Importância do farmacêutico na Atenção Primária / The importance of pharmacists in Primary Care

Objetivo: Verificar a presença do farmacêutico nas Unidades Básicas de Saúde, identificando as classes terapêuticas mais dispensadas e suas condições de armazenamento. Métodos: Estudo de campo, com caráter descritivo e abordagem qualiquantitativa, utilizando Graphpad Prism®, versão 5.03, e o Microsoft Excel 2010. Resultados: O farmacêutico estava ausente nas 96 Unidades Básicas de Saúde estudadas. Por meio de checklist aplicado em 18 Unidades Básicas de Saúde, 8 tinham algum tipo de fonte de calor; 4, umidade; 14 não controlavam temperatura para produtos termolábeis; 8 tinham medicamentos próximos do piso, da parede e do teto; 1 tinha medicamentos sujeitos a controle especial fora de um armário com chave. Todas as Unidades Básicas de Saúde apresentaram descarte correto das medicações vencidas. As classes medicamentosas mais dispensadas foram anti-inflamatórios não esteroides, anti-hipertensivos, antidiabéticos, anticoncepcionais, anti-helmínticos, antibióticos, antifúngicos, inibidores da bomba de prótons e psicotrópicos. Conclusão: A ausência do farmacêutico nas Unidades Básicas de Saúde estudadas possivelmente foi responsável pelas inconformidades nas condições de armazenamento dos medicamentos, regulamentada inclusive por Resolução da Diretoria Colegiada. As classes terapêuticas dispensadas estavam de acordo com o padrão da Atenção Primária, porém a não participação do farmacêutico pode gerar riscos aos pacientes. As autoridades devem se conscientizar da importância da participação desse profissional no ciclo primário de saúde. (AU)

Objective: To verify the availability of pharmacists in the Basic Health Units, and to identify the most dispensed types of drugs, and their storage conditions. Methods: This is a descriptive field study with a qualitative/quantitative approach, using GraphpadPrism ® version 5.03 and Microsoft Excel 2010. Results: The pharmacist was absent in 96 Basic Health Units studied. A checklist applied to the 18 Basic Health Units showed that 8 of them had heat sources; 4, humidity; 14 lacked control of temperature for thermolabile products; 8 kept drugs near the floor, wall, and ceiling; 1 kept prescription drugs out of lockable cabinets; all of them presented correct disposal of expired medications. The most dispensed drug types were: non-steroidal anti-inflammatory drugs (NSAIDs), antihypertensives, antidiabetic drugs, contraceptives, anthelmintics, antibiotics, antifungals, proton pump inhibitors, and psychotropics. Conclusion: The absence of pharmacists in the Basic Health Units studied was possibly responsible for nonconformities in the drugs maintenance conditions, which are regulated by an ANVISA's Board Resolution. The dispensed therapeutic classes are in accordance with the Primary Care standard, but the absence of a pharmacist can lead to risks to the patients. The authorities shall be aware of the importance of the participation of this professional in the primary health cycle. (AU)

Pharmacists in dispensing drugs (PharmDisp): protocol for a clinical trial to test the effectiveness of distance education in training pharmacists for dispensing drugs

ABSTRACT Dispensing drug is a moment in which the pharmacist is able to analyze pharmacotherapy and contribute to its rational use. However, research has shown that some pharmacists lack adequate knowledge to perform this service. This study aims to describe a research protocol for a clinical trial to test the effectiveness of a distance learning program to train pharmacists in dispensing drugs. This is a protocol for an open diagnostic, non-randomized, single group clinical trial. A 12-week duration distance learning course was structured on the Moodle platform for training community pharmacists who are registered in the Regional Board of Pharmacy and work as employees or owners in Brazilian community pharmacies. The course curricula involves concepts and practice of dispensing drugs applied to the treatment of hypertension, diabetes mellitus, dyslipidemia and asthma. Pharmacists are divided randomly into groups, to which previously selected tutors give directions to the discussion and clarify questions. A validated questionnaire is being used before and after the course to measure participants' knowledge. Participant satisfaction with the course is also being measured. Pharmacists who work in the study headquarters municipality receive two visits from a mystery shopper, before and after the course, to evaluate their performance in dispensing drugs. The virtual platform and the content of the course material were evaluated by judges. The study has been approved by the Research Ethics Committee of the School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo. The sample size was estimated to provide desired power for testing the significance of the difference between baseline-to-endpoint change scores. Information about the course is being released through channels such as social networks. The results will be submitted for publication in scientific journals, but information enabling the identification of the study subjects will be kept confidential. The trial has been registered in The Brazilian Clinical Trials Registry with number RBR7mbrp3 on January 15th, 2015.

Evaluation of community pharmacists' involvement in public health activities in Nigeria

The aims of the study were to identify the types, determine the extent of community pharmacists' involvement, and evaluate the factors influencing their participation in public health activities in Nigeria. The study was a cross-sectional survey of randomly selected 130 registered community pharmacies. Pretested questionnaire was the instrument for data collection. Descriptive and inferential statistics were used to analyse data. Response rate was 94.9%. The study identified 31 types of public health activities which community pharmacists participated in. Their extent of involvement was highest in patient counseling (4.93 ± 0.25), personal hygiene (4.90 ± 0.37), maintenance of normal blood pressure (4.88 ± 0.32), and techniques for using vagina pessaries (4.85 ± 0.38). Lowest areas of involvement were elimination of smokeless tobacco use (2.27 ± 1.56), use of seat belts when driving (2.03 ± 1.46), and the need to live in a safe neighborhood (1.42 ± 0.53). Inadequate training (96%), lack of pharmacists' time (94.6%), inadequate personnel (92.3%), lack of patients' time (88.5%), lack of profit (85.4%), inadequate space in the pharmacy (82.3%) and inadequate patients' information (69.9%) significantly influenced their participation. The study concluded that community pharmacists would participate more in public health activities if the identified barriers are reduced.

Purchase of prescription and OTC medicines in Slovakia: factors influencing patients' expectations and satisfaction

ABSTRACT Slovakia is a country where the purchase of OTC (over the counter) medicines outside the pharmacy is not allowed by the government. This study aimed at evaluating patients' satisfaction and acceptance of community pharmacists. Customer's behaviour and expectations influencing the purchase of prescription and OTC medicines were analyzed. A structured questionnaire having 15 multiple-choice questions was used to analyze the descriptive parameters. Data collection lasted from January to February 2014. The sample size consisted of 357 high-school educated individuals under 40 years of age. The survey showed that the prescription and OTC medicines were bought equally. The participants reported a 96.0%, 96.3% and 90.2% satisfaction rate with willingness and approach of the community pharmacist, pharmacy services and provision of drug information respectively. As for the OTC medicines, 89.5% people considered the pharmacist an expert: 88.2% purchased medicines with pharmacist's recommendation, 97.8% needed a professional counselling and 97.2% required a pharmacist's guidance. As for the prescription drugs, only 72.1% considered the pharmacist an expert: 96.3% suggested that physician's prescription was significant and 88.3% considered pharmacist's guidance in the process of selection of prescription medicines nonessential. A comprehensible and respectable conversation was highly expected in regards to both the OTC and prescription medicines.

Recomendações farmacêuticas em unidade de terapia intensiva: três anos de atividades clínicas / Pharmacist recommendations in an intensive care unit: three-year clinical activities

RESUMO Objetivo: Analisar 3 anos de atividades clínicas e recomendações farmacêuticas aceitas durante a rotina diária do farmacêutico na unidade de terapia intensiva clínica adulta. Métodos: Estudo exploratório, descritivo, transversal, realizado no período de junho de 2010 a maio de 2013, em um hospital universitário, terciário, durante o qual foram categorizadas e analisadas as recomendações farmacêuticas. Resultados: Foram analisadas 834 recomendações farmacêuticas (média anual de 278), sendo estas classificadas em 21 categorias. As recomendações farmacêuticas foram dirigidas principalmente a médicos (n = 699; 83,8%), sendo as mais frequentes: manejo de diluição (n = 120; 14,4%), ajuste de dose (n = 100; 12,0%) e manejo de evento adverso a medicamento (n = 91; 10,9%). Comparando-se os períodos, verificou-se crescimento, ao longo dos anos, das recomendações farmacêuticas com maior componente clínico e diminuição daquelas referentes a aspectos logísticos, como a provisão de medicamentos. As recomendações envolveram 948 medicamentos, tendo destaque para os anti-infecciosos de uso sistêmico. Conclusão: A atuação do farmacêutico no cuidado intensivo evoluiu na instituição onde o estudo foi realizado, caminhando das ações reativas associadas à logística para a participação clínica efetiva junto à equipe multiprofissional (ações proativas). .

ABSTRACT Objective: To analyze the clinical activities performed and the accepted pharmacist recommendations made by a pharmacist as a part of his/her daily routine in an adult clinical intensive care unit over a period of three years. Methods: A cross-sectional, descriptive, and exploratory study was conducted at a tertiary university hospital from June 2010 to May 2013, in which pharmacist recommendations were categorized and analyzed. Results: A total of 834 pharmacist recommendations (278 per year, on average) were analyzed and distributed across 21 categories. The recommendations were mainly made to physicians (n = 699; 83.8%) and concerned management of dilutions (n = 120; 14.4%), dose adjustment (n = 100; 12.0%), and adverse drug reactions (n = 91; 10.9%). A comparison per period demonstrated an increase in pharmacist recommendations with larger clinical content and a reduction of recommendations related to logistic aspects, such as drug supply, over time. The recommendations concerned 948 medications, particularly including systemic anti-infectious agents. Conclusion: The role that the pharmacist played in the intensive care unit of the institution where the study was performed evolved, shifting from reactive actions related to logistic aspects to effective clinical participation with the multi-professional staff (proactive actions). .

Pharmaceutical services and health promotion: how far have we gone and how are we faring? Scientific output in pharmaceutical studies

The objective of this study was to investigate the scientific output on health promotion within the pharmaceutical field and its relation with the development of pharmaceutical services within health systems. A comprehensive review of published scientific articles from the Medline and Lilacs databases was carried out. The review comprised articles published until December 2011, and used combinations of the terms 'health promotion' or 'health education' and 'pharmacy', 'pharmacist' or 'pharmaceutical'. The articles were selected according to inclusion and exclusion criteria. A total of 170 full texts and 87 indexed abstracts were analyzed, evidencing that most described actions of health promotion in community pharmacies and other services. Following the Ottawa Charter, most of the studies dealt with new guidance of the service and the supply of pharmaceutical information and services. It was concluded that there is a lack of theoretical background on health promotion in the pharmaceutical field to sustain the professional education and practice required by the health system and the population.

O objetivo do estudo foi investigar a produção científica sobre o desenvolvimento teórico e prático da promoção da saúde na farmácia e sua relação com o desenvolvimento da área e dos serviços farmacêuticos. A revisão integrativa de artigos científicos foi realizada a partir das bases de dados Medline e Lilacs. Ela compreendeu os artigos publicados até dezembro de 2011, através da combinação dos termos 'promoção da saúde ou educação em saúde' e 'farmácia, farmacêutico ou farmacêutica'. Critérios de inclusão e exclusão definiram a seleção dos textos. Ao todo, 170 artigos e 87 resumos foram analisados, sendo a maioria identificada como trabalhos teóricos que relatam atividades descritas como de promoção da saúde em farmácias comunitárias ou outros serviços. Confrontando com o referencial da Carta de Ottawa, a maioria dos estudos revelou ter como campo de investigação principal alguma proposição de reorientação dos serviços de saúde e oferta de informações e práticas farmacêuticas. Conclui-se que há uma carência de embasamento teórico sobre promoção da saúde na área farmacêutica para sustentar a formação e prática profissional, conforme exigido pelo sistema de saúde e pela população.

Restricción de la venta de antibióticos en farmacias de Bogotá, Colombia: estudio descriptivo / Restriction of antibiotic sales in pharmacies in Bogotá, Colombia: a descriptive study

Objetivo. Describir el estado de la aplicación de la norma relacionada con la prohibición dela venta de antibióticos sin prescripción médica en farmacias de Bogotá, Colombia. Métodos. Estudio descriptivo transversal, en el cual se utilizó la técnica de simulación de compra en farmacias (droguerías) de Bogotá. La muestra de 263 farmacias se calculó con una precisión de 5% y un factor de corrección de 2% mediante estratificación (farmacias de cadenae independientes) y asignación aleatoria simple en cada estrato. Resultados. Del total de farmacias estudiadas, 80,3% no cumplen la norma que establecela venta de antibióticos con receta. En 20,1% de los casos, el expendedor indagó la edad del paciente o sus síntomas o ambos, con el fin de ofrecer otros medicamentos o para cambiar elantibiótico. En ninguna oportunidad se preguntó por antecedentes personales de alergia a los antibióticos. En los casos en los cuales hubo intención de venta del antibiótico, la presentación genérica fue la más comúnmente ofrecida (81,2%). Algunos expendedores de medicamentos hicieronrecomendaciones inapropiadas. Las localidades con mayor incumplimiento de la norma coinciden con aquellas que tienen altas tasas de necesidades básicas insatisfechas. Conclusiones. A cinco años de adopción de la norma orientada a contrarrestar la ventalibre de antibióticos, su cumplimiento es mínimo y la entrega no se realiza de acuerdo a los parámetros establecidos. El personal de farmacia no suministra la información requerida de acuerdo con sus competencias.

Objective. Describe the implementation status of a regulation prohibiting antibiotic sales without a medical prescription in pharmacies of Bogotá, Colombia. Methods. A cross-sectional descriptive study was conducted using the simulated purchase technique in Bogotá pharmacies (drugstores). The sample of 263 pharmacies was calculated by stratification (chain pharmacies and independent pharmacies) with 5% accuracy and a 2% correction factor. Simple randomization was assigned in eachstratum. Results. Out of the total pharmacies studied, 80.3% did not comply with the regulation established for prescription sales of antibiotics. In 20.1% of the cases, the dispenser asked about the patient’s age, symptoms, or both age and symptoms in order to offer other drugs or change the antibiotic. There were no inquiries about amedical history of allergy to antibiotics. In cases in which there was the intention to sell antibiotics, the generic format was most commonly offered (81.2%). Some drug dispensers made inappropriate recommendations. The locations with the highest levels of noncompliance with the regulation were also those with high rates of unmetbasic needs. Conclusions. Five years after passage of a regulation to halt the unrestricted sales of antibiotics, there is minimal compliance, and dispensing does not conform to the established parameters. Pharmacy personnel do not provide the required information according to their responsibilities.

Automedicação em profissionais das áreas de enfermagem e farmácia em ambiente hospitalar na cidade de São José do Rio Preto-SP / Self Medication in nursing and pharmacist personnel at in-hospital

Introdução: no Brasil a prática da automedicação é bastante difundida. Atualmente existem vários trabalhosabordando este assunto, porém sem ênfase aos profissionais de saúde que estão em contato direto commedicamentos, bem como poucas campanhas de prevenção a esta prática. Objetivos: verificar a prevalênciada automedicação em profissionais das áreas de enfermagem e farmácia em ambiente hospitalar, utilizandouma pesquisa não experimental descritiva. Materiais e métodos: foram avaliados todos os profissionais daárea farmacêutica do hospital e de enfermagem nos setores de ginecologia e obstetrícia, pediatria, UTIspediátrica, neonatal, semineonatal, semipediátrica e cardiopediátrica, por meio de um instrumento de coletade dados na forma de questionário elaborado pelos próprios pesquisadores tomando como base umquestionário publicado na literatura. O questionário respondido foi colocado em um envelope lacrado e depositado em uma urna disponibilizada pelos pesquisadores. Resultados: Foram avaliados 237 profissionais.A prevalência da automedicação foi de 56%, sendo que 58% eram mulheres de até 41 anos e 37% relataram seautomedicar por achar o problema pouco importante. A maior prevalência foi observada para as enfermeiras(75%). A classe medicamentosa mais utilizada foi o analgésico com 91% de relatos, 27% dos pesquisadosresponderam ter notado algumas reações adversas aos medicamentos. Discussão e conclusão: Os resultadosindicam que a automedicação é uma prática frequente também em profissionais da área da saúde. Aautoconfiança e o descuido com a própria saúde são fatores fundamentais na automedicação desse grupo.

Introdution: In Brazil, the practice of self-medication is widespread. Today, there are several studies to address this issue. Although, they have not focused on the health professionals directly involved with medication, and there have been only a few campaigns to address the prevention of self-medication. Aim: For this reason, this study aimed at the verification of self-medication prevalence among nursing and pharmaceutical professionals at hospitals, employing non-experimental descriptive research. Materials andmethods: We evaluated all the professionals working in the hospital pharmaceutical area, as well as thenursing personnel in the following areas: obstetrics and gynecology, pediatrics, pediatric ICU, neonatal ICU,semi-neonatal ICU, cardio-pediatric ICU, and semi-cardio-pediatric ICU. A questionnaire was used as aninstrument to collect data. It was elaborated by researchers themselves with the aid of a questionnairepublished in the literature. When the questionnaire was completely answered, it was placed in a sealedenvelope and deposited in a ballot-box provided by researchers. Results: It has been evaluated 237 professionals. The prevalence of self-medication was 56%, of which 58% were women up to the age of 41 years. In this study, 37% of the people studied reported self-medicating themselves because they believed their problem was of minor importance. The highest percentage was observed in nurses (75%). Analgesicwas the most commonly used drug, accounting for 91% of the cases, and 27% of the participants noticedadverse reactions to medications. Discussion and conclusion: The results indicate that self-medication among health professionals is a common practice. Over-confidence in medical matters and neglect of their own health are fundamental factors, which lead to self-medication in this group.

Effect of a pharmaceutical care program on quality of life and satisfaction with pharmacy services in patients with type 2 diabetes mellitus / Efeito de um programa de cuidados farmacêuticos na qualidade de vida e satisfação com serviços da farmácia em pacientes com diabetes mellitus tipo 2

The aim is to evaluate the humanistic outcomes in type 2 diabetic patients by the adoption of pharmacotherapy follow-up in community pharmacies. Controlled, non-randomized, 12-months trial; n=161 patients distributed into control and intervention groups; 6 community pharmacies involved, all in the Curitiba city region, in the state of Paraná were used. The health-related quality of life (HRQoL) and the satisfaction index were determined using both the DQOL assessment tool, which measures HRQoL, and the satisfaction evaluation tool (QSSF). Interventions on 119 negative therapeutic outcomes were done (2.3/patient [SD=1.6]); the most commonly found problems were related to ineffectiveness of pharmacotherapy (68.1 percent). The Intervention-Group showed a significant improvement in HRQoL compared with the Control Group (0.08 vs -0.01, respectively; p=0.036). Satisfaction and impact domains presented the most significant improvement (0.13 vs 0.00 [p=0.030] and 0.07 vs -0.04 [p=0.033], respectively). After adjusting for baseline variables, the difference in improvement scores between groups on the QSSF was attributed to the allocation of patients in the intervention group. Pharmacotherapy follow-up of type 2 diabetic patients in community pharmacies can improve the HRQoL and satisfaction of patients.

O objetivo foi avaliar os resultados humanísticos de pacientes com diabetes tipo 2, por meio da adoção de acompanhamento farmacoterapêutico nas farmácias comunitárias. Utilizaram-se: ensaio controlado, não-randomizado, de 12 meses; n=161 pacientes, distribuídos entre Grupo Controle e de Intervenção, e 6 farmácias comunitárias, todas na região da cidade de Curitiba, Estado do Paraná. A qualidade de vida relacionada à saúde (HRQoL) e o índice de satisfação foram determinados utilizando a ferramenta de avaliação DQOL, que mede a HRQoL, e a ferramenta de avaliação da satisfação (QSSF). Intervenções em 119 resultados terapêuticos foram efetuadas (2,3/paciente [SD=1,6]. Os problemas mais comumente encontrados foram aqueles relacionados à ineficácia da farmacoterapia (68,1 por cento). O Grupo de Intervenção mostrou melhoria significativa da HRQoL em comparação ao Grupo Controle (0,08 versus 0,00 [p=0,030 e 0,07 versus -0,04 [p=0,033], respectivamente). Após o ajuste da linha base das variáveis, a diferença na contagem de melhoramento entre os grupos no QSSF foi atribuída à alocação de pacientes no Grupo de Intervenção. O acompanhamento farmacoterapêutico em pacientes de diabetes tipo 2 em farmácias comunitárias pode melhorar a HRQoL e a satisfação dos pacientes.

Perfil dos profissionais farmacêuticos na cidade de Umuarama-PR / Profile of the pharmaceutic professionals inthe city of Umuarama-PR

O estudo teve por objetivo verificar o perfil dos profissionais farmacêuticos em Umuarama-PR. Foi aplicado um questionário padrão aos farmacêuticos responsáveis técnicos pelas farmácias e drogarias da cidade, elaborado com questões fechadas. Realizaram-se entrevistas com 43 farmacêuticos, mediante consentimento expresso individual e aprovado pelo comitê de ética da Universidade Paranaense (UNIPAR). Foram coletados dados pessoais do profissional, dados referentes ao tempo de atuação na área farmacêutica, formação acadêmica, remuneração e tempo de trabalho. Os dados obtidos mostraram um predomínio de profissionais (76,7 por cento) que se graduaram na UNIPAR, sendo que 14,0 por cento e 34,9 por cento, respectivamente homens e mulheres realizaram cursos de especialização em Farmacologia. O fato de os farmacêuticos buscarem atualização profissional, principalmente em farmacologia, mosta a preocupação e o interesse do profissional em estar melhor preparado para enfrentar os desafios da profissão. Os resultados demonstraram que ainda há uma pequena parcela de profissionais que se sujeitam a trabalhar por salários inferiores ao piso, porém importantes conquistas têm se concretizado por farmacêuticos que ousam, acreditam e têm transformado a realidade da sua profissão, como alguns profissionais que mesmo trabalhando por 04 horas recebem um salário acima do piso estabelecido pela categoria