, não foi evidenciada a relevância da sequência infusional. As interações dependentes de sequência foram principalmente relacionadas à toxicidade, farmacocinética e eficácia da combinação de fármacos. A definição da sequência infusional possui grande impacto na otimização da terapia, aumentando a eficácia e a segurança dos protocolos, contendo terapias combinadas de antineoplásicos.

11.
Pharm Pract (Granada) ; 15(1): 943, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28503228

RESUMO

Systematic reviews and pairwise meta-analyses of randomized controlled trials, at the intersection of clinical medicine, epidemiology and statistics, are positioned at the top of evidence-based practice hierarchy. These are important tools to base drugs approval, clinical protocols and guidelines formulation and for decision-making. However, this traditional technique only partially yield information that clinicians, patients and policy-makers need to make informed decisions, since it usually compares only two interventions at the time. In the market, regardless the clinical condition under evaluation, usually many interventions are available and few of them have been studied in head-to-head studies. This scenario precludes conclusions to be drawn from comparisons of all interventions profile (e.g. efficacy and safety). The recent development and introduction of a new technique - usually referred as network meta-analysis, indirect meta-analysis, multiple or mixed treatment comparisons - has allowed the estimation of metrics for all possible comparisons in the same model, simultaneously gathering direct and indirect evidence. Over the last years this statistical tool has matured as technique with models available for all types of raw data, producing different pooled effect measures, using both Frequentist and Bayesian frameworks, with different software packages. However, the conduction, report and interpretation of network meta-analysis still poses multiple challenges that should be carefully considered, especially because this technique inherits all assumptions from pairwise meta-analysis but with increased complexity. Thus, we aim to provide a basic explanation of network meta-analysis conduction, highlighting its risks and benefits for evidence-based practice, including information on statistical methods evolution, assumptions and steps for performing the analysis.

12.
Pharm. pract. (Granada, Internet) ; 15(1): 0-0, ene.-mar. 2017. tab, ilus, graf
Artigo em Inglês | IBECS | ID: ibc-161867

RESUMO

Systematic reviews and pairwise meta-analyses of randomized controlled trials, at the intersection of clinical medicine, epidemiology and statistics, are positioned at the top of evidence-based practice hierarchy. These are important tools to base drugs approval, clinical protocols and guidelines formulation and for decision-making. However, this traditional technique only partially yield information that clinicians, patients and policy-makers need to make informed decisions, since it usually compares only two interventions at the time. In the market, regardless the clinical condition under evaluation, usually many interventions are available and few of them have been studied in head-to-head studies. This scenario precludes conclusions to be drawn from comparisons of all interventions profile (e.g. efficacy and safety). The recent development and introduction of a new technique - usually referred as network meta-analysis, indirect meta-analysis, multiple or mixed treatment comparisons - has allowed the estimation of metrics for all possible comparisons in the same model, simultaneously gathering direct and indirect evidence. Over the last years this statistical tool has matured as technique with models available for all types of raw data, producing different pooled effect measures, using both Frequentist and Bayesian frameworks, with different software packages. However, the conduction, report and interpretation of network meta-analysis still poses multiple challenges that should be carefully considered, especially because this technique inherits all assumptions from pairwise meta-analysis but with increased complexity. Thus, we aim to provide a basic explanation of network meta-analysis conduction, highlighting its risks and benefits for evidence-based practice, including information on statistical methods evolution, assumptions and steps for performing the analysis (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Metanálise como Assunto , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Resultado do Tratamento , Técnicas de Apoio para a Decisão , Avaliação de Resultado de Intervenções Terapêuticas/métodos
13.
Res Social Adm Pharm ; 13(1): 201-208, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-26846907

RESUMO

A critical analysis of the research on clinical pharmacy services with regards to study characteristics has not been undertaken since 1998. However, several meta-analyses have been conducted to demonstrate the impact of pharmacists' interventions in specific medical conditions. These meta-analyses present high heterogeneity in part because the interventions are poorly and inconsistently described in primary studies. The aim of this article is to present the characteristics of randomized control trials (RCTs) that assess clinical pharmacy services to identify areas of improvement in future pharmacy practice research studies. Different emphasis of research across geographic regions of the world were also examined. During these 40 years, 520 articles reporting 439 RCTs assessing clinical pharmacy services were published. Of the 439 studies, 77.7% (n = 341) were published in the year 2000 or thereafter, 41.46% (n = 182) were conducted in the US, 27.56% (n = 121) in Europe, and 30.98% (n = 136) in the rest of the world. Studies in pharmacy practice have improved in terms of design, with an increase in the number of published RCTs after 2000. However, the small sample size of RCTs is still an issue. After 2000, a significantly higher proportion of studies were conducted in community pharmacy, targeting specific medical conditions, and with a higher number of patients randomized to the intervention group. Conversely, a significantly smaller proportion of studies were conducted in the hospital and targeted a single recipient after 2000. Studies conducted in the US had significantly more intervention arms, focused mostly on a specific medical condition, and were performed in primary care. Different health care systems' organization and policies may influence clinical pharmacy services research across countries.


Assuntos
Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Projetos de Pesquisa/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Tamanho da Amostra
14.
Einstein (Sao Paulo) ; 14(3): 384-390, 2016.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27759828

RESUMO

Objective:: To implement a clinical pharmacy service focused on the comprehensive review of antineoplastic drugs used in therapy of hematological diseases. Methods:: An interventional study was conducted in a Brazilian tertiary teaching hospital in two different periods, with and without a clinical pharmacy service, respectively. This service consisted of an antineoplastic prescription validation (analysis of patients' characteristics, laboratory tests, compliance with the therapeutic protocol and with pharmacotechnical parameters). When problems were detected, the pharmacist intervened with the physician or another health professional responsible for the patient. Inpatients and outpatients with hematological diseases were included. Results:: We found an increased detection of drug-related problem by 106.5% after implementing the service. Comparing the two periods, an increase in patients' age (26.7 years versus 17.6 years), a predominance of outpatients (54% versus 38%), and an increase in multiple myeloma (13% versus 4%) and non-Hodgkin lymphoma (16% versus 3%) was noted. The most commonly found problems were related to dose (33% versus 25%) and cycle day (14% versus 30%). With regard to clinical impact, the majority had a significant impact (71% versus 58%), and in one patient from the second period could have been fatal. The main pharmaceutical interventions were dose adjustment (35% versus 25%) and drug withdrawal (33% versus 40%). Conclusion:: The pharmacy service contributed to increase the detection and resolution of drug-related problems, and it was an effective method to promote the safe and rational use of antineoplastic drugs. Objetivo:: Implementar um serviço farmacêutico clínico centrado na revisão completa dos antineoplásicos utilizados no tratamento de doenças hematológicas. Métodos:: Estudo intervencional conduzido em um hospital universitário terciário brasileiro em dois períodos distintos, com base na ausência e na presença do serviço farmacêutico clínico, respectivamente. O referido serviço consistiu na validação farmacêutica de prescrição de medicamentos antineoplásicos (análise de características do paciente, exames laboratoriais, conformidade com o protocolo terapêutico e parâmetros farmacotécnicos). Após a detecção dos problemas, o farmacêutico interveio junto ao médico ou outro profissional de saúde responsável pelo paciente. Foram incluídos pacientes internados e ambulatoriais com doenças hematológicas. Resultados:: Observou-se um aumento de 106,5% na detecção de problemas relacionados com medicamentos após a implementação do serviço. Comparando-se os dois períodos, verificou-se aumento na idade dos pacientes (26,7 anos versus 17,6 anos), predomínio de pacientes ambulatoriais (54% versus 38%) e aumento de mieloma múltiplo (13% versus 4%) e linfoma não Hodgkin (16% versus 3%). Os problemas mais comumente encontrados foram relacionados à dose (33% versus 25%) e ao dia do ciclo (14% versus 30%). Quanto ao impacto clínico, a maioria apresentou impacto significante (71% versus 58%) e um poderia ter sido fatal no segundo período. As principais intervenções farmacêuticas realizadas foram ajuste de dose (35% versus 25%) e suspensão de medicamento (33% versus 40%). Conclusão:: O serviço farmacêutico contribuiu para o aumento da detecção e resolução de problemas relacionados com medicamentos, tratando-se de um método efetivo para promover o uso seguro e racional de medicamentos antineoplásicos.


Assuntos
Antineoplásicos/administração & dosagem , Prescrições de Medicamentos/normas , Neoplasias Hematológicas/tratamento farmacológico , Serviço de Farmácia Hospitalar/organização & administração , Adolescente , Adulto , Antineoplásicos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Masculino , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Adulto Jovem
15.
Einstein (Säo Paulo) ; 14(3): 384-390, July-Sept. 2016. tab, graf
Artigo em Inglês | LILACS-Express | ID: lil-796973

RESUMO

ABSTRACT Objective: To implement a clinical pharmacy service focused on the comprehensive review of antineoplastic drugs used in therapy of hematological diseases. Methods: An interventional study was conducted in a Brazilian tertiary teaching hospital in two different periods, with and without a clinical pharmacy service, respectively. This service consisted of an antineoplastic prescription validation (analysis of patients' characteristics, laboratory tests, compliance with the therapeutic protocol and with pharmacotechnical parameters). When problems were detected, the pharmacist intervened with the physician or another health professional responsible for the patient. Inpatients and outpatients with hematological diseases were included. Results: We found an increased detection of drug-related problem by 106.5% after implementing the service. Comparing the two periods, an increase in patients' age (26.7 years versus 17.6 years), a predominance of outpatients (54% versus 38%), and an increase in multiple myeloma (13% versus 4%) and non-Hodgkin lymphoma (16% versus 3%) was noted. The most commonly found problems were related to dose (33% versus 25%) and cycle day (14% versus 30%). With regard to clinical impact, the majority had a significant impact (71% versus 58%), and in one patient from the second period could have been fatal. The main pharmaceutical interventions were dose adjustment (35% versus 25%) and drug withdrawal (33% versus 40%). Conclusion: The pharmacy service contributed to increase the detection and resolution of drug-related problems, and it was an effective method to promote the safe and rational use of antineoplastic drugs.


RESUMO Objetivo: Implementar um serviço farmacêutico clínico centrado na revisão completa dos antineoplásicos utilizados no tratamento de doenças hematológicas. Métodos: Estudo intervencional conduzido em um hospital universitário terciário brasileiro em dois períodos distintos, com base na ausência e na presença do serviço farmacêutico clínico, respectivamente. O referido serviço consistiu na validação farmacêutica de prescrição de medicamentos antineoplásicos (análise de características do paciente, exames laboratoriais, conformidade com o protocolo terapêutico e parâmetros farmacotécnicos). Após a detecção dos problemas, o farmacêutico interveio junto ao médico ou outro profissional de saúde responsável pelo paciente. Foram incluídos pacientes internados e ambulatoriais com doenças hematológicas. Resultados: Observou-se um aumento de 106,5% na detecção de problemas relacionados com medicamentos após a implementação do serviço. Comparando-se os dois períodos, verificou-se aumento na idade dos pacientes (26,7 anos versus 17,6 anos), predomínio de pacientes ambulatoriais (54% versus 38%) e aumento de mieloma múltiplo (13% versus 4%) e linfoma não Hodgkin (16% versus 3%). Os problemas mais comumente encontrados foram relacionados à dose (33% versus 25%) e ao dia do ciclo (14% versus 30%). Quanto ao impacto clínico, a maioria apresentou impacto significante (71% versus 58%) e um poderia ter sido fatal no segundo período. As principais intervenções farmacêuticas realizadas foram ajuste de dose (35% versus 25%) e suspensão de medicamento (33% versus 40%). Conclusão: O serviço farmacêutico contribuiu para o aumento da detecção e resolução de problemas relacionados com medicamentos, tratando-se de um método efetivo para promover o uso seguro e racional de medicamentos antineoplásicos.

16.
J Manag Care Spec Pharm ; 22(6): 699-713, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27231797

RESUMO

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide and has a substantial impact on people's health and quality of life. CVD also causes an increased use of health care resources and services, representing a significant proportion of health care expenditure. Integrating evidence-based community pharmacy services is seen as an asset to reduce the burden of CVD on individuals and the health care system. OBJECTIVES: To (a) identify community pharmacy evidence-based services designed to help prevent CVD and (b) provide fundamental information that is needed to assess their potential adaptation to other community pharmacy settings. METHODS: This review used the DEPICT database, which includes 488 randomized controlled trials (RCT) that address the evaluation of pharmacy services. Articles reviewing these RCTs were identified for the DEPICT database through a systematic search of the following databases: MEDLINE, Scopus, SciELO (Scientific Electronic Library Online), and DOAJ (Directory of Open Access Journals). The DEPICT database was reviewed to identify evidence-based services delivered in the community pharmacy setting with the purpose of preventing CVD. An evidence-based service was defined as a service that has been shown to have a positive effect (compared with usual care) in a high-quality RCT. From each evidence-based service, fundamental information was retrieved to facilitate adaptation to other community pharmacy settings. RESULTS: From the DEPICT database, 14 evidence-based community pharmacy services that addressed the prevention of CVD were identified. All services, except 1, targeted populations with a mean age above 60 years. Pharmacy services encompassed a wide range of practical applications or techniques that can be classified into 3 groups: activities directed at patients, activities directed at health care professionals, and assessments to gather patient-related information in order to support the previous activities. CONCLUSIONS: This review provides pharmacy service planners and policymakers with a comprehensive list of evidence-based services that have the potential to be adapted to different settings from which they were originally implemented and evaluated in order to reduce the burden of CVD. DISCLOSURES: Funding for this review was provided by the University of Technology Sydney Chancellor's Postdoctoral Fellowship awarded to Sabater-Hernández. No other potential conflict of interest was declared. Study concept and design were contributed by Sabater-Hernández, Fernandez-Llimos, Rotta, and Correr. Sabater-Galindo and Sabater-Hernández took the lead in data collection, along with Franco-Trigo and Rotta. Data interpretation was performed by Sabater-Hernández, Durks, and Lopes. The manuscript was written primarily by Sabater-Hernández, along with Hossain, and revised by Fernandez-Llimos, Rotta, and Benrimoj, with assistance from Durks, Sabater-Galindo, Franco-Trigo, and Correr.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Serviços Comunitários de Farmácia , Prática Clínica Baseada em Evidências/métodos , Farmacêuticos , Papel Profissional , Doenças Cardiovasculares/epidemiologia , Bases de Dados Factuais , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
17.
Eur Respir J ; 47(4): 1134-43, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26677937

RESUMO

The objective of this systematic review was to evaluate the impact of pharmacists' interventions on clinical asthma outcomes on adult patients and to identify the outcome indicators used.PubMed, Scopus, Web of Science and Scielo were searched. Studies addressing pharmacists' interventions on adult asthma patients reporting clinical asthma outcomes were incorporated.11 clinical outcomes were identified in 21 studies. 10 studies measured the impact of the intervention on asthma control. Randomised controlled trials (RCT) and non-RCTs found positive results in percentages of controlled patients and Asthma Control Questionnaire (ACQ) scores. Discordant results were found for Asthma Control Test results. Asthma severity was assessed in four studies. One RCT found a significant decrease in the percentage of severe patients; two non-RCTs found significant improvements in severity scores. 11 studies reported pulmonary function indicators, showing inconsistent results. Eight studies measured asthma symptoms; three RCTs and four non-RCTs showed significant improvements.RCTs and non-RCTs generated similar results for most outcomes. Based on the evidence generated by RCTs, pharmacists' have a positive impact on the percentage of controlled patients, ACQ scores, severity and symptoms. Future research should report using the core outcome set of indicators established for asthma (PROSPERO CRD42014007019).


Assuntos
Asma/tratamento farmacológico , Farmacêuticos , Adulto , Bases de Dados Factuais , Humanos , Adesão à Medicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Testes de Função Respiratória , Inquéritos e Questionários , Resultado do Tratamento
18.
Artigo em Português | LILACS | ID: lil-758419

RESUMO

Este estudo avaliou a morbimortalidade relacionada a medicamentos no Brasil, sua prevalência, grupos farmacológicos e fatores de risco, Foi realizada uma revisão sistemática de estudos observacionais publicados até agosto de 2012, sem restrição de data de início, nas bases de dados Medline, Lilacs, Scielo, Embase, IPA, Science Direct, Scopus e Web of Science, Foram selecionados estudos nacionais avaliando a ocorrência de qualquer tipo de dano ocasionado por medicamento, Foram incluídos 45 estudos, A maior prevalência de evento adverso a medicamento foi observada em hospitais, em adultos e idosos, variando de 15,6% a 34,1%, Nas creches, 19,9% das crianças sofreram alguma reação adversa, Em serviços de emergência, 25% dos adultos ou idosos sofreram dano relacionado à falha terapêutica, Medicamentos atuantes no sistema nervoso central foi o principal grupo farmacológico envolvido, Os principais fatores de risco foram idade, presença de comorbidades e uso de > 5 medicamentos, Os resultados encontrados são alarmantes e demonstram a necessidade da avaliação e estratificação de risco populacional, ações preventivas e de intervenção precoce que possam reduzir o impacto da morbimortalidade relacionada a medicamentos no Brasil...


This study evaluated the drug-related morbidity and mortality in Brazil, its prevalence, the pharmacological groups and risk factors associated. We performed a systematic review of observational studies published up to August 2012, without restriction start date, in the databases Medline, Lilacs, SciELO, EMBASE, IPA, Science Direct, Scopus and Web of Science. Were selected national studies evaluating the occurrence of any damage caused by medications. We included 45 studies. The highest prevalence of adverse drug events was observed in hospitals for adults and elderly, ranging from 15.6% to 34.1%. In nurseries, 19.9% of the children suffered some adverse drug reaction. In emergency departments, 25% of adults and elderly suffered harm related to therapeutic failure. Medications acting on the central nervous system were the main pharmacological group involved. The main risk factors were age, comorbidities and use of more than 5 medications. The results are alarming and demonstrate the need for screening and medication risk stratification in the population, and preventive or early interventions that can reduce the impact of drug-related morbidity and mortality in Brazil...


Assuntos
Uso de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Brasil
19.
Int J Clin Pharm ; 37(5): 687-97, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26001356

RESUMO

BACKGROUND: Multiple reviews have evaluated the impact of pharmacist-delivered patient care on health-related outcomes. However, it is unclear which of the pharmacist-delivered interventions in these services are the most effective. Aim of the review To gather the evidence of the impact of clinical pharmacy services on the medication use process or on patient outcomes using an overview of systematic reviews. METHODS: PubMed was searched to retrieve systematic reviews published between 2000 and 2010 that assessed the impact of clinical pharmacy services on the medication use process or patient outcomes. Two independent reviewers evaluated the study eligibility and one extracted the description and results of the services. The methodological quality of each review was assessed with the R-AMSTAR tool. RESULTS: Of the 343 potentially relevant records identified, 49 systematic reviews, comprising a total of 269 randomized controlled trials, met the selection criteria. Clinical pharmacy services that focused on specific medical conditions, such as hypertension or diabetes mellitus, revealed a positive impact of pharmacists' interventions on patient outcomes. For other medical conditions, however, the results were inconclusive (e.g., dyslipidemia or thromboprophylaxis). Interventions that targeted medication adherence and assessed the impact of clinical pharmacy services in prescription appropriateness also produced inconclusive results because of the variability of methods used to assess both medication adherence and medication appropriateness. CONCLUSIONS: Systematic reviews that assessed clinical pharmacy services targeting specific conditions were more conclusive given that the intervention was well defined, and the measured outcomes were unequivocal and tangible. Conversely, the results were inconclusive for interventions with a broader target and with monitoring parameters that were unclearly established or inconsistently assessed across studies. These findings emphasize the need to better define clinical pharmacy services and standardize methods that assess the impact of these services on patient health outcomes.


Assuntos
Avaliação do Impacto na Saúde/estatística & dados numéricos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Resultado do Tratamento , Gerenciamento Clínico , Prescrições de Medicamentos/estatística & dados numéricos , Humanos , Adesão à Medicação/estatística & dados numéricos
20.
J Eval Clin Pract ; 21(4): 584-90, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25676042

RESUMO

RATIONALE, AIMS AND OBJECTIVES: DEPICT (Descriptive Elements of Pharmacist Intervention Characterization Tool) was created in response to the frequently reported issue of poor intervention description across studies assessing the impact of clinical pharmacy activities. The aim of this study was to create an improved version of DEPICT (i.e. DEPICT 2) to better characterize clinical pharmacy services in order to ensure consistent reporting, therefore enhancing reproducibility of interventions in practice. METHOD: A qualitative approach through a thematic content analysis was performed to identify components of pharmacist interventions described in 269 randomized controlled trials. A preliminary version of DEPICT 2 was applied independently by two authors to a random sample of 85 of the 269 RCTs and reliability determined by the prevalence-adjusted bias-adjusted kappa (PABAK) or the intraclass correlation coefficient (ICC). The final version of DEPICT 2 was compared against DEPICT 1. RESULTS: The final version of DEPICT 2 comprised 146 items and 11 domains. The inter-rater agreement analysis showed that DEPICT presented good to optimal reproducibility, with a mean PABAK value of 0.87 (95% CI 0.85-0.89) and a mean ICC value of 0.88 (95% CI 0.62-1.14). The mean difference between items checked in the two versions (DEPICT 2 - DEPICT 1) was 10.58 (95% CI 9.55-11.61), meaning that approximately 11 more components were identified in the new version of DEPICT. CONCLUSIONS: DEPICT 2 is a reliable tool to characterize components of clinical pharmacy services, which should be used to ensure consistent reporting of interventions to allow their reproducibility in practice.


Assuntos
Intervenção Médica Precoce/normas , Serviço de Farmácia Hospitalar/normas , Relatório de Pesquisa , Prática Clínica Baseada em Evidências , Pesquisa sobre Serviços de Saúde , Humanos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes
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