Evaluación de las condiciones estructurales para implementar el seguimiento farmacoterapéutico en farmacias comunitarias cubanas, 2016 / Evaluation of the structural conditions to implement the pharmacotherapy follow-up of the Cuban community pharmacies, 2016

Introducción: El seguimiento farmacoterapéutico es una de las actividades orientadas al paciente que debe desarrollar la farmacia comunitaria para disminuir la morbilidad y la mortalidad asociada al uso de medicamentos. Su implementación representa una oportunidad de optimizar la farmacoterapia y de mejorar la calidad de vida de los pacientes que reciban el servicio. Objetivo: Evaluar las condiciones básicas estructurales para la implementación del servicio de seguimiento farmacoterapéutico en las farmacias comunitarias de los municipios Diez de Octubre y Cerro de la provincia de La Habana. Métodos: Estudio descriptivo transversal realizado en el periodo de febrero-abril de 2016. Se evaluaron 44 farmacias comunitarias del municipio Diez de Octubre y 22 del municipio Cerro. Se empleó una guía de evaluación validada por expertos según Moriyama, que exploró cinco dimensiones y diez aspectos. Resultados: El municipio Cerro fue el menos favorable con menos dimensiones cumplidas. Para los dos municipios la dimensión de menor afectación fue la de recursos materiales y la de mayor la de servicios. Otras dimensiones afectadas fueron las de equipamiento, infraestructura y la de recursos humanos. La farmacia 710 de Diez de Octubre cumplió con la mayoría de las dimensiones evaluadas, excepto el acceso al Portal de la red Infomed. Conclusiones: Las farmacias comunitarias de los municipios Diez de Octubre y Cerro no tienen las condiciones básicas estructurales para implementar el servicio de seguimiento farmacoterapéutico(AU)

Introduction: Pharmacotherapy follow-up is one of the activities aimed to patients that must develop the community pharmacies to reduce morbidity and mortality associated to medications use. Its implementation represents an opportunity to optimize pharmacotherapy and to improve the quality of life for patients receiving the service. Objective: To evaluate the basic structural conditions for the implementation of the service of pharmacotherapy follow-up at the community pharmacies of 10 de Octubre and Cerro municipalities in Havana province. Methods: Descriptive cross-sectional study conducted in the period from February to April 2016. 44 community pharmacies were assessed in 10 de Octubre municipality and 22 in Cerro municipality. It was used a guide for the assessment validated by experts according to Moriyama, that explored five dimensions and ten aspects. Results: Cerro municipality was the least favourable with fewer dimensions accomplished. For both municipalities, the dimension with less affectation was the material resources and the one with greater affectation was services. Other affected dimensions were the equipment, infrastructure and human resources. The pharmacy #710 in 10 de Octubre municipality complied with most of the dimensions assessed, except for the access to INFOMED network´s web page. Conclusions: Community pharmacies of 10 de Octubre and Cerro municipalities do not have basic structural conditions to implement the service of pharmacotherapy follow-up(AU)

Conocimiento sobre el método Dáder de seguimiento farmacoterapéutico en farmacias comunitarias de la ciudad de Sucre / Knowledge of the Dadder method of pharmacotherapeutic follow-up in community pharmacies of the city of Sucre

La presente investigación tuvo la finalidad de conocer y evaluar el conocimiento sobre el método Dáder de seguimiento farmacoterapéutico en farmacias comunitarias del patrimonio histórico de la ciudad de Sucre, ya que es necesario e importante el seguimiento farmacoterapéutico en la población para detectar problemas relacionados con los medicamentos y prevenir como solucionar respuestas negativas asociadas a los medicamentos siendo útil el método Dáder por ser un procedimiento operativo sencillo pero con parámetros fundamentales y bien estructurados para realizar el seguimiento farmacoterapéutico de una forma sistematizada, continuada y documentada para registrar, monitorizar y evaluar los efectos de la farmacoterapia. Las farmacias comunitarias son farmacias privadas de interés público, en el que se accede diariamente a comprar medicamentos, en las que el farmacéutico brinda un servicio individualizado y puede coordinar con el paciente un plan de seguimiento, lo que es diferente en una farmacia hospitalaria en la cual sus acciones son limitadas por el hospital o médicos, y se tomó en cuenta la zona del patrimonio histórico de la ciudad de Sucre ya que es muy concurrida con mucha afluencia de gente y las farmacias tienen mayor gama de productos farmacéuticos e innovadores, lo cual permite realizar seguimiento farmacoterapéutico. Entre los resultados se obtuvo un insuficiente conocimiento del método Dáder de seguimiento farmacoterapéutico en las farmacias comunitarias, dando un valor del 77% (n=27) de los farmacéuticos encuestados de un total de 35 con un conocimiento insuficiente, además se relacionaron el género, edad, cargo profesional del farmacéutico en las farmacias comunitarias y asistencia del farmacéutico a cursos de Seguimiento Farmacoterapéutico, como también el uso del Método Dáder.

The present investigation had the purpose of knowing and evaluating the knowledge about the Dader Method of Pharmacotherapeutic Monitoring in community pharmacies of the historical heritage of the city of Sucre, since it is necessary and important the Pharmacotherapeutic Monitoring in the population to detect problems related to medications and prevent how to solve negative responses associated with medications, the Dader Method being useful because it is a simple operating procedure but with fundamental and well-structured parameters to carry out Pharmacotherapeutic Follow-up in a systematic, continuous and documented way to record, monitor and evaluate the effects of Pharmacotherapy Community pharmacies are private pharmacies of public interest, which are accessed daily to buy medications, in which the pharmacist provides an individualized service and can coordinate with the patient a follow-up plan, which is different in a hospital pharmacy in the which their actions are limited by the hospital or doctors, and the area of the historical heritage of the city of Sucre was taken into account since it isvery busy with a lot of people and pharmacies have a greater range of pharmaceutical and innovative products, which allows pharmacotherapeutic follow-up. Among the results, insufficient knowledge of the Dader Method of Pharmacotherapeutic Follow - up was obtained in community pharmacies, giving a value of 77% (n = 27) of the pharmacists surveyed out of a total of 35 with insufficient knowledge, in addition the gender was related, Age, professional position of the pharmacist in the community pharmacy and assistance of the pharmacist to Pharmacotherapeutic Follow-up courses, as well as the use of the Dader Method.

Avaliação da efetividade do acompanhamento farmacoterapêutico no controle do diabetes mellitus tipo 2 em longo prazo / Evaluation of the effectiveness of pharmacotherapy follow-up in long-term control of diabetes mellitus type 2

Introdução: O número de farmacêuticos que atuam em unidades básicas de saúde é reduzido, dificultando a execução do acompanhamento farmacoterapêutico (AFT) para um elevado número de pacientes. Portanto, deve-se estabelecer um período de execução do AFT, para que muitos pacientes sejam contemplados, contudo são escassos os estudos que avaliam a continuidade do controle da doença após a alta do serviço. Dessa forma, este estudo propôs avaliar o desfecho clínico de pacientes diagnosticados com Diabetes mellitus tipo 2 (DM2) após a alta de um serviço de AFT. Métodos: Estudo de coorte retrospectiva após estudo de intervenção de um acompanhamento farmacoterapêutico, que avaliou 64 pacientes divididos em dois grupos: estudo (participaram de um programa de AFT) e controle (não participaram do programa de AFT). Foram coletados dados clínicos e laboratoriais destes pacientes ao final do programa de AFT (baseline - março/2006 a fevereiro/2007), e nos quatro anos após o término do programa de AFT (março/2007 a agosto/2011). Resultados: Dentre os 64 pacientes, 56 foram incluídos. Nos quatro anos posteriores ao serviço observou-se nove óbitos, sendo seis do grupo controle e três do grupo de estudo (p=0,151). O grupo de estudo manteve os valores de hemoglobina glicada após AFT (HbA1c) (8,5% vs 8,0%, p = 0,082), enquanto que o grupo controle reduziu os valores de hemoglobina glicada (HbA1c) (9,1% vs 8,1%; p = 0,004). O controle da glicemia de jejum (GJ) do grupo de estudo foi mantido após quatro anos (149,5 mg/dL vs 148,8 mg/dL, p = 0,884), bem como o grupo controle (170,7 mg/dL vs 170,6 mg/dL, p = 0,993), no entanto ao comparar os dois grupos após AFT, o grupo de estudo apresenta valor significativamente menor que o grupo controle (p = 0,047). Conclusão: Apesar das diferenças obtidas entre os grupos com o AFT não permanecerem após quatro anos, os resultados clínicos e laboratoriais não apresentaram piora significativa nesse período. (AU)

Introduction: The number of pharmacists working at primary health care units is small, which means that pharmacotherapy follow-up (PFU) cannot be offered to a high number of patients. An established period of PFU could then lead to more patients being treated. However, studies assessing management of chronic diseases after discharge from this service are scarce. Thus, this study evaluated clinical outcomes of patients diagnosed with diabetes mellitus type 2 (DM2) after PFU discharge. Methods: This retrospective cohort study was conducted after a PFU intervention study, which evaluated 64 patients divided into two groups: study (who participated in a PFU program) and control (who did not participate in a PFU program). Laboratory and clinical data were collected from these patients at the end of the program (baseline ­ March 2006 to February 2007) and for four years after the end of the program (March 2007 to August 2011). Results: Of 64 patients, 56 were enrolled. In four years after discharge, nine patients died, six of them were from the control group and three from the study group (p = 0.151). The study group maintained glycated hemoglobin A (HbA1c) levels after PFU (8.5% vs. 8.0%, p = 0.082), while the control group showed reduced levels (9.1% vs. 8.1%; p = 0.004). Fasting glucose remained under control in the study group (149.5 mg/dL vs. 148.8 mg/dL, p = 0.884) as well as in the control group (170.7 mg/dL vs. 170.6 mg/dL, p = 0.993) after four years. However, when the groups were compared after PFU, the study group showed a significantly lower value than the control group (p = 0.047). Conclusion: Although the differences observed between the groups during PFU did not remain after four years, clinical and laboratory results did not show significant worsening in the period. (AU)

Content design and validation of a Standard Operating Procedure to provide pharmacotherapy follow-up for the elderly in Cuba

ABSTRACT Incorporating methodological tools that allow uniform and standardized development from the clinical pharmacy services to the Pharmaceutical Care practice, is nowadays a necessity. Considering the importance of pharmaceutical care provision to elderly patients, this manuscript introduces the design and content validation of a standard operating procedure to provide pharmacotherapy follow-up to the elderly in nursing homes in Cuba. The procedure was designed based on a deep analysis of documents relative to experiences focused on holistic care to elderly patients, criteria for the identification and assessment of potentially inappropriate prescriptions and the relationship between functional geriatric evaluation and the use of drugs. The content validation was conducted by a panel of experts, using the Delphi methodology, through two working sessions. In addition, we used Likert-type scale to evaluate the procedure by experts, in line with the indicators described. In general, the criteria issued by the experts were very appropriate and allowed us to modify, add or keep several elements of the instrument for the final version. The findings demonstrated that the instrument can be used at any level of health care.

Quality of life perception of type 1 diabetic patients treated with insulin analogs and receiving medication review with follow-up in a public health care service from Ponta Grossa-PR, Brazil

ABSTRACT Glycemic control in patients with diabetes mellitus type 1 (DM1) reduces the risk of complications but requires a rigorous health care routine. Thus, diabetes education is central to increasing treatment compliance and self-care practices. This study aimed to evaluate the quality of life (QoL) and glycemic control of DM1 patients being treated with insulin analogs and receiving medication review with follow-up. This was a transversal study that included 110 patients registered at the 3rd Health Regional of Ponta Grossa-PR, aged ≥ 18 years, and receiving pharmaceutical care for at least 1 year. The Diabetes Quality of Life Measure (DQOL)-Brazil was used to evaluate QoL. The data were statistically analyzed using SPSS version 17.0 with 95% confidence levels. Of the 110 patients, 58.2% were women. The average age was 33.7 years (±10.5), and the average glycated hemoglobin (HbA1c) value was 8% (±1.4). The mean total DQOL-Brazil score was 2.11 (95% confidence interval, 2.02 - 2.21). All DQOL-Brazil scores were lower in patients with HbA1c ≤ 8%, indicating a better QoL. Good glycemic control, thus, appears to have a positive influence on the QoL, and pharmaceutical interventions are able to contribute to the achievement of therapeutic targets.

Pharmaceutical care as a strategy to improve the safety and effectiveness of patients? pharmacotherapy at a pharmacy school: a practical proposal

Several patients experience at least one drug-related problem and Pharmaceutical Care can change this reality. This work describes a model for structuring the pharmaceutical care service at a pharmacy training unit of the Brazilian Public Health System based on pharmacotherapy follow-up program of Parkinson’s disease patients’ results. From the follow-up results (phase 1), a Therapy Management Scheme was designed (phase 2). Of the 57 patients followed-up, 30 presented at least one drug-related problem and 42% were non-adherent to treatment, which supported the need of pharmacotherapy management. The Pharmacotherapy Management Scheme was proposed as a pharmaceutical care service model, which presents 6 steps: first, the pharmacist fills out the dispensing form and assesses patient´s pharmacotherapy, if there is a suspect problem, he is invited to the follow-up (steps 1 and 2) and they agree the first appointment. After that, pharmacist studies the patient’s case (study phase, steps 3 and 4). At the second meeting, the pharmacist proposes the intervention needed, and at the third, assesses the intervention results and new problems (steps 5 and 6, respectively). The process ends when all therapeutics outcomes are reached. This practical model can significantly contributed to the development and organization of pharmaceutical care services.

Muitos pacientes vivenciam pelo menos um problema relacionado ao medicamento e à atenção farmacêutica pode mudar este fato. Este trabalho descreve um modelo para estruturar o serviço de atenção farmacêutica numa farmácia escola do Sistema Único de Saúde brasileiro baseado nos resultados de um programa de seguimento farmacoterapêutico de pacientes com Doença de Parkinson. A partir dos resultados do seguimento, um esquema de gerenciamento da farmacoterapia foi desenhado. Dos 57 pacientes acompanhados, 30 apresentaram um problema relacionado ao medicamento e 42% não aderiram ao tratamento, o que reforça a necessidade de gerenciar a farmacoterapia. O esquema proposto apresenta 6 passos: primeiro, o farmacêutico preenche o formulário de dispensação e avalia a farmacoterapia do paciente; caso haja suspeita de um problema, ele é convidado a participar do seguimento farmacoterapêutico (passos 1 e 2) e marcam a primeira consulta. Após esta, o farmacêutico estuda o caso (fase de estudo, passos 3 e 4). Na segunda consulta, o farmacêutico propõe as intervenções necessárias e, na terceira, avalia seus resultados e novos problemas (passos 5 e 6, respectivamente). O processo termina quando todos os objetivos terapêuticos são alcançados. Este modelo de prática pode contribuir significativamente para o desenvolvimento e organização de serviços de atenção farmacêutica.

Impacto de un servicio de seguimiento farmacoterapéutico implementado a pacientes con diabetes mellitus tipo 2 / Impact of a pharmaceutical follow-up service implemented in type 2 diabetes mellitus patients

Se evaluó el impacto de un servicio de seguimiento farmacoterapéutico implementado a 30 pacientes con diabetes mellitus tipo 2, dispensarizados en la Farmacia Principal Municipal Santiago de Cuba, según la metodología Dáder, en el período comprendido desde enero del 2009 hasta enero de 2010. El índice de impacto de la estabilidad clínica de los pacientes resultó moderado, mientras que en las intervenciones farmacéuticas aceptadas y el nivel de satisfacción de los pacientes, los índices de impacto obtenidos fueron elevados, por lo que el impacto global del servicio de seguimiento farmacoterapéutico implementado para la atención de estos fue considerado alto

The impact of a pharmacotherapy follow-up service was assessed in 30 patients dispensarized in municipal main drugstore of Santiago de Cuba according to Dáder's methodology from January, 2009 to January, 2010. The level of the clinical stability impact of patients was qualified as moderate, whereas in the accepted pharmaceutical interventions and at level of patient's satisfaction, the rates of impact achieved were high thus; the global above mentioned service repercussion was also qualified as high