El largo y sinuoso camino de la farmacia clinica en Chile / The long and winding road of the clinical pharmacy in Chile

Clinical pharmacy is a health discipline in which pharmacists provide patient care that optimizes rational medication use and promotes health, wellness and disease prevention. The beginnings of clinical pharmacy in Chile were inspired by the origin in the School of Pharmacy of the University of California, San Francisco (UCSF), in the mid-1960s. However, the historical development in our country, both in teaching and in the professional field, was accompanied by difficulties and success, which became a long and winding road. This article shares the events that gave rise to its beginnings in Chile, first through teaching, then in pharmacovigilance and clinical pharmacokinetics, to later describe its professional expansion and recognition as a specialty of pharmacy. This article briefly recounts the history of the Chilean clinical pharmacy to this day. Some names of people or institutions were not mentioned. Therefore the authors apologize in advance to pharmacists and organizations whose contribution cannot be recognized in this way. However, we know that this specialty has not been forged only by the names that appear, but by all those who love and respect the work of the clinical pharmacy.

Análise das intervenções farmacêuticas clínicas em Unidade de Terapia Intensiva de um hospital de urgência e trauma / Analysis of clinical pharmaceutical interventions in the Intensive Care Unit of an emergency and trauma hospital

Analisar o perfil das intervenções farmacêuticas providas pelos farmacêuticos clínicos por meio da análise de prescrições médicas em uma Unidade de Terapia Intensiva (UTI) adulto generalista. Metodologia: Trata-se de um estudo transversal, prospectivo e observacional, com abordagem quantitativa, realizado na UTI de um hospital público referência em urgência e trauma do estado de Goiás. Os dados foram coletados no período de junho a agosto do ano de 2022, por meio da análise diária das prescrições. Resultados: A população estudada compreendeu 74 pacientes, em sua maioria do sexo masculino (68,92%), hipertensos (27,03%), e diabéticos (14,86%). Foram analisadas 568 prescrições, e identificados 489 problemas relacionados a medicamentos, sendo os mais prevalentes: medicamento inapropriado/desnecessário ou contraindicado (30,67%) e necessidade de medicamento adicional (24,34%). As classes de medicamentos mais envolvidas nos problemas foram: anti-infecciosos gerais para uso sistêmico (23,72%), e agentes do sistema nervoso (23,11%). Das intervenções farmacêuticas promovidas, 84,25% foram aceitas, com maior frequência: suspender medicamento (30,67%) e iniciar terapia medicamentosa (23,72%). Conclusão: Diante dos resultados apresentados, nota-se a boa taxa de aceitabilidade das intervenções, destacando a importância da atuação do farmacêutico clínico dentro da UTI na prevenção de problemas relacionados à farmacoterapia, bem como na melhoria dos desfechos terapêuticos

To analyze the profile of pharmaceutical interventions provided by clinical pharmacists through the analysis of medical prescriptions in a generalist adult Intensive Care Unit (ICU). Methodology: This is a cross-sectional, prospective and observational study, with a quantitative approach, conducted in the ICU of a public hospital that is a reference in emergency and trauma in the state of Goiás. Data were collected from June to August of 2022, through the daily analysis of prescriptions. Results: The population being studied comprised 74 patients, mostly male (68.92%), hypertensive (27.03%), and diabetic (14.86%). 568 prescriptions were analyzed, and 489 problems related to medication were identified, the most prevalent being: inappropriate/unnecessary or contraindicated medication (30.67%) and need for additional medication (24.34%). The drug classes most involved in the problems were: general anti-infectives for systemic use (23.72%) and nervous system agents (23.11%). Of the promoted pharmaceutical interventions, 84.25% were accepted, most frequently: discontinuing medication (30.67%) and starting medication therapy (23.72%). Conclusion: In view of the results presented, there is a good rate of acceptability of the interventions, highlighting the importance of the role of the clinical pharmacist within the ICU in preventing problems related to pharmacotherapy, as well as in improving therapeutic outcomes

Establishment and application of pediatric outpatient and emergency intelligent pharmacy service system in our hospital / 中国药房

OBJECTIVE To provide reference for the construction of intelligent pharmacy and quality control of each link in medical institutions. METHODS The problems， difficulties， and risk points in the links of prescription extraction， allocation， drug resource utilization， prescription and child information verification in pediatric outpatient and emergency pharmacy of our hospital were sorted out to put forward the solutions. The pediatric outpatient and emergency intelligent pharmacy service system of our hospital was established， and its effectiveness was analyzed. RESULTS & CONCLUSIONS In response to the risk points of drug accumulation， dispensing errors， being prone to complaints or disputes， safety hazards in dispensing， and pharmacist’s incorrect operation in various stages such as payment， taking medicine and dispensing， pediatric outpatient and emergency intelligent pharmacy service system was established in our hospital by adding intelligent queuing links， enabling “QR codes”， introducing devices such as rapid dispensing machines， intelligent drug racks， and intelligent dismantling machines. After using the system， the average outpatient dispensing speed increased from 37.55 s/piece to 16.97 s/piece （direct delivery prescriptions） and 27.10 s/piece （non-direct delivery prescriptions）， and the average emergency dispensing speed increased from 26.98 s/piece to 19.61 s/piece （P＜ 0.01）. The walking distance for pharmacists to dispense prescriptions had decreased from 4-16 m/piece to 2-5 m/piece， and the inventory rate had shortened from 2.0-2.2 h/time to 1.5-1.7 h/time. The rate of dispensing error decreased from 0.003% to 0 （P＜ 0.01）. At the same time， the improvement of pharmaceutical service quality has been demonstrated in terms of shortening the waiting time of family members of child， precise drug supplement and helping family members understand medication information. The application of the system can further promote pediatric outpatient and emergency pharmacy services in our hospital.

Application of “Cloud Pharmaceutical Service System”in the medication therapy management for chronic airway diseases / 中国药房

OBJECTIVE To evaluate the effect of “Cloud Pharmacy Service System” electronic management platform in medication therapy management （MTM） of chronic airway diseases. METHODS MTM module setting of “Cloud Pharmaceutical Service System” was introduced. Totally 371 patients with chronic airway disease admitted to our hospital from January 2021 to March 2022 were selected for MTM based on the “Cloud Pharmacy Service System”. The standardization of inhalation device mastery and compliance of patients before and after intervention were compared with self-made inhalation device evaluation scale and Morisky medication adherence scale-8 （MMAS-8）. The satisfaction of patients with pharmacist after intervention was investigated. RESULTS “Cloud Pharmaceutical Service System” is mainly divided into 4 modules， such as medication therapy review， pharmacist intervention， personal medication record and the medication-related action plan， other functions. Among 371 patients， there were 237 outpatients （142 cases of asthma， 95 cases of chronic obstructive pulmonary disease） and 134 inpatients （19 cases of asthma and 115 cases of chronic obstructive pulmonary disease）. The score of the patients using inhalation device increased from 74.76±24.71 before intervention to 99.45±2.12 after intervention （P＜0.05）. MMAS-8 score increased from 7.14± 1.15 before intervention to 7.88±0.44 after intervention （P＜0.05）. The degree of patients’ satisfaction with pharmacists reached 100% after intervention. CONCLUSIONS “Cloud Pharmacy Service System” is helpful to improve the effects of pharmaceutical service for patients with chronic airway disease by providing whole-process， online， visual and immediate MTM.

Indicadores de qualidade para otimização da qualidade em farmácia hospitalar / Quality indicators for quality optimization in hospital pharmacy / Indicadores de calidad para la optimización de la calidad en farmacia hospitalaria

Objetivo: identificar, a partir de publicações científicas, indicadores de qualidade para a otimização da gestão em farmácia hospitalar. Método: revisão integrativa com levantamento bibliográfico nas bases de dados Scopus, Web of Science e Medline, entre 2019 e 2023, utilizando os descritores Patient Safety, Quality Indicators e Pharmacy Service. Foram incluídos documentos em português, inglês e espanhol, com os resumos disponíveis nas bases de dados selecionadas e disponíveis na íntegra sem custos. Para análise dos documentos, aplicou-se a ferramenta CASP adaptada. Resultados: foram identificados 15 documentos na Web of Science, 24 na Scopus e dois na Medline com a temática abordada no tópico. Conclusão: as ferramentas de gestão da qualidade mais frequentemente reportadas foram as relacionadas com a definição da causa raiz. Os indicadores de qualidade utilizados para monitorar os resultados foram, principalmente, satisfação da equipe de trabalho, tempo gasto na execução das atividades e redução de erros e custos.

Objective: to identify, from scientific publications, quality indicators for optimizing management in hospital pharmacy. Method:integrative review with bibliographic survey in the databases Scopus, Web of Science and Medline, between 2019 and 2023, using the descriptors Patient Safety, Quality Indicators and Pharmacy Service. Documents were included in Portuguese, English and Spanish, with abstracts available in the selected databases and available in full at no cost. The adapted CASP tool was used to analyze the documents. Results: 15 documents were identified in Web of Science, 24 in Scopus and two in Medline with the theme addressed in the topic. Conclusion: the most frequently reported quality management tools were those related to root cause definition. The quality indicators used to monitor the results were mainly satisfaction of the work team, time spent performing the activities, and reduction of errors and costs.

Objetivo: identificar, a partir de publicaciones científicas, indicadores de calidad para optimizar la gestión en farmacia hospitalaria.Método: revisión integrativa con levantamiento bibliográfico en las bases de datos Scopus, We of Science y Medline, entre 2019 y 2023, utilizando los descriptores Seguridad del Paciente, Indicadores de Calidad y Servicio de Farmacia. Se incluyeron documentos en portugués, inglés y español, con resúmenes disponibles en las bases de datos seleccionadas y disponibles en su totalidad sin costo. Para el análisis de los documentos se utilizó la herramienta CASP adaptada. Resultados: foram identificados 15 documentos na Web of Science, 24 na Scopus e dois na Medline com a temática abordada no tópico. Conclusión: las herramientas de gestión de la calidad más utilizadas fueron las relacionadas con la definición de la causa raíz. Los indicadores de calidad utilizados para monitorizar los resultados fueron principalmente la satisfacción del equipo de trabajo, el tiempo empleado en la realización de las actividades y la reducción de errores y costes.

Conciliação medicamentosa em hospital universitário: estratégia de segurança em pacientes neurocirúrgicos / Medication reconciliation in a university hospital: safety strategy in neurosurgical patients / Conciliación de medicamentos en un hospital universitario: estrategia de seguridad en pacientes neuroquirúrgicos

Esse trabalho teve como objetivo identificar as discrepâncias medicamentosas, por meio do serviço de conciliação de medicamentosa, em pacientes admitidos na clínica cirúrgica de uma unidade especializada no atendimento de doença relacionadas ao sistema neuromuscular na cidade de Manaus, Amazonas. Trata-se de um estudo descritivo e prospectivo, realizado no período de setembro a dezembro de 2020 em pacientes submetidos a conciliação medicamentosa. Na primeira etapa realizou-se a anamnese farmacêutica em formulário semiestruturado e foi elaborada a melhor história possível de medicamentos (MHPM). Os medicamentos prescritos na admissão foram comparados com a MHPM e as discrepâncias foram identificadas e classificadas quanto a intencionalidade e tipo. Ao total 54 pacientes foram incluídos no estudo, sendo que para 32 foi realizada a conciliação medicamentosa por usarem medicamentos de uso contínuo. Foram identificadas 20 discrepâncias intencionais, 3 discrepâncias intencionais não documentadas e 12 discrepâncias não intencionais. Omissão de medicamentos foi o tipo de discrepância mais comum (86%). Diante do exposto, concluímos que a conciliação medicamentosa mostrou-se um importante recurso para identificação de discrepâncias na transição de cuidado de pacientes com doenças neurológicas, principalmente no que se refere à omissão de medicamentos. As intervenções farmacêuticas a partir das discrepâncias encontradas, conseguiram mitigar erros de medicação e possíveis eventos adversos, aumentando a segurança do paciente.

This work aimed to identify medication discrepancies, through the medi- cation reconciliation service, in patients admitted to the surgical clinic of a unit special- ized in treating diseases related to the neuromuscular system in the city of Manaus, Ama- zonas. This is a descriptive and prospective study, carried out from September to Decem- ber 2020 in patients undergoing medication reconciliation. In the first stage, the pharma- ceutical anamnesis was carried out in a semi-structured form and the best possible medi- cation history (MHPM) was prepared. Medications prescribed on admission were com- pared with the MHPM and discrepancies were identified and classified according to in- tentionality and type. 54 patients were included in the study, and for 32 medication rec- onciliation was performed because they used continuous medication. A total of 20 inten- tional discrepancies, 3 intentional undocumented discrepancies and 12 unintentional dis- crepancies were identified. Medication omission was the most common type of discrep- ancy (86%). We conclude that medication reconciliation proved to be an important re- source for identifying discrepancies in the transition of care for patients with neurological diseases, especially with regard to medication omission. Pharmaceutical interventions, based on the discrepancies found, managed to mitigate medication errors and possible adverse events, increasing patient safety.

Este estudio tuvo como objetivo identificar las discrepancias de medicación a través del servicio de reconciliación de medicamentos, en pacientes internados en la clínica quirúrgica de una unidad especializada en el tratamiento de enfermedades relacio- nadas con el sistema neuromuscular en la ciudad de Manaus, Amazonas. Este es un estu- dio descriptivo y prospectivo, realizado de septiembre a diciembre de 2020 en pacientes en conciliación de medicación. En la primera etapa se realizó la anamnesis farmacéutica de forma semiestructurada y se elaboró el mejor historial de medicación posible (MHPM). Los medicamentos prescritos al ingreso se compararon con el MHPM y se identificaron las discrepancias y se clasificaron según la intencionalidad y el tipo. Un total de 54 pacientes fueron incluidos en el estudio, y a 32 se les realizó conciliación de medi- cación por utilizar medicación continua. Se identificaron un total de 20 discrepancias in- tencionales, 3 discrepancias intencionales no documentadas y 12 discrepancias no inten- cionales. La omisión de medicamentos fue el tipo más común de discrepancia (86%). Concluimos que la conciliación de medicamentos demostró ser un recurso importante para identificar discrepancias en la transición de la atención a pacientes con enfermedades neurológicas, especialmente en lo que respecta a la omisión de medicamentos. Las inter- venciones farmacéuticas, en base a las discrepancias encontradas, lograron mitigar errores de medicación y posibles eventos adversos, aumentando la seguridad del paciente PALABRAS CLAVE: Conciliación de Medicamentos; Seguridad del Paciente; Servicio de Farmacia Hospitalaria; Neurología.

An analysis of pharmaceutical care for critical patients of an adult Intensive Care Unit

Abstract This work analyzed the pharmacotherapeutic problems identified by the clinical pharmacist in an intensive care unit (ICU) and the acceptance of pharmaceutical interventions in solving these problems. This is a descriptive cross-sectional retrospective study, carried out in the adult ICU of a public hospital. All patients hospitalized during the study period had their pharmacotherapy monitored and those whose stay at the ICU lasted less than 24 hours were excluded. The pharmacotherapeutic problems were classified according to type, cause, acceptability/implementation, mode of intervention, outcome and related pharmacotherapeutic group. 302 patients were followed up and 350 pharmacotherapeutic problems were identified. Most of them were classified as unnecessary drug-treatment (n=186; 53.1%). The most frequent causes were excessive drug administration (n=181; 97.3%), and antimicrobials was the main group of drugs associated to that type of problem. 350 pharmaceutical interventions were performed, highlighting "prescriber informed only" (n=178; 50.9%), with an average acceptability of 90.7%, with those carried out on site being more effective (93.4%). The number of pharmacotherapeutic problems that were totally solved was 282 (80.6%). Clinical pharmacy activities in the ICU identified, prevented and corrected pharmacotherapeutic problems, contributing to the optimization of pharmacotherapy in aspects related to the need, efficacy and safety of treatments.

Redução de custos hospitalares após implementação de ferramentas informatizadas na logística de um serviço de farmácia hospitalar Hospital / Hospital costs reduction after implementation of informatized tools in the logistics of a hospital pharmacy service

A farmácia hospitalar é atualmente uma unidade hospitalar que tem, entre outros objetivos, garantir o uso seguro e racional dos medicamentos e atender às demandas dos pacientes hospitalizados; para tanto, deve possuir um sistema eficiente de informações e dispor de um sistema de controle e acompanhamento de custos. As diversas inovações tecnológicas na informação e controle de dados aplicados aos serviços de saúde trazem agilidade no processo, maior segurança para os pacientes e melhor gerenciamento no processo logístico, reduzindo custos como aqueles associados à expiração da validade de produtos. Nessa perspectiva de análise de custo, o presente trabalho avalia os impactos que um processo de informatização da rastreabilidade e o uso de ferramentas informatizadas proporcionaram a um serviço de farmácia hospitalar, com o objetivo de descrever os impactos financeiros após a implementação dessas ferramentas. Realizamos um estudo observacional, longitudinal e retrospectivo a partir de dados financeiros relacionados a perdas por expiração de validade de medicamentos e produtos para a saúde e de compras emergenciais desses insumos em um período de seis anos. Os dados foram coletados em dezembro de 2021 referentes aos anos de 2015 a 2020 a partir de relatórios extraídos do Smart (Pixeon). Observamos que os custos com perdas por expiração de validade dos produtos para a saúde caíram substancialmente em 2019, com o menor custo em 2020, correspondendo a uma redução média de 47,9% nesses dois últimos anos em relação à média dos quatro anos anteriores. Também houve redução média de 70% nos custos com compras emergenciais ao longo desse período. Assim, quando avaliamos esses resultados, percebe-se que a informatização da rastreabilidade e o uso de ferramentas informatizadas para suporte no processo de trabalho logístico permitem contribuir significativamente para reduzir custos hospitalares.

The hospital pharmacy is currently a hospital unit that has, among other objectives, to guarantee the safe and rational use of drugs and to provide for the demands of inpatients; for such, it must have an efficient information system and have a cost control and monitoring system. The various technological innovations in information and data control applied to health services bring agility to the process, greater security for patients, and better management in the logistics process, reducing costs such as those associated with the expiration of product shelf life. In this perspective of cost analysis, the present study evaluates the impacts that a traceability informatization process and the use of informatized tools provided to a hospital pharmacy service with the objective of describing the financial impacts after the implementation of the process. We conducted an observational, longitudinal and retrospective study from financial data related to expiration losses of medicines and health products and emergency supplies purchases over a six-year period. The data was collected in December 2021 for the years 2015 to 2020 from reports extracted from Smart (Pixeon). We note that health product expiration loss costs fell substantially in 2019, with the lowest cost in 2020, corresponding to an average reduction of 47.9% in these last two years from the previous four-year average. There has also been an almost 70% reduction in emergency purchasing costs over this period. Thus, when we evaluate these results, it can be seen that the informatization of traceability and the use of informatized tools to support the logistical work process can contribute significantly to reducing hospital costs.

Cuidado clínico farmacêutico e estratégia para o uso racional e adesão ao tratamento em pacientes com hanseníase numa Policlínica do Recife / Pharmaceutical clinical care and strategy to rational use and adhesion to treatment in Hansen's disease patients at a policlinic from Recife

Introdução: a hanseníase é uma doença de fácil diagnóstico, possuindo tratamento e cura. Quando diagnosticada tardiamente, pode trazer graves consequências para os portadores e seus familiares. Uma vez que o tratamento da hanseníase está inserido no componente estratégico da assistência farmacêutica, são exigidos cuidados e orientação. Há necessidade de intervenção clínica farmacêutica, com objetivo de acompanhar prescrições medicamentosas, analisando a adesão dos pacientes ao tratamento com a promoção de ações de educação em saúde, além de minimizar a ocorrência de eventos adversos relacionados aos fármacos do tratamento com possível redução de custos associados aos agravos. Objetivo: realizar o monitoramento para identificar e tratar as possíveis intercorrências que estão comumente presentes no tratamento de hanseníase. Metodologia: a realização do estudo deu-se com o acompanhamento dos pacientes atendidos no serviço de referência a partir da aplicação de questionários em consultas periódic as, vis to que a adesão ao tratamento, reduç ão dos eventos adver sos e controle dos comunic antes são de suma impor tância para o controle epidemiológico. Resultados: os principais sintomas dos indivíduos acometidos foram dormência e eritema nodoso hansênico. A maioria utilizava como tratamento o esquema multibacilar e talidomida. O acometimento relatado dos pacientes foi em nível moderado. Os pacientes possuíam comorbidades como hipertensão, artrose e diabetes. O acompanhamento clínico foi relatado como positivo pela maioria dos entrevistados. Conclusão: o desfecho do estudo mostra que a adesão do paciente é crucial para o êxito do tratamento e o acompanhamento do farmacêutico clínico constitui um pilar positivo, contribuindo para a prevenção de agravos e conscientização da comunidade.

Introduction: Hansen's disease is an easily diagnosed disease, with treatment and cure available. When diagnosed late, it can bring serious consequences for patients and their families. Since the treatment of Hansen's disease is part of the strategic component of pharmaceutical assistance, care and guidance are required. There is a need for clinical pharmaceutical intervention, aiming to monitor drug prescriptions, analyze patients' adherence to treatment while promoting health education actions, in addition to minimizing the occurrence of adverse events related to treatment drugs with possible reduction in costs associated to grievances. Objective:thus, the present study aimed to monitor, identify, and treat possible complications commonly present in the treatment of Hansen's disease. Methodology: The study was carried out with the follow-up of patients seen at the reference service, through the application of questionnaires in periodic appointments, since adherence to treatment, reduction of adverse events and control of communicants are of short importance for epidemiological control. Results:The main symptoms of Hansen's disease patients were numbness and leprosy nodosum erythema. Most used the multibacillary scheme and thalidomide as treatment. The reported involvement of patients was at a moderate level. Patients had other comorbidities such as hypertension, arthrosis and diabetes. The clinical assistance was reported as positive by most interviewees. Conclusion: The outcome of the study shows that patient's compliance is crucial for the success of treatment and the clinical pharmacist's accompaniment is a positive pillar, contributing to the prevention of complications and community awareness.

Analysis of drug use in community empty-nest and non-empty-nest elderly hypertension patients / 药学实践杂志

Objective To explore the needs of community pharmacy services in elderly hypertensive patients in the community, especially empty-nest elderly patients. Methods Elderly hypertensive patients living in Ouyang street were randomly selected and divided into empty-nest and non-empty-nest groups by cluster random sampling method. The basic information of the respondents, the frequency of hypertension monitoring, the taking of hypertensive drugs, and the taking of other drugs were compared and analyzed. Results In term of “blood pressure monitoring frequency”, the daily pressure measurement of the empty-nest group and the non-empty-nest group accounted for 33.6% and 19.3%, respectively. There was significant difference between the two groups (P<0.05).In term of “the varieties of hypertension drugs” and taking 3 kinds of hypertension drugs at the same times, the empty-nest group accounted for 28.8% and the non-empty-nest group accounted for 16.7%, and the difference between the two groups was significant (P<0.05)；In term of “the varieties of drugs” and taking 1-2 kinds of Chinese patent drugs at the same time, the empty-nest group accounted for 39.6% and the non-empty-nest group accounted for 26.0% , and the difference between the two groups was significant (P<0.05)。Conclusion Community elderly patients with hypertension, especially empty-nest elderly patients have an urgent need for community pharmacy services，Community pharmacy services personnel should provide personalized and targeted medication education and guidance to elderly patients, especially empty-nest elderly patients, to promote the rational drug use in elderly patients.

Perception of pharmacists regarding human resources, training, and development of a national hospital pharmacy: a preliminary report on Basel Statements

Abstract The hospital pharmacy needs a constant process of evaluation and monitoring of its activities. In Brazil, several agencies establish tasks and duties for pharmacists, but little is known about the compliance and the perception of the professional regarding these policies. The present study aims to characterize the pharmacist's perception of Brazilian hospital pharmacy policies according to the Basel Statements. A search was performed for the contacts of all medium and high complexity hospitals in the country. Subsequently, a questionnaire elaborated following the Basel Statements was sent by e-mail to hospital pharmacists throughout the country. The domain analyzed was "Human Resources, Training, and Development". Statistical analyses were performed using SPSS 19.0. Pharmacists representing a total of 111 hospitals from all Brazilian regions answered the survey questionnaire and showed that more than half of the hospital pharmacists perceive themselves as not complying, whether in the service of local, national, or pharmaceutical education. Besides updating the professionals in relation to national policies, it is necessary that the representative bodies of the pharmaceutical class be more present in the elaboration and evaluation of the policies directed to human resources, seeking uniformity and the possibility of carrying out the activities required.

Contribución del químico farmacéutico en los programas de gerenciamiento de antimicrobianos: estudio de cohortes ambispectivo / Pharmacist´s contribution on antimicrobial stewardship program: ambispective cohort study

INTRODUCCIÓN: El programa de gerenciamiento de antimicrobianos (PGAn) promueve el uso racional de los antimicrobianos, garantizando que cada paciente reciba el fármaco correcto, por el tiempo correcto, por la vía y a la dosis correcta. OBJETIVO: Establecer la asociación de los resultados de un PGAn liderado por un químico farmacéutico, en términos de consumo de antimicrobianos, duración del tratamiento y costos, en una institución prestadora de salud de alta complejidad. MATERIALES Y MÉTODO: Estudio de cohortes ambispectivo. En la cohorte expuesta, (entorno de un PGAn), un químico farmacéutico con entrenamiento en enfermedades infecciosas evaluó e intervino la indicación, dosis, duración del tratamiento y espectro bacteriano del antimicrobiano. La cohorte no expuesta fue una población retrospectiva similar (pareada) a la cohorte expuesta, pero sin la evaluación de su terapia antimicrobiana. RESULTADOS: Se identificaron 258 pacientes en la cohorte expuesta y 247 en la cohorte no expuesta al PGAn. Se observó una disminución en el consumo de antimicrobianos (119.831 vs 137.678 DDD/100 pacientes-día, p < 0,001) y una disminución de 34,1% en los costos asociados a la antibioticoterapia de la cohorte expuesta, en comparación con la cohorte no expuesta al PGAn. CONCLUSIÓN: El PGAn liderado por un químico farmacéutico se asocia a mejores resultados en términos de consumo y menores costos de la terapia antimicrobiana.

BACKGROUND: Antimicrobial stewardship program (AMSP) promotes the rational use of the antimicrobial, ensuring that each patient receives the correct antibiotic, by the correct time and at the correct dose. AIM: To establish the association of the results of an AMSP led by a pharmaceutical chemist, in terms of antibiotic consumption, duration of treatment and costs in a tertiary healthcare setting. METHOD: Ambispective cohort study. In the exposed cohort, in the environment of a AMSP, a pharmacist with training in infectious diseases evaluated and intervened the indication, dosage, duration of treatment and bacterial spectrum of the antimicrobial. The no-exposed cohort corresponded to a retrospective population that was similar (paired) to the exposed cohort, but that did not receive an evaluation of its antimicrobial therapy. RESULT: 258 patients were identified in the exposed cohort and 247 in the cohort not exposed to the AMSP. Decrease in the consumption of antibiotics was observed (119,831 vs 137,678 DDD/100 patients-day, p < 0.001) and a decrease in 34.1% of the costs associated with antibiotic therapy of the exposed cohort, in comparison with the cohort not exposed to the AMSP. CONCLUSION: AMSP led by a pharmacist have better outcomes in terms of consumption and lower costs associated with antibiotic therapy.

Construction and exploration of pregnancy registries for medicine based on pharmaceutical service / 中华医院管理杂志

The pregnancy registry for medicine is a common method for risk evaluation for drug safety evaluation during pregnancy. The authors introduced the exploration and practice of the pregnancy drug registry mode based on pharmacy service in Women′s Hospital School of Medicine Zhejiang University. The registry of pregnancy medication with the drug consultation clinic as the fulcrum was managed by the pharmacist team in a homogenization way, and implemented according to the information process of consultation, pharmacy guidance and regular follow-up. In the consultation and follow-up work, the pharmacists established the consultation drug history through three data sources: independent report of the consultant, inquiry of pharmaceutical personnel and case sampling. The pharmacists designed and constructed information screening system, classified the consultation medicine history according to the pregnancy exposure of specific drugs. The prospective research method was designed to meet the characteristics of pregnancy medication. The study was carried out on the relationship between pregnancy exposure and birth defects of offspring. Relying on the improvement of standardization, refinement and information management level of pharmaceutical services, multi center cooperation will be strengthened in the future to carry out continuous research on pregnancy drug exposure registry and follow-up system.

The pharmaceutical care bundle: development and evaluation of an instrument for inpatient monitoring

Introduction: Care bundles help healthcare professionals provide the best care possible in a structured and reliable way. The purpose of this study was to develop and apply an instrument for inpatient follow-up by clinical pharmacists, and evaluate its results. Methods: The care bundle was based on previously validated instruments. Population consisted of patients monitored by clinical pharmacists at a general hospital. The study was conducted in two phases: the first involved the development and implementation of the bundle, and the evaluation of pharmaceutical interventions; the second involved analyzing data from patients treated with the bundle over one year. Results: The bundle included fourteen pharmaceutical follow-up criteria used in different patterns by each area of care. In the first phase of the study, 3263 patients were monitored and 536 pharmaceutical interventions were performed, with an 85.3% compliance rate. In the second phase of the study, follow-up data was collected from 21,214 patients. The bundle criteria were used in a similar way in clinical, surgical and cancer patients. Pharmacotherapy review was the most prevalent intervention in all cases (60.1%). Hospital discharge planning and medication reconciliation were performed with a similar frequency in clinical, surgical, pediatric and general patients. Conclusions: The development and validation of a bundle aimed at guiding the clinical activities of pharmacists helped standardize procedures and interventions. Pharmacotherapy review was the bundle criterion with the highest rate of application and interventions due to the hospital's complexity and the need to consider individual patient needs and follow institutional policies. (AU)

Continuous improvements for the new service model in outpatient pharmacy under the environment of medical reform / 药学实践杂志

Objective To introduce the improvements of multi-mode outpatient pharmacy services based on the new medical reform policy. Methods The pharmacist’s roles, responsibilities, working procedures and the achievements were discussed. Results and conclusion On-site pharmacy counseling services and online WeChat pharmacy consulting services were established to include collaborative drug therapy management of pharmacists and physicians (Alzheimer's disease and anticoagulation clinic), the outpatient pharmacy services by pharmacists (chemo medication counseling). The multi-mode pharmacy services in our hospital have optimized patient's medication regime, safeguarded patient's medication therapy, improved patient's compliance and reduced medication cost. The individualized medication therapy reduced adverse reactions significantly. The multi-mode outpatient pharmacy services established by our hospital were successful and could serve as a model for other pharmacies in our country.

Pharmaceutical care-based interventions in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials / Intervenções farmacêuticas no diabetes mellitus tipo 2: uma revisão sistemática e metanálise de ensaios clínicos randomizados

ABSTRACT Objective To investigate the impact of pharmaceutical care-based interventions on type 2 diabetes mellitus . Methods PubMed®, Cochrane and Web of Science data bases were searched for randomized controlled clinical trials. Studies evaluating pharmaceutical care-based interventions in type 2 diabetes mellitus published between 2012 and 2017 were included. Glycated hemoglobin was defined as the primary endpoint; blood pressure, triglycerides and cholesterol as secondary endpoints. The random effects model was used in meta-analysis. Results Fifteen trials involving 2,325 participants were included. Meta-analysis revealed considerable heterogeneity (I2>97%; p<0.001), reduction in glycated hemoglobin (-1.07%; 95%CI: -1.32; -0.83; p<0.001), glucose (-29.91mg/dL; 95%CI: -43.2; -16.6; p<0.001), triglyceride (19.8mg/dL; 95%CI: -36.6; -3.04; p=0.021), systolic blood pressure (-4.65mmHg; 95%CI: -8.9; -0.4; p=0.032) levels, and increased HDL levels (4.43mg/dL; 95%CI: 0.16; 8.70; p=0.042). Conclusion Pharmaceutical care-based clincal and education interventions have significant impact on type 2 diabetes mellitus . The tools Summary of Diabetes Self-Care Activities and the Morisky Medication Adherence Scale may be useful to monitor patients.

RESUMO Objetivo Identificar o impacto das intervenções providenciadas pelo cuidado farmacêutico no diabetes mellitus tipo 2. Métodos Buscas por ensaios clínicos randomizados controlados foram realizadas nas bases PubMed®, Cochrane e Web of Science . Foram incluídos estudos publicados entre 2012 e 2017, que avaliaram o impacto do cuidado farmacêutico no diabetes mellitus tipo 2. A hemoglobina glicada foi o desfecho primário, e os secundários foram pressão arterial, triglicérides e colesterol. O modelo de efeitos aleatórios foi utilizado na metanálise. Resultados Foram incluídos 15 estudos envolvendo 2.325 participantes. A metanálise demonstrou heterogeneidade elevada (I2>97%; p<0,001), redução nos níveis de hemoglobina glicada (-1,07%; IC95%: -1,32; -0,83; p<0,001), glicose (-29,91mg/dL; IC95%: -43,2; -16,6; p<0,001), triglicérides (19,8mg/dL; IC95%: -36,6; -3,04; p=0,021), pressão arterial sistólica (-4,65mmHg; IC95%: -8,9; -0,4; p=0,032) e aumento do colesterol HDL (4,43mg/dL; IC95%: 0,16; 8,70; p=0,042). Conclusão As intervenções clínicas e educacionais providenciadas pelo cuidado farmacêutico têm impacto significativo no diabetes mellitus tipo 2. Ferramentas como o Summary of Diabetes Self-Care Activities e a Morisky Medication Adherence Scale podem ser úteis no acompanhamento dos pacientes.

Avaliação da economia gerada por meio das intervenções farmacêuticas realizadas em um hospital universitário terciário de grande porte / Evaluation of cost savings generated through pharmaceutical inverventions performed in a large tertiary university hospital

Introdução: A farmácia clínica tem como objetivo garantir uma farmacoterapia adequada ao paciente. A avaliação de prescrição é uma das principais atividades do farmacêutico clínico, o que pode resultar em intervenções e economia para a instituição, além de promover o uso racional e seguro de medicamentos. O objetivo deste estudo foi avaliar a economia gerada por meio das intervenções realizadas pelos farmacêuticos clínicos durante o processo de avaliação farmacêutica de prescrição. Métodos: Estudo transversal, observacional e analítico, onde foi analisada a economia gerada através das intervenções realizadas pelos farmacêuticos no período entre janeiro e julho de 2017. Resultados: Foram realizadas 3.033 intervenções no período do estudo e 943 foram incluídas. O valor da economia gerada foi de R$ 72.648,39 (US$ 23.134,95), sendo as intervenções mais frequentes relacionadas à adequação de apresentação (847) e forma farmacêutica (44). Dentre os medicamentos cujas intervenções farmacêuticas resultaram em maior economia, estão a anfotericina B lipossomal (R$ 18.919,75), a daptomicina (R$ 8.575,00), o valganciclovir (R$ 7.452,00) e a anidulafungina (R$ 7.422,35). Algumas intervenções não resultaram em economia direta do tratamento medicamentoso, como ocorreu com a risperidona comprimido (− R$ 264,04) e o sulfametoxazol+trimetoprima comprimido (− R$ 208,62), que foram substituídos por solução oral para administração por sondas. Conclusão: O estudo demonstrou que a atuação do farmacêutico clínico resultou na efetivação de intervenções relacionadas à adequação de dose, correção de diluição, alteração de apresentação, substituição de forma farmacêutica, adequação de tempo de tratamento e a adesão aos protocolos institucionais. Essas intervenções refletiram diretamente na redução de custo dos tratamentos, otimizando recursos e gerando economia ao serviço de saúde. (AU)

Introduction: Clinical pharmacy aims to ensure appropriate pharmacotherapy for patients. Prescription evaluation is one of the main activities of the clinical pharmacist and can result in interventions and cost savings for the institution, in addition to promoting the rational and safe use of medications. The objective of this study was to evaluate cost savings generated through interventions performed by clinical pharmacists during the process of prescription evaluation. Methods: This cross-sectional, observational, analytical study analyzed cost savings generated through interventions performed by pharmacists from January to July 2017. Results: A total of 3,033 interventions were performed during the study period, of which 943 were included. Cost savings amounted to R$ 72,648.39 (US$ 23,134.95), and the most frequent interventions were related to the adequacy of presentation (847) and dosage form (44). The medications whose pharmaceutical interventions resulted in the greatest cost savings are liposomal amphotericin B (R$ 18,919.75), daptomycin (R$ 8,575.00), valganciclovir (R$ 7,452.00), and anidulafungin (R$ 7,422.35). Some interventions did not result in direct cost savings, such as treatment with risperidone tablet (− R$ 264.04) and trimethoprim-sulfamethoxazole tablet (− R$ 208.62), which were replaced by oral solution for tube administration. Conclusion: The study demonstrated that the performance of clinical pharmacists resulted in the implementation of interventions related to dose adjustment, dilution correction, change of presentation, replacement of dosage form, adjustment of treatment duration, and adherence to institutional protocols. These interventions directly resulted in the reduction of treatment costs, optimizing resources and generating cost savings for the health system. (AU)

Cost-benefit analysis of pharmacist interventions over 36 months in a university hospital

ABSTRACT OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI −31,850 − -10,610), -US$27,112 (95%CI −33,160-11,720) for the hospital and; 3.0 (95%CI 1.97-4.94), US$51,048 (95%CI 27,645-75,716) and, 4.6 (95%CI 2.24-10.05), US$91,496 (95%CI 34,700-168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.

Developing Consensus Indicators to Assess Pharmacy Service Quality at Primary Health Centres in Yogyakarta, Indonesia

@#Background: There have been no existing performance indicators to measure the overall quality of pharmacy services, including the aspects of drug management and clinical pharmacy services, at primary health centres in Indonesia. This study aimed to obtain these indicators based on a consensus of experts. Methods: The modified Delphi method was used to obtain the consensus. The initial indicators, based on a literature review, were evaluated and assessed by members of the expert panel through three rounds of repetition until the consensus was reached. The expert panel members were selected based on their knowledge of or expertise in pharmacy service performance and geographical considerations. Analysis of the expert panel consensus level was determined by calculating the mean and interquartile range. Results: Fifteen expert panel members started the first round (93.7% of the 16 targets) with 12 of them (75%) completing the third round of the modified Delphi method. Three expert panel members were representatives of the Regency Health Office, and the others were pharmacist practitioners at primary health centres from three different regencies. The consensus results were 26 indicators of drug management, 19 indicators of clinical pharmacy services, and two indicators of overall pharmacy performance. Conclusion: The consensus indicators for measuring drug management, clinical pharmacy services, and overall pharmacy performance can be used as a reference and standard to measure the quality of pharmacy services at primary health centres. Therefore, the measurement results are more relevant if compared between one and other studies.

National Survey on Clinical Pharmacy Services of Second-level Hospitals in China:Part 2. Analysis on the Status Quo of Clinical Pharmaceutical Services / 中国药学杂志

OBJECTIVE: To collect relevant data on the development of clinical pharmaceutical services in secondary hospitals in China and analyze the existing problems of clinical pharmaceutical services and provide relevant policy suggestions. METHODS: A face-to-face interview survey was conducted to collect data on the secondary hospital clinical pharmacists′ perception of their own work, physicians′ knowledge of clinical pharmacists′ work and patient′s attitude toward clinical pharmacists′ work, et al which was analyzed with descriptive statistics tools. RESULTS: Among the clinical pharmacists, physicians, and patients surveyed, 52.8% of clinical pharmacists think that the clinical pharmacists in the hospital work smoothly, but 35.8% of clinical pharmacists think the configuration of clinical pharmacists in the hospital is unreasonable; 42.0% of the doctors had a basic understanding of the work of clinical pharmacists; the attitude of the clinical pharmacists on medication recommendations or dosing regimens was mainly partly adopted (82.5%). Most of the patients did not understand but had heard of clinical pharmacy services (39.7%).CONCLUSION: The work and assignment of clinical pharmacists, understandings between clinical pharmacists and physician, patients of secondary hospitals in China require further improvement.