Professionals' and Patients' Perspectives on Criteria for Referring Hypertensive Patients to Comprehensive Medication Management Services in Public Primary Health Care.

Patient prioritization in comprehensive medication management services allows coordinating care and guiding patients according to their clinical profile and their medication use. The aim of the study is to identify and describe factors that indicate the need for comprehensive medication management services among primary care hypertension patients within a public health system from the perspective of patients, pharmacists, nurses and physicians. A qualitative study was carried out with interviews with nurses, pharmacists and physicians (n = 20), and two focus groups with hypertensive patients (n = 12) at primary health care facilities and a public outdoor fitness area between January and February 2019 in Brazil. All interviews were transcribed and analyzed using the Atlas.ti® software. The data analysis revealed the following factors indicative of the need to refer hypertension patients to a pharmacist: lifestyle habits, comorbidities, health care utilization and medication use. The issues identified and the information obtained from the qualitative research and compared with literature studies reviewed allowed defining dimensions that should be considered as an aid in the selection of uncontrolled hypertensive patients for comprehensive medication management services.

Tools to prioritize outpatients for pharmaceutical service: A scoping review.

BACKGROUND: The performance of pharmacists in clinical services contributes to improving outcomes in patient drug therapy. In the context of streamlined resources and high health services' demand, the use of patient selection tools can screen those who would benefit more from a pharmaceutical service. OBJECTIVE: This review aims to map and describe tools developed for patient selection for pharmaceutical services delivered in primary health care and outpatient settings. METHODS: The search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Health Sciences. The search strategy included terms relating to patient selection and outpatient pharmaceutical service. We included papers on outpatient settings, and which described the tool developed for the selection of a patient for pharmaceutical service. Two reviewers extracted data of each study concerning the types and items making up the tool. The items composing the tools were grouped into categories. RESULTS: Twelve studies were included in the literature. Most of the studies were developed in the United States (53.8%), followed by Canada (30.8%). Approximately half of the studies developed tools for selecting patients for a medication review (46.2%), and only 15.4% for drug therapy management. Identification of patients at risk of drug-related problems, the need for pharmaceutical service follow-up, and patients at risk of hospital readmission were the main objective to develop the tools. In total, 92.3% of the developed tools had items related to drug therapy complexity, 76.9% to comorbidities and 61.5% to adherence/subjective aspects. Statistical methods were employed to evaluate the validation parameters, such as the ROC curve and internal consistency. CONCLUSIONS: Few studies that developed tools to select outpatients for pharmaceutical services were found. However, many tools showed unsatisfactory validation parameters. Thus, it is necessary to improve the development of instruments that can identify patients who would benefit from the pharmaceutical service accurately.

Complexidades do trabalho do agente comunitário de saúde com pacientes em uso de medicamentos / Community health agents and the complexities of the working with patients using medicines / Complejidad del trabajo del agente comunitário de salud con pacientes en uso de medicamentos

Resumo Os agentes comunitários de saúde representam importante elemento na gestão de informações sobre o uso de medicamentos na atenção primária, melhorando a interação da equipe de saúde com a comunidade. O objetivo do estudo foi revelar como o uso de medicamentos está presente na rotina deles e compreender as relações que se estabelecem entre agentes, usuários e equipe. Tratou-se de um estudo qualiquantitativo, com utilização de observação participante, entrevista semiestruturada e grupo focal. Foi desenvolvido em três unidades básicas de saúde em um município de Minas Gerais no período de março de 2013 a fevereiro de 2015. Os resultados revelaram que os agentes se relacionam constantemente com usuários que vivenciam problemas com o uso de medicamentos e apresentam dúvidas sobre suas indicações, efeitos esperados, reações adversas, entre outras. Eles realizam algumas intervenções diretamente com o usuário, porém preferem encaminhar os casos à equipe de saúde. Alguns agentes referiram-se ao farmacêutico como profissional de referência no tocante ao uso de medicamentos, mas a procura por esse profissional mostrou-se baixa pelos sujeitos do estudo. Ressalta-se a importância da formação do agente sobre utilização de medicamentos para instrumentalizá-los no reconhecimento de situações inadequadas, no desenvolvimento de intervenções com a equipe de saúde e no acompanhamento dos usuários.

Abstract The community health agents are an important element in the management of medication information in primary healthcare setting, improving healthcare team interaction with the community. The aim of this study was to reveal how the use of medicines is present in the routine of agentes and understand the relationships established between agents, users and healthcare team. This is a quantitative and qualitative study, using participant observation, semi-structured interview and focus group. This study was conducted at three basic health units in a municipality of Minas Gerais, Brazil, between March, 2013 and February, 2015. The results show that agents constantly relate with patients who experience drug therapy problems and have doubts about the indication, effects, adverse drug reactions, among other. They perform some interventions directly with the patient, but usually they prefer to refer cases to the healthcare team. Some agents said recognizing the pharmacist as a reference on medicines, but the demand for this professional was low by the subjects of this study. We emphasize the importance of the agents training on medication use to instrumentalize them to recognize problematic situations, to develop interventions with the support of the healthcare team and to follow up patients using medicines.

Resumen El agente comunitario de salud representa um elemento importante en la gestión de la información sobre el uso de medicamentos en la atención primaria, mejorando la interacción del equipo de salud con la comunidad. El objetivo de este estudio fue revelar cómo el uso de medicamentos está presente en la rutina de los agentes y entender las relaciones que se establecen entre agentes, usuarios y equipo de salud. Se trata de un estudio cuantitativo y cualitativo, utilizando la observación participante, entrevista semi-estructurada y grupos focales. Lo studio fue desenvolvido en tres unidades básicas de salud en um municipio de Minas Gerais, Brasil, en el período de marzo de 2013 a febrero de 2015. Los resultados muestran que los agentes se relacionan constantemente con usuarios que experimentan problemas con el uso de medicamentos y que tienen dudas acerca de la indicación de medicamentos, los efectos esperados, las reacciones adversas, entre otros. Los agentes realizan algunas intervenciones directamente con el usuario, no obstante prefieren referir los casos para el equipo de salud. Algunos agentes se refieren al farmacéutico como profesional de referencia con respecto al uso de medicamentos, sin embargo, la demanda de estos profesionales por los sujetos de este estudio fue baja. Se resalta la importancia de la formación de los agentes sobre el uso de medicamentos, para darles instrumentos en el reconocimiento de situaciones inadecuadas, el desarrollo de intervenciones con el equipo de salud y el seguimiento de los usuarios.

Clinical outcomes of medication therapy management services in primary health care

ABSTRACT This study evaluates whether the integration of pharmacists into health-care teams through the delivery of pharmaceutical care-based medication therapy management (MTM) services can improve the clinical outcomes of patients with chronic health conditions in the primary health-care setting. A retrospective descriptive study of 92 outpatients assisted by MTM pharmacists in primary health-care units was carried out over 28 months (median follow-up: 05 months). Patients were followed up by MTM pharmacists, with a total of 359 encounters and a ratio of 3.9 encounters per patient. The prevalence of hypertension, diabetes mellitus and dyslipidaemia was 29.5%, 22.0% and 19.4%, respectively. There was a high prevalence of drug-related problems with a ratio of 3.4 per patient. Pharmacists performed a total of 307 interventions to prevent or resolve drug-related problems. With regard to control of the most prevalent chronic medical conditions, a high percentage of patients reached their therapy goals by the last encounter with the pharmacist: 90.0% for hypertension, 72.3% for diabetes mellitus and 90.3% for dyslipidaemia. MTM services provided by pharmacists resolved drug therapy problems and improved patients' clinical outcomes. This study provides evidence for health-care managers of the need to expand the clinical role of pharmacists within the Brazilian public health-care system.