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

Abstract

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.

Impact of pharmaceutical care interventions in improving clinical outcomes among patients with pulmonary tuberculosis: a systematic review

“…Thirteen articles were included in this review that reported data on 3,886 patients. Four studies were conducted in USA (Carter et al, 2017 ; Hess et al, 2009 ; Jakeman et al, 2020 ; Tavitian et al, 2003 ), two studies in Brazil (Lara-Júnior et al, 2022 ; Lopes et al, 2017 ) and one study was conducted in each of the following countires: Spain (Juan et al, 2006 ), China (Tang et al, 2018 ), Turkey (Clark et al, 2007 ), Canada (Tang et al, 2018 ), Thailand (Tanvejsilp et al, 2017 ), Indonesia (Karuniawati et al, 2019 ), and India (Thomas et al, 2018 ). There were 10 cohort studies (Carter et al, 2017 ; Hess et al, 2009 ; Jakeman et al, 2020 ; Juan et al, 2006 ; Lara-Júnior et al, 2022 ; Lopes et al, 2017 ; Moadebi et al, 2005 ; Tanvejsilp et al, 2017 ; Tavitian et al, 2003 ; Thomas et al, 2018 ), two RCTs (Clark et al, 2007 ; Tang et al, 2018 ) and 1 quasi-experimental study (Karuniawati et al, 2019 ).…”

“…Four studies were conducted in USA (Carter et al, 2017 ; Hess et al, 2009 ; Jakeman et al, 2020 ; Tavitian et al, 2003 ), two studies in Brazil (Lara-Júnior et al, 2022 ; Lopes et al, 2017 ) and one study was conducted in each of the following countires: Spain (Juan et al, 2006 ), China (Tang et al, 2018 ), Turkey (Clark et al, 2007 ), Canada (Tang et al, 2018 ), Thailand (Tanvejsilp et al, 2017 ), Indonesia (Karuniawati et al, 2019 ), and India (Thomas et al, 2018 ). There were 10 cohort studies (Carter et al, 2017 ; Hess et al, 2009 ; Jakeman et al, 2020 ; Juan et al, 2006 ; Lara-Júnior et al, 2022 ; Lopes et al, 2017 ; Moadebi et al, 2005 ; Tanvejsilp et al, 2017 ; Tavitian et al, 2003 ; Thomas et al, 2018 ), two RCTs (Clark et al, 2007 ; Tang et al, 2018 ) and 1 quasi-experimental study (Karuniawati et al, 2019 ). Six studies had a comparator group (Clark et al, 2007 ; Juan et al, 2006 ; Karuniawati et al, 2019 ; Moadebi et al, 2005 ; Tang et al, 2018 ; Tanvejsilp et al, 2017 ); one study compared pharmacist care to nurse care (Moadebi et al, 2005 ), while three studies compared pharmacist care to usual practice (Clark et al, 2007 ; Hess et al, 2009 ; Tang et al, 2018 ).…”

“…Tanvejsilp et al compared pharmacist intervention to home visits and modified DOT (Tanvejsilp et al, 2017 ), while Juan et al compared pharmacist-led DOT to self-administered therapy (Juan et al, 2006 ). On the other hand, Lara-Junior et al compared patients who received pharmaceutical follow-up services to those who did not receive the service (Lara-Júnior et al, 2022 ). The earliest study was conducted in USA in 2003 (Tavitian et al, 2003 ), while the latest study was conducted in Brazil in 2022 (Lara-Júnior et al, 2022 ).…”

“…On the other hand, Lara-Junior et al compared patients who received pharmaceutical follow-up services to those who did not receive the service (Lara-Júnior et al, 2022 ). The earliest study was conducted in USA in 2003 (Tavitian et al, 2003 ), while the latest study was conducted in Brazil in 2022 (Lara-Júnior et al, 2022 ). The characteristics of the included studies are summarised in Table 2 .…”

Multidisciplinary tuberculosis care: leveraging the role of hospital pharmacists

“…Non-adherence to treatment is a significant factor causing inadequate drug effectiveness and adverse reactions, leading to drug resistance 24 25. Pharmacist intervention through CPS can address these issues,25–28 but its implementation is challenging18 and requires a comprehensive and collaborative approach focusing on the unique traits of each patient 2 7…”