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Res Social Adm Pharm ; 13(1): 201-208, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-26846907


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.

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
Int J Clin Pharm ; 38(6): 1362-1366, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27817171


Background Adherence to prescribed drug therapy is associated with lower rates of cardiovascular causes of death. In view of the relevance for public health, it is important to understand the relation between medication adherence tools' scores, especially in low literacy patients discharged from a cardiology ward. Objectives We aimed to assess: (a) the association between number of controlled clinical conditions and adherence tools scores, and (b) the correlation between the scores of three instruments to assess adherence. Methods We conducted a prospective study and included patients discharged from a specialized cardiovascular ward in Brazil. The results of the Beliefs about Medicines questionnaire (BMQ), the Adherence to Refills and Medication Scale (ARMS) and the MedTake test were compared. Results Of 53 included patients, most of them were elderly, and did not complete primary school. On average, there were six health conditions per patient, where two of them were not controlled. ARMS was the only tool that was associated with number of controlled health conditions (r = -0.312, p < 0.05). Moreover, ARMS (average score 15.6 ± 3.4) had significant correlation with MEDTAKE (r = 0.535, p < 0.01) and BMQ (r = 0.38, p < 0.01). BMQ and MEDTAKE were also positively correlated (r = 0.311, p < 0.05). Conclusions Clinically, higher ARMS scores (>12) suggest assumed non-adherence. It is also negatively correlated with the number of controlled clinical conditions in low literacy elderlies with cardiovascular diseases.

Serviço Hospitalar de Cardiologia , Doenças Cardiovasculares/tratamento farmacológico , Alfabetização em Saúde , Adesão à Medicação , Alta do Paciente , Idoso , Brasil/epidemiologia , Serviço Hospitalar de Cardiologia/tendências , Doenças Cardiovasculares/epidemiologia , Feminino , Alfabetização em Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/tendências , Estudos Prospectivos
BioDrugs ; 28(2): 211-28, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24190520


OBJECTIVES: The objectives of this study were to evaluate the efficacy, safety, and tolerability of biologic drugs compared with placebo for systemic lupus erythematosus (SLE) treatment. METHODS: A systematic review evaluating the efficacy and safety of biologic therapies compared with placebo in adult SLE patients treatment was performed. Data from studies performed before September 2013 were collected from several databases (MEDLINE, Cochrane Library, SCIELO, Scopus, and International Pharmaceutical Abstracts). Study eligibility criteria included randomized, double-blind, placebo-controlled trials; regarding treatment with biologic agents in SLE adult patients; and published in English, German, Portuguese, and Spanish. Extracted data were statistically analyzed in a meta-analysis using the Review Manager (RevMan) 5.1 software. Efficacy outcomes included the SELENA-SLEDAI (Safety of Estrogens in Lupus Erythematosus National Assessment version of the SLE Disease Activity Index) score, the SRI (Systemic Lupus Erythematosus Responder Index), normalization of low C3 (<90 mg/dL), anti-double-stranded DNA positive to negative, and no new BILAG (British Isles Lupus Assessment Group index) 1A or 2B flares. Data on safety profile included adverse events, serious and severe adverse events, death, malignancy, infections, and infusion reactions. We also evaluated withdrawals from treatment due to lack of efficacy or adverse events. RESULTS: Thirteen randomized placebo-controlled trials met the criteria for data extraction for systematic review. A meta-analysis regarding the efficacy and safety of belimumab compared with placebo involving four of these trials was undertaken and the remainder contributed to a meta-analysis of the safety of biologic agents. In addition, two trials allowed the performance of a meta-analysis regarding the efficacy and safety of rituximab compared with placebo. Belimumab was more effective than placebo in most evaluated outcomes. No significant differences in the safety and tolerability data were observed between the belimumab and placebo groups. No differences were observed between the rituximab and placebo groups for the efficacy outcomes or safety parameters. Extracted data from the 13 studies were pooled, allowing assessment of the safety of biologic drugs. The meta-analysis revealed a satisfactory safety profile of these agents when used for SLE treatment, as there were no significant differences between the two evaluated groups (biologic agents and placebo) for all outcomes analyzed. CONCLUSION: Belimumab exhibited a satisfactory profile regarding efficacy, safety, and tolerability. Rituximab showed no superiority over placebo in terms of efficacy, despite its suitable safety profile. Biologic agents exhibited a good safety profile for SLE treatment, indicating that these agents are promising therapies and should be further investigated.

Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais Murinos/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Adulto , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Murinos/efeitos adversos , Humanos , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/uso terapêutico , Lúpus Eritematoso Sistêmico/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Rituximab
Braz. j. pharm. sci ; 47(4): 787-795, Oct.-Dec. 2011. graf, tab
Artigo em Inglês | LILACS | ID: lil-618072


In the treatment of mental disorders, nonadherence to medication, the main cause of psychiatric morbidity, is observed in about 50 percent of the cases and is responsible for numerous losses. This study evaluated adherence to drug treatment by patients seen in a Psychosocial Care Center (CAPS) in northeastern Brazil. Adherence to treatment was evaluated using the Haynes-Sackett and Morisky-Green-Levine tests. All patients registered in the CAPS were included in the study (n= 101). Only 11.88 percent of the patients adhered to drug treatment. The main reasons not to use medication were: oblivion (68.83 percent), feeling unwell after taking the medication (54.22 percent), not having money to buy the medication (43.83 percent), not finding the medication in the public health service (39.94 percent) and fear of harm that might be caused by the drug (28.90 percent). Furthermore, 85.1 percent of the patients did not know their diseases, 88.1 percent did not know their treatment, 86.4 percent did not feel good when they took their medication, and 88.1 percent took their medication incorrectly. The results revealed that the lack of information about diseases and drugs used, the nuisance posed by drug therapy and the low access to medications reduce adherence to treatment and, consequently, treatment effectiveness.

No tratamento de desordens mentais, a não-adesão ao tratamento ocorre em cerca de 50 por cento dos casos e é responsável por inúmeros prejuízos, além de ser a principal causa de morbidade psiquiátrica. O presente estudo objetivou avaliar a adesão ao tratamento medicamentoso de pacientes atendidos em um Centro de Atenção Psicossocial (CAPS) no Nordeste do Brasil. A avaliação da adesão ao tratamento foi feita através dos testes de Haynes-Sackett e Morisky-Green-Levine. Todos os pacientes cadastrados no CAPS foram incluídos no estudo (n = 101). Observou-se que apenas 11,88 por cento dos pacientes aderiram ao tratamento medicamentoso. As principais razões para o não uso dos medicamentos foram: esquecimento (68,83 por cento), sentir-se mal após a ingestão de medicamentos (54,22 por cento), não ter dinheiro para comprar medicamentos (43,83 por cento), não encontrar os medicamentos no serviço público de saúde (39,94 por cento) e medo dos danos causados pelos medicamentos (28,90 por cento). Além disso, observou-se que 85,1 por cento dos pacientes não conheciam suas doenças, 88,1 por cento não conheciam seus tratamentos, 86,4 por cento não se sentiam bem quando usavam medicamentos e 88,1 por cento usavam os medicamentos incorretamente. Os resultados demonstram que a falta de informação sobre doenças e medicamentos, os danos decorrentes da terapia medicamentosa e o baixo acesso aos medicamentos comprometem a adesão ao tratamento e, consequentemente, a eficácia do tratamento.

Humanos , Adesão à Medicação , Serviços de Saúde Mental/classificação , Cooperação do Paciente , Tratamento Farmacológico , Saúde Mental/classificação