Resident pharmacist participation in shared medical appointments in palliative care in São Paulo, Brazil: experience and contributions.

OBJECTIVE: To describe the resident pharmacist's participation in Shared Medical Appointments (SMA) in palliative care. METHODS: The resident pharmacist participated in face-to-face SMA with the attending physician, medical and gerontology students, and a nurse. KEY FINDINGS: The resident pharmacist supported interdisciplinary discussions and performed pharmaceutical interventions. He helped raise awareness about the effective, safe, and convenient use of medicines, helping improve the quality of life of patients and caregivers. CONCLUSIONS: Providing pharmaceutical care to patients in palliative care helped to improve the quality of clinical services offered to these patients, as well as adding value to resident pharmacists' interprofessional practice.

Assessment of the implementation of pharmacist prescribing: Challenges and pathways for ambulatory practice.

BACKGROUND: Prescribing by pharmacists is an increasingly common practice worldwide. In Brazil regulation of this practice began in 2013, and the practice remains unexplored as a research topic. OBJECTIVE: We aimed to explore and gain insights into pharmacist prescribing practices in Brazil and assessing pharmacist's perceptions of their training and preparedness to prescribe medications. METHODS: A cross-sectional survey was conducted between October 2022 and March 2023 via convenience sampling. Data were collected using an online questionnaire covering sociodemographic issues, academic training, prescribing practices, and perceptions regarding the provision of pharmacist prescribing in ambulatory care. Exploratory descriptive analysis and Poisson regression were performed to estimate the associations between pharmacist characteristics and their practices in prescribing medicines. RESULTS: Among the 305 valid responses, 58.7% of the outpatient pharmacists stated that they had not prescribed any medication in the previous three years. Over-the-counter medication prescriptions were most common (42.0%). Only 4.6% of respondents had prescribed prescription-only medicines provided through collaborative agreement, with 2.6% reporting that they had adjusted doses, and 2.3% played a role in prescription renewal. Pharmacists living in Northeast regions tended to be more active prescribers (PR = 1.42; 95%CI 1.03-2.18), whereas those in primary healthcare (PR = 0.61; 95%CI 0.39-0.96) and self-declared Black pharmacists (PR = 0.30; 95%CI 0.10-0.97) prescribed less. Respondents strongly believed in the pharmacist's role as a prescriber, although they remained ambivalent regarding their responsibility for patient outcomes. Progress barriers include infrastructure gaps and strained relationships with physicians. CONCLUSIONS: This study suggests that pharmacists in Brazil predominantly prescribe over-the-counter medications, and variations in setting, region, and race can influence prescribing by pharmacist in ambulatory care.

How to link patients with suspicious COVID-19 to health system from the community pharmacies? A route proposal.

Colombia confirmed its first case of the COVID-19 on March 6th, 2020. On March 16th, 2020, 54 cases have been confirmed (36 imported and 18 associated), therefore, Colombia is at highest alert, and it is now trying to avoid or minimize the last stage of "community transmission". We present a route proposal that shows how the community pharmacist may develop his responsibility to contribute to the early detection and appropriate referral of possible cases of the COVID-19. In the route have been considered three possible entrances depending on the needs of the users: anti-flu drugs, symptoms related to COVID-19 infection or the request for items for hygiene and prevention of transmission such as alcohol and face masks. Later, self-care education should be given, and the possible cases should be reported to the telephone lines designated by the mayor or the governor, continuing the healthcare process. Community pharmacies and pharmacy staff play a crucial role in minimizing the stage of "community transmission" of COVID-19, through properly detection and management of possible cases and customer education.

Changes in workflow to a University Pharmacy to facilitate compounding and distribution of antiseptics for use against COVID-19.

This article is a report from an experience about a work developed by Farmácia Universitária at UFRJ (FU-UFRJ) during the nCov-19 pandemic period. The aim of this work was to describe its contribution in the production of antiseptic supplies used to prevent contagion by the new coronavirus. The work routine at the pharmacy has been changed to allow the implementation of local workflow during the pandemic, and to adapt the protection rules to meet the safety measures. FU-UFRJ started to manipulate two antiseptic formulations: 70% ethyl alcohol and gel alcohol, which are included in the National Form, manufacturing around 100 L of these formulations, weekly, to donate to different health units. The experience enabled the adaptation to emergency health standards, planning and meaningful guidance to pharmacists and technicians to attend clinics at university hospitals, vaccination center and UFRJ city hall, in order to facilitate the access to adequate hand hygiene to the population.

Role of pharmacist during the COVID-19 pandemic: A scoping review.

BACKGROUND: Since the start of the new Coronavirus (COVID-19) outbreak in December 2019, pharmacists worldwide are playing a key role adopting innovative strategies to minimize the adverse impact of the pandemic. OBJECTIVES: To identify and describe core services provided by the pharmacist during the COVID-19 pandemic. METHODS: A literature search was performed in MEDLINE, Embase, Scopus, and LILACS for studies published between December 1st, 2019 and May 20th, 2020 without language restriction. Studies that reported services provided by pharmacists during the COVID-19 pandemic were included. Two independent authors performed study selection and data extraction with a consensus process. The pharmacist's intervention identified in the included studies were described based on key domains in the DEPICT v.2. RESULTS: A total of 1189 records were identified, of which 11 studies fully met the eligibility criteria. Most of them were conducted in the United States of America (n = 4) and China (n = 4). The most common type of publication were letters (n = 4) describing the workplace of the pharmacist in hospitals (n = 8). These findings showed the different roles of pharmacists during the COVID-19 pandemic, such as disease prevention and infection control, adequate storage and drug supply, patient care and support for healthcare professionals. Pharmacists' interventions were mostly conducted for healthcare professionals and patients (n = 7), through one-to-one contact (n = 11), telephone (n = 6) or video conference (n = 5). The pharmacists' main responsibility was to provide drug information for healthcare professionals (n = 7) as well as patient counseling (n = 8). CONCLUSIONS: A reasonable number of studies that described the role of the pharmacists during the COVID-19 pandemic were found. All studies reported actions taken by pharmacists, although without providing a satisfactory description. Thus, future research with more detailed description as well as an evaluation of the impact of pharmacist intervention is needed in order to guide future actions in this and/or other pandemic.

The pharmacist's role in implementation of the ABCDEF bundle into clinical practice.

PURPOSE: To summarize published data regarding implementation of the ABCDEF bundle, a multicomponent process for avoidance of oversedation and prolonged ventilation in intensive care unit (ICU) patients; discuss pertinent literature to support each bundle element; and discuss the role of the pharmacist in coordinating bundle elements and implementation of the ABCDEF bundle into clinical practice. SUMMARY: Neuromuscular weakness and ICU-acquired weakness are common among critically ill patients and associated with significant cost and societal burdens. Recent literature supporting early liberation from mechanical ventilation and early mobilization has demonstrated improved short- and long-term outcomes. With expanded use of pharmacy services in the ICU setting, pharmacists are well positioned to advocate for best care practices in ICUs. A dedicated, interprofessional team is necessary for the implementation of the ABCDEF bundle in inpatient clinical practice settings. As evidenced by a number of studies, successful implementation of the ABCDEF bundle derives from involvement by motivated and highly trained individuals, timely completion of individual patient care tasks, and effective leadership to ensure proper implementation and ongoing support. Factors commonly identified by clinicians as barriers to bundle implementation in clinical practice include patient instability and safety concerns, lack of knowledge, staff concerns, unclear protocol criteria, and lack of interprofessional team care coordination. This narrative review discusses research on bundle elements and recommendations for application by pharmacists in clinical practice. CONCLUSIONS: Despite the benefits associated with implementation of the ABCDEF bundle, evidence suggests that the recommended interventions may not be routinely used within the ICU. The pharmacist provides the expertise and knowledge for adoption of the bundle into everyday clinical practice.

Adverse drug reactions' reporting in a Mexican hospital.

OBJECTIVES: To summarize the procedure for reporting adverse drug reactions (ADRs) in a Mexican hospital, with the purpose of promoting and facilitating the report of ADRs by the heath team. We outline the relevance of pharmacists in performing these activities in Mexican hospitals. METHODS: A pharmacovigilance study was carried out following the establishment of the Pharmacovigilance Unit of a Mexican hospital on January 2014 through March 2019. KEY FINDINGS: There is an undernotification rate of ADRs, since only 137 ADRs were notified in a five-year period, mostly by biopharmaceutical chemists holding bachelor's degrees that were acting as pharmacists. CONCLUSIONS: To improve the safety of medications, it is necessary to improve ADR notifications in Mexico's health system. One important step in this direction is to establish a Pharmacy degree with training for promoting and performing ADR notifications.

Evaluation of the effects of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in Colombia drugstores and drugstores/pharmacies: study protocol of a multicenter, cluster-randomized controlled trial.

BACKGROUND: Health disorders, due to the use of drugs with fiscalized substances, including controlled substances, have become a common problem in Colombia. Multiple reasons can help explain this problem, including self-medication, since access to these drugs may be easier. Also, there is a lack of knowledge that these drugs are safer than illicit drugs. The use of these drugs without a valid medical prescription and follow-up can have negative consequences such as drug abuse, addiction, and overdose, and eventually, have negative health consequences. Pharmacy staff is essential to both assure the correct drug use and minimize prescription errors to help outpatients have better management of their pharmacotherapy. For this reason, it is necessary to increase key competencies like knowledge, skills, and attitudes in the pharmacy staff of ambulatory (outpatients) pharmacies. METHODS: This study is a prospective, cluster-randomized, parallel-group, multicenter trial of drugstores and drugstores/pharmacies (ambulatory pharmacies). The study is designed to determine the effectiveness of a drug with fiscalized substance dispensation, health education, and pharmacovigilance continuing education program in drugstores and drugstores/pharmacies. Pharmacy staff will be randomly selected and assigned to one of the study groups (intervention or control). The intervention group will receive a continuing education program for over 12 months. The control group will receive only general information about the correct use of complex dosage forms. The primary objective is to evaluate the effectiveness of a continuing education program to improve pharmacy staff competencies (knowledge, skills, and attitudes) to improve the ambulatory (outpatient) pharmacy services: dispensation, health education, and pharmacovigilance of drugs with fiscalized substances. The secondary outcomes include (a) processes associated with the management of drugs with fiscalized substances in drugstores and drugstores/pharmacies, including regulation compliance; (b) degree of implementation of ambulatory (outpatient) pharmacy services targeting these drugs in drugstores and drugstores/pharmacies; (c) patient satisfaction with such services; and (d) pharmacy staff satisfaction with the continuing education program. DISCUSSION: This clinical trial will establish whether providing a continuing education program for the adequate utilization of drugs with fiscalized substances improves pharmacy staff competencies regarding these drugs. TRIAL REGISTRATION: ClinicalTrials.gov NCT03388567. Registered on 28 November 2017. First drugstore or drugstore/pharmacy randomized on December 1, 2018. PROTOCOL VERSION: 0017102017MC.

Benefit of Incorporating Clinical Pharmacists in an Adult Intensive Care Unit: A Cost-saving Study.

WHAT IS KNOWN AND OBJECTIVE: A framework to evaluate the impact of clinical pharmacists in intensive care units (ICUs) in Chile has not yet been established. This study evaluates the cost avoidance and cost-benefit ratios of clinical pharmacist interventions in terms of treatment optimization in an adult ICU in southern Chile. METHODS: Clinical pharmacist interventions in a multidisciplinary adult ICU were assessed between January and December 2019. Only interventions suggested by pharmacists and accepted by the healthcare team were included in the analysis. Interventions were classified into six categories, and cost avoidance (in US dollars) was calculated for each category using a systematic validated approach. A cost-benefit ratio for clinical pharmacy services in the adult ICU was also calculated. RESULTS AND DISCUSSION: Over the 12-month period, 505 interventions were performed in 169 patients, of whom 62% were male. Interventions were classified into the following six categories: adverse drug event prevention (18%), which led to $87 882 in savings; resource utilization (ie change in medication route) (10%), which led to $50 525 in savings; individualization of patient care (ie dose adjustment) (36%), which led to $57 089 in savings; prophylaxis (ie initiation of stress ulcer prophylaxis) (<1%), which led to $167 in savings; hands-on care (ie bedside monitoring) (23%), which led to $57 846 in savings; and administrative and supportive tasks (ie patient own medication evaluation) (13%), which led to $9988 in savings. The total cost savings over the year-long period were $263 500, resulting in a cost-benefit ratio of 1:24.2. WHAT IS NEW AND CONCLUSION: The participation of a clinical pharmacist in a multidisciplinary ICU team reduces healthcare expenditures through treatment optimization translated into cost avoidance. This study has corroborated prior evidence that clinical pharmacist involvement in ICUs provides economic value and quality assurance in healthcare settings.

Mapping the characteristics of meta-analyses of pharmacy services: a systematic review.

BACKGROUND: Suboptimal meta-analyses with misleading conclusions are frequently published in the health areas, and they can compromise decision making in clinical practice. AIM OF THE REVIEW: This systematic review aimed to map the characteristics of published meta-analyses of pharmacy services and their association with the study conclusions. METHOD: We searched electronic databases (PubMed, Scopus, and Web of Science) to identify published meta-analyses of pharmacy services up to January 2019. Components of meta-analyses were extracted (i.e. studies' metadata; methods used in the systematic review; description of the statistical model used for the meta-analysis; main results; conflict of interest and funding source). The methodological quality was evaluated using the R-AMSTAR tool. RESULTS: A total of 85 meta-analyses were included, with 2016 as the median publication year. Overall, the methodological quality of meta-analyses of pharmacy services was considered suboptimal. Only one-third of authors registered a protocol; complete search strategy and raw data were provided by 55.3% and 9.4% of studies, respectively. Evidence strength (GRADE) was evaluated in only 19.2% of studies. PRISMA and Cochrane recommendations were stated to be followed in 60% and 27.4% of articles, respectively. Around half of studies performed sensitivity analysis, however, the prediction interval was presented by only one meta-analysis. Studies that favoured the pharmacists' interventions poorly discussed the methodological quality and heterogeneity of primary trials. CONCLUSION: Poor conduction and reporting were observed in meta-analyses of pharmacy services, especially in those that favoured the pharmacist's interventions. Reproducibility and transparency should be rigorously ensured by journal editors and peer-reviewers.

The pharmacist in the Brazilian Primary Health Care: insertion under construction. / O farmacêutico na atenção primária no Brasil: uma inserção em construção.

The objective is to analyze the insertion of the pharmacists work in primary health care in Brazil. The search was performed on BVS, SciELO, Lilacs e Medline databases from 1998 to 2016. From the 157 articles found, excluding the duplicates, theses, dissertations and reviews, after the complete reading the review included 9 articles dealing with the pharmacist's work describing experiences, attributions, potentialities, difficulties and challenges. Results show incipient production and predominance of qualitative studies starting in 2007. The insertion in the team is the central topic of the studies, pointing out the challenges and the difficulties related to the recognition and acceptance of the pharmacists interventions. The potentialities reside in the area of actions directed to the client, the families and the team, as well as in the professional training field as well as in the dissemination of the results of the pharmaceutical actions. The pharmacists' isolation in the primary care prevails, albeit there are perspectives of strengthening the integration in the team that has been stimulated by the recent institutional and regulatory transformations in the national scenario. Beyond the present difficulties and experiences reported, the researchers focus on the potentialities for the professional practice, glancing at the construction of the future.

O objetivo é analisar a inserção do trabalho do farmacêutico na atenção primária no Brasil. Foram realizadas buscas nas bases de dados BVS, SciELO, Lilacs e Medline, no período de 1998 a 2016. Dos 157 artigos encontrados, excluindo-se os duplicados, teses, dissertações e revisões e após leitura integral, foram incluídos 9 que tratavam do trabalho do farmacêutico e que relatavam experiências, atribuições, potencialidades, dificuldades e desafios para a prática profissional. Os resultados apontam produção incipiente e predomínio de estudos qualitativos a partir de 2007. A inserção na equipe, como espaço de qualificação das ações, é tema central dos estudos, que apontam desafios e dificuldades quanto ao reconhecimento e aceitação das intervenções do farmacêutico. As potencialidades estão no âmbito das ações voltadas para o usuário, as famílias e a equipe, assim como na formação profissional e na difusão dos resultados das ações farmacêuticas. Há predomínio do isolamento do farmacêutico na atenção primária, com perspectivas de fortalecimento da sua integração à equipe, que tem sido impulsionada pelas recentes mudanças institucionais e normativas no cenário nacional. Os pesquisadores focam nas potencialidades para a prática profissional, com o olhar para o futuro em construção.

O farmacêutico na atenção primária no Brasil: uma inserção em construção / The pharmacist in the Brazilian Primary Health Care: insertion under construction

Resumo O objetivo é analisar a inserção do trabalho do farmacêutico na atenção primária no Brasil. Foram realizadas buscas nas bases de dados BVS, SciELO, Lilacs e Medline, no período de 1998 a 2016. Dos 157 artigos encontrados, excluindo-se os duplicados, teses, dissertações e revisões e após leitura integral, foram incluídos 9 que tratavam do trabalho do farmacêutico e que relatavam experiências, atribuições, potencialidades, dificuldades e desafios para a prática profissional. Os resultados apontam produção incipiente e predomínio de estudos qualitativos a partir de 2007. A inserção na equipe, como espaço de qualificação das ações, é tema central dos estudos, que apontam desafios e dificuldades quanto ao reconhecimento e aceitação das intervenções do farmacêutico. As potencialidades estão no âmbito das ações voltadas para o usuário, as famílias e a equipe, assim como na formação profissional e na difusão dos resultados das ações farmacêuticas. Há predomínio do isolamento do farmacêutico na atenção primária, com perspectivas de fortalecimento da sua integração à equipe, que tem sido impulsionada pelas recentes mudanças institucionais e normativas no cenário nacional. Os pesquisadores focam nas potencialidades para a prática profissional, com o olhar para o futuro em construção.

Abstract The objective is to analyze the insertion of the pharmacists work in primary health care in Brazil. The search was performed on BVS, SciELO, Lilacs e Medline databases from 1998 to 2016. From the 157 articles found, excluding the duplicates, theses, dissertations and reviews, after the complete reading the review included 9 articles dealing with the pharmacist's work describing experiences, attributions, potentialities, difficulties and challenges. Results show incipient production and predominance of qualitative studies starting in 2007. The insertion in the team is the central topic of the studies, pointing out the challenges and the difficulties related to the recognition and acceptance of the pharmacists interventions. The potentialities reside in the area of actions directed to the client, the families and the team, as well as in the professional training field as well as in the dissemination of the results of the pharmaceutical actions. The pharmacists' isolation in the primary care prevails, albeit there are perspectives of strengthening the integration in the team that has been stimulated by the recent institutional and regulatory transformations in the national scenario. Beyond the present difficulties and experiences reported, the researchers focus on the potentialities for the professional practice, glancing at the construction of the future.

Current interventions to promote safe and appropriate pain management.

PURPOSE: Describe patient-, clinician-, system-, and community-level interventions for pain management developed and employed by 9 healthcare systems across the United States and report on lessons learned from the implementation of these interventions. SUMMARY: The high cost associated with pain coupled with the frequent use of opioid analgesics as primary treatment options has made novel pain management strategies a necessity. Interventions that target multiple levels within healthcare are needed to help combat the opioid epidemic and improve strategies to manage chronic pain. Patient-level interventions implemented ranged from traditional paper-based educational tools to videos, digital applications, and peer networks. Clinician-level interventions focused on providing education, ensuring proper follow-up care, and establishing multidisciplinary teams that included prescribers, pharmacists, nurses, and other healthcare professionals. System- and community-level interventions included metric tracking and analytics, electronic health record tools, lockbox distribution for safe storage, medication return bins for removal of opioids, risk assessment tool utilization, and improved access to reversal agents. CONCLUSION: Strategies to better manage pain can be implemented within health systems at multiple levels and on many fronts; however, these changes are most effective when accepted and widely used by the population for which they are targeted.

Development and validation of key performance indicators for medication management services provided for outpatients.

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

Clinical pharmacists' contributions to hematopoietic stem cell transplantation: A systematic review.

AIMS: The goal of the present review was to identify studies that assess how pharmaceutical services contribute to hematopoietic stem cell transplantation (HSCT). METHODS: We conducted a systematic literature review of published studies describing results from clinical services provided by pharmacists working with HSCT, conducted according to PRISMA guidelines ( PROSPERO registration number CRD42017062391). A search strategy was applied within PubMed, CENTRAL, EMBASE, SCOPUS, and LILACS databases in April 2017. Inclusion criteria were observational or experimental studies that addressed the following research question: "What are a clinical pharmacist's main contributions to HSCT?" The quality of selected studies was evaluated using the Downs and Black checklist. RESULTS: We identified 1838 studies, and seven were included in the systematic review. The results indicated that clinical pharmacy is useful during HSCT treatment within both inpatient and outpatient settings. Pharmaceutical contributions identified included management of pharmacotherapy-related problems, participation in discussions with clinical teams, drug reconciliation, patient and team education regarding pharmacotherapy, preparation of guidelines and educational materials, and evaluation of medication adherence. These activities favored the control and prevention of pharmacotherapy-related problems, the maintenance of immunosuppressive serum levels, improvement in patients' clinical and nutritional status, facilitated medication adherence, and provided economic and humanistic gains. CONCLUSIONS: Despite the small number of articles discussing the topic under analysis, the results were unanimous in confirming the positive impact of pharmacists' contributions to clinical practice for HSCT.

Clinical and financial effects of smart pump-electronic medical record interoperability at a hospital in a regional health system.

PURPOSE: The pharmacist-led implementation of a smart pump-electronic medical record (EMR) interoperability program at a hospital within a regional health system is described. SUMMARY: Smart pump-EMR interoperability involves a wireless, bidirectional connection by which infusion information transmitted by the EMR prepopulates infusion devices, reducing keystokes and opportunities for manual programming errors. The smart pumps transmit time-stamped infusion data to the EMR for nurse documentation. Use of interoperability technology forces the use of dose-error reduction software so that 100% of prepopulated infusions and dosage adjustments are protected. To improve i.v. medication safety and documentation at a 286-bed hospital within an 8-hospital health system, pharmacists led an initiative to implement smart pump-EMR interoperability as a first step toward systemwide implementation. The hospital's smart pump-EMR interoperability initiative resulted in patient safety and revenue-generation gains in the first 8 months after implementation. The mean number of keystrokes needed to program an infusion was reduced from 15 to 2 (an 86% decrease). Pump alerts, alert overrides, and reprogrammed or cancelled infusions were decreased. In addition, the program improved outpatient charge capture, resulting in $370,000 in incremental revenue. CONCLUSION: A pharmacist-led implementation of smart pump-EMR interoperability led to measurable, data-based improvements in i.v. medication safety and improved accuracy, timeliness, and efficiency of i.v. infusion documentation. Revenue was increased due to improved charge capture for outpatient i.v. infusions.

Comorbidities, potentially dangerous and low therapeutic index medications: factors linked to emergency visits.

This article aims to investigate the morbidities related to medications, their risk factors and causes detected in patients who seek the Hospital Emergency Service of a University in the South of Brazil. Data collection was based on application of a questionnaire to patients of a minimum age of 18 years, that signing the Term of Free and Informed Consent (TFIC), during the period from October 2013 to March 2014, and analysis of electronic record charts. Cases were evaluated by pharmacists and a doctor to define whether it was a case of medication related morbidity (MRM) and to establish its possible causes. Avoidability of MRM was verified based on criteria previously established in the literature. In total 535 patients were interviewed, and the frequency of MRM was 14.6%, Approximately 45% of MRMs were related to safety in the use of medications, and approximately 50% presented user-related questions as the possible cause. Hospitalization was required in 44.8% of MRM cases; 62.7% of cases were considered avoidable. Presence of chronic disease and use of potentially dangerous medication and low therapeutic index were considered independent factors associated with development of MRM, according to statistical analysis.

Comorbidities, potentially dangerous and low therapeutic index medications: factors linked to emergency visits / Comorbidades, medicamentos potencialmente perigosos e de baixo índice terapêutico: fatores associados à busca da emergência hospitalar

Abstract This article aims to investigate the morbidities related to medications, their risk factors and causes detected in patients who seek the Hospital Emergency Service of a University in the South of Brazil. Data collection was based on application of a questionnaire to patients of a minimum age of 18 years, that signing the Term of Free and Informed Consent (TFIC), during the period from October 2013 to March 2014, and analysis of electronic record charts. Cases were evaluated by pharmacists and a doctor to define whether it was a case of medication related morbidity (MRM) and to establish its possible causes. Avoidability of MRM was verified based on criteria previously established in the literature. In total 535 patients were interviewed, and the frequency of MRM was 14.6%, Approximately 45% of MRMs were related to safety in the use of medications, and approximately 50% presented user-related questions as the possible cause. Hospitalization was required in 44.8% of MRM cases; 62.7% of cases were considered avoidable. Presence of chronic disease and use of potentially dangerous medication and low therapeutic index were considered independent factors associated with development of MRM, according to statistical analysis.

Resumo O objetivo deste artigo é investigar as morbidades relacionadas a medicamentos (MRM), os fatores e as causas detectados em pacientes que buscam o serviço de emergência de hospital universitário do sul do Brasil. A coleta de dados baseou-se na aplicação de um questionário aos pacientes com idade mínima de 18 anos, durante o período de outubro de 2013 a março de 2014, e na análise do prontuário eletrônico. Os casos foram avaliados para definir se era um caso de MRM e para estabelecer as suas possíveis causas. A evitabilidade da MRM foi verificada com base em critérios previamente estabelecidos na literatura. No total foram entrevistados 535 pacientes e a frequência de MRM foi de 14,6%. Aproximadamente, 45% das MRMs foram relacionadas com a segurança no uso de medicamentos e cerca de 50% apresentou como possível causa questões relacionadas ao usuário. Houve necessidade de internação em 44,8% dos casos de MRM; 62,7% dos casos foram considerados evitáveis. Presença de doença crônica e utilização de medicamentos potencialmente perigosos e de baixo índice terapêutico foram consideradas fatores associados ao desenvolvimento de MRM.