Pharmaceutical care as a strategy to improve the safety and effectiveness of patients? pharmacotherapy at a pharmacy school: a practical proposal

Abstract

Several patients experience at least one drug-related problem and Pharmaceutical Care can change this reality. This work describes a model for structuring the pharmaceutical care service at a pharmacy training unit of the Brazilian Public Health System based on pharmacotherapy follow-up program of Parkinson's disease patients' results. From the follow-up results (phase 1), a Therapy Management Scheme was designed (phase 2). Of the 57 patients followed-up, 30 presented at least one drug-related problem and 42% were non-adherent to treatment, which supported the need of pharmacotherapy management. The Pharmacotherapy Management Scheme was proposed as a pharmaceutical care service model, which presents 6 steps: first, the pharmacist fills out the dispensing form and assesses patient´s pharmacotherapy, if there is a suspect problem, he is invited to the follow-up (steps 1 and 2) and they agree the first appointment. After that, pharmacist studies the patient's case (study phase, steps 3 and 4). At the second meeting, the pharmacist proposes the intervention needed, and at the third, assesses the intervention results and new problems (steps 5 and 6, respectively). The process ends when all therapeutics outcomes are reached. This practical model can significantly contributed to the development and organization of pharmaceutical care services. Muitos pacientes vivenciam pelo menos um problema relacionado ao medicamento e à atenção farmacêutica pode mudar este fato. Este trabalho descreve um modelo para estruturar o serviço de atenção farmacêutica numa farmácia escola do Sistema Único de Saúde brasileiro baseado nos resultados de um programa de seguimento farmacoterapêutico de pacientes com Doença de Parkinson. A partir dos resultados do seguimento, um esquema de gerenciamento da farmacoterapia foi desenhado. Dos 57 pacientes acompanhados, 30 apresentaram um problema relacionado ao medicamento e 42% não aderiram ao tratamento, o que reforça a necessidade de gerenciar a farmacoterapia. O esquema proposto apresenta 6 passos: primeiro, o farmacêutico preenche o formulário de dispensação e avalia a farmacoterapia do paciente; caso haja suspeita de um problema, ele é convidado a participar do seguimento farmacoterapêutico (passos 1 e 2) e marcam a primeira consulta. Após esta, o farmacêutico estuda o caso (fase de estudo, passos 3 e 4). Na segunda consulta, o farmacêutico propõe as intervenções necessárias e, na terceira, avalia seus resultados e novos problemas (passos 5 e 6, respectivamente). O processo termina quando todos os objetivos terapêuticos são alcançados. Este modelo de prática pode contribuir significativamente para o desenvolvimento e organização de serviços de atenção farmacêutica.Unitermos: Atenção farmacêutica. Seguimento farmacoterapêutico. Farmácia comunitária. Pacientes/ segurança.

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

“…This finding highlights the importance of health professionals following up the patient’s medication use in order to investigate if the symptoms are a consequence of non-adherence or of the disease’s progression. In this way, unnecessary dosage change or addition of new medicines can be avoided, reducing the risk of adverse events [ 8 , 14 , 42 , 43 ].…”

Content and impact of pharmacy services for patients with Parkinson's disease

“…Of these, 1529 were excluded after duplicates were removed and title/abstract screening, leaving 78 papers eligible for full-text review. Of these 19 studies met the inclusion criteria [ 9 – 11 , 13 – 28 ] involving 1458 PD patients. Figure 1 provides details of the reasons for excluding studies from this review.…”

“…The 19 included studies were from 9 countries: three were conducted in the Netherlands, [ 18 , 20 , 21 ] Germany, [ 15 , 16 , 23 ] the United States, [ 9 , 17 , 26 ] China, [ 24 , 25 , 28 ] 2 were in Brazil [ 10 , 13 ] and in the UK. [ 14 , 27 ] Others were conducted in Canada, Malta and Thailand.…”

Análise de interações medicamentosas em prescrições dentárias

“…The actions to be taken depend on the intensity of the interaction's effects, including changes in dosage only, or, in more severe cases, discontinuation of therapy, referral to the appropriate health service and reporting of the reaction to health surveillance. 23,24 This study has as a limiting factor the fact that there were no interviews with patients for the collection of data on the evaluation of possible symptoms that could predict the actual occurrence of DIs. Also, the unavailability of information in most of the records may be subject to adjustments through the collecting of the patients' full clinical history, including at least the complete demographic data, the history of prior and current diseases, and all drugs being used concurrently, as well as their respective dosage.…”