Acceptability and consumers' willingness to pay for comprehensive medication management services in Brazil.

Aim: Comprehensive medication management (CMM) is a clinical service that aims to optimize the therapeutic results of patients at the individual level. Studies carried out in Brazil and in several parts of the world have found a positive impact of the service, mainly in the resolution of drug therapy problems and in improving clinical outcomes and patients' quality of life. This service is not widespread and its acceptability and willingness to pay were not defined by the population yet. Objective: This work aims to conduct a study with users of private health services to determine the acceptability and willingness to pay for CMM services. Methods: This is a cross-sectional survey conducted through face-to-face interviews, among residents over 18 years of age of the metropolitan region of Belo Horizonte, capital of Minas Gerais State, Brazil. Results: For this study, 563 individuals were interviewed. Most respondents were female (55.1%), had completed high school (46.8%) and were employed (62.5%). The acceptability for the service was 93,25%, and among all respondents, 37 would not accept the service even if it was free. The amount of consumers' willingness to pay for the CMM service was estimated at $17.75 (40.00 BRL). Conclusion: The research results show that most people are willing to pay for the CMM service. This study can contribute to the decision-making regarding the implementation and pricing of the service in Brazil.

Interprofessional education for shared decision making in drug therapy: a scoping review.

The current complex scenario of medication use calls for the implementation of interprofessional education (IPE) initiatives focused on shared decision making (SDM) in drug therapy. A scoping review was conducted to collate, summarize, and report the evidence available on IPE teaching and learning approaches in this context, involving pre-licensure healthcare students. Searches were conducted in seven electronic databases, with 21 articles meeting the inclusion criteria. This review examines educational strategies employed for interprofessional SDM as well as characteristics of students, teachers, and tutors involved in IPE interventions. The reviewed studies lack detailed description of the students' decision-making process, and none addresses aspects related to patient preferences as a part of learning outcomes. We identified shortcomings in how IPE interventions are assessed and reported. Only a few of the studies explicitly describe the use of competency-based frameworks proposed by national and international organizations, and less than 60% describe learning outcomes. The absence of experiences focused on interprofessional SDM in drug therapy suggests a gap that needs to be addressed with future studies evaluated in a robust way. We argue that such experiences enable students, as a team, to learn to share decisions with the patient as an effective team member.

The Medication Experience of TB/HIV Coinfected Patients: Qualitative Study.

Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy and the stigma related to both diseases are complex. The patients' subjective experiences with diseases and medications are of utmost importance in pharmaceutical care practice. This study aimed to understand the subjective medication experience of TB and HIV/AIDS coinfected patients. The study was based on descriptive research of a qualitative and quantitative nature using data collected during pharmaceutical care appointments and from medical records from September 2015 to December 2016 at a tertiary infectious diseases referral hospital in Southeastern Brazil. Data from 81 patients were analyzed. Regarding patient subjective medication experience, the following responses to the quantitative questionnaire were most frequent: preference for a route of administration (12.4%) and for non-pharmacological therapy (50.6%); concerns about price (11.1%) and adverse effects (18.5%); and association of a worsening of their health status with a change in medication dosage (23.5%). In the thematic analysis, adversity and socially constructed aspects were more prominent. Resolvability, associated with the patient's understanding of relief from signs and symptoms and health recovery, was observed; however, feelings of ambivalence permeated the other aspects, hence leading to treatment abandonment. The evaluation of patient medication experience can be a path to understanding and intervening in the phenomenon of treatment abandonment among TB and HIV/AIDS coinfected individuals.

Implementation and Effectiveness of a Pharmacotherapeutic Follow-Up Service for People with Tuberculosis in Primary Healthcare.

Tuberculosis (TB) is a disease of great relevance, responsible for 1.5 million deaths worldwide. Therefore, actions to control TB are necessary, and pharmacists may play an important role, especially in primary healthcare (PHC), where the diagnosis and management of this infection occurs. In a large Brazilian city, pharmacotherapeutic follow-up in PHC has been offered by pharmacists to people with TB since 2018. The objective of this study was to evaluate the implementation and effectiveness of this service though a longitudinal type 1 effectiveness-implementation hybrid study. Data were collected from January 2018 to February 2020 in the pharmaceutical services system. The service indicators were described and effectiveness was evaluated using Poisson regression analysis to compare the incidence of cure among patients using and not using the service. The service was performed in 148 PHC units by 82 pharmacists. Of the total of 1076 treatments, 721 were followed up by pharmacists, and TB was cured more frequently in these cases (90.4% attended vs. 73.5% unattended). The adjusted hazard ratio of cure among patients enrolled in the pharmacotherapeutic follow-up service was 2.71 (2.04-3.61; p < 0.001). Pharmacotherapeutic follow-up for people with TB significantly increased the incidence of cure and should be encouraged.

Assessment of Pharmaceutical Services for Smoking Cessation: An Effectiveness-Implementation Hybrid Study.

Smoking is the main preventable cause of illness and early death worldwide. Thus, it is better to promote smoking cessation than to treat tobacco-related diseases. The objective of this study was to assess the implementation and effectiveness of smoking cessation pharmaceutical services offered in primary health care (PHC) in a large Brazilian city through a type 1 effectiveness-implementation hybrid study. The services were offered through individual or group approaches (Jan/2018-Dec/2019). The service indicators were described and the incidence of cessation in the services was evaluated. Factors associated with cessation were assessed by Poisson regression analysis. The services were offered in most PHC centers (61.2%) and by most pharmacists (81.3%). In total, 170 individual (9.7%) and 1591 group (90.3%) approaches occurred, leading to cessation in 39.4% (n = 67) and 44.8% (n = 712) of these, respectively. The use of nicotine plus antidepressants (RR = 1.30; 95%CI = 1.08-1.57; p = 0.006) and the number of sessions with pharmacists (RR = 1.21; 95%CI = 1.19-1.23; p < 0.001) were positively associated with cessation; a very high level of dependence was negatively associated (RR = 0.77; 95%CI = 0.67-0.89; p = 0.001). The smoking cessation services were effective and should be encouraged.

The Lived Experience of Patients Utilizing Second-Generation Direct-Acting Antiviral for Treatment of Chronic Hepatitis C Virus Infection: A Phenomenological Analysis.

Hepatitis C is a global public health problem, and the aim of this study was to understand the experiences of patients with hepatitis C using second-generation antivirals. In-depth interviews were conducted with ten outpatients, cognitively capable of reporting their experience, followed up at a university clinic. Field diaries kept during the interviews were also used. The researchers carried out a thematic analysis to identify the ways in which individuals experienced their medication; then, these ways were reorganized to encompass the essential structures of the experience. The patients experienced the use of DAAs as providing resolution and it was permeated by: the experience of time-stagnant time, waiting for medication and the cure; the experience of spaces, understood as necessary and imposed spaces; the experience of relationships with others, personified by the support provided by healthcare professionals; the experience of sexuality, when patients developed several coping strategies to deal with the challenges imposed by the treatment. To conclude, increasing the knowledge about the patients' experiences can contribute to improve the healthcare model for hepatitis C, since several patients have severe hepatic impairment, and the eradication of the virus is only one of the stages of patients' treatments.

Factors associated with the identification of drug therapy problems among older patients in Primary Health Care.

OBJECTIVE: To determine the frequency of drug therapy problems among older adults in Primary Health Care, and to analyze the factors associated with their identification in the initial patient assessment, carried out by pharmacists offering medication therapy management services. METHODS: A cross-sectional study conducted with data from 758 older adults followed up in medication therapy management services in Primary Health Care in the cities of Belo Horizonte, Betim, and Lagoa Santa (MG, Brazil). Univariate and multivariate analyses were performed to evaluate the factors associated with identification of four or more drug therapy problems in the initial clinical assessment. RESULTS: A total of 1,683 drug therapy problems were identified, 73.6% of older patients had at least one problem. The most frequent problems were nonadherence (23.0%) and the need for additional drug therapy (18.0%). Polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and aged 75 years or older remained positively and statistically associated with identification of four or more drug therapy problems (p<0.05). CONCLUSION: There is a high frequency of problems related to medication use among older users of Primary Health Care, and the medication therapy management services should be prioritized to the older patients, who present with polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and age ≥ 75 years, since they are more likely to have more drug therapy problems.

A pilot integrated qualification program to improve medication use in a long-term care facility: a hybrid effectiveness-implementation study

Objective: to describe the implementation and to assess the effectiveness of a pilot integrated qualification program to improve the medication use in a long-term care facility (LTCF). Methods: This was a type 1 hybrid effectiveness-implementation study. A pilot integrated qualification program to improve the medication use in a LTCF was carried out by implementing a new drug distribution system and a comprehensive medication management (CMM) service according to the following four steps: I) implementation of the drug distribution system followed by the evaluation of the health team's opinion; II) prescription review with the identification of potential drug therapy problems (PDTPs); III) provision of the CMM service according to the framework of Pharmaceutical Care practice within one year; and, IV) evaluation of the effectiveness of the program through the comparison of clinical and laboratory parameters (blood pressure, glycated hemoglobin and lipid fractions) using the t-test or Wilcoxon signed-rank test. Results: In step I, the distribution system was fully outsourced to a company that furnished all solid oral dosage forms in individual boxes containing a plastic coil with multiple envelopes for 30 days. In step II, 180 PDTPs were identified, and all patients presented with at least one of them. In step III, after the first assessment of the CMM Service, 43 actual drug therapy problems (DTPs) were identified. After one year of service provision, 96 DTPs were identified and 75.8% of them were resolved (n=72). In step IV, a statistically significant difference was observed between the initial and final minimum and maximum systolic and diastolic blood pressure (p<0,05). Conclusions: The pilot integrated qualification program had a positive impact on the clinical parameters. The global population is rapidly aging, making this type of study important to exemplify a multifaceted strategy to improve the quality of drug therapy for institutionalized patients.

Clinical pharmaceutical screening in critical situations in a radioiodine therapy management service.

Radioiodine therapy can be used in differentiated thyroid carcinoma and requires extensive evaluation to ensure effectiveness and safety. Therefore, it is necessary to evaluate all health problems and medications used in the pre-radioiodine therapy period and comprehensive medication managementservices can serve as a screening tool in this context. The present study aims to describe critical clinical situations identified during the initial assessments of a comprehensive medication management service offered to differentiated thyroid carcinoma patients pre-radioiodine therapy, and the pharmaceutical interventions performed to solve them. A descriptive study with regard to the initial ten months of a comprehensive medication management service was carried out in a large oncology hospital (Rio de Janeiro, Brazil). Descriptive analysis was used to describe the critical clinical situations identified, as well as the correspondent drug therapy problems and the type, acceptability, and outcomes of the pharmaceutical interventions performed to solve them. Thirty patients with an average of 45.8 years and 5.1 medications were evaluated. Five critical clinical situations were identified; corresponding to drug therapy problems two(needs additional drug therapy - n = 4) and drug therapy problems four (dosage too low - n = 1). All pharmaceutical interventions were accepted. The comprehensive medication management service provision pre-radioiodine therapy is feasible and represents an important screening strategy.

Autoetnografia colaborativa em tempos de pandemia: uma experiência de ensinoaprendizagem terapêutica e decolonial / Autoetnografía colaborativa en tiempos de pandemia: una experiencia de enseñanza-aprendizaje terapéutica y decolonial / Collaborative autoethnography in pandemic times: a therapeutic and decolonial teachinglearning experience

Esta Autoetnografia colaborativa teve como objetivo compreender a experiência de três estudantes em disciplina de Autoetnografia no programa de pós-graduação na Faculdade de Farmácia da Universidade Federal de Minas Gerais durante o período inicial da pandemia de Covid-19. Para tal, os diários de campo e as produções autoetnográficas dos estudantes - textos, poemas, fotografias, arquivos em áudio e arquivos em vídeo com performances ou dança - foram analisados. Destacaram-se os diversos aspectos terapêuticos e decoloniais que a Autoetnografia oportuniza pelo exercício metacognitivo. A disciplina humanizou o ambiente acadêmico proporcionando interconexão das ciências convencionais com as artes e a cultura. Este trabalho aponta os benefícios da Autoetnografia para a formação de profissionais de saúde críticos e reflexivos, especialmente os farmacêuticos, por promover competências apropriadas ao cuidado centrado na pessoa. (AU)

Esta autoetnografía tuvo el objetivo de comprender la experiencia de tres estudiantes de la asignatura de Autoetnografía en el programa de postgrado en la Facultad de Farmacia de la Universidad Federal de Minas Gerais durante el período inicial de la pandemia de Covid-19. Para ello, se analizaron los diarios de campo y las producciones autoetnográficas de los estudiantes: textos, poemas, fotografías, archivos de audio y archivos de video con performances o danza. Se destacaron los diversos aspectos terapéuticos y decoloniales a los que la Autoetnografía da oportunidad a partir del ejercicio metacognitivo. La asignatura humanizó el ambiente académico, proporcionando interconexión de las ciencias convencionales con las artes y la cultura. Este trabajo señala los beneficios de la Autoetnografía para la formación de profesionales de salud críticos y reflexivos, especialmente los farmacéuticos, por promover competencias apropiadas al cuidado centrado en la persona. (AU)

This collaborative autoethnography aimed to understand the experience of three students in an Autoethnography course in a graduate program at the Minas Gerais Federal University School of Pharmacy during the initial stages of the Covid-19 pandemic. To this end, the students' field journals and autoethnographic data - such as texts, poems, photographs, audio and video files with performances or dance - were analysed. The study highlighted multiple therapeutic and decolonial facets of autoethnography that arise from its metacognitive practice. This course humanized the academic environment, providing interconnectivity of conventional sciences with arts and culture. This research points out the benefits of including autoethnography in the training of health professionals as its critical and reflective features promote cultural and humanistic competences useful to person-centered care, which are very relevant to pharmacists. (AU)

Potentially inappropriate medication use in a comprehensive therapy management service: clinical outcomes and interventions

Abstract This study aimed to describe potentially inappropriate medication (PIM) use according to the Beers criteria among older adults followed in a comprehensive medication management (CMM) service, the pharmacists´ interventions, and the clinical outcomes of PIM use. All older adults in a CMM service delivered in the Brazilian public primary care system were included in the study (n = 389). Two methodological approaches were developed: (I) cross-sectional - prevalence of PIM use and associated factors were identified (univariate analysis - Pearson's chi-square; multivariate - logistic regression); (II) documental analysis of the negative clinical outcomes potentially associated with PIM use and pharmacists' interventions. The prevalence of PIM use was 48.3%, and it was independently and positively associated with the use of ≥ 5 drugs. For 21.3% of PIMs, a potential negative clinical outcome was identified. The most common negative clinical outcome was hypotension (35.1% of the negative outcomes), fractures or diagnosis of osteoporosis (21.1%), and hypoglycemia (14.0%). For most of them (78.9%), an intervention was performed to mitigate harm or discontinue use. A high prevalence of PIM was detected and was associated with polypharmacy. A significant proportion of PIM showed potential negative clinical outcomes that were identified by clinical pharmacists, and the majority of pharmacists' interventions aimed at its mitigation or deprescription. Overall, our findings reinforce the potential of CMM services for reducing PIM use and the occurrence of negative outcomes.

Medicalização da vida nas práticas vinculadas à estratégia saúde da família / Medicalization of life in practices linked to the family health strategy / La médicalisation de la vie dans les pratiques liées à la stratégie santé de la famille / Medicalización de la vida en prácticas vinculadas a la estrategia de salud de la familia

A inclusão dos cuidados em Saúde Mental na Atenção Primária tem ocorrido em diversos países, incluindo o Brasil, para suprir a existência de uma lacuna assistencial. A integração dos serviços é apontada como necessária, mas ao mesmo tempo um grande desafio. O objetivo deste estudo foi realizar a análise exploratória das práticas discursivas sobre o uso dos medicamentos psicotrópicos e das abordagens não farmacológicas para superação de eventos negativos da vida. As entrevistas realizadas com médicos que trabalham na saúde da família, sobre a prática clínica nos cuidados primários em saúde mental, compuseram o corpus da pesquisa. Os dados foram tratados a partir dos pressupostos da análise do discurso. As descrições analíticas foram construídas a partir dos enunciados identificados na formação discursiva da medicalização da vida. Os resultados da análise evidenciaram o pluralismo terapêutico dos psicotrópicos e seus efeitos, com o uso menos frequente das abordagens não farmacológicas; a prescrição exclui tramas sociais mais amplas, captura a potência da vida modulando os comportamentos individuais e coletivos, para que a convivência seja assegurada e legitimada, para garantir o pretenso bem comum.

Inclusion of mental health care into primary care has occurred in several countries, including Brazil, to tackle the lack of assistance. The integration of services is seen as necessary, but at the same time a major challenge. The aim of this study was to conduct an exploratory analysis of discursive practices on the use of psychotropic drugs and non-pharmacological approaches to overcome negative life events. Interviews conducted with physicians working in family health on the clinical practice of primary mental health care made up our research corpus. Data were analyzed based on the assumptions of discourse analysis. The analytical descriptions were built based on the statements identified in the discursive formation of the medicalization of life. The results of the analysis showed the therapeutic pluralism of psychotropics and their effects, less frequently using non-pharmacological approaches. Prescription excludes broader social plots, captures the power of life by modulating individual and collective behavior, so that social life is assured and legitimized, thus ensuring the alleged common good.

L'inclusion des soins de santé mentale dans l'attention primaire se développe dans divers pays, y compris au Brésil, pour combler l'existence d'une lacune assistancielle. L'intégration des services est considérée comme nécessaire, mais également comme un défi. L'objectif de cette étude a été de réaliser l'analyse exploratoire des pratiques discursives sur l'usage des médicaments psychotropes et des approches non pharmacologiques pour surmonter les événements négatifs de la vie. Les entretiens réalisés avec les médecins travaillant en santé familiale à propos de la pratique clinique dans les soins primaires de santé mentale ont composé le corpus de la recherche. Les résultats de l'analyse ont mis en évidence le pluralisme thérapeutique des psychotropes et leurs effets, avec l'usage moins fréquent des approches non pharmacologiques. La prescription exclut des trames sociales plus amples, capture la puissance de la vie en modulant les comportements individuels et collectifs pour que la vie sociale soit assurée et légitimée, pour garantir le prétendu bien commun.

La inclusión de la atención en salud mental en el ámbito de la atención primaria se ha dado en varios países, entre ellos Brasil, para suplir la existencia de un vacío asistencial. La integración de los servicios se considera como necesaria y, al mismo tiempo, como un gran desafío. El objetivo de este estudio fue realizar un análisis exploratorio de las prácticas discursivas sobre el uso de medicamentos psicotrópicos y sobre los abordajes no farmacológicos para superar los eventos negativos de la vida. Las entrevistas a médicos, que trabajan en salud familiar, sobre la práctica clínica en salud mental dentro de la atención primaria, constituyeron el corpus de la investigación. Los datos fueron tratados a partir de los postulados del análisis del discurso. Las descripciones analíticas se construyeron a partir de las declaraciones identificadas en la formación discursiva de la medicalización de la vida. Los resultados del análisis mostraron el pluralismo terapéutico de los psicotrópicos y sus efectos, con un uso menos frecuente de abordajes no farmacológicos, la prescripción excluye tramas sociales más amplias, capta la potencia de la vida modulando os comportamientos individuales y colectivos, para garantizar y legitimar la coexistencia y garantizar el supuesto bien común.

The Subjective Experience of Using Medications: What We Know and the Paths Forward.

Medications can cause bodily changes, where the associated benefits and risks are carefully assessed based on the changes experienced in the phenomenal body. For this reason, the phenomenology of Merleau-Ponty is an important theoretical framework for the study of experience related to the daily use of medications. The aim of this study was to discuss the contribution of a recently developed framework of the general ways people can experience the daily use of medications-resolution, adversity, ambiguity, and irrelevance-and present reflections about the little-understood aspects of this experience. However, some issues raised throughout this article remain open and invite us to further exploration, such as (1) the coexistence of multiple ways of experiencing the use of medications, by the same individual, in a given historical time; (2) the cyclical structure of this experience; (3) the impact of habit and routine on the ways of experiencing the daily use of medications; and (4) the contribution of the concept of existential feelings to this experience and its impact on patients' decision-making. Therefore, the experience with the daily use of medications is a complex and multifaceted phenomenon that directs the decision-making process of patients, impacting health outcomes.

Decision-Making Process in Comprehensive Medication Management Services: From the Understanding to the Development of a Theoretical Model.

In Comprehensive medication management (CMM), the practitioner applies a decision-making method to assess patients' pharmacotherapy in order to identify and solve drug therapy problems. Grounded theory was used to understand how pharmacists make clinical decisions when providing CMM service. Data collection included individual semi structured interviews with 11 pharmacists, observation of clinical case discussions and CMM consultations provided by the participating pharmacists. Two main categories emerged: 1. Understanding the rational method of decision-making: the foundation of the patient care process. 2. Balancing the care equation: the objective and the subjective, which includes a theoretical proposal explaining the pharmacists' decision-making process and the factors that can modify this process. The pharmacotherapy knowledge should guide the anamnesis. Thus, the professional can evaluate the indication, effectiveness, safety and convenience of medications used by the patient. After exploring patients' medication experiences, pharmacists can follow two courses of action: helping the patient overcome barriers to medication use; or matching the pharmacotherapy to the patient's routine. Professional autonomy and absence of the patient at the time of the decision were some factors that influenced the pharmacist's decision. Findings provide a broad understanding of pharmacists' decision-making process during the care of patients using medications. It can be applied as a basis for educational interventions to train professionals on decision-making.

Overview and Prospect of Autoethnography in Pharmacy Education and Practice.

Objective. To provide an overview of autoethnography as a valuable qualitative methodology in the human and health sciences and to endorse its use to answer meaningful research questions in pharmacy education and assist with the preparation of person-centered pharmacists. Findings. Today, pharmacists must participate in the health care system as care providers rather than simply drug dispensers. The call for change, which began with the evolution of clinical pharmacy and continued with the introduction of pharmaceutical care practice in the 1990s, is still proving to be dramatic for the profession. Thus, new problems are surfacing demanding new types of research questions and new ways of answering them. Autoethnography is a qualitative methodology that combines the principles of ethnography and autobiography in a way that highlights researchers' reflexivity and subjectivity. The paper describes autoethnography, its diverse forms (eg, evocative or analytical), the process of producing it, and associated standards of high-quality work. It presents autoethnographies carried out in health care research as well as in pharmacy, pointing to the usefulness of this methodology to produce meaningful investigations that can enrich the preparation of future pharmacists and advance the profession. Summary. Autoethnography is gaining recognition in many disciplines in health care. Even though it is still incipient in pharmacy, autoethnography can expand pharmacy students' and pharmacists' consciousness regarding their own situation and open the possibility for pursuing research that might enhance the lives of others and themselves.

The use of psychotropic medications and non-pharmacological approaches in everyday life: a qualitative study of the lived experience / O uso de medicamentos psicotrópicos e abordagens não farmacológicas na vida cotidiana: um estudo qualitativo da experiência vivida / L'usage de médicaments psychotropes et approches non pharmacologiques dans la vie quotidienne: une étude qualitative de l'experience vécue / El uso de medicamentos psicotrópicos y abordajes no farmacológicos en la vida cotidiana: um estudio cualitativo de la expericncia vivida

Increased consumption of psychotropic drugs has been noted in Brazil and other Western countries in the last few decades for different reasons. The objective of this study was to understand the lived experience of individuals who used psychotropic drugs to cope with the problems faced in daily life. A qualitative study guided by hermeneutic phenomenology was carried out. In-depth interviews were conducted. The experience was grouped into two themes: experience of using psychotropic and the search for non-pharmacological approaches. Psychotropics were considered necessary for regaining a point of equilibrium when the problems faced were recognized as having a high degree of difficulty. In some cases, the drugs were perceived as insufficient for solving the problem, leading or not to the search for alternatives to deal with the difficulty.

O aumento do consumo de psicotrópicos tem sido observado no Brasil e em outros países ocidentais nas últimas décadas, por diferentes razões. O objetivo deste estudo foi compreender a vivência de indivíduos que utilizaram psicotrópicos para lidar com os problemas enfrentados no cotidiano. Um estudo qualitativo guiado pela fenomenologia hermenêutica foi realizado, agrupando-se o resultado em dois temas: experiência com o uso dos psicotrópicos e busca por abordagens não farmacológicas. Os psicotrópicos foram considerados necessários para recuperar um ponto de equilíbrio quando se reconheceram os problemas enfrentados como tendo alto grau de dificuldade. Em alguns casos, os fármacos foram percebidos como insuficientes para solucionar o problema, levando ou não à busca de alternativas para lidar com as dificuldades.

Au cours des dernières décennies, on a observé l'augmentation de la consommation de médicaments psychotropes au Brésil et dans d'autres pays occidentaux pour différentes raisons. L'objectif de cette étude est de comprendre le vécu d'individus qui ont utilisé les psychotropes pour faire face aux problèmes de la vie quotidienne. Une étude qualitative, guidée par la phénoménologie herméneutique, a été réalisée. Le résultat a été divisé en deux thèmes: l'expérience découlant de l'usage de psychotropes et la recherche d'approches non pharmacologiques. Les psychotropes ont été considérés nécessaires pour récupérer un point d'équilibre lorsque les problèmes vécus ont été reconnus comme ayant un degré élevé de difficulté. Dans certains cas, les médicaments se sont révélés insuffisants pour résoudre le problème, entraînant ou pas la recherche d'alternatives pour faire face aux difficultés.

En las últimas décadas y por diferentes razones, se ha observado en Brasil y en otros países occidentales un aumento en el consumo de psicotrópicos. El objetivo de este estudio fue comprender la vivencia de individuos que utilizaron psicotrópicos para enfrentar los problemas del día a día. Se realizó un estudio cualitativo dirigido por la fenomenología hermenéutica. El resultado fue agrupado en dos temas: experiencia con el uso de los psicotrópicos y la búsqueda de enfoques no farmacológicos. Los psicotrópicos fueron considerados necesarios para recuperar un punto de equilibrio cuando los problemas enfrentados fueron reconocidos como problemas de alto grado de dificultad. En algunos casos, los fármacos fueron percibidos como insuficientes para solucionar el problema, llevando o no a la búsqueda de alternativas para enfrentar las dificultades.

In den letzten Jahrzehnten wird ein steigender Konsum von Psychotropika in Brasilien und in anderen westlichen Ländern festgestellt, der auf verschiedenen Faktoren beruht. Ziel dieser Untersuchung war es, die Lebensweise von Personen zu verstehen, die psychotropische Medikamente benutzen, um Alltagsprobleme zu meistern. Basierend auf der hermeneutischen Phänomenologie wurde dazu eine qualitative Untersuchung durchgeführt. Das Ergebnis wurde in zwei Themen eingeteilt: Erfahrungen mit der Benutzung von Psychotropika und die Suche nach nicht-pharmakologischen Ansätzen. Die Psychotropika wurden als notwendig betrachtet, um ein Gleichgewicht wiederherzustellen, wenn Probleme mit hohem Schwierigkeitsgrad zu meistern waren. In einigen Fällen wurden diese als unzureichend empfunden, was zur Suche nach Alternativen führte, um mit diesen Problemen umzugehen.

Clinical Results of Comprehensive Medication Management Services in Primary Care in Belo Horizonte.

The high prevalence of chronic diseases and use of multiple medications identified in Primary Health Care (PHC) suggest the need for the implementation of Comprehensive Medication Management (CMM) services. This study aimed to evaluate the clinical results of CMM services in a Brazilian PHC setting. A quasi-experimental study was performed with patients followed-up for two years (n = 90). Factors associated with the detection of four drug therapy problems (DTP) or more in the initial assessment were evaluated (univariate and multivariate analyses), as well as the clinical impact observed in laboratory parameters (HbA1c, Blood Pressure, LDL- and HDL-covariance analysis). A predominance of women (61.1%), a mean age of 65.5 years, and a prevalence of polypharmacy (87.8%)-use of five or more drugs-were observed. A total of 441 DTP was identified, 252 required interventions with the prescriber, 67.9% of which were accepted and 59.6% were solved. The main DTP were 'non-adherence' (28.1%), 'need for additional drug therapy' (21.8%), and 'low dose' (19.5%). Hypertension was positively associated with the identification of four DTP or more. A statistically significant reduction was detected in all assessed laboratory parameters (p < 0.05). CMM services contributed to the resolution of DTP and improved clinical outcomes.

Development and validation of a logic model for comprehensive medication management services.

OBJECTIVES: To develop and validate a theoretical logic model for comprehensive medication management (CMM) services. METHODS: The components of a logic model were constructed after a literature review and interviews with 4 CMM professionals. To validate the logic model, a panel of 17 CMM experts participated in three online Delphi method rounds to achieve consensus on the model. The consensus between the experts on each component of the logic model was evaluated using the Content Validity Index and Inter-rater Agreement in each of the rounds. KEY FINDINGS: A logic model for CMM services containing 51 items was constructed and validated. Both the items of each component of the model and the linkage between the main components were agreed upon among the experts. CONCLUSIONS: A logic model for CMM services was developed and validated. It is an innovative tool that, if used as a theoretical framework for the implementation of CMM, can ensure greater reproducibility of CMM services in different scenarios of practice and levels of care.

Competencies for the provision of comprehensive medication management services in an experiential learning project.

OBJECTIVE: To understand students' and tutors' perceptions of the development of clinical competencies for the delivery of comprehensive medication management services in an experiential learning project linked to a Brazilian school of pharmacy. METHODS: An autoethnographic qualitative study was carried out based on participant observation, focus groups and individual interviews with students and tutors involved in an experiential learning project. RESULTS: The study revealed the development of competencies related to the philosophy of practice, the pharmacotherapy workup of drug therapy and interprofessional relationships. CONCLUSIONS: The experiential learning project contributed to the professional development of pharmacy students in pharmaceutical care practice, pointing to its potential benefits for incorporation into professional pharmacy curricula.

The phenomenology of Merleau-Ponty in investigations about medication use: constructing a methodological cascade.

Merleau-Ponty innovated when giving primacy to the body and perception in his philosophical proposal. Within the field of health, his thinking gives us access to the knowledge gained from the corporeality of individuals with chronic diseases. The objective of this study was to expand the understanding of phenomena associated with the daily use of medication, which includes increasingly complex drug regimes, through the lens of Merleau-Ponty. To this end, we described the research steps anchored in his phenomenological philosophy and structured them in the form of a cascade, beginning with the definition of phenomenology as a new form of epistemology, existence as a paradigm, and the body as a theory. Furthermore, the methodology included the use of existential structures, namely, time, space, relationships with others, and sexuality, connected through the intentional arc to reach an understanding of the phenomenon of medication use.