Percepção de farmacêuticos na implantação do Cuidado Farmacêutico na Atenção Básica / Pharmacists' perceptions on the implementation of Pharmaceutical Care in Primary Care

Resumo O artigo descreve a percepção de 10 farmacêuticos da Atenção Básica (AB) de uma região do município de São Paulo que participaram do processo de implantação do Cuidado Farmacêutico. A partir de uma pesquisa qualitativa com grupos focais e abordagem descritiva, os conteúdos foram analisados utilizando-se a Análise de Conteúdo. Das 52 unidades de registro organizadas em 10 categorias, resultaram três sínteses sobre o processo de implantação do CF. Nesse contexto, foi possível descrever o papel do farmacêutico na AB após a implantação dos serviços clínicos, de modo a identificar suas percepções, dificuldades e avanços. Os resultados demonstraram aspectos positivos, além da necessidade de uma mudança gradual no perfil e nas competências dos farmacêuticos para o desenvolvimento de serviços clínicos, ultrapassando os limites da categoria e dependendo do trabalho em equipe realizado na AB. Logo, os resultados promovem os diferentes papéis dos atores envolvidos nesta prática (usuários, equipe de saúde, gestores e farmacêuticos) e valorizam novas formas de cuidado no SUS.

Abstract The article describes the perception of 10 pharmacists from the Primary Health Care (PHC) of a region in the municipality of São Paulo that participated in the process of implementing the Pharmaceutical Care (PC). Based on qualitative research with focus groups and descriptive approach, contents were reviewed using the Content Analysis. The 52 registration units organized in 10 categories resulted in three summaries about the PC implementation process. In this context, we could describe the role of pharmacists in PHC after the implementation of clinical services, in order to identify their perceptions, difficulties and advances. Results unveiled positive aspects, besides the need for gradual change in the profile and competences of pharmacists to develop clinical services, extrapolating the category boundaries, and depending on the teamwork performed at PHC. Therefore, results promote the different roles of the players involved in this practice (users, health team, managers, and pharmacists), and value new forms of care in the Brazilian Health System (SUS).

Interface entre a saúde mental de crianças e adolescentes e a atuação clínica do farmacêutico: um estudo qualitativo / The interface between child and adolescent mental health and clinical pharmacy: a qualitative study / Interfaz entre la salud mental de niños y adolescentes y la actuación clínica del farmacéutico: un estudio cualitativo

O estudo objetivou analisar a percepção do farmacêutico sobre a sua atuação clínica em Centros de Atenção Psicossocial Infantojuvenil (CAPSi). Foi realizado estudo qualitativo, por meio de entrevistas on-line individuais e semiestruturadas com seis farmacêuticas de CAPSi. As entrevistas foram gravadas, transcritas, analisadas e categorizadas segundo o método de análise de conteúdo. As categorias temáticas foram "Equipe multidisciplinar e as diferentes formas de produção de cuidado", "Inserção do farmacêutico no serviço", "Aspectos que se relacionam ao uso de psicofármacos" e "Nuances do trabalho farmacêutico em rede na infância e adolescência". Os resultados mostram uma gradual mudança de paradigma da atuação do farmacêutico em direção ao cuidado da pessoa em sofrimento mental, culminando em ampla atuação na equipe multidisciplinar. Apesar disso, foi apontada a necessidade de documentos que guiem a atuação clínica deste profissional com o público infantojuvenil.(AU)

This study analyzes pharmacists' perceptions of clinical pharmacy in child and adolescent psychosocial care centers (CAPSi). We conducted a qualitative study with six pharmacists working in CAPSis using online semi-structured interviews. The interviews were recorded, transcribed, analyzed, and categorized using content analysis. The thematic categories were: "Multidisciplinary team and different forms of care delivery"; "The integration of pharmacists into services"; "Aspects linked to the use of psychotropic drugs"; and "The nuances of the network-based approach to pharmaceutical care for children and adolescents". The findings show a gradual shift in the paradigm of clinical pharmacy towards care for people with mental suffering, culminating in pharmacists playing a broad role within a multidisciplinary team. However, the results also highlight the need for documents that provide guidance on pharmaceutical care for children and adolescents.(AU)

El objetivo del estudio fue analizar la percepción del farmacéutico sobre su actuación clínica en Centros de Atención Psicosocial Infantojuvenil (CAPSi). Se realizó un estudio cualitativo, por medio de entrevistas online individuales y semiestructuradas con seis farmacéuticas de CAPSi. Las entrevistas se grabaron, transcribieron, analizaron y categorizaron según el método de análisis de contenido. Las categorías temáticas fueron: Equipo multidisciplinario y las diferentes formas de producción de cuidado"; "La inserción del farmacéutico en el servicio"; "Aspectos relacionados con el uso de psicofármacos"; y "Los matices del trabajo farmacéutico en red en la infancia y adolescencia". Los resultados muestran un cambio gradual de paradigma de la actuación del farmacéutico en dirección hacia el cuidado de la persona en sufrimiento mental, culminando en una amplia actuación en el equipo multidisciplinario. A pesar de ello, se señaló la necesidad de documentos que guíen la actuación clínica de este profesional con el público infantojuvenil.(AU)

Understanding the provision of a clinical service in mental health and the role of the pharmacist: a qualitative analysis / Compreendendo a provisão de um serviço clínico na saúde mental e o papel do farmacêutico: uma análise qualitativa / Comprender la prestación de un servicio clínico en salud mental y el papel del farmacéutico: un análisis cualitativo

Pharmacists have important roles in mental health disease; however, their performance in Brazilian Psychosocial Care Centers (CAPS) is unknown. This qualitative study was conducted in a CAPS, Brazil; using interviews and analyzes from the perspective of Bardin, in which categories arising from the perceptions of patients and the health team emerged in relation to the provision of the medication review with follow up (MR) service and the role of the pharmacist in mental health. According to the participants, the MR service is essential and important because it allows professional recognition, beyond the identification of professional attributes of the pharmacists. Moreover, there was a duality in the pharmacist's role between the logistic and clinical attributes of mental health. Thus, this perception helps to elucidate the pharmacist's process of work in mental health and supports future strategies of action in this area. (AU)

Farmacêuticos têm papéis importantes na área da saúde mental; entretanto, sua atuação nos Centros de Atenção Psicossociais (CAPS) brasileiros é desconhecida. Este estudo qualitativo foi realizado em um CAPS, Brasil; utilizando-se de entrevistas e análises sob a perspectiva de Bardin, no qual categorias em relação à prestação do serviço de acompanhamento farmacoterapêutico (AFT) e ao papel do farmacêutico na saúde mental emergiram através das percepções dos pacientes e equipe de saúde. Segundo os participantes, o serviço de AFT é essencial e importante porque permite o reconhecimento profissional, além da identificação dos atributos profissionais dos farmacêuticos. Além disso, houve uma dualidade no papel do farmacêutico em relação aos atributos logísticos e clínicos na saúde mental. Assim, essas percepções ajudam a elucidar o processo de trabalho do farmacêutico em saúde mental, subsidiando futuras estratégias de ação nesta área. (AU)

Los farmacéuticos tienen un papel importante en el área de la salud mental; sin embargo, se desconoce su desempeño en los Centros de Atención Psicosocial de Brasil (CAPS). Este estudio cualitativo se llevó a cabo en un CAPS, Brasil; utilizando entrevistas y análisis desde la perspectiva de Bardin, en las que de las percepciones de los pacientes y del equipo de salud surgieron categorías en relación a la prestación del servicio de seguimento farmacoterapéutico (SFT) y el papel del farmacéutico en la salud mental. Según los participantes, el servicio de SFT es fundamental e importante. Además, existía una dualidad en el rol del farmacéutico en relación a los atributos logísticos y clínicos en salud mental. Así, estas percepciones ayudan a dilucidar el proceso de trabajo del farmacéutico en salud mental, apoyando futuras estrategias de actuación. (AU)

Impact of discharge medication counseling in the cardiology unit of a tertiary hospital in Brazil: A randomized controlled trial

OBJECTIVES: This study aimed to evaluate the impact of pharmacist-provided discharge counseling on mortality rate, hospital readmissions, emergency department visits, and medication adherence at 30 days post discharge. METHODS: This randomized controlled trial was approved by the local ethics committee and included patients aged 18 years or older admitted to the cardiology ward of a Brazilian tertiary hospital. The intervention group received a pharmacist-led medication counseling session at discharge and a telephone follow-up three and 15 days after discharge. The outcomes included the number of deaths, hospital readmissions, emergency department visits, and medication adherence. All outcomes were evaluated during a pharmacist-led ambulatory consultation performed 30 days after discharge. RESULTS: Of 133 patients, 104 were included in the analysis (51 and 53 in the intervention and control groups, respectively). The intervention group had a lower overall readmission rate, number of emergency department visits, and mortality rate, but the differences were not statistically significant (p>0.05). However, the intervention group had a significantly lower readmission rate related to heart disease (0% vs. 11.3%, p=0.027), despite the small sample size. Furthermore, medication counseling contributed significantly to improved medication adherence according to three different tools (p<0.05). CONCLUSIONS: Pharmacist-provided discharge medication counseling resulted in better medication adherence scores and a lower incidence of cardiovascular-associated hospital readmissions, thus representing a useful service for cardiology patients.

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.

Knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city.

OBJECTIVES: This study was done to find out the knowledge and attitudes of pharmacists regarding oral health care and oral hygiene products in Chennai city. MATERIALS AND METHODS: A cross-sectional survey among a sample of the pharmacists in Chennai city was done and data regarding their knowledge and attitudes towards oral health care and oral hygiene products were obtained using a closed-ended questionnaire. RESULTS: Among the 60 pharmacies approached, 50 pharmacists participated in the study and completed the questionnaire. Though 48% of the participants gave a positive answer when asked whether they had met the dentist practicing close to their pharmacies, the frequency with which they met the dentist ranged from once a week (24%) to once a month (28%). Most of the pharmacists stocked oral health-related products, which comprised 15-25% of their total stock. Of these products toothpaste was the most common (62%), followed by mouth rinses (12%). Toothache or painful teeth was the most common dental problem (78%) for which patients approached the pharmacists for advice. With regard to the advice given, 38.5% of the pharmacists asked the patient to consult a nearby dentist after dispensing medications, while 22.4% of the pharmacists dispensed antibiotics and painkillers without any referral. Seventy percent of the pharmacists expressed interest in giving oral health care advice to patients. However, many of them (38%) felt that lack of proper knowledge is a barrier to providing oral health care advice. CONCLUSION: It is clear from the present study that pharmacists are presently an underutilized resource, and there is a definitive need to improve their training and access to information on available dental services.

Knowledge, attitudes and practices (KAP) regarding the management of diarrhea by pharmacists and licensed drug sellers in eastern Nepal.

Diarrhea constitutes a major cause of morbidity and mortality in developing countries. Inappropriate drug prescribing is common in diarrhea, resulting in an increase in cost and adverse drug reactions. In Nepal, drug sellers often act as the first contact persons for the underprivileged. No information has been available regarding their knowledge, attitudes and practices (KAP) regarding diarrhea management. Using a structured questionnaire, between the 1st of January and the 31st of December 2003, 109 drug sellers in eastern Nepal were interviewed about their educational status, patient/attendant presentation at the outlet and their advice to patients/attendants. Only 2.7% of drug sellers were qualified in health education. Eighty percent of the patients/attendants sought advice from the drug sellers, only 20% presented to the outlet with prescriptions. The data reveals that about half of them were taking note of the nature of the diarrhea. Although 62 (56.8%) of them were aware of dehydration, only 2 (1.8%) of them knew all three signs of dehydration (dry tongue, non-elastic skin and sunken eyes). Sixty-six (60.5%) of them knew about oral rehydration solution (ORS), its principle and the required period of administration. About 50 to 60% of them were aware of the implications resulting from dehydration from uncontrolled diarrhea and of the importance of ORS in its management. Only 20% of the drug sellers advised ORS alone, otherwise it was dispensed along with drugs, such as antimotility agents (AMA) or metronidazole. As a result of the above findings, it is important to educate the drug sellers by conferring knowledge about the ethical aspects of drugs in the management of diarrhea.

Physicians and pharmacists adherence to presecribing guidelines of controlled psychotropic drugs. A study in private sector, Riyadh, Saudi Arabia

To assess the adherence of physicians and pharmacists in private sector to the guidelines of controlled psychotropic medications [CPM], the practicality of the guidelines and the degree of enforcement and follow-up of these guidelines stipulated by the Ministry of Health. The present study was performed in ten private community pharmacies [PCPs] and six private hospital pharmacies authorized to dispense CPM in Riyadh city. Data collection form was used to assess pharmacy records for CPM, and to collect data on prescription parameters in order to assess whether the prescriptions are properly written and dispensed. A twenty% random sample of prescriptions dispensed in each pharmacy, during January 1999 to September 2001 were collected through a systematic random sampling to assess the degree of physicians and pharmacists compliance to the guidelines laid down by the MOH. The pharmacists' opinions on the practicality of the guidelines and degree of enforcement and follow up were assessed prospectively through questionnaire. An analysis of 2077 prescriptions revealed that 54% of patients were male and the mean age was 37.7 years [ +/- 14.4]. Degree of physicians' adherence to guidelines was poor in documenting patient's full name in the prescription [12,5%], use of generic name of the drug when prescribing [12.1%], duration of treatment [22.4%] and quantity to be dispensed were specified in 52.2% of prescriptions. Moreover, prescribing drugs in class 1 and 2 for maximum of two weeks was observed only in 3.1% of prescriptions. Pharmacists documented the details of prescriptions dispensed in 90.5% and stamped 76.4% of prescriptions dispensed. Furthermore, the pharmacist write his/her name and sign the prescription upon dispensing in 62.7% of situations and in 7% of situations pharmacists dispensed prescriptions after the seven days period. About 69% of pharmacies were inspected only once during the year 2001 and prescriptions were repeated for the same patients within 14 days period in 3% of prescriptions. The most commonly prescribed drugs are alprazolam [41.6%], bromazepam [16.1%], diazepam [9.2%] and chlordiazepoxide [8.8%]. Several recommendations emerged from this study that could help MOH to gain better insight to control CPM. The MOH should review the current guidelines to address the problems raised by pharmacists, distribute the guidelines to all pharmacies, improve the inspection process, introduce electronic prescribing for CPM, and setting up a national computer network. The MOH, pharmacists and physicians should agree on the minimum standards of CPM prescription and the documentation procedures, which must be adhered to by both physicians and pharmacists. Finally, a national survey of psychotropic drugs prescribing should be conducted and consumption trend analyzed and compared with other countries