Ensino experiencial na farmácia universitária: um estudo de perspectiva etnográfica na educação / Experiential learning in a university pharmacy: a study adopting the ethnographic approach to education / Enseñanza experiencial en la farmacia universitaria: un estudio de perspectiva etnográfica en la educación

O objetivo deste estudo foi refletir sobre o desafio da formação de identidade profissional do farmacêutico clínico em um contexto de currículo não integrado e em um ambiente tradicional e especializado. Desenvolveu-se uma pesquisa qualitativa orientada pelos pressupostos da perspectiva etnográfica na educação, empregando-se múltiplos métodos de coleta de dados entre abril e julho de 2019. O cenário de ensino experiencial foi uma Farmácia Universitária da região Sul do Brasil. Por meio de uma descrição densa e com uso da reflexividade teórica e intertextual, é apresentada uma narrativa utilizando a voz dos participantes como âncora para dar visibilidade ao processo vivenciado. A ausência de um padrão para o cuidado na profissão farmacêutica, o currículo tradicional e a desarticulação entre teoria e prática constituem desafios para os estudantes de Farmácia legitimarem a prática profissional farmacêutica centrada no usuário.(AU)

The aim of this study was to reflect on the challenge of forming the professional identity of clinical pharmacists in the context of non-integrated curriculums and a traditional specialized environment. We conducted a qualitative study between April and July 2019 guided by the ethnographic approach to education, employing multiple data collection methods. The experiential learning setting was a university pharmacy in the south of Brazil. By means of a thick description and through the use of theoretical and intertextual reflexivity, we present a narrative using the voice of the participants as an anchor to provided visibility to the experienced process. The absence of a standard for the care process in the pharmacy profession, the traditional curriculum, and the lack of connection between theory and practice are challenges facing pharmacy students in legitimizing patient-centered professional practice.(AU)

El objetivo de este estudio fue reflexionar sobre el desafío de la formación de la identidad profesional del farmacéutico clínico en un contexto de currículum no integrado y en un ambiente tradicional y especializado. Se desarrolló una investigación cualitativa orientada por las presuposiciones de la perspectiva etnográfica en la educación, utilizándose múltiples métodos de colecta de datos entre abril y julio de 2019. El escenario de la enseñanza experiencial fue una Farmacia Universitaria de la región sur de Brasil. Por medio de una descripción densa y con el uso de la reflexividad teórica e intertextual se presenta una narrativa que utiliza la voz de los participantes como ancla para dar visibilidad al proceso vivido. La ausencia de un estándar para el proceso de cuidado en la profesión farmacéutica, el currículum tradicional y la desarticulación entre teoría y práctica se constituyen en desafíos para que los estudiantes de Farmacia legitimen la práctica profesional farmacéutica centrada en el usuario.(AU)

The clinical pharmacist's role in a high-cost medicine pharmacy: Patient-centered care

Abstract In Brazil, medicine dispensing is a pharmacy service provided within the national health system that allows the pharmacist to interact directly with the patient in order to prevent, detect and solve problems related to pharmacotherapy and health needs. However, it is known that most dispensing services provided in the country are still limited to supplying medications and, at their finest, offering advice on medication utilization. Attempts to change this scenario present new challenges the area of pharmacy, which involve the need for a patient-centered pharmaceutical service model. This paper describes the patient-centered pharmaceutical service of high-cost medicine dispensing performed at a pharmacy linked to the Brazilian Unified Health System. In the model described here, the medicine-dispensing activity is the pharmacist's main field of practice, which consists of identifying patient needs related to health care itself and medication utilization. It also aims to introduce the instrument developed (a Pharmaceutical Care Protocol) that contributed to implementing this clinical service provided by the pharmacist. The protocols guide and qualify the service by providing information that helps in evaluating the effectiveness and safety of treatments and in the preparation of the care plan and can be used as a basis for other services that intend to adopt clinical pharmacy practices.

Teaching and Learning Pharmacy Services: A Teaching Method for Developing Competencies for Patient-Centered Care Through Experiential Learning in a Real Workplace.

INTRODUCTION: Considering the transformation process that has been occurring in pharmacy education and the urgent need to address social health needs, proposals of teaching methods for the development of competences and skills in patient-centered care have become an issue worth discussing. The study describes and discusses the method that has been used for developing of these competencies through experiential learning in a university pharmacy in Brazil. EDUCATIONAL ACTIVITY: The Teaching and Learning of Pharmacy Services (TLPS) method encompasses 2 components: theoretical-reflexive one (developing protocols covering the patient care process) and practical-reflexive one (using the protocols with real patients). TLPS connects the 2 components in a way to enable students to acquire and apply theoretical knowledge for a comprehensive assessment of the patients' needs and understand how clinical reasoning and decision-making take place. The assessment process is performed, by the supervisor, which evaluates the behaviors necessary for good professional performance. DISCUSSION: The active learning methodologies have been effectively used in the classroom as a way to stimulate critical thinking, problem-solving, and clinical reasoning. However, experiential learning is considered a central point in the learning process and essential for knowledge building. Thus, the method herein described is shown as an innovative tool to promote self-learning, consolidation and interrelation of the acquired knowledge, easier identification of patients' needs, normalization of behaviors, and improvement in the quality of care.

Medication Therapy Management Service for Patients with Parkinson's Disease: A Before-and-After Study.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease characterized by motor manifestations, autonomic and neurological disorders and sensorial symptoms. Medication therapy management (MTM) consists of a service undertaken by pharmacists to optimize pharmacological therapy results. This way, the pharmacist monitors the treatment prescribed by the doctor and formulates a healthcare plan to guarantee the treatment's effectiveness, safety and convenience, thereby improving the patient's quality of life (QoL). OBJECTIVE: To analyze the effect of MTM upon medicine-related problems, motor symptoms, autonomic disorders and QoL of patients with Parkinson's disease, and describe the pharmaceutical interventions. METHODS: Quasi-experimental uncontrolled before-and-after study carried out between September 2012 and March 2013 in a community pharmacy. Pharmacotherapy data were collected from medical prescriptions, patient diaries, medical charts and all the medicines (over-the-counter and prescription) brought by the patients to the appointment with the pharmacist. The medicine-related problems were classified as indication, effectiveness, safety and adherence. Adherence was measured through clinical interviews and the Morisky questionnaire. PD symptoms were assessed according to the patients' and/or caregivers' perceptions about the On/Off state of the motor symptoms and relief of the nonmotor symptoms. QoL was assessed using the PDQ-39 scores. The interventions were targeted to patients/caregivers and/or doctors, with pharmacological and non-pharmacological measures. RESULTS: Seventy patients were followed up, showing a decrease in medicine-related problems (1.67 ± 1.34 to 0.8 ± 0.9 (p < 0.001), positive impact on adherence (from 37 to 10 non-adherent patients, p < 0.001), QoL improvement related to emotional wellbeing (p = 0.012) and autonomic disorder. Most interventions were performed directly with the patients (73.8%), including non-pharmacological guidance (28.5%), pharmacological guidance (24.3%) and rescheduling (13.6%). CONCLUSIONS: To carry out MTM with PD patients, the pharmacist's expertise needs to transcend the technical knowledge about the PD pharmacological treatment. The study showed a positive effect with a decrease in the medicine-related problems after the interventions, especially improving adherence and patients' QoL.

Atenção farmacêutica no contexto da estratégia de saúde da família / Pharmaceutical care in the context of the family health strategy

A assistência farmacêutica, no âmbito do Sistema Único de Saúde (SUS), é muitas vezes realizada com o objetivo primordial de garantir o abastecimento dos medicamentos nas Unidades Locais de Saúde. Freqüentemente, os cuidados com os pacientes e a promoção do uso racional dos medicamentos são marginalizados. Contudo, durante o desenvolvimento do seguimento farmacoterapêutico, são identificados problemas relacionados aos medicamentos (PRM) e dificuldades na adesão ao tratamento farmacológico, os quais estão relacionados a questões familiares e sociais, e têm contribuído para o não-sucesso terapêutico, portanto pontos-chave a serem considerados durante a Atenção Farmacêutica. Foi realizado o seguimento farmacoterapêutico de quatro pacientes atendidos em uma unidade de saúde do município de Florianópolis. Para a resolução dos PRMs, adotou-se abordagem que inclui os contextos familiar e social e, que utiliza ferramentas como o genograma e o ecomapa, além do trabalho interdisciplinar. Observou-se a importância da família e dos grupos de apoio para a resolução dos PRMs e a necessidade do farmacêutico de aprimorar a prática de atenção farmacêutica mediante a utilização de tais ferramentas. Percebeu-se, ainda, a importância das visitas domiciliares para conhecer melhor o ambiente familiar e a necessidade de trabalho interdisciplinar para melhorar a qualidade do atendimento.

The main objective of pharmaceutical policy management within the scope of SUS (Brazilian National Health System) is to guarantee the supply of drugs to local health centers, therefore displacing patient care When drug-related problems (DRP) and difficulties in adhering to the prescribed treatment are identified during the development of pharmaceutical follow-up, family and social issues have been shown to be reasons for unsuccessful treatment. They are key points to be considered during Pharmaceutical Care. The methodology chosen for this study was the pharmaceutical care of four patients monitored in a Health Unit in the city of Florianópolis. To solve drug related problems an approach was adopted that included family and social contexts using tools such as genogramming, ecomapping and interdisciplinary work. Family and support groups were shown to be important in addressing DRPs and there appears to be a need for the pharmacist to improve Pharmaceutical Care Practice by using these tools. The importance of home visits to gain a better understanding of the family environment was also observed, as well as the necessity of interdisciplinary work to improve the quality of care.