Can pharmaceutical care decrease the oxidative stress in type 2 diabetes mellitus?

Type 2 diabetes mellitus (T2D) is a chronic metabolic disorder characterized by an increase in oxidative stress, which is itself related to development of T2D's main chronic complications. Oxidative stress caused by elevated production of reactive species of oxygen and decrease of antioxidant defense system level, leads to activation of lipid peroxidation (LPO) and oxidative lipoprotein modification with increasing atherogenicity. Therefore, the aim of this study was to evaluate whether pharmacotherapeutic follow-up in patients with T2D, users and non-users of insulin, interferes with the levels of oxidative stress, measuring lipid peroxidation and protein oxidation, nitric oxide and superoxide dismutase levels. After the follow-up, there was a decrease in nitric oxide levels and an increase in superoxide dismutase concentration for the group with insulin therapy. Accordingly, these results show that the proposed pharmaceutical care program reduced the oxidative stress levels, mainly in patients in insulin therapy, as a consequence, can impact in the surging of the main chronic complications in T2D.

Implementación del Proceso Estandarizado de Evaluación Farmacoterapéutica en pacientes hospitalizados y ambulatorios / Implementation of the standardized process of Pharmacotherapeutic evaluation in inpatients and outpatients

Objetivos el seguimiento farmacoterapéutico (SFT) realizado por el farmacéutico clínico puede enmarcarse dentro de 3 actividades: la identificación, la resolución y la prevención de eventos adversos a medicamentos. Estas deben ajustarse a los requerimientos y los recursos de cada institución, generando la necesidad de desarrollar procedimientos que aumenten la eficiencia del SFT y garanticen la seguridad del paciente. Los farmacéuticos clínicos de la Red de Salud UC-CHRISTUS Chile desarrollamos un Proceso Estandarizado de Evaluación Farmacoterapéutica (PEEF). El objetivo principal del estudio fue evaluar el impacto de esta herramienta en términos del número de evaluaciones e intervenciones de los farmacéuticos clínicos y secundariamente determinar el ahorro de costos potenciales y directos asociados a las intervenciones en la Unidad de Cuidados Intensivos (UCI). Método estudio cuasi-experimental que evaluó la frecuencia y tipo de evaluaciones e intervenciones realizadas por los farmacéuticos clínicos en unidades de pacientes adultos de la Red UC-CHRISTUS, previo y posterior a la utilización del PEEF. La distribución de variables se evaluó mediante el test Shapiro–Wilk, la asociación entre el uso del PEEF y el número de evaluaciones e intervenciones fue realizada mediante el test Chi cuadrado. La evaluación de costos asociados a las intervenciones del farmacéutico clínico en UCI se realizó utilizando la metodología propuesta por Hammond et al.10. Resultados el total de pacientes evaluados pre- y pos-PEEF fue de 1.781 y 2.129, respectivamente. Las evaluaciones e intervenciones en el periodo pre-PEEF fueron 5.209 y 2.246, en el periodo pos-PEEF fueron 6.105 y 2.641, respectivamente. El aumento de las evaluaciones como de las intervenciones fue significativo solo en las unidades de mayor complejidad. La reducción potencial de costos estimados en el periodo pos-PEEF en UCI fue de 492.805 dólares americanos. ... (AU)

Objectives The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU). Methods A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro–Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. Results A total number of 1,781 patients was evaluated before and 2,129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5,209 and 2,246. In the after-SPEP period were 6,105 and 2,641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805.... (AU)

Negative Outcomes Associated with Medication in Neonates on Parenteral Nutrition Therapy.

OBJECTIVE: In Ecuador, studies on clinical daily practice problems focused on parenteral nutrition in neonates are scarce. Therefore, this research aimed to identify negative results associated with medications (NRAM) in neonates with parenteral nutrition (PN) in a third-level hospital in Ecuador. MATERIAL AND METHODS: An observational, prospective, descriptive study was designed in the neonatology area of a tertiary-level public hospital, where, for over four months, the medical records, PN prescriptions, and pharmacy-managed databases of 78 patients were analyzed. Drug-related problems (DRPs) as possible causes of NRAM were classified through administrative, physicochemical, and clinical validation. RESULTS: DRPs classified as follows were found: 78.81% by physicochemical, 17.62% by clinical, and 3.57% by administrative validation. The NRAM were 72% quantitatively uncertain, 16% needed, and 11% quantitatively ineffective. CONCLUSION: The NRAM associated with DRPs were statistically related to prematurity condition, APGAR score, PN time, and the number of medications administered, which suggests the need to create a nutritional therapy committee at the health facility.

Problemas relacionados con los medicamentos en pacientes de Santiago de Cuba hospitalizados / Drug related problems in inpatients of Santiago de Cuba

Introducción: Los problemas relacionados con los medicamentos constituyen una gran preocupación sanitaria por su elevado impacto en la morbilidad de pacientes hospitalizados.Método: Estudio observacional, descriptivo y transversal en los servicios clínicos de cinco instituciones de salud de Santiago de Cuba, durante el primer trimestre de 2020. Se revisaron los perfiles de 329 pacientes que recibieron seguimiento farmacoterapéutico. La muestra fue caracterizada según variables biosociales, clínicas y farmacoterapéuticas, la identificación de los problemas relacionados a la medicación fue realizada utilizando los criterios de Cipolle, Stramd y Morley, determinándose además los medicamentos implicados en los problemas relacionados a la medicación. Los datos fueron procesados a través de frecuencias absolutas y relativas representadas por medio de tablas y figuras.Resultados: Predominaron los pacientes mayores o iguales de 60 años representando un 38,6 %; respecto al género un 61,4 % perteneció al femenino. La mayoría de los pacientes presentaron hasta dos enfermedades (76,3 %), las infecciones respiratorias complicadas (35,6 %) fueron el motivo de ingreso más frecuente. El 36,5 % consumió entre cuatro y seis medicamentos, siendo los antibacterianos de usos sistémicos los más prescritos. Se identificaron 598 Problemas Relacionados con los Medicamentos para una proporción de 1,8 PRM/paciente, de estos un 42,8 % corresponde a los problemas de Seguridad, un 31,1 % de Indicación, seguido de 24,9 % de Efectividad y finalmente el 1,2 % de Adherencia.Conclusiones: Los antimicrobianos resultaron los más implicados en la aparición de los problemas relacionados a la medicación. La atención farmacéutica ofrece servicios que garantizan el uso adecuado de los medicamentos. (AU)

Introduction: Drug-related problems are a major health concern because of their high impact on inpatient morbidity. Method: Descriptive and cross-sectional observational, study in the clinical services of five health institutions of Santiago de Cuba, during the first quarter of 2020. The profiles of 329 patients who received pharmacotherapeutic follow-up were reviewed. The sample was characterized according to biosocials, clinical and pharmacotherapeutic variables, the identification of medication-related problems was performed using the criteria of Cipolle, Stramd and Morley, also determining the drugs involved in medication-related problems. The data were processed through absolute and relative frequencies represented by means of tables and figures. Results: Patients over or equal to 60 years of age predominated, representing 38.6 %; 61.4 % of the patients were female. Most of the patients had up to two diseases (76.3 %); complicated respiratory infections (35.6 %) were the most frequent reason for admission. Between four and six medications were consumed by 36.5 %, with antibacterials for systemic use being the most prescribed. A total of 598 drug-related problems were identified for a ratio of 1.8 DRP/patient, of which 42.8 % corresponded to safety problems, 31.1 % to indication, followed by 24.9 % to effectiveness and finally 1.2 % to adherence. Conclusions: Antimicrobials were the most implicated in the occurrence of medication-related problems. Pharmaceutical care offers services that ensure the appropriate use of medications. (AU)

Implementation of the standardized process of Pharmacotherapeutic evaluation in inpatients and outpatients. / Implementación del Proceso Estandarizado de Evaluación Farmacoterapéutica en pacientes hospitalizados y ambulatorios.

OBJECTIVES: The Pharmacotherapeutic follow-up program (PFU) carried out by the clinical pharmacist can be categorized within 3 fundamental activities; identification, resolution and prevention of adverse drug events. These must be adjusted to the requirements and resources of each institution, developing procedures to increase PFU efficiency and to guarantee patient safety. The clinical pharmacists of UC-CHRISTUS Healthcare Network developed a Standardized Pharmacotherapeutic Evaluation Process (SPEP). The main goal of our study is to evaluate the impact of this tool through the pharmacist evaluation number and pharmacist interventions number. Secondarily to determine the potential and direct cost savings associated with the pharmacist interventions in an Intensive care unit (ICU). METHODS: A quasi-experimental study evaluated the frequency and type of pharmacist evaluation and pharmacist interventions performed by clinical pharmacists in adult patients units of UC-CHRISTUS Healthcare Network, before and after the implementation of SPEP. The distribution of variables was evaluated using the Shapiro-Wilk test and the association between the use of SPEP and the pharmacist evaluation and pharmacist interventions number was performed using the Chi-square test. The cost evaluation associated with pharmacist interventions in the ICU was carried out using methodology proposed by Hammond et al. RESULTS: A total number of 1,781 patients was evaluated before and 2,129 after the SPEP. The pharmacist evaluation and pharmacist interventions number in the before-SPEP period were 5,209 and 2,246. In the after-SPEP period were 6,105 and 2,641, respectively. The increase in both the pharmacist evaluation and pharmacist interventions number was significant only in critical care patients. The potential cost saving in after-SPEP period in the ICU was USD 492,805. Major adverse drug events prevention was the intervention that generated the most savings with a reduction of 60.2%. The total direct savings for sequential therapy was USD 8,072 in the study period. CONCLUSIONS: This study shows a clinical pharmacist developed tool called SPEP that increased the pharmacist evaluation and pharmacist interventions number in multiple clinical scenarios. These were significant only in critical care patients. Future investigations should make effort to evaluate the quality and clinical impact of these interventions.

Resultados de Servicio de Indicación Farmacéutica y Servicio de Seguimiento Farmacoterapéutico en Farmacia Comunitaria como herramienta de optimización de la farmacoterapia en paciente polimedicado con tos persistente / Results of Minor Ailment Service and Pharmacotherapeutic Follow-up Service in Community Pharmacy as an optimization tool of the pharmacotherapy on a polymedicated patient with persistent cough

Se brindó Servicio de Indicación Farmacéutica y Seguimiento Farmacoterapéutico (SFT) a una mujer de 61 años, exfumadora, diagnosticada de hipertensión y cáncer de mama, que presentaba tos persistente. Tomaba 4 medicamentos.Tras revisión de la farmacoterapia y análisis de narrativas extraídas de entrevistas en profundidad, se determinó la presencia de tos como Problema Relacionado con Medicamentos (PRM) derivado del uso de un IECA (Inhibidor de la Enzima Conver-tidora de Angiotensina). Se realizaron derivaciones al Médico de Atención Primaria (MAP) proponiendo sustitución farmacológica por ARAII (Antagonista de Receptor de Angiotensina II), que fueron declina-das por no existir similitud de criterio clínico.Durante este periodo la paciente acudió a médi-cos privados, probando diferentes tratamientos farmacológicos, así como a sesiones de medicina tradicional (acupuntura) sin obtener mejoría.Tras un año de SFT, se logra aceptación de la pro-puesta del farmacéutico por el MAP, lo cual derivó en una resolución del PRM, un proceso de desme-dicalización y una mejora en salud que permitió a la paciente retomar sus actividades cotidianas. (AU)

Minor Ailment Service and Pharmacotherapeutic Follow-up (PFU) was provided to a 61-year-old woman, ex-smoker, diagnosed with hypertension and breast cancer, who presented persistent cough. She was taking 4 medications.After the review of the pharmacotherapy and analy-sis of narratives extracted from in-depth interviews, the presence of cough was determined as a Drug Related Problem (DRP) derived from the use of an ACEI (Angiotensin-converting enzyme inhibitors). Referrals to the Primary Care Physician (PCP) were made, proposing pharmacological substitution for ARBs Angiotensin II receptor blocker), which were declined because there was no similarity in clinical criteria.During this period, the patient went to private doc-tors, trying different pharmacological treatments, as well as traditional medicine sessions (acupunc-ture) without obtaining improvement.After a year of PFU, acceptance of the pharmacist's proposal was achieved by the PCP, which led to a resolution of the DRP, a deprescription process and an improvement in health that allowed the patient to resume her daily activities. (AU)

Evaluación clínica y económica de las intervenciones farmacéuticas en un hospital de comunidad / Clinical and economic evaluation of pharmaceutical interventions in a community hospital

Objetivo: Cuantificar, evaluar e interpretar las intervenciones farmacéuticas realizadas por el equipo de farmacia clínica, desde un punto de vista clínico y económico, en las áreas de internación clínico-quirúrgica y crítica de adultos y en el área pediátrica de un hospital de comunidad.Método: Estudio retrospectivo, observacional y transversal de 6 meses de duración. Se clasificaron las intervenciones farmacéuticas según su problema relacionado con medicamentos y su relevancia clínica como potencialmente letal, seria, significativa y no significativa. También, se determinó el exceso de estancia potencialmente prevenido por la intervención. Considerando toda esta arista clínica, se estimó el costo unificado potencialmente evitado, en el período de estudio, para determinar el impacto económico. Se realizó un análisis de subgrupos para poder comparar el impacto clínico y económico correspondiente a cada sector del hospital.Resultados: Se analizaron 2.442 intervenciones farmacéuticas que corresponden a un total de 1.156 pacientes. Las intervenciones más frecuentes fueron las relacionadas con las dosis indicadas. Según severidad, la mayoría de las intervenciones se clasificaron como significativas, habiendo evitado, en promedio, 2,67 días de exceso de estancia. La aceptación fue del 95%. Se calculó un costo unificado potencialmente evitado superior a los 13 millones de pesos argentinos durante el período de estudio.Conclusiones: Se observó un impacto clínico y económico favorable de las intervenciones, tanto a nivel global como en las subpoblaciones de pacientes de cada sector considerado. (AU)

Objective: To quantify, evaluate and interpret the pharmaceutical interventions carried out by the clinical pharmacy team from a clinical and economic perspective in areas of clinical-segurical and critical care for adults and in the pediatric area of a community hospital.Methods: Retrospective, observational and cross-sectional study lasting 6 months. Pharmaceutical interventions were classified according to their problems related to drugs and their clinical relevance as potentially lethal, serious, significant and non-significant. The excess in stay potentially prevented by the intervention was also determined. Considering all this clinical edge, we estimated the unified cost potentially avoided, in the study period, to determine the economic impact. A subgroup analysis was performed to compare the clinical and economic impact corresponding to each section considered.Results: 2,442 pharmaceutical interventions were analyzed corresponding to a total of 1,156 patients. The most frequent interventions were those related to the indicated doses. According to severity, most of interventions were classified as significant, having avoided, on average, 2.67% of excess in stay. Acceptance was 95%. An unified potentially avoided cost of over 13 million Argentine pesos was calculated during the study period.Conclusions: A favorable clinical and economic impact related to the interventions was observed, both globally and in the subpopulations of patients in each section. (AU)

Desarrollo de una herramienta estructurada y un sistema de puntuación para detectar pacientes clínicos con alta necesidad de seguimiento farmacoterapéutico exhaustivo: presentación inicial / Development of a structured tool and scoring system to detect clinical patients with a high need for exhaustive pharmacotherapeutic follow-up: initial presentation

Objetivos: Analizar y validar los resultados obtenidos con una herramienta para la selección de pacientes clínicos con alta necesidad de seguimiento farmacoterapéutico exhaustivo. Presentar y evaluar un sistema de puntuación en base a factores predisponentes.Métodos: Estudio prospectivo, transversal, observacional y monocéntrico. Se analizaron y validaron los resultados de la herramienta de selección, a partir de los datos extraídos de la historia clínica de ingreso del paciente. Se recabaron datos demográficos y se calculó el porcentaje de selección de la herramienta, el tiempo de estancia, los reingresos y la muerte de los pacientes incluidos. Se construyó un sistema de puntuación a partir del odds ratio de las variables sexo, edad y tipo de ingreso al hospital.Resultados: La herramienta dividió en partes iguales a los pacientes con alta y baja necesidad de seguimiento farmacoterapéutico exhaustivo. Se observó que la edad de los pacientes en el primer grupo, así como también su estancia, cantidad de reingresos y eventos de muerte, era significativamente mayor en comparación con el grupo de baja necesidad. La edad avanzada, el sexo masculino y el ingreso de tipo clínico serían factores predisponentes, en la muestra de estudio, para la alta necesidad de seguimiento farmacoterapéutico.Conclusiones: La herramienta propuesta demostró poseer potencial clínico y operativo para ser implementada. Se construyó un sistema de puntuación teniendo en cuenta el peso de las variables sexo masculino, edad avanzada e ingreso de tipo clínico, el cual mostró resultados similares a los de la herramienta. (AU)

Objetives: Analyze and validate the results obtained with a tool for the selection of clinical patients with a high need for exhaustive pharmacotherapeutic follow-up. Present and evaluate a scoring system based on predisposing factors.Methods: Prospective, cross-sectional, observational and monocentric study. The results of the tool were analyzed and validated, based on the data extracted from the patient’s admission medical history. Demographic data were collected and the percentage of tool selection, length of stay, readmissions, and death of the included patients were calculated. A scoring system was constructed based on the adds ratio of the variables sex, age and type of hospital admission.Results: The tool divides patients with high and low need for exhaustive pharmacotherapeutic follow-up equally. It was observed that the age of patients in the first group, as well as their stay, number of readmissions, and death events, were significantly higher compared to the low need group. Advanced age, male sex, and clinical admission would be predisposing factors, in the study sample, for exhaustive pharmacotherapeutic follow-up.Conclusions: The proposed tool proved to have clinical and operational potential to be implemented. A scoring system was built with the corresponding weights for the variables male sex, advanced age and clinical admission, which showed results similar to the tool ones. (AU)

Desarrollo de una guía de seguimiento farmacoterapéutico de pacientes pediátricos con enfermedad renal crónica / Pharmacotherapeutic follow-up guide for pediatric patients with chronic kidney disease

Introducción: A nivel latinoamericano, existen estudios sobre el desarrollo e implementación de programas de atención farmacéutica en pacientes pediátricos con resultados positivos en los pacientes y sus cuidadores. Sin embargo, en el caso de Costa Rica, solamente hay reportados estudios en hospitales que atienden población adulta.Objetivo: Desarrollar una guía de seguimiento farmacoterapéutico (SFT) para pacientes pediátricos con enfermedad renal crónica (ERC), atendidos en el Hospital Nacional de Niños Dr. Carlos Sáenz Herrera (HNN), para mejorar la adherencia a la terapia y el uso adecuado de la medicación.Métodos: Se realizó una búsqueda bibliográfica sobre la enfermedad y sobre diferentes programas de atención farmacéutica para elaborar la guía de atención farmacéutica y SFT. Por último, se elaboraron y validaron materiales educativos dirigidos a los cuidadores y niños atendidos en el servicio de nefrología.Resultados: Se desarrolló y validó una guía de SFT. Esta incluyó las siguientes secciones: recopilación de datos demográficos, desarrollo de la consulta, fase de estudio y registro. Se adaptó un instrumento de medición de adherencia para ser usado en la población pediátrica. Se desarrollaron y validaron cuatro materiales educativos.Conclusiones: El protocolo y recursos informativos planteados fueron considerados, por los farmacéuticos del Hospital Nacional de Niños, herramientas de utilidad y aplicabilidad para brindar una atención integral a pacientes del servicio de Nefrología y promover la adherencia terapéutica de los pacientes. (AU)

Introduction: In Latin America, there is a wide body of information on the development and implementation of pharmaceutical care programes for children, with positive results for the patients and their parents. However, there are no such reports for Costa Rica. Aim: To develop a pharmaceutical follow-up protocolo for pediatric patients with chronic renal disease, who attend the Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, in order to enhance adherence to therapy.Results: We developed and validated a pharmaceutical follow-up protocol. This protocol included three sections: demographic data collection, pharmacotherapeutic, clinical and adherence history review, study phase and reg-istry. We adapted an adherence instrument to be used on pediatric patients and developed four different types of educational material. Conclusions: The pharmacists considered the protocol and educational materials to be useful for the pharmaco-therapeutic follow-up service, to promote adherence in pediatric patients. (AU)

Pharmaceutical Care in Sports.

Pharmaceutical care in sports is a new field of work to clinical pharmacists, focused on promoting pharmacotherapeutic follow up and clinical services to athletes, physical activity practitioners and enthusiasts of any sports modality. A broad range of pharmaceuticals, dietary supplements and herbal drugs have been used historically as performance promoters, doping or ergogenic aids. In this context, the role of pharmacists in prevent adverse events, drug interactions or any drug related problems, as doping issues, was described. Its actions can be important to contribute with a multi professional clinical health team, leading athletes to use these resources in a rational way, promoting and optimizing the therapeutic when its necessary.

Estudio de prescripción-indicación en pacientes con antimicrobianos de amplio espectro en medicina interna de un hospital del Ecuador / Pharmacotherapeutic Follow-up in Patients with Broad-spectrum Antimicrobial in Internal Medicine of a Hospital in Ecuador / Estudo de prescrição-indicação em pacientes com antimicrobianos de amplo espectro em medicina interna de um hospital do Equador

Resumen Introducción: desde hace varios años existe preocupación por el incremento específico en el consumo de antimicrobianos por los problemas que estos generan. Por tal motivo se decidió diseñar un programa de atención farmacéutica en pacientes hospitalizados en servicios abiertos para evitar el desarrollo de problemas relacionados con medicamentos asociados con antimicrobianos. Materiales y métodos: se realizó un estudio retrospectivo de utilización de medicamentos, del tipo prescripción-indicación en una muestra de estudio de 25 pacientes que recibieron antimicrobianos de amplio espectro en el área de medicina interna del hospital José María Velasco Ibarra desde abril hasta julio del 2016. Resultados: el 76 % de los pacientes fueron mujeres. La patología más frecuente que requirió la utilización de antimicrobianos fue la infección de vías urinarias complicada (48 %): el 24 % de los pacientes recibió más de un antibiótico de amplio espectro y el más utilizado fue el imipenem/cilastatina (34.4 %), seguido de la piperacilina/tazobactam y el cefepime, ambas con un 28.1 % y la vancomicina (9.4 %). El 48 % de las prescripciones fueron inadecuadas, se detectó la presencia de PRM en el 84 % de los pacientes. Conclusión: el diseño de un programa de atención farmacéutica en pacientes hospitalizados garantiza la identificación, prevención y/o solución de los problemas relacionados con medicamentos, su uso adecuado y la calidad de la atención.

Abstract Introduction: For several years there has been concern about the specific increase in the consumption of antimicrobials due to the problems they generate. For this reason it was decided design a pharmaceutical care program for hospitalized patients in open services to avoid the development of problems related to antimicrobial-associated drugs. Materials and methods: A retrospective study was conducted on the use of medications, of the prescription-indication type in a study sample of 25 patients who received broad-spectrum antimicrobials in the internal medicine area of the José María Velasco Ibarra Hospital from April to July. 2016. Results: 76 % of the patients were women; The most frequent pathology that required the use of antimicrobials was complicated urinary tract infection (48 %>); 24 % of patients received more than one broad spectrum antibiotic and the most widely used was imipenem/cilastatin (34.4 %), followed by piperacillin / tazobactam and cefepime, both with 28.1 % and vancomycin (9.4 %); 48 % of the prescriptions were inadequate, the presence of PRM was detected in 84 % of the patients. Conclusion: The design of a pharmaceutical care program in hospitalized patients guarantees the identification, prevention and / or solution of the problems related to medicines, their proper use and the quality of care.

Resumo Introdução: desde há vários anos existe preocupação pelo incremento específico no consumo de antimicrobianos pelos problemas que estes geram. Por tal motivo decidiu-se desenhar um programa de atenção farmacêutica em pacientes hospitalizados em serviços abertos para evitar o desenvolvimento de problemas relacionados com medicamentos associados a antimicrobianos. Materiais e métodos: realizou-se um estudo retrospectivo de utilização de medicamentos, do tipo prescrição-indicação em uma amostra de estudo de 25 pacientes que receberam antimicrobianos de amplo espectro na área de medicina interna do Hospital José María Velasco Ibarra desde abril até julho de 2016. Resultados: o 76 % dos pacientes foram mulheres; a patologia mais frequente que requereu a utilização de antimicrobianos foi a infeção de vias urinárias complicada (48 %); o 24 % dos pacientes recebeu mais de um antibiótico de amplo espectro e o mais utilizado foi o imipeném/cilastatina (34.4 %), seguido da piperacilina/tazobactam e o cefepima, ambas as duas com um 28.1 % e a vancomicina (9.4 %>); o 48 % das prescrições foram inadequadas, detectou-se a presença de PRM no 84 % dos pacientes. Conclusão: o desenho de um programa de atenção farmacêutica em pacientes hospitalizados garante a identificação, prevenção e/ou solução dos problemas relacionados com medicamentos, o uso adequado dos mesmos, e a qualidade da atenção.

Evaluation of the impact of pharmaceutical care for tuberculosis patients in a Secondary Referral Outpatient Clinic, Minas Gerais, Brazil

ABSTRACT Pharmaceutical care is a professional practice seeking the responsible provision of drug therapy by identifying, resolving, and preventing Drug-Related Problems (DRP). The study aims to describe and evaluate the impact of pharmaceutical care given to patients being treated for tuberculosis (TB). Study concurrent, longitudinal, prospective conducted during pharmaceutical care in the TB outpatient clinic, Clinical Hospital, Federal University of Minas Gerais during the period August 2009 to July 2012. The Pharmacotherapy Workup proposed by Cipolle et al. (2004) was used. Statistical analyses were performed by X2 or Fisher exact test, as appropriate. A total of 62 patients were followed up, and 128 drug-related problems (DRP) were identified: 69.5% related to safety, 13.3% to effectiveness, 12.5% ​​to indication, and 4.7% to treatment adherence, and 62.1% of the DRP were resolved. A total of 115 pharmaceutical interventions were performed. The impact of pharmaceutical care was satisfactory for 73.9% of patients with a resolution rate of 77%. There was a greater impact on pharmaceutical care (index ≥ 0.50) for those patients who were not smokers (p <0.05). The impact of pharmaceutical care was important, so the pharmacist should work alongside the multidisciplinary team to monitor treatment and perform interventions.

Implementación y evaluación de un servicio de atención farmacéutica en la unidad de cuidados paliativos y alivio del dolor en el Hospital Clínico Félix Bulnes Cerda / Implementation and evaluation of a pharmaceutical care in palliative care and pain relief unit at Hospital Félix Bulnes Cerda

INTRODUCCIÓN: la atención farmacéutica se define como la provisión responsable e individualizada del tratamiento farmacológico, con el propósito de mejorar la calidad de vida del paciente, lo que se puede lograr mediante la correcta utilización de los medicamentos, realizando un seguimiento farmacoterapéutico para prevenir o resolver problemas relacionados con medicamentos (PRM). se ha comprobado que la inclusión del químico farmacéutico dentro de los programas de cuidados paliativos y alivio del dolor han mejorado los resultados obtenidos con la farmacoterapia y la calidad de vida de los pacientes. OBJETIVOS: Implementar y evaluar un servicio de atención farmacéutica para pacientes de la uidad de cuidados paliativos y alivio del dolor en el Hospital Clínico Félix Bulnes Cerda. MATERIALES Y MÉTODOS: se realizó en 3 etapas: la primera de forma retrospectiva, se revisaron recetas de mayo a julio de 2015, provenientes de la unidad para obtener un estado situacional. en una segunda etapa se implementó el servicio de atención farmacéutica, basado en el método DADER. en una tercera etapa, se tipificaron las intervenciones totales realizadas y se evaluó tanto la adherencia al tratamiento como la satisfacción del servicio ofrecido a los pacientes y/o cuidadores. RESULTADOS: etapa I de 500 recetas se seleccionaron 244, detectando 165 (67,5%) con posibles PRMs, los cuales se resolvieron en un 35% con 58 intervenciones al equipo médico.etapa II se enrolaron 39 pacientes a quienes se les realizaron entrevistas sucesivas, se detectaron 53 PRMs, los que se resolvieron con 39 intervenciones.finalmente, se evaluó el servicio ofrecido: se tipificaron 111 intervenciones (84 a médico y 27 a paciente), se evaluó adherencia terapéutica mediante test SMAQ, mejorando en un 61,5% entre la evaluación inicial y una posterior (a los 3 meses) y la satisfacción usuaria del servicio con una encuesta obteniendo un 100% de satisfacción.CONCLUSIÓN: la complejidad del dolor y los tratamientos actuales para aliviarlo representan un gran desafío en los actuales equipos de cuidados paliativos. la integración y participación activa del Farmacéutico clínico en el proceso clínico-asistencial permitió garantizar la calidad y seguridad tanto del proceso de dispensación, interviniendo en la selección de la fármaco terapia de acuerdo a parámetros farmacocinéticos y farmacodinámicos que apunten a la optimización e individualización de la terapia; como además interviniendo al paciente o cuidador, entregando herramientas que logren un uso racional de los medicamento. como resultado de esto, se mejoró la adherencia al tratamiento, se entregó información sobre su correcta administración y también se realizó seguimiento farmacoterapéutico, que permitió prevenir problemas relacionados con los medicamentos (PRM). estos resultados mostraron un alto grado de aceptación, tanto por parte del equipo médico como del paciente, avalando la importancia del farmacéutico.

INTRODUCTION: the pharmaceutical care is defined as responsible pharmacological treatment in order to improve the life quality of a patient. may be achieved using the right drug, and monitoring the side effect to prevent problem with the medical prescription. It has been proved that pharmacist inclusion in the therapy improve the health and welfare of these patients.OBJECTIVES: carry out and evaluate a pharmaceutical care in patient that need to be relieved at Félix Bulnes Hospital.method and equipment: it was realize in three steps, in the first one the prescriptions were audited in a retrospective way from march to july in the year 2015 in this unit to evaluate this period.In the second step: a pharmacological attention service using DADER method in the third step: OBJECTIVES AND METHOD were evaluated and tipified .the treatment progress and the patient satisfaction were also evaluated. RESULTS: from 500 prescription in the step one 244 were selected finding on 165 (67.5%) possibles PRMs .from that number (500) only 35% were solved with the help of medical auditory.In the second step, 39 patient were selected and interviewed finding 53 PRMs, these were solved with 39 interventions. finally, the service were evaluated: 111 intervention were tipified (84 to medical attention and 27 to the patient), therapeutical adherence were evaluated using SMAQ test improving 61,5 comparing the inicial evaluation with a posterior one (three month later). the satisfaction in the attention service using a survey were 100%. CONCLUSION: the pain and nowadays treatments complexity to relieve it are such a big challenge for current palliative care teams. the active integration and participation of clinical pharmacist in the clinical assistance process guarantees quality and security, not only on the dispensation process by intervening the pharmacotherapy selection according to pharmacokinetic and pharmacodynamic parameters that work on optimization and individualization therapy, but also by intervening the patient and assistant, by giving them necessary tools to get a rational drug use. as a result, the adherence to treatment was improved, information about the correct drug use was given and there was also a pharmacotherapy tracing that allowed to avoid any problems related to the drugs themselves. these results showed a higher acceptance degree either for patiens and professionals.

Seguimiento farmacoterapéutico de pacientes chilenos con infección por VIH/SIDA hospitalizados en un centro de alta complejidad durante un período de un año / Pharmacotherapy follow-up of Chilean inpatients with HIV/AIDS in a high complexity hospital during one year

Background: Pharmaceutical follow-up consists on the detection, prevention, and resolution of drug-related problems (DRP) in a continuous, systematized, and documented way. DRP is a health problem connected to pharmacotherapy, which can interfere with the expected health outcomes in the patient. Aim: To make a pharmacotherapeutic surveillance in HIV/AIDS inpatients attended at "Hospital San Juan de Dios" throughout a year prospective study (January to December 2012). Results: 88.6% (93/105) of patients were in stage AIDS with a median of CD4+ lymphocytes of 29 cells/mm³ and a viral load of 107,000 RNA copies/mL. The 16.2% were admitted to a intensive care unit ICU. 296 DRP (DRP 2.8 per patient) were detected, 72% of DRP (n; 213) were associated with treatment safety, 94 were adverse reactions, 19 required dose adjustments, and 6 interactions had a negative clinical impact; 23.3% (n: 69) experimented the necessity to add or remove a drug and 4.7% (n: 14) presented problems associated with effectiveness. A statistically significant relation was observed when associating the number of DRP with admittance to the ICU and the use of more than six drugs. Conclusion: The results allow the conclusion that inpatients present drug-related problems mainly related to toxicity, becoming risk factors for the development of them admittance to ICU, and concomitant use of more than 6 drugs.

Introducción: El seguimiento farmacoterapéutico, consiste en la detección, prevención y resolución de los problemas relacionados con los medicamentos (PRM), en forma continua, sistematizada y documentada. Un PRM es un problema de salud vinculado con la farmacoterapia, que interfiere o puede interferir con los resultados de salud esperados en el paciente. Objetivo y Métodos: Realizar un seguimiento farmacoterapéutico a pacientes hospitalizados con infección por VIH/SIDA del Hospital San Juan de Dios, a través de un estudio prospectivo de un año (enero a diciembre 2012). Resultados: El 88,6% (93/105) de los pacientes se encontraba en etapa SIDA, con una mediana de linfocitos TCD4+ de 29 céls/mm³ y una carga viral de 107.000 copias ARN/mL. El 16,2% de los pacientes ingresó a una unidad de paciente crítico. Se detectaron 296 PRM (2,8 PRM por paciente); el 72% de los PRM (n: 213) estuvieron asociados a seguridad del tratamiento, objetivándose 94 reacciones adversas, 19 eventos con necesidad de ajustes de dosis y seis interacciones con repercusión clínica negativa; 23,3% (n: 69) a la necesidad de incorporar o eliminar algún fármaco y 4,7 % (n: 14) a problemas asociados a efectividad. Se observó una relación estadísticamente significativa al asociar el N° de PRM con la unidad de pacientes críticos y uso de más de seis fármacos. Conclusión: Los resultados permiten concluir que los pacientes hospitalizados presentan problemas relacionados al uso de medicamentos, principalmente asociado a toxicidad, encontrándose como factores de riesgo para el desarrollo de éstos la permanencia en una unidad de paciente crítico y el uso concomitante de más de seis fármacos.

Pharmacotherapeutic Follow-up and Pharmacogenetics of CYP2C9 and CYP3A4 in Antihypertensive Therapy: A Pilot Study in a Community Pharmacy.

No pharmacogenetic studies have yet been conducted in community pharmacies, despite pharmacogenetics being an emerging discipline. Pharmacotherapeutic follow-up (PFU) was performed for 6 months in 37 patients receiving antihypertensive treatment, and they were genotyped for variant alleles *2 and *3 in the CYP2C9 gene and *1B in CYP3A4. Systolic blood pressure, cardiovascular risk, and adherence improved with PFU. Most of the interactions between drugs were represented by concurrent administration of statins and calcium channel blockers, which both use CYP3A4 for their metabolism. Heterozygotic patients for the CYP2C9*2 allele showed higher mean heart rate values after PFU than homozygous patients (73.4 ± 10.0 pulse/min vs 66.2 ± 10.6 pulse/min, respectively; P = .048). Carriers of CYP2C9*2 showed a tendency to less frequent negative outcomes associated with medication due to inefficacy than homozygous patients (50% vs 78.9%, respectively; P = .072). Pharmacogenetics and PFU can be used in community pharmacies to carry out a more exhaustive study of medication in hypertensive outpatients.

Propuesta de adaptación de la hoja de historia farmacoterapéutica del método Dáder para aprendices / Proposal of adaptation of the sheet of pharmaceutical history of Dáder method for learners

Introducción: en 2008, Freitas & Marques propusieron una hoja de historia farmacoterapéutica: el Dáder modificado. Objetivo: evaluar la aplicabilidad del Dáder modificado comparándolo con el Dáder. Métodos: las hojas de historia farmacoterapéutica fueron aplicadas a usuarios crónicos de medicamentos por estudiantes de Farmacia. Al final de la aplicación, los entrevistadores atribuyeron notas de 0 a 5 para varios aspectos de su aplicabilidad. También se evaluaron si los datos recogidos estaban completos. Resultados: las dos hojas de historia farmacoterapéutica se mostraron equivalentes, pues no hubo diferencia significativa para las tres preguntas acerca de la aplicabilidad. Conclusiones: En el contexto de la Atención Farmacéutica, la existencia de una nueva hoja de historia farmacoterapéutica ofrece la posibilidad de elegir la que mejor se adapte a las necesidades del farmacéutico.

Introduction: Freitas & Marques proposed a sheet of pharmacotherapeutical history (SPH) in 2008: the Dáder adaptation (DA). Objective: this study was aimed at evaluating the applicability of DA compared with Dáder. Methods: the sheets of pharmacotherapeutical history (SPH) were applied to chronic users of drugs by pharmacy students. At the end, interviewers attributed scores ranged from 0 to 5 points to various aspects of their applicability. The completeness or not of the collected data was also evaluated. Results: the two SPH were equivalent, because there was no statistically significant difference for the three questions about the applicability. Conclusions: In the context of pharmaceutical care, this new sheet of pharmacotherapeutical history offers possibilities to choose the one that best fits the needs of the pharmacist.

Quality of life of HIV+ patients undergoing pharmacotherapeutic follow-up

The influence of pharmacotherapeutic follow-up (PTF) on quality of life was evaluated in 45 HIV+ patients, who were undergoing initial antiretroviral therapy at a specialized care center in northeast Brazil. PTF lasted nine months and quality of life was analyzed at the 1st and 9th meetings using a questionnaire validated for Brazil. The study identified 643 problems related to antiretrovirals and there were 590 pharmaceutical interventions during the PTF. The comparative analysis between the results of the 1st and the 9th meeting was statistically significant for all domains of the questionnaire. For asymptomatic patients, only one domain was statistically significant. For symptomatic patients, six domains were significant. Patients with one year of HIV/AIDS diagnosis had statistically significant differences in five domains. The results suggest that the PTF contributed to improving quality of life, particularly for symptomatic patients and those diagnosed for at least one year - important target groups for Pharmaceutical Treatment.

A influência do seguimento farmacoterapêutico (SFT) sobre a qualidade de vida foi avaliada em 45 pacientes HIV+ assistidos em serviço de atendimento especializado do nordeste brasileiro. O SFT teve duração de 9 meses e a qualidade de vida foi analisada no 1º e 9º encontros através de questionário validado no País. Identificaram-se 643 problemas relacionados aos antirretrovirais e realizaram-se 590 intervenções farmacêuticas durante o SFT. A análise comparativa entre os resultados de qualidade de vida do 1º e 9º encontro foi estatisticamente significativa em todos os domínios do questionário. Quando analisados somente os pacientes assintomáticos, apenas um domínio apresentou significância estatística. Entre os sintomáticos, seis domínios foram significativos. Pacientes com até um ano de diagnóstico de HIV/AIDS apresentaram validade estatística em cinco domínios. Os resultados sugerem que o SFT contribuiu para a melhoria da qualidade de vida dos pacientes, sobretudo dos sintomáticos e/ou com até um ano de diagnóstico, representando grupos-alvo para a prática da Atenção Farmacêutica.

Acompanhamento farmacoterapêutico de pacientes hipertensos usuários da farmácia popular: avaliação das intervenções farmacêuticas / Pharmacotherapeutic follow-up service to hypertensive patients who attend the popular pharmacy: review of pharmaceutical interventions

O objetivo deste trabalho foi fornecer o serviço de Atenção Farmacêutica e acompanhamento farmacoterapêutico a hipertensos usuários da Farmácia Popular de Alfenas-MG, avaliando seu impacto no controle da pressão arterial. Este trabalho foi desenvolvido com pacientes de ambos os sexos com faixa etária entre 40 ? 70 anos ou mais, usuários da Farmácia Popular de Alfenas-MG. Foram selecionados a esmo 27 pacientes que foram alocados em grupo controle (GC) (n= 12) e teste (GT) (n=15). O método de Acompanhamento Farmacoterapêutico utilizado foi o Programa Dáder. Os pacientes do grupo controle tiveram sua pressão arterial aferida periodicamente, mas sem receber as intervenções farmacêuticas. O grupo teste recebeu o acompanhamento farmacoterapêutico por 12 meses. Os dados foram analisados quanto à distribuição normal (Shapiro Wilk) e uma vez confirmada a normalidade, foi realizado o teste ?t? de Student para avaliar a significância dos dados obtidos. No início a média das pressões do grupo controle era 143,3 mmHg (sistólica) e 75,83 mmHg (diastólica) reduzindo para 137,5 mmHg (p=0,0945) e 75,83 mmHg (p=0,5) ao final do estudo. A média das pressões do GT ao final do acompanhamento teve uma redução de 19 mmHg (sistólica) (p<0,0001) e 12,67 mmHg (diastólica) (p<0,0001). A redução da pressão sistólica do GT foi maior que a do GC (p=0,0244).

The purpose of this study was to provide the service of Pharmaceutical Care and pharmacotherapeutic follow-up to hypertensive patients who attend the Popular Pharmacy of the city of Alfenas, in Minas Gerais- Brazil, through the assessment of its impact on arterial pressure control. The present study was conducted with patients of both sexes aged between 40 and 70 years and above, who attend at the Popular Pharmacy of Alfenas, Minas Gerais. So it was selected 27 patients and they were allocated to control groups (CG) (n= 12) and test groups (TG) (n=15). The pharmacotherapeutic follow-up used was the Dáder Program. The patients in the control group had their arterial pressure periodically measured but they did not receive pharmaceutical care. The test group received pharmacotherapeutic follow-up for 12 months. The data were analyzed as to normal distribution (Shapiro Wilk) and when its normality was confirmed, it was performed the test ?t? of Student to assess the significance of the obtained data. In the beginning, the average arterial pressure of patients in the control group was 143.3 mmHg (systolic) and 75.83 mmHg, which was reduced to 137.5 mmHg (p=0.0945) and 75.83 mmHg (p=0.5) at the end of the study. The average arterial pressure of patients in the test group (TG) at the end of follow-up was reduced in 19 mmHg (systolic) (p<0.0001) and 12.67 mmHg (diastolic) (p<0.0001). The reduction in the systolic pressure of the TG was higher than that of the CG (p=0.0244).

A influência do acompanhamento farmacoterapêutico na adesão à terapia anti-hipertensiva e no grau de satisfação do paciente / Influence of pharmacotherapeutic follow-up on patient compliance and satisfaction with antihypertensive therapy

O objetivo desta pesquisa foi proporcionar o serviço de Acompanhamento Farmacoterapêutico (AFT) a pacientes hipertensos usuários da Farmácia Popular de Alfenas (MG), além de avaliar a adesão do usuário aos medicamentos antes e após o AFT e o grau de satisfação com o serviço prestado. O trabalho foi realizado com 27 pacientes de ambos os sexos e com faixa etária entre 40 e 70 anos ou mais. Os pacientes foram divididos em grupo controle e teste, ambos responderam ao questionário de adesão no início do estudo e, ao final, apenas os pacientes do grupo teste o fizeram. Os pacientes do grupo teste receberam Acompanhamento Farmacoterapêutico durante dez meses (2008) e, ao final desse período, responderam o questionário de satisfação pelo serviço. Um dos motivos mais importantes para a não adesão foi o esquecimento de administrar o medicamento (67% para ambos os grupos). Outros fatores, como a falta de informação sobre a doença e a não compreensão sobre como utilizar os medicamentos, foram sanados com a intervenção farmacêutica. Dos pacientes participantes desta pesquisa, 80% achavam importante o trabalho conjunto do farmacêutico com o médico e 100% disseram que continuariam a utilizar o serviço prestado e o indicariam a amigos e parentes. Os dados sugerem que as intervenções farmacêuticas foram efetivas no sentido de aumentar a adesão no grupo que recebeu AFt e que os pacientes ficaram satisfeitos com o serviço prestado.

This research was designed to provide a Pharmacotherapeutic Follow-up (PF) service to hypertensive patients who attend the Popular Pharmacy in Alfenas (Minas Gerais, Brazil) and to assess user adherence to medication before and after the PF and the degree of satisfaction with the service rendered. This study was carried out with 27 patients of both sexes, aged 40 years and above. The patients were divided into two groups, control and test; all patients answered the adherence questionnaire at the beginning of the study and, at the end, only those in the test group. The patients in the test group received PF for ten months (2008) and, at the end of this period, they were asked to complete a questionnaire regarding their satisfaction with the service. One of the commonest reasons given for non-adherence to medication was forgetfulness (67% for both groups). Other problems, such as lack of information on the disease and poor understanding of how to take the medicines, were solved by pharmaceutical intervention. According to 80% of the patients involved, this teamwork between pharmacist and physician is important, and 100% reported they would continue to use the service and would recommend it to friends and relatives. The data suggest that pharmaceutical interventions were effective in improving adherence to medication among patients in the group that received PF and that the patients were satisfied with the service given.

Avaliação econômica do seguimento farmacoterapêutico em pacientes com diabetes melito tipo 2 em farmácias comunitárias / Economic evaluation of pharmacotherapeutic follow-up in type 2 diabetic mellitus patients in community pharmacies

OBJETIVO: Avaliar os resultados econômicos do seguimento farmacoterapêutico (SFT) em pacientes com diabetes melito tipo 2 em farmácias comunitárias privadas do sistema suplementar de Saúde. MÉTODOS: Foi realizado estudo clínico prospectivo com 161 pacientes separados em dois grupos, dos quais somente um recebeu SFT durante 12 meses. A partir dos resultados, foram calculados os dados de efetividade e os custos. O desfecho primário foi a avaliação econômica do SFT por meio da utilização de um indicador de efetividade (variação de hemoglobina glicada), relacionada aos custos do atendimento farmacêutico. Os desfechos secundários foram os valores de pressão arterial, circunferência abdominal e índice de massa corporal dos pacientes, que foram utilizados e relacionados a custos do atendimento do farmacêutico. RESULTADOS: Foi observada uma redução adicional de 1,3 por cento da HbA1 no grupo que recebeu SFT em comparação ao grupo controle. Os custos anuais por paciente do grupo SFT relacionados à redução de 1 por cento nos valores da HbA1 foram de R$ 78,83. Para melhoria no controle dos pacientes diabéticos tipo 2, esse recurso pode ser implementado com o investimento anual médio de R$ 456,05 por paciente, utilizando SFT e monitorização com testes de glicemia. CONCLUSÕES: É possível obter redução da HbA1 para níveis desejados por meio da utilização do SFT. Este pode ser considerado um recurso adicional para o alcance do controle metabólico, resultando, nesse estudo, em um custo de R$ 76,00 paciente/ano, para redução de 1 por cento nos valores da HbA1.

OBJECTIVE: Assess economics results of Pharmacotherapeutic Follow-up (PF) in patients with diabetes mellitus type 2 in community pharmacies from additional Health system. METHODS: In a prospective clinic study, 161 patients were divided into two groups, of which only one group received PF for 12 months. From the results, we calculated data of effectiveness and costs. The primary endpoint was the economic evaluation PF by using an indicator of effectiveness (changes in glycated hemoglobin), which was related to the costs of pharmaceutical care. Secondary endpoints were values of blood pressure, waist circumference and body mass index of patients, also related to costs of pharmaceutical care. RESULTS: A real reduction of 1.3 percent of HbA1 was observed in the PF group, in comparison to control group. The annual cost of the reduction in 1 percent in HbA1 values in the PF group patients was $45.15. This feature to improve the control of type 2 diabetic patients can be implemented with annual investments of about $225.76 per patient, using PF and monitoring of blood glucose test. CONCLUSIONS: It is possible to reduce the HbA1 values to desired levels by using PF. This can be considered an additional resource for the attainment of metabolic control, resulting in this study a cost of $37.62 per patient, per year, to reduce 1 percent in the HbA1 values.