Drug Therapy Problems Research Articles

Assessment of attitude, practice and barriers to pharmaceutical care among community pharmacists in Ibadan

Background: Pharmaceutical care (PC) is a professional responsibility of a pharmacist that involves medication management with the overall goal of improving the quality of life of patient.Objectives: To evaluate the attitude, practice, and barriers to PC among community pharmacists in Ibadan.Method: A cross-sectional survey was conducted among community pharmacists between May and July 2021, with the aid of a self-administered questionnaires, information on socio-demographic characteristics, practice, attitudes, and barriers to PC was obtained. A consecutive sampling technique was used for participants’ enrolment. Participating pharmacists must have had a minimum of one-year practice experience in a community pharmacy. Pharmacy students, interns, non-pharmacist attendants, and community pharmacists who were absent from their pharmacies during the study were excluded. Data were summarized with descriptive statistics.Results: Over 12 weeks, 120 survey were collected (90.9% response rate). About (115; 95.8%) of respondents had good practice of PC and reported that pharmaceutical care is a timely innovation to pharmacy practice. However, only (62; 52.0%) had positive attitude and (117; 97.5%) believed more pharmaceutical care could be provided. Regarding their practice, most respondents (118; 98.3%) stated pharmaceutical care involves monitoring improvement in patient response to treatment and adherence to treatment regime and counselling patients with drug therapy problems. The top detected barriers for PC provision included insufficient time (71; 59.2%), and inadequate collaboration with other healthcare professionals (56; 46.7%).Conclusion: Community pharmacists in Ibadan demonstrated good practice and positive attitudes towards PC provision. However, further work should emphasise on improving PC understanding, better collaboration among other healthcare professionals and overcoming system-related barriers.

Teaching pharmacy students a systematic approach to medication order verification

Background and purposeInpatient medication order verification is an important skill for pharmacy students to learn for patient safety. This article describes a systematic approach to order verification that enables students to apply didactic knowledge and determine the presence of drug therapy problems during verification decisions. Educational activity and settingAt two different colleges of pharmacy, an order verification module for second-year pharmacy students introduced a checklist for reviewing medication orders in a patient chart and identifying the presence of drug therapy problems. Students had to make a “verify or not” decision for each non-verified order and document their decision in both the chart and on a game-based learning platform. FindingsOver four academic years, 756 students participated in the module. With the checklist approach to order verification, students were able to identify the drug therapy problems of “dose too high” and “no drug therapy problem present” but were challenged by “wrong drug,” “dose too low/renal dosing,” and “duplication of therapy.” SummaryThe order verification checklist was a beneficial tool for teaching a systematic approach to inpatient medication order verification.

Clinical Pharmacy Services in Ambulatory Oncology: An Environmental Scan of the Canadian Practice Landscape.

Canadian clinical pharmacy key performance indicators (cpKPIs) have been developed for inpatient hospital practice but are not established for ambulatory oncology. This study represents the first step in developing cpKPIs for ambulatory oncology. To describe the current landscape of pharmacy services in ambulatory oncology in Canada and to identify perspectives related to the development and implementation of cpKPIs in this practice setting. In this national cross-sectional study, a web-based questionnaire was distributed to pharmacists working in ambulatory oncology settings. Potential participants who self-identified as pharmacists practising in an ambulatory oncology setting were eligible. Survey questions focused on participants' demographic characteristics, oncology pharmacy services provided, metrics captured, and pharmacists' perceptions of cpKPIs. All data were analyzed using descriptive statistics. A total of 44 responses were received, with most respondents practising in community hospitals in British Columbia, Ontario, and Atlantic Canada. The services most commonly provided were chemotherapy order verification, laboratory monitoring, identification and resolution of drug therapy problems, and counselling on anticancer medications. Twenty-six of the 44 respondents (59%) indicated that performance metrics or patient outcomes were tracked at their respective institutions, with none being universally captured. Overall, 43 (98%) of the respondents favoured the development of cpKPIs for ambulatory oncology practice. Despite growing patient care needs in ambulatory oncology, there is significant heterogeneity in the scope of pharmacy services offered and the outcomes used to qualify their impact within this setting across Canada. This study demonstrates a clear need for national consensus cpKPIs to inform pharmacy resource utilization and patient-centred quality improvement initiatives.

Evaluation of Awareness and Knowledge of Pharmacovigilance amongst Final Year Students of Rivers State College of Health Science and Technology, Nigeria

Adverse drug reactions (ADRs) till date are still considered as one of the main problems of drug therapy. Pharmacovigilance is the monitoring of drug safety by means of spontaneous adverse-effect reporting systems, case control and cohort studies.
 This study evaluated the levels of awareness and knowledge of pharmacovigilance (i.e., ADR reporting) amongst final year students of Rivers State College of Health Science and Technology, Port Harcourt, Nigeria. It was a cross sectional awareness and knowledge survey amongst 200 students from the eight Schools of the institution. Specially adapted and structured questionnaires were administered to the students to obtain information on their levels of awareness and knowledge on reporting of ADRs. Simple descriptive statistics was used to analyze the data that were obtained. The result showed that over 72% of the students from each of the Schools had good knowledge of ADR, about 62% were aware of ADR reporting system, while less than 50% had knowledge of the process of reporting ADRs.
 Final year students of College of Health Science and Technology, Port Harcourt have good knowledge of ADR. However, their awareness of the reporting system and particularly the process of reporting (pharmacovigilance) is poor and needs improvement.
 Keywords: Awareness, adverse drug reaction, pharmacovigilance

Identifying Drug-Therapy Problems among Syrian Refugees in Zaatari Refugee Camp.

Background: Due to a lack of proper pharmaceutical care, Syrian refugees in the Zaatari refugee camp are more likely to have drug-related issues, such as prescription errors and adverse drug occurrences. Aim: The current study aims to identify drug-therapy problems among Syrian refugees in the Zaatari refugee camp. Method: This is a retrospective cross-sectional study. Patients’ files were collected from the Zaatari camp database. Patients who were 18 years or older and were previously diagnosed with a chronic disease were included. A classification of drug therapy problems (DTPs) was adapted. Results: The data of 1530 adult patients (896 females) were collected. The mean age of the sample was 53.7 years and the mean Body mass Index (BMI) was 27.20. The mean of all taken medications was 4.01 (±2.33) medications, with a maximum number of 13. A total of 3572 DTPs was identified, with a mean of 2.33 (±1.26) DTPs per patient. Based on the above-mentioned classification, 70.32% of the DTPs were related to indication, 26.65% were related to effectiveness, and 3.03% were related to safety. Conclusion: This study found that refugees in the Zaatari refugee camp have numerous DTPs among their medications. Greater focus should be placed on their medical care, in order to prevent any future complications due to DTPs.

Drug therapy problems and predicting factors among ambulatory epileptic patients in Jimma Medical Center, Southwest Ethiopia.

BackgroundThe care of epileptic patients is complicated by the cognitive adverse effect of the drug, disease, pharmacokinetics, and pharmacodynamics properties of antiepileptic drugs which in turn intensify the risk of drug therapy problems among epileptic patients.ObjectiveTo assess drug therapy problems and predicting factors among ambulatory epileptic patients at Jimma University Medical Center, Southwest Ethiopia, from September 2020 to May 2021.MethodologyA hospital-based prospective observational study was conducted. A semi-structured questionnaire was used to collect data from patients as well as from charts. Drug therapy problems were identified using Cipolle’s, Morley, and Strand drug therapy problem identification and classification method. Data were entered into Epi data manager version 4.6 and exported to statistical software package for social science version 23.0 for analysis. Multiplestepwise backward logistic regression analysis was carried out to identify predictors of drug therapy problems. The 95% CI was used to show an association between the dependent and independent variables. P-value < 0.05 was considered as statistically significant.ResultsOf the total 320 epileptic patients 224(70.0%) patients had at least one drug therapy problem. A total of 395 drug therapy problems were identified among two hundred twenty-four patients with an average of 1.2 drug therapy problems per patient. The frequently identified drug therapy problems were non-compliance 115(29.11), adverse drug reaction 110(27.84%), and dose too low 103(26%). Getting of a drug by purchasing [AOR = 4.6,95%CI:(2.05–10.7)], poorly involvement of the patients in therapeutic decision making [AOR = 3.02,95%CI:(1.5–6.06)], the number of medications ≥ two [AOR = 5.3,95%CI:(1.2–22.9)] and having had uncontrolled seizure [AOR = 10.9,95%CI:(4.9–24.2)] were independent predictors of drug therapy problems.ConclusionsDrug therapy problems were common among epileptic patients in the study area. Patients who were getting their drugs by purchasing, poorly involved in therapeutic decision making, having had an uncontrolled seizure, and taking two and above drugs were more likely to experience drug therapy problems. Therefore, due attention should be given to patients with the aforementioned problems to decrease the occurrence of drug therapy problems and improve overall outcomes among epileptic patients.

Investigation of Pharmaceutical Care Practice in Two Tertiary Health Care Facilities in Central Monrovia, Liberia

Aims: to identify elements of pharmaceutical care and to what extend it is practiced in these hospitals and to identify any drug-related therapeutic problems and determine the perceived importance of pharmaceutical care.&#x0D; Study Design: A prospective, cross-sectional descriptive survey was carried out among hospital pharmacists and some selected physicians and physician assistants working at two major tertiary healthcare facilities in Liberia.&#x0D; Place and Duration of Study: John F. Kennedy Memorial Hospital, and Eternal Love Winning Africa Hospital, between August, 2021 and October, 2021.&#x0D; Methodology: Pretested structured questionnaires covering demographics and the key elements of pharmaceutical care documentation was administered randomly to 43 health professionals in these hospitals and collected for compilations and analysis.&#x0D; Results: Twenty percent (20.9%) confirmed the documentation of pharmaceutical care elements in both facilities, and 18.6% confirmed the documentations of interventions. Methods used in documentation are paper (13.9%), manual (72.1%) and computers (6.9%) respectively. Unnecessary drug therapy/unwanted indication, adverse drug reactions, drug interactions, need for additional drugs, dosage too high, dosage too low, wrong drugs, and inappropriate compliance are the drug therapy problems that exist at both facilities. The overall percentage of all the drug therapy problems is twenty-five percent (25.6%), of which most are highlighted at John F. Kennedy Memorial Hospital, though these problems exist at both hospitals. There is an increase in drug therapy problems and a decrease in standard documentation format and method used to document pharmaceutical care at both hospitals. Thirty-nine percent (39.5 %) of the respondents recognized the importance of the documentation of pharmaceutical care (PC). &#x0D; Conclusion: The study findings revealed that there is semblance of elements of pharmaceutical care activities at the both hospitals, but it is limited. Inadequate documentations of PC interventions coupled with primitive methods of recording PC data are highlighted by respondents. The practice of pharmaceutical care in the Liberia’s healthcare system can greatly improve the quality of pharmaceutical services and enhance the quality of life and therapeutic outcomes to patients/clients.

Drug Therapy Problems Associated with Antibiotics Prescriptions in University of Uyo Health Centre, Uyo, Nigeria

Introduction: Antibiotic resistance has contributed as one of the greatest public health threats at present. This study aimed at identifying drug therapy problems (DTPs) associated with prescriptions of antibiotics to patients attending the University of Uyo Health Centre and presented a seminar as an intervention.&#x0D; Method: A prospective observational study was carried out. One hundred (100) patient folders with 147 antibiotics prescriptions were used for the survey for the first-month collation of antibiotics prescriptions while one hundred and sixty (160) patient folders with 160 antibiotics prescriptions were used at the second -month of the survey. The seminar presentation on drug therapy problems associated with antibiotics prescriptions was held after the first -month of the survey. Data obtained were analyzed by using descriptive statistical tools such as frequency, mean, standard deviation and bar chart. The statistical analytical tool such as student T- test was used and significance was considered at p ≤ 0.05.&#x0D; Result: The first survey involved 147 prescriptions of antibiotics. Prescriptions with DTPs were 77 (52.4%) while the most frequently occurring DTPs was drug interactions (37.1%), followed by inappropriate dosage frequency (23.7%) and unnecessary medication (22.7%). The follow up survey included 160 prescriptions of antibiotics, out of which 112 (70%) prescriptions of antibiotics contained 209 DTPs. The most frequent DTPs was drug interactions (49.3%), followed by inappropriate dosage duration (19.1%) and inappropriate dosage frequency (11.5%). The results also showed that antibiotics prescriptions with DTPs were significantly increased in the follow-up survey (p=0.00) of the study. Drug interaction (p=0.00), overdosing (p=0.00), underdosing (p=0.00) and Inappropriate dosage duration (p=0.00) were significantly increased in the follow-up survey.&#x0D; Conclusion: This study had indicated prevalence of DTPs associated with antibiotic prescriptions. Drug interaction, inappropriate dosage frequency and unnecessary medication were very common among antibiotic prescriptions.

Role of Pharmaceutical Care in Type 2 Diabetic Patients in Kirkuk City

Background and objectives. Diabetes Mellitus is a chronic metabolic disorder that negatively affects patient’s quality of life and creates a huge burden on both patients and health care system. Effective pharmaceutical intervention could result in a tighter disease control,&#x0D; &#x0D; reducing long term complications and improving the quality of life.&#x0D; Methods: In this study, a prospective clinical trial was performed to evaluate the role of pharmaceutical care in reducing complications and in improving the quality of life among patients with T2DM.A total of 189 patients were included and divided into two groups; the first group: consisted of 95 patients, comprised the intervention group who received regular pharmaceutical care on monthly basis. The rest 94 patients were allocated to the non-intervention group who only received usual medical care. Patient selection was carried out according to certain inclusion and exclusion criteria. Two categories of data were recorded from each participant at 6 time points during the study period. The first category was assessment of risk factors of complication such as hypertension, hyperlipidemia, uncontrolled hyperglycemia, physical inactivity and smoking. The second category was current status of diet and quality of life.&#x0D; Results: The number of drug therapy problems non-adherence to medication and HBA1c were significantly reduced and quality of life was significantly improved among intervention group. Other Clinical and blood parameters were not affected.&#x0D; Conclusion: Pharmacist collaboration with physicians regarding management of type II diabetes patients have yielded a better patient management outcome, reduced risk factors and improved the quality of life in those patients.

Developing clinical reasoning: An introduction for pharmacy preceptors

AbstractClinical reasoning is the thinking and decision‐making process undertaken to solve and manage a clinical problem. This process differs from problem solving or critical thinking and refers to the process of identifying drug therapy problems and optimizing therapeutic options. While clinical reasoning is a professional expectation of pharmacists in practice, pharmacy preceptors may find it difficult to teach and assess the complexity and nuances of clinical reasoning. The purpose of this guide is to briefly review clinical reasoning processes in pharmacy practice and to summarize practical strategies for preceptors to implement with their learners to promote the development of clinical reasoning.

Impact of medication therapy management interventions on drug therapy problems, medication adherence and treatment satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia: a one-group pre–post quasi-experimental study

ObjectiveTo determine the impact of medication therapy management interventions on drug therapy problems (DTPs), medication adherence and treatment satisfaction among ambulatory heart failure (HF) patients.Study design, setting and participantsA one-group...

Prescription of medicines for the management of childhood acute watery diarrhoea at a tertiary hospital in Ebonyi state, Nigeria

Background: The burden of childhood diarrhoea in Nigeria is huge and has been persistently high over the years with an estimated 205 under-fifives dying daily. Asimple combination of oral rehydration salts (ORS) and zinc tablets (ORS/Zinc) has been approved for its treatment by the WHO since it is benefificial for rehydration which is the goal of therapy. However, huge resources are spent on antibiotics and other medications which are not benefificial for rehydration, thereby exposing children to unnecessary medications and other drug therapy problems. This study was set to evaluate the prescription of medicines for acute watery diarrhea (AWD) in under-fifive children and to determine the appropriateness of these prescriptions. Method: This study was conducted in a tertiary hospital in Abakaliki, Ebonyi State. It was a retrospective review of prescriptions of medicines for AWD in under-fifives for a period of 28 months (January 2019 to April 2021). All available cases of AWD (338) were extracted from the prescription registers. Data were entered into SPSS version 24.0 and descriptive analysis was done. The guideline set by WHO for the management of AWD was followed for evaluating the prescriptions. Results: Out of the 338 cases of AWD, 190 (56.2%) occurred in male children and 265 (84.4%) in children under 24 months. Of the total cases, 291 (86.1%) received prescriptions containing ORS, zinc, and probiotics either alone or in difffferent combinations with only 154 (45.6%) containing ORS and zinc together. Of these prescriptions with ORS/Zinc, 47 (30.5%) also contained antibiotics, antimalarials and infusions. In total, there were 99(29.3%) and 48 (14.2%) prescriptions containing antibiotics and antimalarials respectively. The most frequently prescribed antibiotic classes were sulfonamides (41; 40.6%), cephalosporins (29; 28.7%) and flfluoroquinolones (13; 12.9%). Less prescribed antibiotic classes include macrolides, penicillins and nitroimidazoles. Other groups of medicines prescribed were analgesics, anthelmintics, oral potassium and antacids, and antihistamines. Overall, only 107 (36.8%) prescriptions were appropriate for the management of AWD. Conclusion: This study revealed that only 36.8% of AWD cases received appropriate prescriptions according to guideline. Therefore, there is urgent need for intervention in the study setting to improve appropriate treatment of AWD.

Factors associated with the identification of drug therapy problems among older patients in Primary Health Care.

To determine the frequency of drug therapy problems among older adults in Primary Health Care, and to analyze the factors associated with their identification in the initial patient assessment, carried out by pharmacists offering medication therapy management services. A cross-sectional study conducted with data from 758 older adults followed up in medication therapy management services in Primary Health Care in the cities of Belo Horizonte, Betim, and Lagoa Santa (MG, Brazil). Univariate and multivariate analyses were performed to evaluate the factors associated with identification of four or more drug therapy problems in the initial clinical assessment. A total of 1,683 drug therapy problems were identified, 73.6% of older patients had at least one problem. The most frequent problems were nonadherence (23.0%) and the need for additional drug therapy (18.0%). Polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and aged 75 years or older remained positively and statistically associated with identification of four or more drug therapy problems (p<0.05). There is a high frequency of problems related to medication use among older users of Primary Health Care, and the medication therapy management services should be prioritized to the older patients, who present with polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and age ≥ 75 years, since they are more likely to have more drug therapy problems.

Risk factors for drug therapy problems among Cambodian Americans with complex needs: a cross-sectional, observational study

ABSTRACT Background Pharmaceutical drug therapy problems (DTPs) are a major public health problem. We examined patient-level risk factors for DTPs among Cambodian Americans. Methods Community health workers (CHWs) verbally administered surveys and completed a detailed medication review form with participants. A doctoral-level pharmacist reviewed the form with the patient and CHW to determine DTP number and type (appropriateness, effectiveness, safety, and adherence). Results Participants (n = 63) averaged 55 years old, 6 years of education, 52% were married, 87% spoke Khmer at home, with modal household income <$20,000 (41%). The percentage of participants with DTPs was: 45% appropriateness, 25% effectiveness, 64% safety, and 30% adherence, averaging 3.7 DTPs per patient. In multiple regressions, patient characteristics uniquely predicted each type of DTP. In a multiple regression controlling for number of medications, being married reduced total DTPs (IRR = 0.70) and being depressed increased total DTPs (IRR = 1.26). Conclusions Vulnerable patients should be prioritized for pharmacist/CHW teams to identify DTPs. Trial registration: ClinicalTrials.gov identifier: NCT02502929.

Antimicrobial use-related drug therapy problems and associated factors among patients in the medical ward of Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Southwest Ethiopia.

This study assessed the antimicrobial use-related drug therapy problems (DTPs) among patients admitted to the medical ward of Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital (WCUNEMMCSH), Southwest Ethiopia. A hospital-based prospective observational study design was used to assess antimicrobial use-related DTPs among patients admitted to the medical ward of WCUNEMMCSH from June to August 2021. Data were collected using a structured data abstraction format. In all, 128 patients admitted to the medical ward were enrolled. Among the study participants, at least one form of antimicrobial DTP occurred in 98 (76.6%) of them. The most prevalent DTPs were unnecessary drug treatment in 42 (32.8%), the need for additional drug treatment in 36 (28.1%), and non-adherence in 30 (23.4%) of the patients. There were a total of 288 antimicrobial drug orders. Ceftriaxone 120 (41.7%) and azithromycin 69 (24.0%) were the most commonly prescribed antimicrobial drugs. In multivariate logistic analysis, the length of hospital stay (adjusted odds ratio (AOR) = 2.97, 95% confidence interval (CI): 1.06-8.32; p = 0.04) and the number of diagnosed diseases (AOR = 3.10, 95% CI: 1.12-8.15, p = 0.02) were predictors of antimicrobial use-related DTPs. Antimicrobial use-related DTPs are common among patients admitted to the medical ward of WCUNEMMCSH. Health professionals should work together to reduce the high prevalence of DTPs among medical ward admitted patients in this hospital.

Treatment outcome and associated factors among epileptic patients at ambulatory clinic of Mettu Karl Comprehensive Specialized Hospital: A cross-sectional study.

Objective:The study was aimed to assess the magnitude and associated factors of 2-year seizure-free status of epileptic patients at Mettu Karl Comprehensive Specialized Hospital (MKCSH).Methods:A retrospective cross-sectional study was conducted at MKCSH from 12 February 2020 to 11 August 2020. Treatment outcome was measured in terms of seizure control status and seizure frequency. Accordingly, good treatment outcome was declared if the patients had a 2-year seizure-free status and poor if the patient had episodes of seizure in the last 2 years. The pharmaceutical care network Europe guideline was used to assess the presence of medication-related problems. Multivariable logistic regression was used to analyze the variables by using crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence interval (CI). Finally, the predictors of epilepsy treatment outcome were declared if a P-value was ⩽0.05.Results:Over the study period, more than half of the participants (172 (57.7%)) were males. The median age of participants was 29 and majorly distributed to 18–30 classes. More than one-fourth of the patients were suffering from absent seizure 85 (28.5%) and general tonic-clonic seizure 83 (27.9%). The most commonly prescribed medication was Phenobarbitone which accounts 34 (11.41%), whereas Valproic acid 8 (2.68%) was the least prescribed. Overall, less than half 131 (43.96%) of patients developed poor treatment outcomes. The predictors of treatment outcomes were having head the injury (AOR = 5.7; 95% CI: 3.18, 10.31), family history of epilepsy (AOR = 5.6; 95% CI: 3.07, 10.46) and the presence of drug therapy problems (AOR = 5.2; 95% CI: 2.79, 9.69).Conclusion:The magnitude of poor epilepsy treatment outcome was found to be high. The predictors of epilepsy treatment outcome were the history of head injury, family history of epilepsy and drug therapy problems. Therefore, to improve the treatment outcome of epileptic patients, health care providers should pay close attention to the identified factors. Besides this, the clinical pharmacy service should be implemented to minimize any medication-related problems

A pilot integrated qualification program to improve medication use in a long-term care facility: a hybrid effectiveness-implementation study

Objective: to describe the implementation and to assess the effectiveness of a pilot integrated qualification program to improve the medication use in a long-term care facility (LTCF). Methods: This was a type 1 hybrid effectiveness-implementation study. A pilot integrated qualification program to improve the medication use in a LTCF was carried out by implementing a new drug distribution system and a comprehensive medication management (CMM) service according to the following four steps: I) implementation of the drug distribution system followed by the evaluation of the health team’s opinion; II) prescription review with the identification of potential drug therapy problems (PDTPs); III) provision of the CMM service according to the framework of Pharmaceutical Care practice within one year; and, IV) evaluation of the effectiveness of the program through the comparison of clinical and laboratory parameters (blood pressure, glycated hemoglobin and lipid fractions) using the t-test or Wilcoxon signed-rank test. Results: In step I, the distribution system was fully outsourced to a company that furnished all solid oral dosage forms in individual boxes containing a plastic coil with multiple envelopes for 30 days. In step II, 180 PDTPs were identified, and all patients presented with at least one of them. In step III, after the first assessment of the CMM Service, 43 actual drug therapy problems (DTPs) were identified. After one year of service provision, 96 DTPs were identified and 75.8% of them were resolved (n=72). In step IV, a statistically significant difference was observed between the initial and final minimum and maximum systolic and diastolic blood pressure (p&lt;0,05). Conclusions: The pilot integrated qualification program had a positive impact on the clinical parameters. The global population is rapidly aging, making this type of study important to exemplify a multifaceted strategy to improve the quality of drug therapy for institutionalized patients.

The effects of pharmacist interventions on health outcomes in patients with advanced prostate cancer in Brazil

This study examined the effects of pharmacist interventions for patients with advanced prostate cancer. A pre-post study was conducted between October 2014 and August 2017 in a community pharmacy in Brazil for outpatients with advanced prostate cancer, aged ≥ 18 years, using cyproterone acetate and/or goserelin. The patients had face-to-face meetings with a pharmacist who dispensed antiandrogenic drugs and performed interventions aimed at solving and/or preventing drug-therapy problems. Primary outcomes regarding prostate-specific antigen (PSA) and testosterone levels were compared at 0, 6, and 12 months, whereas secondary outcomes-medication adherence and quality of life-were compared at baseline and at the 12-month follow-up. Medication adherence was assessed using the Morisky-Green test, and quality of life was measured by the Medical Outcomes Study 36-item Short Form (SF-36) and the Functional Assessment of Cancer Therapy-Prostate (FACT-P). The analysis included 20 patients; 311 drug-therapy problems were identified and most of them were related to adverse reactions (78.5%). The most common adverse reactions were reduced libido, erectile dysfunction, hyperglycemia, fatigue, and gynecomastia. Testosterone levels significantly decreased at 6 months, and PSA levels at 6 and 12 months. No significant changes in adherence were noted at the end of the study. A significant increase in the “pain” domain and an improvement trend in the “physical aspects” and “vitality” domains were observed based on the SF-36 instrument. The findings show that pharmacist interventions were able to improve PSA and testosterone levels, and some domains of quality of life of patients.

Profile of pharmaceutical interventions of a pharmacotherapeutic follow-up model for diabetic patients in a community pharmacy

The insertion of Pharmaceutical Care in Primary Health Care (PHC) improves patients’ clinical outcomes and quality of life. Pharmacotherapeutic follow-up can contribute to the management of chronic diseases such as diabetes, promoting better glycemic control and adherence to therapy. This study aimed to assess the Drug-therapy Problems (DTPs) and Pharmacist Interventions (PIs) on the pharmacotherapeutic management in patients with type 2 diabetes mellitus (T2DM) in a community pharmacy. A quantitative, retrospective, and cross-sectional study was conducted in a Pharmaceutical Care Program within the PHC in Juiz de Fora (Minas Gerais, Brazil). Inclusion criteria were patients with T2DM above 18, who attended at least three pharmaceutical consultations between July 2016 and October 2018 and presented two or more glycated hemoglobin tests. The study group (n = 17) was largely composed of women (65%), elderly (76%), sedentary (72%), and obese people (52%). The resolution was achieved in 79% of the DTPs identified (n = 115). Most of DTPs were related to administration and adherence to pharmacotherapy (46%). 60% of the 437 PIs involved the provision of information and counseling. In other words, accessible interventions lead to high resolvability. Therefore, clinical actuation of pharmacists could improve the prognosis in diabetes treatment.

Drugs in geriatric patient

Older adults are a vulnerable group of patients with multiple medical needs. The ageing process induces numerous physiological changes, which affect the pharmacological profile of drugs. The multiple conditions accumulated with advancing age, geriatric syndrome and frailty require that the geriatric patient use multiple medications simultaneously, which increases the risk of drug therapy problems. The comprehensive, multidimensional assessment of the geriatric patient is essential for the development of an individualised care plan that takes into account the patients’ specific health and social characteristics and goals. The pharmacist must take into account the age-specific changes that occur in the pharmacokinetics, pharmacodynamics and pharmacotoxicology of drugs in order to advise their optimal use.