Impact Assessment of Pharmaceutical Care in the Management of Hypertension and Coronary Risk Factors after Discharge

Abstract

IntroductionAlmost 50% of the 17.5 million deaths worldwide from cardiovascular disease have been associated with systemic arterial hypertension (SAH). Into this scenario, Pharmaceutical Care (PC) has been inserted in order to improve the management of SAH and reduce its risks.ObjectiveTo evaluate the outcomes and healthcare assistance achieved after discharge of hypertension patients from the PC program.MethodsThis is a quasi-experimental study with historical controls. Retrospective data collection from 2006 to 2012 was begun in 2013 and included a PC program performed over one year. PC was performed in two basic units of the public health system in Ribeirão Preto-SP, Brazil, where the pharmacist followed up 104 hypertensive patients. The clinical indicators of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, total-cholesterol, high and low density lipoprotein cholesterol were collected, as well as care indicators related to the number of consultations (basic, specialized and emergency care) and antihypertensive drugs used. The coronary risk of patients by the Framingham risk score was also calculated. For the analysis, the data were divided into three periods, 2006–2008 as pre-PC, 2009 as PC and 2010–2012 as post-PC.ResultsIn the pre-PC period, 54.4%, 79.0% and 27.3% of patients presented satisfactory levels of SBP, DBP and total-cholesterol, respectively. In the post-PC period, the percentages were 93.0% for SBP and DBP [p <0.001] and 60.6% for total-cholesterol [p <0.001]. The average number of consultations per patient/year in primary care was 1.66 ± 1.43 and 2.36 ± 1.73, [p = 0.012]; and for emergency care was 1.70 ± 1.43 and 1.06 ± 0.81, [p = 0.002] in the pre-PC and post-PC periods, respectively. The pre-PC Framingham risk in the last year was 14.3% ± 10.6 and the average post-PC was 10.9% ± 7.9.ConclusionPC was effective in the control of blood pressure and total-cholesterolafter discharge of the hypertensive patients from PC program.

The role of the pharmacist in the care of patients with cardiovascular diseases

“…In the period before taking pharmaceutical care 54.4%, 79.0%, and 27.3% of patients presented satisfactory levels of systolic (SBP), diastolic (DBP) blood pressure, and lipid profile, respectively. During the two-year observation period (2010- -2012) after the pharmaceutical intervention, the percentages were 93.0% for SBP and DBP (p < 0.001) and 60.6% for total-cholesterol (p < 0.001) [25]. Similar conclusions can be derived from another, recently published, randomised clinical trial.…”

Serviços Farmacêuticos Clínicos Na Atenção Primária À Saúde Do Brasil

“…A maior parte dos estudos brasileiros, quando se remete à prática dos serviços farmacêuticos clínicos, relaciona a sua operação por meio do seguimento/acompanhamento farmacoterapêutico, caracterizando-o como atividade mais mencionada e estudada (Lyra-Júnior et al, 2007a, 2007bFoppa et al, 2008;Provin et al, 2010;Obreli-Neto et al, 2011a, 2011b, 2015Plaster et al, 2012;Mourão et al, 2013;Firmino et al, 2015;Cazarim et al, 2016).…”

“…Assim, a literatura atual já reporta a existência simultânea, a importância e a interlocução dos diversos serviços clínicos nos programas de cuidado farmacêutico aos usuários das redes de atenção à saúde (Lyra-Júnior, Marcellini e Pelá, 2008;Cazarim et al, 2016;Melo e Castro, 2017;Javadi et al, 2016;Ndefo et al, 2017).…”

Economic Evaluations in Health from the Perspective of the Costs Associated with Diabetes Mellitus Treatment

“…Many studies have presented the theme of economic evaluation focused on the care provided by the pharmacist, such as pharmaceutical care, which uses methods such as MTM and patient empowerment [22,44]. Pharmaceutical care in a program for the elderly with T2DM and systemic arterial hypertension followed in primary health care in a municipality in the interior of the state of São Paulo, showed that the implementation of pharmaceutical care does not add significant costs to the health service when compared to the results of the best outcomes achieved in patient care [35].…”

“…The WHO estimates that the costs of loss of productivity of DM patients can exceed up to five times the direct costs of this disease [20,36]. It is seen that empowerment of the diabetic patient improves glycemic control and, consequently, reduces the incidence of DM complications over time, which is the main aspect to reduce costs with the treatment of the disease; empowerment of the diabetic patient can be considered an efficient health technology for health systems.Many studies have presented the theme of economic evaluation focused on the care provided by the pharmacist, such as pharmaceutical care, which uses methods such as MTM and patient empowerment [22,44]. Pharmaceutical care in a program for the elderly with T2DM and systemic arterial hypertension followed in primary health care in a municipality in the interior of the state of São Paulo, showed that the implementation of pharmaceutical care does not add significant costs to the health service when compared to the results of the best outcomes achieved in patient care [35].…”