Pharmacotherapy problems in cardiology patients 30 days post discharge from a tertiary hospital in Brazil: a randomized controlled trial

Abstract

OBJECTIVES:This is a randomized controlled trial that aims to evaluate the impact of pharmacist-led discharge counseling on reducing pharmacotherapy problems in the 30-day postdischarge period of cardiology patients from a tertiary hospital in Brazil.METHODS:At discharge, two cardiovascular pharmacy residents performed a medication counseling session with the intervention group, and the follow-up was performed by telephone (3 and 15 days after discharge). The number of pharmacotherapy problems was evaluated during a pharmacist-led ambulatory consultation 30 days after discharge.RESULTS:A total of 66 and 67 patients were randomized to the intervention and control groups, respectively, but only 51 patients were analyzed in each group, all with similar baseline characteristics. The intervention group had significantly fewer pharmacotherapy problems compared to the control (p<0.001), and 100% of the patients had at least one problem. We observed five problems significantly more frequently in the control group: “incorrect time of taking” (p=0.003), “use higher dose of medication” (p=0.007), “use lower dose of medication” (p=0.014), “restart discontinued medication” (p=0.011), and “underdosing prescription” (p=0.009). Simvastatin, enalapril, carvedilol, and atorvastatin were the medications more associated with pharmacotherapy problems.CONCLUSIONS:We concluded that pharmacist-led discharge counseling should be an indispensable service, as patients exhibited less pharmacotherapy problems in the 30-day postdischarge period, especially related to drug administration and adherence.

Continuidade da assistência ao paciente pós-tratamento do infarto agudo do miocárdio: Revisão integrativa

“…Em relação ao ano de publicação, 6,4 % (2) foram publicados em 2015; 25,8% (8) em 2016; 22,6% (7) em 2017; 25,8% (8) em 2018; 19,4% (6) em 2019. Outrem, sobre os níveis de evidencia (NE), quatro artigos apresentaram NE II (Bonetti et al, 2019;Heaton et al, 2019;La Sala et al, 2015& Volpp et al, 2017; dois artigos tiveram NE III (Munkhaugen et al, 2018& Hamar et al, 2016; 18 artigos demonstraram NE IV (Di Martino et al, 2016;Hickson et al, 2017;Rosenson et al, 2017;Rymer et al, 2018;Soto et al, 2018;Mahmoud et al, 2018;Schang et al, 2019;Kini et al, 2018;Chen et al, 2015;Chin et al, 2016;Wadhera et al, 2019;Marbach et al, 2018;Ventura et al, 2019;Fordyce et al, 2016;Sulo et al, 2017;Krumholz et al, 2016;Beckman et al, 2016, dois estudos evidenciaram NE V (Arakawa et al,2016& Luu et al, 2019; e cinco artigos mostraram ter NE VI (Tung et al, 2017;Zabawa et al, 2018, Dharmarajan et al, 2017Pocock et al, 2017& Pouche et al, 2016.…”

“…Em conformidade, estudo realizado no Brasil (Bonetti et al, 2019) analisou um programa de aconselhamento de alta, conduzido por farmacêutico, que consistia na realização de consultas com os pacientes ou seus cuidadores 30 dias após a alta, também voltado para a educação em saúde, incluindo questões sobre doses, esquema posológico, duração da terapia e possíveis eventos adversos. Posteriormente, os pacientes eram contatados por telefone pelo mesmo farmacêutico 3 e 15 dias após a alta, para reforço da sessão de aconselhamento anterior.…”