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Cuidado farmacêutico em pacientes com artrite reumatoide

2024-12-06T00:00:00Z

Título: Cuidado farmacêutico em pacientes com artrite reumatoide Autor(es): Costa, Alana Teles Abstract: Rheumatoid arthritis (RA) is a systemic autoimmune disease whose management involves complex therapies, often associated with polypharmacy and drug-related problems. The involvement of pharmacists within the multidisciplinary healthcare team may enhance the effectiveness and safety of treatment. Therefore, the objective of this study was to evaluate the effect of pharmaceutical care on patients with RA. This study was conducted in three complementary stages. Initially, a systematic review was performed to address the central question: “What is the effect of pharmaceutical care in patients with RA, and how is this care being delivered?” The protocol was registered in PROSPERO (CRD42020133705). Subsequently, a pilot randomized controlled trial (RCT), approved by the research ethics committee and registered under number RBR-8494rf7, was conducted to evaluate the effect of pharmaceutical care in patients with RA attending a rheumatology outpatient clinic in Brazil. Finally, considering that approximately 25% of patients with RA have renal impairment, the third stage consisted of a systematic review on the pharmacokinetics and dose adjustment of antimicrobials in patients undergoing renal replacement therapy (RRT). This protocol was also registered in PROSPERO (CRD42024532462). The systematic review on pharmaceutical care in patients with RA identified a total of 3,078 titles. Six met the predefined criteria and were included, comprising a total of 337 patients with RA. All six RCTs presented some limitations, and only one was classified as having a low risk of bias. In 66.6% of these studies, the intervention consisted of a short-term service focused on health education. When the intervention was remote and short-term, improvements in pharmacotherapy adherence reached up to 8% (P < 0.05). In contrast, when a comprehensive pharmacotherapeutic follow-up service was provided, adherence improved by up to 59% (p=0.002). Pharmaceutical interventions were also associated with significant improvements in beliefs about medicines, patient satisfaction, reductions in drug-related problems, and treatment costs. In the RCT conducted in the second stage, a total of 14 patients with RA were included, with seven allocated to each group. The medication review service, delivered by pharmacists using a hybrid model, demonstrated a statistically significant benefit for the intervention group compared with the control group regarding pharmacotherapy adherence (p=0.041) and drug-related problems (p=0.019). No significant differences were observed in quality of life, pain, or satisfaction with care. The systematic review on antimicrobial pharmacokinetics and dosing in patients undergoing RRT identified 488 titles. Thirty-two met the predefined criteria and were included, encompassing a total of 1,641 patients. Of the 31 included studies, 22 were classified as high quality, three as moderate, and seven as low quality. Most studies indicated that dose adjustments of currently used antimicrobials are required in patients undergoing RRT to ensure effectiveness and safety. These studies recommended regular therapeutic drug monitoring to achieve therapeutic targets and reduce mortality rates. Overall, the results demonstrate that pharmaceutical care, delivered in face-to-face, remote, or hybrid formats, has a significant positive impact on patients with RA. Additionally, the findings provide important context and deeper insights into essential aspects of safer and more personalized clinical pharmacy practice for the subpopulation undergoing RRT.

Uso de tecnologias digitais na formação para o cuidado ao paciente: uma nova onda na educação farmacêutica

2021-05-21T00:00:00Z

Título: Uso de tecnologias digitais na formação para o cuidado ao paciente: uma nova onda na educação farmacêutica Autor(es): Silva, Rafaella de Oliveira Santos Abstract: Throughout its history, the pharmaceutical profession has gone through different phases of development (so-called also waves) that have promoted its evolution and adaptation to the different demands of humanity. In recent decades, the expansion of pharmacy practice has included patient care, with the increasing use of active teaching and learning methodologies, including digital technologies (e.g. digital serious game and Virtual Patient -VP- software), in the development of knowledge, skills, and attitudes. However, there are few high-level evidence studies on the use of these tools in pharmaceutical education, as well as their impact on the new generation of students and professionals. Thus, this Thesis aims to describe the effect of digital technologies (digital serious game and VP software) on the training of pharmacy students and pharmacists for patient care. This study was carried out in three stages. In the first stage, a manuscript (commentary) was prepared with the objective of understanding the integration of digital technologies as a new wave in pharmacy practice and education. In the second stage, a systematic review was carried out on the effect of digital serious game related to patient care in the development of knowledge, skills, and attitudes in pharmaceutical education. In the third stage, a systematic review was elaborated on the effect of VP software on the development of knowledge, skills, and attitudes in pharmaceutical education. Both searches were carried out in the Cochrane, ERIC, Embase, IPA, LILACS, Pubmed, Scopus, and Web of Science databases using words related to “pharmaceutical education”, “pharmacists” and “pharmacy students”. In addition, words related to “games”, “serious games” and “digital games” were used in the second stage; and, words related to “virtual patient” were used in the third stage. From the reflections made in the commentary, it was noted that the pharmacy profession can no longer wait for the expansion and integration of digital technologies in pharmacy practice and education. The achievement of this goal requires both disruptive professors and the development of specific knowledge, skills, and attitudes (clinical and digital). The systematic review on the digital serious game related to patient care in pharmaceutical education identified 1,521 studies, of which seven were included. In most studies, there was no improvement in knowledge, skills, and attitudes (n=6; 85.73%) and user satisfaction with the tool was negative (n=5; 71.43%). Furthermore, in general, the methodological quality of these studies was below ideal. The systematic review on the VP software in pharmaceutical education identified 1,260 studies, of which 29 were included. In most studies, there was an improvement in knowledge, skills, and attitudes (n=26; 89.65%) and user satisfaction with the tool was positive (n=28; 96.55%). In addition, in general, the methodological quality of these studies was satisfactory. From the findings of this Thesis, it was possible to observe that digital technologies, such as digital serious game and VP software, can be innovative tools to be included in the curricula for the development of knowledge, skills, and attitudes related to patient care in view of the learning characteristics of the new generation of pharmacy students and pharmacists.

Tradução e adaptação transcultural de instrumento de avaliação da consulta farmacêutica

2020-08-31T00:00:00Z

Título: Tradução e adaptação transcultural de instrumento de avaliação da consulta farmacêutica Autor(es): Assumpção, Sandro Martins de Abstract: Introduction: In the last decades, the pharmaceutical profession has witnessed great changes in practice, and this professional has joined the professional health care team, promoting the rationalized use of pharmaceutical drugs. The philosophy of pharmaceutical care is the basis for the services provision and defines that the pharmacists' responsibility is to assist, within their professional limits, all the patient's health needs, including the pharmacotherapeutic ones. Facing a wide variety of services provided by the pharmacist, which makes it difficult to measure the positive impacts resulting from the services provided by this professional, there is a need to evaluate these professionals' abilities in consultations, even if this activity retains individual characteristics, there must be a certain behavior standardization, so that the clinical service is delivered to the patient effectively. Objective: to perform the cross-cultural adaptation and validation for the Portuguese language of the instrument called The Medication-Related Consultation Framework (MRCF). Methodology: Initially, a Scoping Review was carried out with the objective of identifying in the literature the support instruments for pharmaceutical consultations. In this context, two reviewers carried out the selection process, evaluating the titles, abstracts and articles in full. Three categories were used in the title and summary selection: 'yes', 'no' and 'maybe'. About the cross-cultural adaptation of the instrument, this was translated by two bilingual translators, native speakers of Portuguese and proficient in English, did independently the translation to the Portuguese of the original versions of the MRCF instrument. In addition to the above, there was the back translation, synthesis of translations, semantic equivalence of translations, pre-test and evaluation of psychometric properties Results: The instruments included to evaluate the pharmaceutical consultation were: Development and validation of the MedicationRelated Consultation Framework (MRCF); The patient care process (PCP) and Medicine Use Reviews (MUR). The MCRF used The Calgary-Cambridge as a guide, however, this instrument was not included in this review, since it aims to instruct in the process of communication and medical interview. The synthesis of the translations also allowed the performance of grammatical adjustments by the experts, to respect the linguistic rules and avoid bias in the interpretation of items whose translations presented divergent constructions. Conclusion: It is evident that the use of these instruments, as a strategy for standardization of conducts, allows a better evaluation of the pharmaceutical professional, thus contributing to the improvement of the services provided to the patient, as well as having a prominent role in their training.

Impacto dos problemas farmacoterapêuticos sobre o tempo de internação hospitalar de pacientes puérperas com pré-eclâmpsia

2022-07-29T00:00:00Z

Título: Impacto dos problemas farmacoterapêuticos sobre o tempo de internação hospitalar de pacientes puérperas com pré-eclâmpsia Autor(es): Goes, Aline Santana Abstract: Introduction: few studies assess the nature and prevalence of drug-related problems (DRPs) in hospitalized pregnant women, as well as studies on the impact of DRPs on hospitalized puerperal women are scarce. Thus, studies in this population may promote patient safety by avoiding undesirable outcomes. Aim of the study: to investigate the impact of DRPs on the length of hospital stay of postpartum women with pre-eclampsia. Methods: a prospective cohort study with postpartum women diagnosed with preeclampsia was carried out to determine the relationship between the manifestation of DRPs and length of hospital stay, followed by a systematic review to determine risk factors for prolonged hospital stay in postpartum women with preeclampsia. Finally, a research letter was developed to discuss the active search for manifested DRPs and medication review in hospitalized patients with preeclampsia. Results and Discussion: 600 women were included in the present study, of these 354 (59%) were exposed to at least one DRP. The most frequent DRPs were non-administration of a medication, non-prescription of a medication. In patients exposed to DRPs, the mean hospital stay was 5.4 (SD 3.6) days versus 4.4 (SD 3.3) days in patients not exposed to DRPs (p = 0.0001). In the systematic review, 1,662 studies were identified in the databases, four of which were included in the final sample. The main risk factors for the increase in length of hospital stay were: presence of ascites (p<0.001), cesarean delivery (p<0.0001), presence of manifested DRPs (p=0.0001), diastolic blood pressure above 10mmHg (p=0.006) and treatment time with MgSO4 equal or greater than 12 hours (0.014). All included studies presented a cohort design, with an overall methodological quality classified as good. To have a significant impact on length of hospital stay, as well as other hospital outcomes, medication review should focus on resolving manifested DRPs. In postpartum women with preeclampsia, this intervention should preferably take place in the first days after delivery. Conclusion: the manifestation of DRPs in postpartum women with preeclampsia significantly increased the length of hospital stay, being a main risk factor for alteration of this important hospital outcome. Medication review is a clinical pharmaceutical service that identifies and resolves these events, and has, therefore, the potential to decisively impact the clinical outcomes related to hospitalized postpartum women with preeclampsia.