PHARMACY BENEFITS AS A FACILITATOR OF CHRONIC DISEASE AGGRAVATORS
ABSTRACT: Pharmaceutical assistance has been shown to be necessary for the acquisition and distribution of allopathies in an appropriate manner, as well as for the promotion of the rational use of medicines in order to prevent secondary complications and reduce hospital expenses resulting from the misuse of medicines tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado. The main objective was to review the impact of pharmacological education actions, based on guidelines aimed at the rational use of medicines and other literature, on the magnitude of prevention and control of underlying diseases and secondary complications of chronic patients. Descriptive in nature, we used books and scientific articles cataloged in databases such as Medline, Pubmed and Scielo. Results pointed the pharmacist as an important ally to the dissemination of information to patients and health professionals about medications, their organic interactions and adverse reactions, and it can intervene suggesting changes in medical prescriptions in order to avoid iatrogenesis and sometimes unnecessary polymedication and contribute to the improvement of the patient’s clinical condition, in addition to guiding him on the use of drugs that do not require a prescription, avoiding their irrational use tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado. As a conclusion, the creation of collective educational programs in hospitals, pharmacies and in the universities themselves should be encouraged so that such information can reach a larger number of people, helping caregivers, family members and the patient himself to use the medications in a way safer.
Keywords: Pharmaceutical assistance. Rational use of medicines. Chronic patients.
ABSTRACT: Pharmaceutical care has been shown necessary for the properly acquisition and distribution of allopathic, and to promote rational use of medicine to prevent secondary complications and reduce hospital costs resulting from the misuse of drugs. The main objective was to review about the impact of drug education activities, based on guidelines aimed at the rational use of medicines and other literature, on the magnitude of disease prevention and control of basic and secondary complications of chronic patients. Of descriptive nature tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado, it was appealed to books and scientific articles cataloged in databases such as Medline, PubMed and Scielo. Results have shown the pharmacist as an important ally to the dissemination of information to patients and health professionals about medicines, their organic interactions and adverse reactions, who may intervene by suggesting changes in medical prescriptions to avoid iatrogenic and polypharmacy, sometimes unnecessary, and contribute to improving the patient’s clinical condition, besides advise the patient regarding the use of drugs that do not require a prescription, preventing their irrational use. In conclusion, the creatoin of educational programs in collective hospitals, pharmacists and the universities should be encouraged to the information reach s more people, contributing to caregivers, family members and patients themselves use medicines in a secure way .
Keywords: Pharmaceutical care. Rational use of medicine . Chronic patients.
The institutionalization of the Unified Health System (SUS) was a major step forward for health management , in a more participatory and less centralized way, minimizing the burden on the State tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado, in an attempt to achieve control over the use of resources and improve care ( BRASIL, 2006 ).
This achievement enabled the development of new complementary strategies in order to achieve excellence in public health care, such as the approval and publication of Ordinance no . 3,916 / GM of October 30, 1998, which establishes the National Medicines Policy (BRASIL, 1998) and the Family Health Program and also the Community Health Agents Program ( SPS , 2000) .
The programs are intended to search for reorientation d model of attention bá silica to family health, or as a criticism of the model based on clinical paradigm, individualistic and practice curative and hospital – centered, through a collaborative model between professionals various areas of health and the individuals themselves, dependent or not on allopathies to control chronic diseases (BRASIL, 1998; GOLDBAUM et al., 2005; RADDATZ; SANTOS; GARLET, 2007; SPS, 2000) .
According to Brasil (1998), the National Medicines Policy, as an essential part of the National Health Policy tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado, constitutes one of the fundamental elements for the effective implementation of actions capable of promoting the improvement of the health care conditions of the population and has the purpose, in addition to ensuring the safety, efficacy and quality of medicines, promoting rational use and the population’s access to those considered essential.
In addition, the Family Health Program together with that of Community Health Agents aims at a proposal that integrates health actions together with educational actions, establishing a new culture of thought about assistance to the population , focused on the prevention of illnesses and diseases. control of those already installed through rational use of allopathies , which contributes to better access to health care in hospitals since the balance between supply and demand in hospital care can be achieved (GOLDBAUM et al., 2005; SPS, 2000) .
According to the National Medicines Policy ( AQUINO, 2008 ) and the World Health Organization (2002), the rational use of medicines consists of the patients receiving “ medication appropriate to their clinical needs, in doses corresponding to their individual requirements, for an appropriate period of time and at the lowest possible cost for them and the community ” .
It is also worth discussing self-medication, defined as “use of medication without prescription, guidance and / or monitoring by a doctor or dentist” (AQUINO, 2008) .
According to the author’s findings, self-medication is part of the routine of more than 30% of the Brazilian population and that of this portion, almost 45% acquire controlled drugs without the presentation of a medical prescription , which can worsen their health status of the consumer, cause intoxications and pathological changes due to drug reactions (ANVISA, 2007; ASSUNÇÃO; SANTOS; DIAS-DA-COSTA, 2002; CIPOLLE ; STRAND; MORLEY, 2001) tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado.
According to the National Toxic-Pharmacological Information System ( SINITOX, 2009 ), medicines were responsible for more than 21 thousand cases of intoxication in the country , although the largest portions were related to suicide attempt and individual accident, totaling more than 8 thousand and 7 thousand cases, respectively .
The factors self- medication and, consequently, administration error and therapeutic use made up more than 3 thousand cases. Interestingly, adults aged between 20 and 29 and 30 to 39 years old comprised the 2nd and 3rd most affected audience, with more than 4 and 2,600 cases, while children aged 1 to 4 years totaled more than 5,000 cases, which may suggest erroneous attitudes on the part of those responsible (ibidem) tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado.
According to the National Health Surveillance Agency (ANVISA, 2007) and Wannmacher (2006), medicines considered “essential”, of low cost and that can be purchased without a prescription tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado, such as analgesics, antipyretics and anti-inflammatories become one of the most consumed by population and also responsible for the high number of cases of intoxication.
Such attitudes may still reflect the decline in the quality of care since they may result in increased spending on hospitalizations and the mortality rate in the sectors of public health care, mainly .
To correct it, Aquino (2008) and Bortolon, Karnikowski and Assis (2007) found that the irrational use of medications and the undesirable effects were responsible for an increase of up to 20% in expenditures totaling 85 billion dollars annually and 15% of total hospitalizations (MASTROIANNI et al. , 2009) , a problem that can be prevented .
Several studies point to the difficulties in implementing family health care programs, including the rigidity of medical thinking still centered on the individualistic and bureaucratic model, which makes multidisciplinary work difficult, and the lack of recognition and appreciation of professionals, in addition to the non-insertion of them in continuing education programs and, therefore, the lack of specific knowledge for health promotion (ALMEIDA; MISHIMA, 2001; SCHERER, 2006).
Thus , not only the implementation of new management policies and primary health care, but education and guidance back to pharmaceutical assistance is necessary for the acquisition and distribution of medicines in an appropriate manner, as well as for the promotion of their rational use for thus, the prevention and control of negative results related to allopathy and the reduction of hospital spending on public health due to the misuse of medicines is achieved (ARRAIS; COELHO, 2000; BRASIL, 1998) tcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado.
Given the above arguments, are udo aims r evisar about d the impact of education activities pharmacological based on oriented guidelines for the rational use of medicines and other literature on the magnitude of prevention and control of basic diseases and secondary complications of chronic patients .
For the classification of the research, the criteria established by Appolinário (2006) are based. Therefore, the research has the following characteristics regarding (to):
– Purpose: pure fundamentaltcc, monografias, monografias prontas, dissertação de mestrado e tese de doutorado , which aims to advance theoretical knowledge in a given area, but does not aim at immediate applicability;
– Type: descriptive , where you want to describe and interpret reality, without interfering with it; not establishing causal relationships. In this way, the study aims to justify the positive or negative results in the adoption of educational actions aimed at the rational use of medicines for patients with chronic diseases ;
– Data source: b ibliográfica or documentary , where the data comes from documentary sources, as literary works and scientific articles;
– Nature: qualitative , which provides for the hermeneutic analysis of the collected data, that is, it interprets the meaning of the words or texts described.
The data were collected between the months of January and May 2011 using information found in literary works and scientific articles made available in libraries and in electronic media (internet).
While descriptive, the study aims to describe and interpret knowledge about the implementation of policies for the rational use of medicines through specific legislation, in addition to discussing the main mechanisms carried out with a view to promoting health benefits for patients dependent on chronic medication and the health care systems .
As a bibliography, the data came from documentary sources, such as literary works and scientific articles, the latter being obtained from the databases of Latin American and Caribbean Literature on Health Sciences Information (Lilacs), Scientific Electronic Library (Scielo) , from the Virtual Health Library (VHL) and U.S. National Library of Medicine / National Institutes for Health (Pubmed), produced and cataloged in the databases between the years 1966 and 2011 .
First, they were selected from articles found with full text or only a summary, available electronically in the vernacular, English and Spanish, involving the following Health Sciences (DeCS) and Medical Subject Headlines (MeSH) Descriptors : Drug Toxicity , Adverse Drug Reaction, Adverse Drug Reaction, Adverse Drug Reaction, Adverse Drug Reactions, Adverse Drug Reactions, Adverse Drug Reactions, Adverse Drug Reactions, Adverse Drug Reactions, Adverse Drug Reactions ( Drug Toxicity ); Drug Delivery Systems ( Drug Delivery Systems ); Rational use of Medicines ( Rational use of Medicine ); Interactions ( Drug Interactions ); Pharmaceutical care ( Pharmaceutical Assistance )
The main inclusion criterion used was to collect prospective studies that aimed to reflect on the application of pharmaceutical education programs and the rational use of medicines for the rational and legal distribution of allopathies and the promotion of therapeutic and informational guidance for patients affected by chronic diseases .
For each survey incorporated into the study, information such as sample characteristics, the methodology employed and the results obtained with the end of the method employed were observed, aimed at pharmaceutical guidance, control and treatment of chronic diseases .
Additional studies identified based on references obtained in the articles selected a priori were also included .
Articles listed in the order in which they appeared in the aforementioned databases were considered according to the theme and date of publication.
The exclusion factor, the items that were not included in specialized databases were discarded s in health and biomedical q ue did not have the descriptors involved in the subject here treated and were not included in the mentioned period of searching .
Before beginning the question of the rational use of medicines, it is important to briefly discuss the health management process in Brazil.
Disease control in the country has proved difficult since the beginning of the 20th century, when there were no public hospitals, but philanthropic entities, that is, non-profit associations maintained by government agencies or not, aimed at providing services to the population. , especially those with low purchasing power, while the so-called family medical assistance was aimed at serving the most economically favored population. The functioning depended on voluntary work, and the entities were seen as an area of isolation and deposit of the sick in order to avoid mass contamination or minimize it ( BRASIL , 2006 ).
The creation of a public health system arose only in the year 1920, with its founder, the physician and sanitarist Oswaldo Cruz, adopting the “health campaigns” model, first disseminated in the United States and Cuba, whose purpose was to eradicate epidemics in the city and endemics in the countryside ( LUZ, 1991; SCLIAR, 2002 ).
As a way of ensuring that society took care of its own sanitary and hygienic care, the campaigns acted in a coercive manner, isolating and forcing the sick to adopt hygiene measures, leading to a social revolt (SCLIAR, 2002 ).
Furthermore, from the 1930s to the end of the 1980s, health surveillance was insufficient, with the State as the sole manager, leading to an increase in the diversion of funds and corruption, making it even more difficult to use capital in methods of disease control and prevention, increasing the hospital cost of care (BRAGA; PAULA, 1981).
In the 1980s, there was a certain pressure from civil society to develop and adopt new policies to enforce what was belatedly established in the Constitution of the Federative Republic of Brazil in 1988 by guaranteeing citizens the right to health, including transfer of such responsibility to the State, giving rise to a decentralized management method allowing the participation of the population and other collegiate bodies (states and municipalities) in the elaboration of goals and tasks to achieve the objectives (LUZ, 1991).
One of the reflexes of this decentralization and delegation of powers is the creation of the Unified Health System (SUS), making each municipality responsible for the administrative and supervisory activities of the money collected to promote the population’s health (ibidem).
Brazil (1990) mentions the importance of knowing and adopting methodologies capable of diagnosing the type of affection affected and, therefore, assisting in the discovery of drugs and the elaboration of effective prevention and control measures .
However, Ribeiro (2006) makes an important observation when emphasizing that, in Brazil, the concern with intervention is still greater than with prevention.
Such an argument goes against legal provisions, such as Article 25 of the Universal Declaration of Human Rights (1948), where: “Everyone has the right to a standard of living capable of ensuring health and well-being for himself and his family, including […] medical care […] ”, and article 196 of the 1988 Federal Constitution, stating that:
Health is the right of all and the duty of the State, guaranteed through social and economic policies aimed at reducing the risk of disease and other diseases and universal and equal access to actions and services for their promotion, protection and recovery.
By just intervening, the State, responsible for the administration of resources aiming at social well-being, is increasingly contributing to the increase in spending on public health, since the intervention requires greater investments in equipment, physical structure, facilities, in addition to equipment for the correct diagnosis of conditions, whether acute or chronic, and treatment of them already manifested in an increasing number of patients.
However, efforts have been made to control chronic diseases through rational drug use programs , since the worsening of the underlying chronic disease and the installation of secondary complications are associated with the use of medication without medical guidance or recommendation ( AQUINO , 2008; BORTOLON; KARNIKOWSKI; ASSIS, 2007; MASTROIANNI et al., 2009)
According to the Ministry of Health, the process that induces the irrational and unnecessary use of medicines and the encouragement of self-medication, present in Brazilian society, are factors that promote an increase in the demand for medicines, also requiring the promotion of their rational use through the reorientation of these practices and the development of an educational process for both the health team and the user (MS, 1998).
It should be noted that consumers, depending on their purchasing power, can spend more than 190 reais per month on the purchase of medicines and represent almost 50% of the total market (ibidem) .
So, has the creation and publication of MS 39 decree 16/98 that sets standards and guidelines for actions are taken in a standardized way through it to P olicy National Drug in order to promote the improvement of the conditions of the resistance for health population (MS, 1998) in accordance with Law No. 8,080 / 90, when describing in its article 6 the “formulation of the drug policy […] of interest to health […] ” ( BRAZIL, 1990)
The literature highlights the importance of giving special emphasis to the educational process of users of chronic medications about the risks of self-medication, interruption and exchange of the medication prescribed on their own, as well as the need for a prescription, with regard to the dispensing of medication. stripe medicines (ASSUNÇÃO; SANTOS; DIAS-DA-COSTA, 2002; CIPOLLE; STRAND; MORLEY, 2001; MS, 1998) .
Likewise, the content of training courses for doctors and pediatricians and other professionals who prescribe products and dispensers such as pharmacists, who must also be equipped with the knowledge described in the previous paragraph, should be emphasized in order to promote education. and orientation of the population as to the risks and benefits of erroneous and well-oriented administration of allopathies , respectively (ibidem) .
It is also mentioned as an educational strategy, in addition to training and continuing education, the holding of events, lectures and distribution of written material for the community that can be prepared by the professionals themselves. Nevertheless, the interaction between professional and patient is of paramount importance since the information obtained is specific and personalized according to the patient’s clinical condition ( PAHO, 1995; VIDOTTI; SILVA; HOEFLER, 2003 ).
The Ministry of Health mentions the elaboration and dissemination of the National Therapeutic Form, an essential tool for guiding the prescription and dispensing of medicines by health professionals, and for rationalizing the use of these products. For this, the form must contain the information relevant to the absorption, actions and organic reactions of the substances contained in the drugs (MS, 1998).
In addition to this, materials such as newsletters, posters or based on documents provided by the Ministry of Health or national and international health associations , including media support and other mass communication vehicles, are seen as alternatives to education and professional guidance, pharmaceutical and population commissions (PAHO, 1995; MS, 1998) .
In order for these materials to really have a positive impact, even if local, the World Health Organization (WHO / O MS ) (1985) points out some precautions that must be taken during the elaboration of information that must be objective and precise , with sufficient scientific basis, and speci physical function in the target population that is intended to instruct the presentada s with a language capable of understanding and aesthetically attractive shape and with distribution Perio dic the .
Attention F armacêutica and I MPACT the S ealth
An important point to be mentioned is the role of the pharmacist .
According to Decree nº 85.878 / 81 which establishes rules for the execution of Law nº 3.820 / 60 on the Exercise of the Pharmacist’s Profession and other measures, the following attributions of the professional establish in article 1 :
I – performance of functions of dispensing or manipulating magisterial and pharmacopoeic formulas, when serving the public in general or even of a private nature;
II – advice and technical responsibility in:
a ) pharmaceutical industrial establishments where products are manufactured that have indications and / or therapeutic, anesthetic or diagnostic aids actions, or capable of creating physical or psychological dependence;
b ) pharmaceutical agencies, laboratories, sectors or establishments in which quality control and / or inspection, prior analysis, control analysis and fiscal analysis of products that have a therapeutic, anesthetic or diagnostic aid or are capable of determining physical dependence or psychic;
c ) pharmaceutical agencies, laboratories, sectors or establishments in which extraction, purification, quality control, quality inspection, prior analysis, control analysis and fiscal analysis of pharmaceutical ingredients of plant, animal and mineral origin are carried out;
d ) deposits of pharmaceutical products of any kind
III – the professional sanitary and technical inspection of companies, establishments, sectors, formulas, products, processes and pharmaceutical methods or of a pharmaceutical nature;
IV – the preparation of technical reports and the carrying out of technical-legal expertise related to pharmaceutical activities, products, formulas, processes and methods or of a pharmaceutical nature […].
However, several studies emphasize its relevance, mainly because it is the professional responsible for dispensing the medication, and it is up to him to disseminate information to the consumer and other health professionals about the effectiveness, care, safety and risks in an appropriate and clear manner , and should, therefore, to be fully aware of your responsibility , that is, to regulate the health of others from the moment the drug is delivered to the consumer ( BARBÉRIO, 2005; COELHO; ZANATTO; MATIAS, 2007; PAHO, 1995; SILVA; VIEIRA , 2005 ).
Thus, Guirguis (2010), in a retrospective study, analyzed the prevalence of drugs that do not require a prescription and other complementary drugs used among elderly people with chronic diseases and the types of pharmaceutical interventions that patients need.
The sample consisted of c inquiries and one chronic patient who needed or used continuous medication.
According to the results, 80.4% of patients used drugs that did not require a prescription , while 21.6% used complementary medication . It was also observed that many products were not used in the right dose, requiring pharmacists to adjust the dose in 18.7% of cases. Other patients (18.8%) were unaware of dosing regimens, while about a third of the patients needed to be educated about the management of the disease that required the use of the medication .
In conclusion the s Patients elderly tes in this study used products without prescription or complementary , often without a proper understanding of the principle s of managing their condition or dosing regimens. Pharmacists should provide advice on disease management and the requests for products not prescribed and complementary .
Mehuys et al. (2010) intended to provide a detailed description of (i) drug therapy, (ii) adherence to the drug, (iii) the inhalation technique and (iv) the health status of patients with chronic obstructive pulmonary diseases (COPD) recruited through community pharmacies. Based on these results, the author believes that problems can be detected and pharmacist interventions to improve COPD treatment can be developed.
A cross-sectional, observational study was carried out in 93 pharmacies in Belgium. Participants (N = 555) completed a questionnaire to collect personal characteristics, history of smoking, flu vaccination, medication for COPD and side effects. Adherence to maintaining COPD medication was analyzed for a period of 1 year retrospectively through the prescription readjustment rates. The inhalation technique was assessed using a checklist .
According to the results, COPD patients had an average age of 68.6 years, 73.7% were men and 37.2% were smokers. The influenza vaccination status was significantly lower in patients under the age of 65 years (65.7%) than in patients over the age of 65 years (86.2%) (p <0.001). Combinations of inhaled corticosteroids and beta2-agonists were the most used drugs for COPD (75.4%). About 48% of the patients did not demonstrate adherence to the treatment, 47% adhered well to the treatment and 5% adhered for a period beyond the prescribed period.
Twenty-one percent of patients made serious errors by inhalation , especially in the manipulation of the dose of inhalants, highlighting the relevance of guidance by the pharmacist .
Bauters, Devulder and Robays (2008) state that, although doctors have a good knowledge of pharmacotherapy in the field of pain medication, pharmacy interventions are necessary to improve the quality of the prescription.
Thus, the authors evaluate am the role and the impact of a clinical pharmacist, as a member of a multidisciplinary team.
In a population of 93 patients, a total of 120 interventions were recorded. The different types of interventions were: providing information (10.0%), clinical intervention (89.2%) and offering a specific product (0.8%). Excluding 107 clinical interventions, a total of 95.3% of interventions were accepted by doctors.
The results underscore the clinical importance of the pharmacy to optimize drug treatment for adult patients with chronic pain.
Veras (2003) points out a problem inserted in the prescription of medications for chronic or chronic-degenerative diseases that can carry secondary complications , leading to a considerable increase in prescriptions , although sometimes without foundation.
As a consequence, Rollason and Vogt (2003) and Rosenfeld (2003 ) mention the occurrence of polypharmacy, characterized by the prescription of an unnecessary drug, but supposedly essential among the other four or more drugs , which can cause adverse reactions; and iatrogenesis, considered a secondary pathogenic effect caused by the interaction of several drugs .
Both problems are more common in elderly patients since chronic diseases and complications are associated with aging .
In Brazil, polypharmacy started to be more observed as there was the institutionalization of several drugs and their various generics (CASSIANI, 2005).
Carvalho (2007) observed the occurrence of polypharmacy in more than 30% of those evaluated in São Paulo , while Coelho Filho, Marcopito and Castelo (2005) observed an incidence of almost 15% in Fortaleza.
As mentioned, after olifarmácia has a close relationship with the occurrence of adverse drug reactions and to its REC ning, and the precipitate interactions , raising the risk of poisoning , iatrogenic and mortality. In addition, there is an increase in health care expenses , including medication , medical consultations , emergency care and hospitalization. Public coffers cost more than $ 75 billion annually in developed countries (PRYBYS et al., 2002).
The chances of serious drug interactions can be increased by up to 100% when using various drugs, even with a prescription, together with others administered on their own as analgesics (CASSIANI, 2005).
Iatrogenesis may be aggravated since the treatment for adverse reactions is through the use of other medications, with the administration of doses in small concentrations or even their suspension being recommended (ibidem).
McKinnon and Jorgenson (2009) intended to determine whether there is an improvement in medication management when pharmacists and family doctors collaborate in prescribing adjustments to the dose of the medication requested by fax.
A prospective, non-randomized controlled study was performed on patients whose pharmacies received requests for prescription renewals between October 2007 and February 2008.
The requests renovaçã the medication were sent s to farmacê utico (working in clinical and m part-time) in the days when he Were Sleeping the working (experimental group ). The pharmacist evaluated drug therapy, the problems that can prevent safe and effective prescription of drugs. The pharmacist and doctor then made the decision collaboratively to authorize the use of the drug or to request additional interventions such as conducting laboratory tests . When the pharmacist was not working, doctors independently managed renewal orders (control group).
Renewals of authorized medications without recommendations, identified medication problems, new orders for monitoring tests, and new appointments scheduled with healthcare professionals were analyzed .
According to the results, a total of 181 renewal requests were included (94 in the control group and 87 in the experimental group ). The control group had significantly more authorized orders if m recommendations (75.5% vs 52.9%; P = 0.001). The experimental group had significantly more identification of medication problems (26 vs 10, P = 0.031), medication changes (24 vs 10; P = 0.044), and a greater number of appointments with family doctors (31 vs 21; P = 0.049).
In conclusion, the authors claim that there is an improvement in medication management when a pharmacist collaborates with family doctors during the prescription of renewals or readjustments of medication doses . The collaborative model enabled greater identification of problems with the medication, the medication changes and new hires , which reflects an improvement in the process of care.
McAulley, Casey and Long (2009) state that, although epilepsy affects men and women equally, there are many health issues involving women in epilepsy. These issues challenge both the woman with epilepsy and the many health professionals involved in caring for her. As antiepileptic drugs (AEDs) play an important role in the treatment of epilepsy, pharmacists can play an important role in the health care of patients with this chronic disease.
Thus, the authors assessed the knowledge of pharmacists about the health issues involved in women in epilepsy using the knowledge of women’s issues and the Epilepsy II questionnaire (Kowie-II).
In a cross-sectional study, the valid and reliable Kowie-II questionnaire was used, a 10-item questionnaire on women’s issues in general, as well as issues related to pregnancy. A random sample of registered pharmacists in Ohio completed the Kowie-II questionnaire. Demographic data and related practices were collected. The correct score was calculated by a pharmacist.
The results showed that the sample consisted of 152 completed surveys. Regarding the questionnaire, the global average score was 60.3% affirmative . Nearly 75% of pharmacists had a score affirmative to the knowledge about the medical interaction mentosa between the enzyme-induced antiepileptic and the contraceptives.
Just under 70% were aware of the issue of bone loss induced by the antiepileptic drug .
Almost a third (32.2%) of respondents answered incorrectly when asked about the frequency of sexual dysfunction in women with epilepsy, although an even higher percentage chose “I don’t know”.
Most pharmacists (69.1%) said “I don’t know” when asked about the relationship between hormones and crisis control. More than 70% correctly answered four of the six pregnancy-related statements (folic acid = 77.0%, healthy babies = 82.9%, adherence to antiepileptic drugs during pregnancy = 86.8%, choice of drug use during pregnancy = 71.1%).
Few pharmacists knew m on the supplementation of vitamin K (57.9%) and even fewer professionals resp ondeu to properly question about breastfeeding (33.6%). The pharmacists who interact with most patients each month had the highest score.
In conclusion, pharmacists have proved to be a key position in helping women with epilepsy. And lthough there are some you areas where pharmacists are generally well informed about the issues of women in epilepsy, there are still gaps in knowledge making educational interventions could prove timely .
Lewis et al. (2008) described the development, implementation and evaluation of a pharmaceutical assistance program for patients who depend on various drugs for the control of chronic diseases.
The sample consisted of 30 pharmacists and 67 patients aged 18 years or older, who used four or more medications continuously, for 3 or more times a week .
Medicines and problems related to patients’ health were evaluated . Pharmacists were in charge d patient education through d and educational materials and recommendations in writing to improve therapy drug and the patient’s overall health.
The program was developed and implemented through a collaborative approach , which included pharmacists from pharmacy schools and managers . Pharmacists were supported by various administrative and clinical services offered by the colleges.
Three managers approved the program as a service for their employees, retirees and dependents.
662 recommendations were made related to drug treatment, healthy living practices and the need for medical evaluation by pharmacists . The acceptance rates of the recommendation, the change dren knowledge of the patient indicated that the program had a positive effect on patient health.
In conclusion, the collaborative approach to development and implementation of comprehensive assessments of medication was beneficial to improve understanding of the patient about the medicines, diagnostics and healthy life choices. The recommendations written by the pharmacist resulted in actions that improved self- monitoring of skills and adequacy of drug therapy. The support of the Faculty of Pharmacy to the administrative and clinical service was fundamental for the improvement of the care delivery network .
In a similar study, Doucette et al. (2005) intended to characterize the management of drug therapy, involving a community pharmacy and local doctors, describing the problems related to the drug found, identifying what types of drugs were associated with these problems, and listing the actions taken by doctors and pharmacists to resolve them.
In the drug therapy management program studied, pharmacists and doctors worked together to manage outpatient drug treatment for patients who used 4 or more drugs for chronic diseases.
After initial assessment, pharmacists made written recommendations to the patient’s doctor, and doctors responded later. Data were extracted from pharmacy records for patients who made one or more visits during the first two years of the program.
Patient demographic data, number of chronic conditions and medications administered at the time, type and number of questions related to the drug, category of drugs, pharmacist’s recommendations and acceptance of medical recommendations were collected.
Data were collected from 150 patients. The mean age was 54.4 ± 19.4 years, and 74.0% were female, with an average use of 9.3 ± 4.6 medications and 6.1 ± 3.1 medical problems indicated upon registration. A total of 886 drug-related questions were classified into seven categories, such as: inadequate adherence (25.9%), the need for additional therapy (22.0%), the use of the wrong medication (13.2% ), unnecessary drug treatment (12.9%), adverse drug reactions (11.1%), very low doses (9.7%) and very high doses (5.3%).
In general, doctors accepted 313 (47.4%) of the 659 recommendations to change drug therapy made by pharmacists, with the highest agreement rates for discontinuing or changing medication (50.3% and 50.0 %, respectively) and with the lowest percentage of agreement to start a new medication (41.7%).
In conclusion, the management program showed that drug therapy for outpatients who use various drugs to treat and control chronic diseases can be improved through collaboration between doctors and pharmacists.
Medicines Information Center and the role of the pharmacist
For clarification purposes, Medicines Information Centers (CIMs) have become of paramount importance even for other professionals, since a substantial increase in the variety of medicines and the manufacture of generics and the like has been observed , and it is necessary to organize a center where it could be possible to resolve several doubts regarding the drugs (AMERSON; GORA-HAPER, 2001; VIDOTTI; SILVA; HOEFLER, 200 3 ).
Thus, mong the activities of the MICs is will the provision of information on medicines , which is up to the pharmaceutical , healthcare systems, with the same charge of careful evaluation for subsequent application of information obtained from literature on patients and professionals may request the service (ibidem).
The pharmacist must therefore know how to make use of technical and scientific information is s updated s and relevant s, properly evaluated and processed s . In addition, agility and the provision of practical feasibility information are essential as the guidance can be aimed at a patient at risk or delicate and who seeks an urgent solution, even if provisional ( PAHO, 1995; VIDOTTI; SILVA; HOEFLER, 2003 ).
In this sense, it is worth discussing the study by Susan et al. (1998) when assessing the knowledge of the benefits and risks of drugs as well as the pharmacist’s ability to disseminate essential information to consumers based on their work in Drug Information Centers .
45 hospital pharmacies in Hong Kong were evaluated , of which 33 were public and 12 private.
Results showed that a large percentage (77.5%) receive from zero to five consultations per day about health care by professionals.
Many pharmacies offer medication information services within the hospital. Of the hospital pharmacies that provide education and professional training , more than 80% provided programs for nursing staff and more than 50% provided programs for dispensers, such as pharmaceutical technicians.
Of the forty-one far hospital Macias, 14 (34.1%) published reports or informative booklets; only 8 (19.5%) did regularly , and 7.3% by w ada month 4.9% every two months and 7.3% every 3 to 4 months .
The number of reference books belonging to the hospital pharmacies ranged b astante from 4 to 191. Between 40 Hospital pharmacies provisionavam data provider 9 (i n cluding those who had Drug Information Center ) were more than 20 books reference s inside the pharmacy.
Forty-three percent of pharmacies had general references like the Martindale directory , as their only type of reference.
Although 85 the 191 books were available at each Center of information, none of the centers presented wide range of references to cover all possible types of information requested on drug s .
Thirty-two percent of f hospital armácias researched s t ine m direct access to an electronic information system within the pharmacy, and the National Library of Medicin and (MEDLINE) the information system electronic drug more present (10 public hospital pharmacies ); followed by DRUGDEX (Micromedex, Englewood, CO), present in 8 public and 1 private pharmacies .
Eight pharmacies (19.5%) had no computerized access to any drug information system, with 9.1% from public hospitals and 62.5% from private hospitals .
Concerningly, the authors noted that of the evaluated pharmacies that had medical libraries within hospitals, including computerized access, 80% of employees and pharmaceutical personnel did not use the facilities.
It was also found that, of the 41 pharmacies, only one with a Drug Information Center had a manual of policies and procedures for responding to requests for information about the drug. Approximately a quarter of pharmacies without an Information Center documented their requests for information about drugs.
Difficulties alleged aside, such as maintaining a full-time pharmacist to attend the Information Center and guidance on the use of libraries, employees who use technology and literature within pharmacies report that sharing responsibilities between pharmaceuticals is the main mechanism for the success of the professional performance of both the level of personal knowledge as the leve level of dissemination of informaçõ es neces s ary to consumers on request (SUSAN et al., 1998) .
As Vidotti, Silva and Hoefler (2003 ), the C enter information about M edications (CIM) is an essential mechanism for obtaining information that should be free in order to guarantee access to the various layers of the population . Information can be requested s telephone / fax, mail, email or attending the establishment .
It is up to the pharmacist , the attendant, to provide the most accurate and appropriate information possible , in order to satisfy the needs of the consultant, whether he is a patient or another professional, and it is essential to know how to make use of the available collections in addition to having diverse medical knowledge (ibidem) .
To corroborate, Santos et al. (2009) described passive information , that is, information that is offered in response to a question from a consumer or professional, carried out by an Information Center at a university hospital in southern Brazil.
According to the results, the center received 8035 requests in the period from 2002 to 2008, with an average of 95.6 ± 13.3 requests / month. These requests are classified as internal or external, according to their origin. Most requests (N = 7802; 97.1%) were made by in-house professionals, while 233 (2.9%) represented requests outside the hospital.
The telephone was the most used means of communication, both for receiving (N = 5856; 72.9%) and for sending responses (N = 5446; 67.8%). E-mail accounted for 4% (N = 323) of the total inquiries received and 9.1% (N = 734) of the total responses sent by the CIM.
Both the questions and answers made personally by the professionals represented 23.1% (N = 1856).
The means of communication used by the CIM to send the information are chosen by the applicant and depends on the amount and complexity of the information contained in the response. Requests regarding medication administration are often answered by telephone quickly, while longer and more elaborate information is usually sent by e-mail, taking into account the urgency of the response.
The time used for preparing and sending responses in more than half of the requests (56.7%) was up to 10 minutes, corresponding to 4553 consultations of the 8035 questions asked in the period. Responses sent in 11 to 30 minutes represented 1860 (23.1%) of the total requests. About 4.6% (N = 368) of requests were answered between 24 and 72 hours, while 2.4% (N = 191) of requests required more time for research (more than 72 hours), being research stability of drugs and solutions the item that demanded a longer research time.
The requests were classified into different themes. The five most requested topics were: administration (25.6%); Identification (16.4%), which includes questions related to the nomenclature, presentation and composition of medicines; dosage (10.6%); stability (9.6%) and compatibility between drugs (7.4%).
Applicants were classified into five categories according to their profession. The group of nurses stood out with 2364 (30.3%) requests, followed by pharmacists with 1894 (24.3%), nursing technicians with 1171 (15%), doctors with 1139 (14.6%), and others with 1228 (15.8%). This last category includes users who cannot be classified in other groups, such as pharmacy technicians, nutritionists and internal professionals. The archived data on requests has changed over the years.
In 2007 , the origin of the request was included. In the years before 2007, the units that had used the service the most were the Adult Intensive Care Center (CTI) and the Pharmacy Service. In 2007 and 2008, 27.9% of requests were made by the Pharmacy Service, followed by 12.5% from Pediatrics and 8.0% from CTI. As pediatrics, inpatient, intensive care, oncology and neonatology units were included.
When checking the profile of the applicants over time, it was observed that more and more professionals involved in the process of prescription, administration and dispensing of medicines are seeking information from the Information Center, translating the relevance of the domain of knowledge and search mechanisms by the responsible pharmacist in order to streamline the service and effectively (SANTOS et al., 2009).
In order to reinforce the importance of the search for information in Drug Centers by professionals from different health areas , it is worth highlighting the study by Tobia et al. (2008) when stating that previous studios that evaluated the adequacy of antibiotics in acute respiratory tract infections (ITR), with a probable bacterial etiology, have focused only on the choice of antibiotic and ignored other important aspects of the prescription, such as dosage, drug interactions and duration of treatment.
Thus, the authors determine am the prevalence and predictors of inappropriate prescribing practices of antibiotics in patients with ITR acute bacterial (pneumon was acquired in the community (PAC) , sinusitis , or EXAC erbações of chronic bronchitis (E B C ).
This retrospective and cross-sectional study evaluated patients with CAP, sinusitis or AECB in an emergency department over a period of one year.
Using electronic medical records, assistants trained research concluded the collection of form data that included patient characteristics as civ state il, history of alcohol abuse , diagnosis, the comorbidities, concomitant medications and prescribed antibiotics.
To assess the adequacy antimicrobial, a clinical pharmacist trained revised forms of data collection and applied the Index Adjustment to Drug ( Medication Appropriateness Index ) (MAI), which ranked the suitability of a drug by 10 criteria: indication, efficacy, dosage, indications, practicality (defined as the ability of r used or implemented), drug interactions, interactions to the disease , unnecessary duplication, duration and cost set as the cost of the drug as compared to other ef agents similar effectiveness and tolerability .
One hundred and fifty and three patients were included, with a mean age of 58 years, 92% male and 65% white . Overall, 99 of the 153 patients (65%) had inappropriate antibiotic prescriptions evaluated by the MAI. High cost to acquire the drug and maintenance of drug therapy (39%) lack of practicality ( 21%) and incorrect dosage (10% ) were the s problem s more frequ entemente identified and associated with inappropriate prescribing . Penicillins, quinolones and macrolides were the most common classes of antibiotics prescribed inappropriately.
In conclusion, future interventions to improve antibiotic prescribing should m consider aspects beyond the choice of agent , such as knowledge about the interactions of the nomenclatures of the generic and its active ingredients, organic reactions and adverse, taking into account the purchasing power of population .
As explained above, it was possible to observe changes in the model of organization of health care services and practices , necessary so that care is not only focused on the act of remedying an already installed problem, but on the act of controlling the disease Compra de Diploma, Comprar Diplomas, Comprar Diploma Quente. However, chronic diseases when already installed can lead to the appearance of complications leading to the need for attention, prevention and control of multifactoriality.
For this, a range of medications has been available in order to improve the patient’s quality of life, but the problem arises when it is irrationally used. The worsening of the clinical condition still occurs p it polypharmacy and rampant commercialization that exposes the patient to r baits potenciai ‘s drug interactions, adverse reactions , which may lead him to death . However, among the list of medications, some therapeutic prescriptions may be unnecessary .
Thus, pharmaceutical assistance emerges as a strategy to promote the rational use of medicines Compra de Diploma, Comprar Diplomas, Comprar Diploma Quente, as it has the function, among others, of orienting the patient on the use and administration of drugs in order not to expose him to damage that may reflect on iatrogeny and / or drug interactions.
The greatest challenge for pharmacists is to contribute to promoting the rational use of medicines and to avoid complications to the health of users , which can be done in conjunction with other health professionals when paying attention to medical prescriptions and suggesting changes . Or, further, contribute to the dissemination of information among physicians with the support of physical and electronic medical libraries that must integrate the Medicines Information Centers or the pharmacies themselves.
Information such that respect m the composition of medicines; the risks of interruption, substitution or inclusion of other medications , even with the knowledge of health professionals Compra de Diploma, Comprar Diploma, Comprar Diploma Quente; to the right following the dose in order to avoid the simultaneous administration of drugs that may interact with each other or with food; the monitoring of adverse reactions implicated in negative outcomes.
In addition, other educational programs collectives in centers hospital, pharmacists and in their own universities should be encouraged so that the information can reach a larger number of people Compra de Diplomas, Comprar Diplomas, Comprar Diploma Quente, helping caregivers, family members and even the patient may use drugs more safely .