Atención farmacéutica en pacientes con inmunodeficiencia adquirida y/o tuberculosis en el área ambulatoria de un hospital pediátrico / Pharmacovigilance in patients with acquired immunodeficiency and/or tuberculosis in the outpatient area of a pediatric hospital

La Atención farmacéutica (AF) ayuda a los pacientes a alcanzar objetivos terapéuticos reduciendo los problemas relacionados al medicamento (PRM). Objetivos: analizar los PRM en la práctica de la AF a pacientes con inmunodeficiencia adquirida (IDA) y/o tuberculosis (TBC) y evaluar su impacto. Método: estudio, descriptivo, observacional, en el área ambulatoria de Farmacia. Se incluyeron pacientes con IDA y/o TBC con: inicio de tratamiento, polifarmacia, reinternaciones frecuentes, regular/mala adherencia, reacciones adversas a medicamentos (RAM) previas y/o comorbilidades. Se entrevistaron pacientes o cuidadores y se registraron PRM, errores, grados de adherencia y conocimiento farmacoterapéutico, retiro oportuno de medicamentos y parámetros clínicos. Se registró la intervención farmacéutica y entregó material educativo. Se repitieron las mediciones en una segunda entrevista. Resultados: Se estudiaron 54 pacientes (28 con IDA y 26 con TBC). Se realizaron 93 intervenciones (29.9% dirigidas al prescriptor, 27.8% a otros profesionales) y se detectaron 8 RAM y 53 errores (28 IDA y 25 TBC), el principal PRM fue la mala/regular adherencia con bajo porcentaje de conocimiento farmacoterapéutico completo. Después de la AF, en IDA el grado de adherencia tuvo una mejora estadísticamente significativa (p= 0.012), también fue significativa la mejora en el retiro oportuno de la medicación (28.6% a 71.4% p=0.005 IDA). Se obtuvieron resultados favorables de carga viral (CV) en 72% pacientes con IDA y aumento de peso en 92% pacientes con TBC, aunque no fueron estadísticamente significativos. Conclusiones: mediante AF se mejoró la adherencia y la comunicación en pacientes pediátricos con IDA y/o TBC (AU)

Pharmacovigilance (PV) helps patients achieve therapeutic goals by reducing drug-related problems (DRP). Objectives: to analyze DRPs in the practice of PV in patients with acquired immunodeficiency (AIDS) and/or tuberculosis (TB) and to evaluate its impact. Methods: A descriptive, observational study was conducted in the outpatient pharmacy area. Patients with AIDS and/or TB with: treatment initiation, polypharmacy, frequent readmissions, regular/poor adherence, previous adverse drug reactions (ADR) and/or comorbidities were included. Patients or caregivers were interviewed, and DRP, errors, adherence and pharmacotherapeutic knowledge, timely drug withdrawal, and clinical parameters were recorded. The pharmaceutical intervention was recorded and educational material was delivered. Measurements were repeated in a second interview. Results: We studied 54 patients (28 with AIDS and 26 with TB). Ninety-three interventions were performed (29.9% addressed to the drug prescriber, 27.8% to other professionals) and 8 ADRs and 53 errors were detected (28 AIDS and 25 TB). The main DRP was poor/regular adherence together with a low level of complete pharmacotherapeutic knowledge. After PV, in patients with AIDS the degree of adherence statistically significantly improved (p= 0.012). The improvement in timely medication withdrawal was also significant (28.6% vs. 71.4% p=0.005 AID). Favorable viral load results were obtained in 72% of patients with AIDS and weight gain in 92% of patients with TB, although they were not statistically significant. Conclusions: PV improved adherence and communication in pediatric patients with AIDS and/or TB (AU)

Study on pharmaceutical care model for drug-related problems in elderly patients based on comprehensive medication management review / 中国药房

OBJECTIVE To explore the pharmaceutical care model for elderly patients with drug-related problems （DRPs） based on the comprehensive medication management review （CMMR）， and to observe the effect of pharmaceutical care under the model. METHODS The pharmaceutical care new model for elderly patients was established by concerning CMMR guidelines in Australia. In other words， clinical pharmacists receive medical care through referral by health practitioners and active consultation by patients or their caregivers. Visits were made by a combination of face-to-face and telephone interviews. Follow-up was carried out in the form of outpatient follow-up， telephone follow-up， appointment， and home guidance to know about the treatment of DRPs by healthcare practitioners or patients.Under this model， the occurrence status and classification of DRPs in elderly patients were studied through cross-sectional investigation. The effect of pharmaceutical care was evaluated from the aspects of hospitalization rate， adverse drug reaction （ADR） incidence，medication compliance， the number of medications， blood lipid level， etc.， through self-before-after comparison. RESULTS In this study， a patient-centered， evaluation-intervention-reevaluation closed-loop pharmaceutical care model was formed. Among 317 study subjects， the average number of DRPs was 1.03 （0-7） cases. Compared before and after the intervention， the number of drug types increased from 2.00（0.00，3.00） to 2.00（1.00，3.00）， but the level of low-density lipoprotein cholesterin in patients decreased from 3.48 （2.58， 4.29） mmol/L to 3.11 （2.29，3.81） mmol/L （P＜0.05）. There was no statistical significance in hospitalization rate， ADR incidence within or medication compliance. CONCLUSIONS CMMR-based pharmaceutical care model can effectively identify and manage the patients’ DRPs and reduce the level of blood lipid.

The status of medication review in addressing drug-related problems of elderly patients in the community / 中国药房

With the increasing aging of our population， the incidence of drug-related problems among elderly patients in the community is gradually increasing. Drug-related problems can lead to an increased incidence of adverse health outcomes such as falls and frailty in elderly patients in the community. Medication review is one of the effective means of addressing drug-related problems. The medication review models in Europe and the United States have been developed for decades to address drug-related problems； medication review model in the United Kingdom focuses on the management of drug therapy for elderly patients in aged care facilities， while the medication review models in the United States and Australia have a broader scope（covering all elderly patients in the community）， and the frequency of medication reviews in the United States and Australia are clearer and more standardized. Compared with the above countries， China’s medication review model has a late start. Our country can learn from the advanced experience of the United Kingdom， the United States， Australia and other countries， actively explore and build a drug review model suitable for China’s national conditions， so as to improve the health level of elderly patients in the community and save social public medical resources.

Acompanhamento farmacoterapêutico no contexto das doenças crônicas e distúrbios menores em uma unidade básica de saúde de São Luís-Ma / Pharmacotherapeutic follow-up in the context of chronic diseases and minor disorders in a basic health unit of São Luís-Ma / Seguimiento farmacoterapéutico en el contexto de enfermedades crónicas y trastornos más pequeños en una unidad de salud básica de São Luís-Ma

As doenças crônicas não transmissíveis (DCNT's) são responsáveis por cerca de 74% da mortalidade global. Nesse contexto, o acompanhamento farmacoterapêutico surge como uma importante ferramenta para garantir uma farmacoterapia racional em prol da melhoria da qualidade de vida do paciente. Levando isso em consideração, este estudo tem como objetivo avaliar o impacto do acompanhamento farmacêutico na qualidade de vida de um paciente idoso com tratamento irracional da hipertensão arterial sistêmica (HAS), diabetes mellitus e outros sintomas da síndrome metabólica. Paciente M.M.D., masculino, 67 anos, hiperglicêmico, dislipidêmico e que se automedicava para hipertensão sem diagnóstico médico com uma série de medicamentos potencialmente inapropriados (PIM's). Após as intervenções farmacêuticas apresentou melhora nos quadros e maior adesão à terapia medicamentosa atrelada a melhores hábitos de vida. Dessa forma, o impacto positivo das intervenções durante o acompanhamento farmacêutico reforça a importância do profissional na atenção básica e na promoção da saúde.

Chronic non-communicable diseases (NCDs) account for about 74% of global mortality. In this context, pharmacotherapeutic follow-up appears to be an important tool for ensuring rational pharmacotherapy in favor of improving the patient's quality of life. Taking this into consideration, this study aims to evaluate the impact of pharmaceutical follow-up on the quality of life of an elderly patient with irrational treatment of systemic arterial hypertension (SAH), diabetes mellitus and other symptoms of metabolic syndrome. M.M.D. patient, male, 67 years old, hyperglycemic, dyslipidemic and self-medicating for hypertension without medical diagnosis with a series of potentially inappropriate medications (PIM's). After the pharmaceutical interventions showed an improvement in the conditions and greater adherence to drug therapy coupled to better habits of life. Thus, the positive impact of interventions during pharmaceutical follow-up reinforces the importance of the professional in basic care and health promotion.

Las enfermedades no transmisibles crónicas representan aproximadamente el 74% de la mortalidad mundial. En este contexto, el seguimiento farmacoterapéutico es una herramienta importante para garantizar una farmacoterapia racional para mejorar la calidad de vida del paciente. Teniendo esto en cuenta, este estudio tiene por objeto evaluar el impacto del seguimiento farmacéutico en la calidad de vida de un paciente de edad avanzada con el tratamiento irracional de la hipertensión arterial sistémica (HAS), la diabetes mellitus y otros síntomas del síndrome metabólico. Paciente con M.M.D. masculino de 67 años de edad, hiperglucemia, dislipidemia y automedicación para la hipertensión sin diagnóstico médico con una serie de medicamentos potencialmente inapropiados (PIMs). Después de las intervenciones farmacéuticas, mostró una mejoría en las tablas y una mayor adherencia a la terapia con medicamentos, junto con mejores hábitos de vida. De esta manera, el impacto positivo de las intervenciones durante el seguimiento farmacéutico refuerza la importancia del profesional en la atención básica y la promoción de la salud.

Drug-related problems of hospitalized elderly patients with limited life expectancy / 中华全科医师杂志

Objective:To analyze drug-related problems (DRPs) of hospitalized elderly patients with limited life expectancy.Methods:A total of 261 patients aged ≥ 70 years with limited life expectancy according to the 1-year mortality prediction index, who were admitted in the geriatric ward of Peking Union Medical College Hospital from January 2015 to December 2021 were included. According to Strand system, the categories, medications and interventions of DRPs were analyzed.Results:Among 261 patients, 187 (71.6%) had 672 DRPs. The most common DRPs were related to drug safety, including 271 (40.3%) adverse drug reactions and 149 over dosages (22.2%). A total of 207 drugs were involved in DRPs, and the top 5 classes with higher frequency of DRPs were antiinfectives for systemic use(20.7%,139/672), nervous system drugs(19.4%,130/672), alimentary tract and metabolism drugs(16.5%,111/672), cardiovascular system drugs(16.1%,108/672), and blood and hemopoietic organs drugs(13.7%,92/672). The recommendations were given by pharmacists for all 672 DRPs, and 643 were accepted by physicians (95.7%). The therapy need to be adjusted in 564 recommendations and the medications need to be monitored in 108 recommendations. In recommendations of therapy adjustment, 49.6%(280/564) were related to deprescribing. The deprescribing with higher frequency included antiinfectives for systemic use(29.6%, 83/280), lipid modifying agents(7.9%,22/280) and antithrombotic agents(7.9%,22/280). Patients with severe disability had significantly higher average DRPs(2 vs. 1) and average deprescribing(1 vs. 0) than patients without severe disability( Z=-4.83, Z=-3.61, all P<0.001). Conclusion:Drug safety is the most common DRP in limited life expectancy elderly inpatients, particularly for those with severe disability.

The Impact Of Clinical Pharmacy Services In General Surgery

Objective: The objectives of this study include performing pharmaceutical care-related research and documenting regarding drug-related problems in the surgery department. Further, these types of studies may bring consciousness to both physicians and patients regarding drug use in surgery. Methods: A Prospective interventional study was conducted in a general surgery hospital. The prescriptions were analyzed for the use of inappropriateness of drugs using the classification for drug-related problems. Results: Out of 100 cases, 62 patients were observed with drug-related problems. The number of antibiotics prescribed was 0, 1, 2, 3, 4, 5, 6 in 8, 11, 12, 32, 18, 18, 1 cases respectively. A significant increase in the outcome of antibiotic rationality and cases adhered to guidelines was seen in November compared to October and somewhat decreased in December due to some limitations. The overall study states that prescribing has a more important cause of Drug-related problems compared to dispensing and the use of the drug. Conclusion: Drug-related problems have to be acknowledged as a very important contributing treatment factor for the best health care outcome. Our study shows the importance of clinical pharmacists in every hospital for identifying and resolving drug-related problems and medication errors.

The role of pharmacist in handling drug-related problems in breast cancer patients at Dr. Cipto Mangunkusumo Hospital

Background: DRP (Drug-Related Problems) affects the outcome of chemotherapy treatment to cancer patients. Matters related to DRP can be prevented by a pharmacist by providing drug information to doctors or other health professionals. The objective of this study was to determine the description of DRP, type of DRP, recommendations given by pharmacists on DRPs, acceptance of the results of recommendations and analysis of factors that affect DRPs.Methods: The research method was carried out through a cross sectional study in which observational data collection was conducted concurrently. The study population was all breast cancer patients from the Division of Surgical Oncology in the period January - April 2018 as many as 228 people. The collected data consisted of dosage suitability, suitability of carrier fluid volume, patient adherence to the schedule for breast cancer patients, recommendations given by pharmacists and the results of acceptance of pharmacist recommendations.Results: Based on research findings, the incidence of DRP was 76.3%. Most problems were regarding carrier fluid volume (64.5%) and dose mismatch (30%). There was also a DRP combination of carrier fluid volume and dose of 19%. The pharmacist’s recommendation was to change the dose by 15.52%, change the carrier fluid volume by 60.92%, and change the dose and volume of the carrier fluid by 23.56%. The recommended dosage received by doctors was 13 patients (7.47%), changing the volume of carrier fluid received by doctors by 106 patients (60.92%).Conclusions: Pharmacists can prevent DRPs through providing drug information to doctors or other health professionals so that increased communication between health professionals is required.

Cost Analysis Of Emergency Visits Due To Drug Related Problems

Objective: To identify patients coming to Emergency Medicine Department (EMD) with drug related problems, classify the DRPs and calculate the direct cost spent for treating them. Methods: This was a prospective observational study conducted in emergency medicine department. The patients coming to EMD with DRPs were classified according to Cipolle’s classification and the direct medical and non-medical costs were calculated. Results: A total of around 107 patients identified with DRPs of which 99 patients were included in the study. In this study, 51% of the cases were due to ADR and 35% due to non-adherence and rest of the cases were due to overdose (10%), drug interaction (3%) and sub therapeutic dose (1%). Major portion for treatment was spent for direct medical cost in which cost for laboratory investigations have contributed the most, INR 10,93,992 (42%) followed by Health care professional cost INR 55,6814 (21%), Pharmacy cost INR 4,00,524.6 (15%), Admission cost INR 3,80,400 (15%). The direct non-medical cost includes cost for diet and travel which was found to be INR 1,68,443 and INR 71,947 respectively. Conclusion: The drug related problems adds a significant economic burden on the patients which can be reduced by imparting knowledge about the proper use of medicines and by improving collaborative efforts of the patients, physicians, pharmacists and caregivers.

Practical Exploration of Introducing PCNE Classification System to Develop MTM in Type 2 Diabetic Patients / 中国药房

OBJECTIVE： To introduce Pharmaceutical Care Network Europe （PCNE） classification system to develop medication therapy management （MTM）， and to investigate the application of PCNE classification system in solving drug-related problems （DRPs） in type 2 diabetic patients and the effect of it on clinical outcomes. METHODS： The patients with type 2 diabetes diagnosed in endocrinology department of our hospital from Jul. 10， 2018 to Oct. 31， 2018 were randomly divided into clinical pharmacist-led intervention （“physician-pharmacist-nurse” mode） group and control group receiving only traditional medical services （“physician-nurse” mode）. According to PCNE classification， the number of DRPs found in the pharmaceutical intervention group， the types of problems， causes， the types of interventions， acceptance for interventions and outcomes were analyzed and evaluated. Drug compliance （the highest score is 8） and HbA1c compliance （＜7％） were compared between 2 groups during hospitalization （or at the discharge） and 3 months after discharge. RESULTS： Totally 76 cases were included （40 cases in pharmaceutical intervention group and 36 cases in control group）. During hospitalization， 51 DRPs were found in the pharmaceutical intervention group， among which 42 problems were related to the effectiveness of treatment， mainly due to improper usage and dosage （23 problems）； the types of intervention was mainly aimed at the patient level （24 problems）. 38 problems received intervention （acceptance rate was 74.51％） and 32 problems （62.75％） were completely solved. Compared with those at admission， after following up for 3 months patients with low score （6 points） in the drug compliance of the pharmaceutical intervention group decreased from 26 to 8 （P＜0.000 1）， patients with medium score （6-8 points） increased from 10 to 22 （P＝0.006 2）， patients with high score （8 points） increased from 4 to 10， and drug compliance improved significantly， while there was no significant change in drug compliance in the control group. Compared with those at the discharge， after 3 months’ follow-up， the HbA1c compliance rate of the pharmaceutical intervention group increased from 25.00％ to 77.50％， and that of the control group increased from 25.00％ to 55.56％. There were statistical differences （P＜0.000 1）， and HbA1c compliance rate of the pharmaceutical intervention group was significantly higher than that of the control group. CONCLUSIONS： In the practice of MTM service， clinical pharmacists use PCNE classification system to collect， analyze， intervene， solve and evaluate DRPs systematically. The service mode can provide reference for standardizing pharmaceutical care mode.

Problemas relacionados a medicamentos em idosos usuários de psicotrópicos: revisão integrativa de literatura / Problems related to drugs in elderly users of psychotropic drugs: an integrative literature review / Problemas relacionados a medicamentos en ancianos usuarios de psicotrópicos: revisión integrativa de literatura

Revisão integrativa da literatura realizada na Biblioteca Virtual em Saúde (BVS), buscou identificar os principais problemas relacionados ao uso de psicotrópicos em idosos e propor soluções. Os principais problemas identificados foram reações adversas, risco de quedas e interações medicamentosas. Foram sugeridas três propostas para a redução de suas ocorrências: a adoção de um programa de prescrição eletrônica, a adoção de medidas educativas e/ou realização de acompanhamento farmacoterapêutico com estes pacientes.

An integrative review of the literature carried out in the "Biblioteca Virtual em Saúde" (BVS), sought to identify the main problems related to the use of psychotropic drugs in the elderly and propose solutions. The main problems identified were adverse reactions, risk of falls and drug interactions. Three proposals were suggested to reduce their occurrences: the adoption of an electronic prescription program, the adoption of educational measures and / or pharmacotherapeutic follow-up with these patients.

Revisión integrativa de la literatura realizada en la "Biblioteca virtual em saúde" (BVS,) buscó identificar los principales problemas relacionados al uso de psicotrópicos en ancianos y proponer soluciones. Los principales problemas identificados fueron reacciones adversas, riesgo de caídas e interacciones medicamentosas. Se sugirieron tres propuestas para la reducción de sus ocurrencias: la adopción de un programa de prescripción electrónica, adopción de medidas educativas y / o realización de seguimiento farmacoterapéutico con estos pacientes.

Assessment of drug related problems and clinical pharmacist interventions in paediatric department of a tertiary care teaching hospital

Background: Drug-related problems (DRPs) are frequent in hospitalization in pediatrics. The main aim of present investigation is to assess drug related problems and clinical pharmacist interventions in pediatric department of tertiary care hospital.Methods: It was a prospective, observational and interventional study carried over a period of 6 months.Results: A total of 66 patients were identified with drug related problems. Among them 31 (42%) were in between 1month–2 years followed by 25 (34%) were in between 2-11 years, 10(24%) were in between 11-18 years of age. 30(45.3%) patients were prescribed with 0-3 drugs followed by 21 (31.3%) were prescribed with 3-5 drugs, 15(23.3%) were prescribed with 6-10 drugs. Most of the DRP’s observed in the study were drug interactions 52(78.78%) [major-19 (36.53%), moderate-27 (5192%) and minor-6(11.53%)] followed by adverse drug reactions 12 (18.18%), and duplication errors were 2 (3.03%). Majority of the clinical pharmacist recommendations were duration change 52 (34.66%), drug change 10(6.66%), dose reduction 2 (1.35%) followed by drug termination 2 (1.33%). Major significance of DRPs were noted high 31(57.96%), whereas 25 (39.8%) were moderate and 8 (12.12%) were minor. The acceptance rate of intervening clinical pharmacist recommendation and change in drug therapy was found to be high in 57 (86.66%) cases while in 9 (13.33%) cases suggestions were accepted but therapy was not changed. There were no cases with neither suggestion were accepted nor therapy changed.Conclusions: Clinical pharmacist involvement in inpatient pediatric care can significantly help to identify, resolve and prevent the drug related problems. The study concluded that the clinical pharmacist has a significant role in patients care at hospital.

Investigation and Analysis on the Drug-related Problems in Clinical Application of Antiepileptic Drugs in Hospitalized Patients of One Hospital / 中国药师

Objective:To discuss the causes and characteristics of drug-related problems(DRPs) of antiepileptic drugs by the in-vestigation of antiepileptic drugs' use in our hospital in order to provide reference for the rational clinical application of antiepileptic drugs. Methods:A retrospective analysis on 878 inpatients' records including antiepileptic drug application in our hospital from Janu-ary to December 2016 was carried out. The gender,age,etiology,application of antiepileptic drugs,usage,combination and adverse reactions were statistically analyzed in order to analyze the epidemiological characteristics of antiepileptic drugs in our hospital. At the same time,the necessity,safety and validity of the DRPs of antiepileptic drugs were studied by the international generic Spanish drug related research method(Granada-Ⅱclassification method). Results:Among the 878 cases,most were male patients(60.71%) and the proportion of patients over 50 years old was 69.02%. Patients with cerebrovascular diseases accounted for the most (323 cases, 36.79%),and 7 varieties of antiepileptic drugs were involved, and sodium valproate was with the largest proportion (489 cases, 51.75%). The DRPs were classified as DRP2(49 cases),DRP5(22 cases) and DRP6(8 cases). Conclusion:In view of the epi-demiological characteristics of antiepileptic drugs and DRPs specific issues in clinical applications, clinical pharmacists need to strengthen the intervention in DRPs of antiepileptic drugs in order to promote the safety and reasonability of clinical application.

Effect Evaluation of Pharmaceutical Care Network Europe Classification System on Drug-related Problems in Respiration Department / 中国药房

OBJECTIVE:To evaluate the effect and role of Pharmaceutical Care Network Europe (PCNE) classification system (8.0 edition) on drug-related problems (DRPs) in respiration department.METHODS:Clinical pharmacists provided pharmaceutical care for DRPs in a patient with acute exacerbation of chronic obstructive pulmonary disease of respiration department by using PCNE classification system (8.0 edition).Type,cause,intervention measure,intervention acceptability and state of DRPs were analyzed.RESULTS:PCNE classification system (8.0 edition) mainly included 5 aspects as problems,reasons,plan intervention,the acceptance of intervention plan,the situation of DRPs.Clinical pharmacists confirmed the type of DRPs,with the help of the system and solved two items of DRPs.Physicians accepted intervention and fully implemented it.CONCLUSIONS:Clinical pharmacists can provide standardardized pharmaceutical care systematically,discover and solve DRPs in time through PCNE classification system (8.0 edition) so as to guarantee safe,effective and reasonable drug use.

Towards a transformation in the pharmacist care paradigm: A scoping study / Hacia una transformación del paradigma del farmacéutico asistencial: una revisión de alcance

SUMMARY Introduction: In a paper published by Hepler, it is mentioned that the Pharmaceutical Care constitutes a change in the paradigm of the profession, an affirmation that it is necessary to clarify since apparently, this concept is not used from the philosophy or the social sciences. Methodology: A scoping study was performed from systematics reviews of literature and meta-analysis published in MEDLINE, EMBASE and LILACS, which the role of the pharmacist in the different settings of health care was studied. It was not restricted by language or date of publication. Results: The selection process identifies 86 reviews published between 1998 and 2014, of which 84.9% are Systematic Review (SR). It was studied all care settings 23.3%, community 22.1%, and ambulatory setting 22.1%. According to the title, 65% referring to the role of the pharmacist, 21% with pharmaceutical care or other related terms and 14% with clinical pharmacy services. There is no uniformity in the concepts of pharmaceutical care or drugs related problems. Conclusions: It is necessary to construct the knowledge object of pharmaceutical care activities from a paradigm that allows another understanding of pharmacist interventions, construct values in the patient-pharmacist relationship supported in Latin American bioethics and a methodology of research that transcends the findings of the performed studies using the designs of classical epidemiology.

RESUMEN Introducción: en un artículo publicado por Hepler, se menciona que la atención farmacéutica constituye un cambio en el paradigma de la profesión, afirmación que es necesario aclarar, ya que, aparentemente, este concepto no se utiliza desde la filosofía o las ciencias sociales. Metodología: se realizó un estudio de alcance a partir de revisiones sistemáticas de literatura y metanálisis publicadas en MEDLINE, EMBASE y LILACS, en las que se estudió el papel del farmacéutico en los diferentes contextos de atención de la salud. No se restringió por el idioma o fecha de publicación. Resultados: el proceso de selección identificó 86 revisiones publicadas entre 1998 y 2014, de las cuales el 84,9% son revisiones sistemáticas. Se estudiaron todos los ámbitos de atención en el 23,3%, comunitario 22,1% y ambulatorio 22,1%. Según el título, el 65% se refiere al papel del farmacéutico, el 21% con atención farmacéutica u otros términos relacionados y el 14% con los servicios de farmacia clínica. No se evidencia uniformidad en los conceptos de atención farmacéutica ni problemas relacionados con medicamentos. Conclusiones: es necesario construir el objeto de conocimiento de las actividades de atención farmacéutica a partir de un paradigma que permita otra comprensión de las intervenciones farmacéuticas, construir valores en la relación paciente-farmacéutico apoyada en la bioética latinoamericana y una metodología de investigación que trascienda los hallazgos de los estudios realizados desde la epidemiología clásica.

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.

Effectiveness of home pharmaceutical interventions in metabolic syndrome: a randomized controlled trial

ABSTRACT Metabolic syndrome (MetS) is a group of different risk factors that raises the chances of develop several health problems such, as cardiovascular disease and diabetes. There are few cases in literature of studies that specifically address the use of pharmaceutical care in MetS. The aim of study was to evaluate the effectiveness of home pharmaceutical interventions in patients with this syndrome. The randomized clinical trial was conducted in subjects with diagnosis of MetS treated in a basic unit of health from Cuité, Paraíba. The patients were randomized in a 1:1 ratio to two groups: intervention (IG) and control (CG). The IG received monthly individual pharmaceutical interventions, while the CG did not. The effectiveness of the intervention protocol was measured after six months, comparing the hemodynamic values, anthropometric, biochemistry, cardiovascular risk, medication adherence, drug related problems (DRP) and quality of life. The sample consisted of 63 individuals (33 IG and 30 CG) and older than 60 years. The majority of pharmaceutical interventions were educational and/or behavioral. In the intervention group, significant differences were observed in the parameters systolic and diastolic blood pressure, triglycerides, medication adherence and DRP. The pharmaceutical interventions at home were effective in improving medication adherence, decreasing DRPs and helping to control components of the metabolic syndrome.

Application of Classification System for European Medical and Health Care Network in the Drug Related Problems in Oncology Department / 中国药师

Objective:To discuss the application of the classification system for European medical and health care network in the drug related problems in oncology department through the practice of the classification system in clinical cases. Methods:The classifi-cation system (version 8. 0) was used to perform the pharmaceutical care for two patients in oncology department, and the drug related problems ( DRPs) including types, causes, interventions, acceptance degree of interventions and the situation of DRPs were analyzed. Results:DRPs were clearly analyzed by the classification system, which provided scientific and systematic pharmaceutical care for the patients. Clinical pharmacists could find DRPs and provide interventions for the patients, which improved the rationality and safety of medication. Conclusion:Clinical pharmacists establish a perfect pharmacy monitoring system for European medical and health care network, and DRPs can be analyzed by the classification system, which promotes reasonable medication and ensures patients' safety.

Estudo do uso de medicamentos em pacientes com diabetes e hipertensão do programa de extensão "Diabetes Mellitus" por meio da metodologia Dader / Drug use study in patients wuth diabetes and hypertension from the "Diabetes Mellitus" extension program using Dader methodology

Introdução: o Estudo do Uso de Medicamentos representa uma importante ferramenta na gestão da Assistência Farmacêutica, principalmente no que diz respeito às patologias crônicas, tais como Diabetes Mellitus tipo II (DM II) e Hipertensão Arterial Sistêmica (HAS). Objetivo: no presente estudo buscou-se caracterizar o uso de medicamentos pelos pacientes atendidos por um Programa de Extensão Multidisciplinar, por meio de uma pesquisa retrospectiva, transversal, de abordagem quantitativa. Material e método: o levantamento dos dados dos pacientes foi realizado no período de agosto/2015 a maio/2016 utilizando a metodologia DADER. Resultados: a partir destes dados coletados, verificou-se que a maior parte dos pacientes era do sexo masculino, sendo que, a faixa etária com maior frequência em ambos os sexos foi superior a 70 anos. A DM II e HAS foram às patologias mais frequentes, em 13 pacientes avaliados, sendo 10 com dislipidemia, onde aproximadamente 66% apresentavam as três patologias de forma concomitante. Em relação aos medicamentos, os mais utilizados segundo a classificação ATC/WHO 2016 foram os da classe C (cardiovascular) com 28,0%, seguido pelos da classe A (trato alimentar e metabolismo) com 22,7%. O uso de mais que 5 medicamentos ocorreu em 80% dos pacientes, sendo que, foram identificadas 77 potenciais interações medicamentosas. No que diz respeito aos problemas relacionados aos medicamentos (PRM), 8 pacientes apresentaram o PRM 4 (inefetividade quantitativa), baseado na avaliação dos parâmetros clínicos e laboratoriais. Conclusão: a atuação do profissional farmacêutico torna-se essencial para identificar e resolver os PRM ́s, buscando melhorias na qualidade de vida do paciente.

Introduction: the Drug Use Study is an important tool in the management of Pharmaceutical Care, especially in regard to chronic diseases, such as Type II Diabetes Mellitus (T2DM) and Systemic Arterial Hypertension (SAH). Objective: this study aimed to characterize drug use by patients from a Multidisciplinary Extension Program through a retrospective, cross-sectional research, with a quantitative approach. Methodology: patients' data was collected from August2015 to May 2016 using Dader methodology. Results: from the collected data, we found that most patients were male and the most frequent age group in both genders was over 70 years. T2DM and HAS were the most frequent pathologies in 13 patients evaluated; there were 10 with dyslipidemia. In addition, approximately 66% of the sampling had these diseases concomitantly. With respect to drugs, the most used, according to the ATC/WHO 2016, were the class C (cardiovascular) with 28.0%, followed by the Class A (gastrointestinal tract and metabolism) with 22.7%. The use of more than five drugs occurred in 80% of the patients; 77 potential drug interactions were also identified. In what regard the problems related to drugs (PRM), eight patients had the PRM 4 (quantitative ineffectiveness), based on the evaluation of clinical and laboratorial parameters. Conclusion: the pharmacist performance is essential to identify and solve PRM's, seeking for improvements in the patient ́s quality of life.

Study of Drug-Drug Interactions in General Medicine Department of a Tertiary Care Hospital.

Objectives Drug therapy (DT) is growing more complex, thus appropriate drug prescription becomes increasingly challenging. Drug interactions (DI) are one of the important factors that modify the response to a drug. The main objective of this study was to monitor the potentially serious and significant Drug-Drug Interactions (DDIs). Material and methods The number of drugs prescribed for each patient, drugs taken by the patient and the drug interactions were recorded. The interactions between the drugs were assessed using Micromedex software and Stockley’s Drug Interaction. The type and severity of prescription with DDIs was also assessed. Results The number of potential DDIs for the study population was 390 and each prescription had at least one interaction. Of the total potential DDIs (n=390) identified, majority were of moderate severity (n = 257, 65.90%). Most frequent DDI was seen between Metformin + Ranitidine (moderate interaction) in 70 prescriptions (50%) and between Ranitidine + Acetaminophen (minor interaction) in 48 prescriptions (34.29%). The common major interactions were seen between Rabeprazole + Clopidogrel in 4 prescriptions (2.86%), Enalapril + Spironolactone and Ciprofloxacin + Tramadol in 3 prescriptions (2.14%). Conclusion The drug related problems, primarily the drug interactions is a permanent patient related risk in hospitals and the utilization of computer software has become the best way to identify and prevent them.

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.