INTRODUCTION: Medication reconciliation is the process of comparing the most accurate list of all medications that a patient is taking with the list of prescription drugs within the healthcare system while considering the patient’s allergies and history of side effects. OBJECTIVES: To reconcile medication upon the patients’ admission to a university hospital in the municipality of Campo Grande, Mato Grosso do Sul, Brazil. METHOD: A prospective, cross-sectional study was conducted between June 2018 and May 2019 at the medical clinic unit of an university hospital. Discrepancies observed between the prescription and the best possible medication history were classified as intentional discrepancy; undocumented intentional; and unintentional. RESULTS: A total of 1,134 discrepancies were found between home-based drugs and those prescribed upon admission to the MCU. Among the discrepancies, 815 (72%) were intentional, 89 (8%) were undocumented intentional, and 230 (20%) were unintentional. The number of consultation sources and the number of medicines in use at home showed significant correlation with the occurrence of unintentional discrepancies (p = 0.039 and p = 0.008, respectively). A total of 318 pharmaceutical interventions were performed, 230 related to unintended discrepancies. Of these, 138 (60%) interventions were not accepted. CONCLUSION: The study verified the high frequency of drug omission, conferring treatment interruption and the need for pharmaceutical assistance of polymedicated patients.

The Specialized Component of Pharmaceutical Care is the Brazilian Unified Health System strategy that aims to ensure comprehensive drug treatment at an outpatient level and improve access to high complexity, high cost treatments, such as multiple sclerosis. Given the diversity of treatments available and the differences in financing and dispensing in different countries, the objective of this study was to present the workings of the model of care for patients with multiple sclerosis through the public health system in Brazil in the state of Mato Grosso do Sul. In Campo Grande, the registration and dispensation of drugs for the treatment of multiple sclerosis is the responsibility of the Pharmacy School Professor Ana Maria Cervantes Baraza of the Federal University of Mato Grosso do Sul. In this center, all patients receive pharmaceutical advice on the administration of injectable drugs and oral medications; the storage, preservation, and transportation of refrigerated drugs; and information on the disease and management of adverse reactions. Clinical pharmacy services are also available to patients in a pharmaceutical office, ensuring patient privacy and comfort and enabling the creation of a bond with the pharmacist. The model of care provided by the Pharmacy School allows for the development of pharmaceutical services, encourages the rational use of medicines, and emphasizes the importance of self-care, adherence to therapy, and the co-responsibility of patients and their families.

OBJECTIVE: To describe the clinical and epidemiological scenario of patients with chronic kidney disease undergoing hemodialysis. METHOD: Retrospective study with secondary data collected from the medical records of patients over 18 years of age on hemodialysis from January 2016 to December 2018. RESULTS: 507 patients underwent ambulatory and/or hospital hemodialysis during the study period. From these, 494 participants were included, comprising 383 who were still under treatment at the end of the study period and 111 who died during the study period. The majority of hemodialysis patients were male, with a mean age of 56.6 years, non-white (77.4%), in a stable relationship (51.6%), retired (54.9%), and with low education (73.9%). Most participants started hemodialysis with the use of a central venous catheter (83.3%), which was maintained for 43.8% of the treatment time. Participants used an average of 18.91 medications daily. More than half of the deaths occurred during the first two years of treatment, with 30.6% of these occurring in the first 12 months of hemodialysis. Evaluation of the results of the clinical outcome of death demonstrated a relationship between age (p= 0.003), number of comorbidities (p = 0.009), time using a central venous catheter (p = 0.025), and white ethnicity (p = 0.021). Septic shock was the main cause of death (56.8%). CONCLUSION: Some factors related to the prognosis of the disease cannot be changed, such as age and white ethnicity. However, greater attention to the management and adequate monitoring of comorbidities is necessary, as well as a reduction in the time spent using a central venous catheter. Due to polymedication, pharmacotherapeutic monitoring is indicated, both for the prevention of drug related problems and for discussions concerning drug discontinuation.