Pharmaceutical Care Intervention Research Articles

Pharmacist involvement in the patient care improves outcome in hypertension patients.

Objective:The main objective of this study was to assess the effects of pharmaceutical care interventions in patients with essential hypertension in Lakshmi Pat Singhania Institute of Cardiology, Kanpur, India.Methods:The study was carried out from July 2010 to August 2011. Pharmaceutical care was provided for 54 patients (intervention group) which was comprised of the patient education, the prescription assistance and the life style modifications and motivation for health. Then the clinical outcome as well as health related quality of life (HRQOL) were compared with the control group (48 patients) in which the pharmaceutical care was not provided. Furthermore, the effect of pharmaceutical care intervention on HRQOL was assessed using Short Form-36 (SF-36), a general health related quality of life questionnaire used to evaluate the QOL of patients. Blood pressure (BP) measurements and QOL survey was performed at baseline and at the follow-up session.Findings:The difference between blood pressure readings from the baseline to the second follow-up was significant for systolic [(P = 0.0001), 12.24 mmHg] and diastolic BP [(P = 0.001), 5.17 mmHg] in the intervention group. The questionnaire used to evaluate the QOL of patients also showed improvement in the mean score for intervention group.Conclusion:Results from our study showed that applying pharmaceutical care to hypertensive patients can help in the control of these patients’ blood pressure, and consequently lower the risk that hypertension poses in cardiovascular disease. Successful implementation of pharmaceutical care has the potential to increase patients’ satisfaction with their pharmacists’ activities and may increase patients’ expectations that pharmacists will work on their behalf to assist them with their healthcare needs.

PHP4 Pharmaceutical Care Intervention for Disease Management in Community Pharmacies in Australia

PHP4 Pharmaceutical Care Intervention for Disease Management in Community Pharmacies in Australia

Educating Our Students About Pharmaceutical Care for Those Living With Cancer

Educating Our Students About Pharmaceutical Care for Those Living With Cancer

Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan.

Glycemic goals (hemoglobin A1c < 7%) are often not achieved in patients with type 2 diabetes despite the availability of many effective treatments and the documented benefits of glycemic control in the reduction of long-term microvascular and macrovascular complications. Several studies have established the important positive effects of pharmacist-led management on achieving glycemic control and other clinical outcomes in patients with diabetes. Diabetes prevalence and mortality are increasing rapidly in Jordan. Nevertheless, clinical pharmacists in Jordan do not typically provide pharmaceutical care; instead, the principal responsibilities of pharmacists in Jordan are dispensing and marketing of medical products to physicians. To assess the primary clinical outcome of glycemic control (A1c) and secondary outcomes, including blood pressure, lipid values, self-reported medication adherence, and self-care activities for patients with type 2 diabetes in an outpatient diabetes clinic randomly assigned to either usual care or a pharmacist-led pharmaceutical care intervention program. Patients with type 2 diabetes attending an outpatient diabetes clinic of a large teaching hospital were recruited over a 4-month period from January through April 2011 and randomly assigned to intervention and usual care groups using the Minim software technique. The intervention group at baseline received face-to-face objective-directed education from a clinical pharmacist about type 2 diabetes, prescription medications, and necessary lifestyle changes, followed by 8 weekly telephone follow-up calls to discuss and review the prescribed treatment plan and to resolve any patient concerns. The primary outcome measure was glycemic control (A1c), and secondary measures included systolic and diastolic blood pressure, complete lipid profile (i.e., total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], serum triglycerides), and self-reported medication adherence (4-item Morisky Scale) and self-care activities (Summary of Diabetes Self-Care Activities questionnaire). Data were collected at baseline and at 6 months follow-up. Changes from baseline to follow-up were calculated for biomarker values, and between-group differences in the change amounts were tested using the t test for independent samples. A P value of < 0.05 was considered statistically significant. A total of 77 of 85 patients (90.6%) randomly assigned to the intervention group and 79 of 86 patients (91.9%) assigned to usual care had baseline and 6-month follow-up values. Compared with baseline values, patients in the intervention group had a mean reduction of 0.8% in A1c versus a mean increase of 0.1% from baseline in the usual care group (P = 0.019). The intervention group compared with the usual care group had small but statistically significant improvements in the secondary measures of fasting blood glucose, systolic and diastolic blood pressure, total cholesterol, LDL-C, serum triglycerides, self-reported medication adherence, and self-care activities. Between-group differences in changes in the secondary measures of HDL-C and body mass index were not significant. Patients with type 2 diabetes who received pharmacist-led pharmaceutical care in an outpatient diabetes clinic experienced reduction in A1c at 6 months compared with essentially no change in the usual care group. Six of 8 secondary biomarkers were improved in the intervention group compared with usual care.

The effect of a multicomponent transitional pharmaceutical care intervention on the incidence and nature of unintentional medication discrepancies in geriatric patients after hospital discharge

The effect of a multicomponent transitional pharmaceutical care intervention on the incidence and nature of unintentional medication discrepancies in geriatric patients after hospital discharge

The Role of the Pharmacist in Optimizing Pharmacotherapy in Older People

Prescription of medicines is a fundamental component of the care of older people, but evidence suggests that pharmacotherapy in this population is often inappropriate. Pharmacists have been involved in different approaches for the optimization of prescribing and rational medication use in older people. This article describes the different models of care in which pharmacists are involved in the optimization of pharmacotherapy in older people, and reviews the impact of these approaches on both process and outcome measures. The provision of pharmaceutical care, medication reviews and educational interventions by pharmacists in the nursing home, ambulatory and acute care settings are discussed. We selected systematic reviews, reviews and original studies, and for the latter, we focused more specifically on European publications published between 2001 and 2011. From the literature reviewed, it is clear that when pharmacists play a proactive role in performing medication reviews and in the active education of other healthcare professionals, pharmacotherapy for older patients is improved. However, the evidence of the impact of pharmacists' interventions on health outcomes, quality of life or cost effectiveness of care is mixed. Better results have been reported when pharmacists are skilled and work in the context of a multidisciplinary team. Opportunities remain for multicentre, European-based, pharmacist-intervention trials in all settings, to determine the effectiveness and economic benefit of pharmacist involvement in the optimization of pharmacotherapy in older people.

Pilot study of a pharmaceutical care intervention in an outpatient lung transplant clinic

Lung transplant recipients have complex drug regimens. Study objectives were to assess drug therapy problems (DTPs), pharmacist recommendations, and patient satisfaction with pharmacist services. Using a pharmaceutical care assessment process, pharmacists identified DTPs and made therapeutic recommendations. Number of DTPs identified per pharmacist visit was calculated and compared to standard care visits through retrospective chart review. Potential clinical impact of recommendations was evaluated by blinded clinicians. Patient satisfaction was assessed via survey. Fifty-five DTPs were identified in 43 patients over 50 pharmacist visits (1.05±1.34 DTPs per visit). In these same patients, rate of DTP identification was 0.51±0.64 DTPs per standard visit in the preceding two-wk period (p=0.018 vs. pharmacist visit). The most common DTPs identified by the pharmacist were adverse drug effect (27%) and untreated indication (25%). Overall, 62% of pharmacist recommendations were rated very significant or significant. Survey return rate was 58% and satisfaction scores ranged from 3 to 5 out of 5. Review of medications and teaching regarding the use of medications received the most "very satisfied" and "highly important" scores. Pharmacists can make valuable contributions in a lung transplant clinic setting by identifying DTPs and making recommendations with a positive impact on patient outcomes and satisfaction.

Impact of pharmaceutical care on health outcomes in patients with COPD

Chronic obstructive pulmonary disease (COPD) treatment goals are often not achieved despite the availability of many effective treatments. Furthermore, clinical pharmacist interventions to improve clinical and humanistic outcomes in COPD patients have not yet been explored and few randomized controlled trials have been reported to evaluate the impact of pharmaceutical care on health outcomes in patients with COPD. The aim of the present study was to evaluate the impact of pharmaceutical care intervention, with a strong focus on self-management, on a range of clinical and humanistic outcomes in patients with COPD. Outpatient COPD Clinic at the Royal Medical Services Hospital. In a randomised, controlled, prospective clinical trial, a total of 133 COPD patients were randomly assigned to intervention or control group. A structured education about COPD and management of its symptoms was delivered by the clinical pharmacist for patients in the intervention group. Patients were followed up at 6 months during a scheduled visit. Effectiveness of the intervention was assessed in terms of improvement in health-related quality of life, medication adherence, disease knowledge and healthcare utilization. Data collected at baseline and at the 6 month assessment was coded and entered into SPSS(®) software version 17 for statistical analysis. A P value of <0.05 was considered statistically significant. The primary outcome measure was health-related quality of life improvement. All other data collected including healthcare utilization, COPD knowledge and medication adherence formed secondary outcome measures. A total of 66 patients were randomized to the intervention group and 67 patients were randomized to the control group. Although the current study failed to illustrate significant improvement in health-related quality of life parameters, the results indicated significant improvements in COPD knowledge (P < 0.001), medication adherence (P < 0.05), medication beliefs (P < 0.01) and significant reduction in hospital admission rates (P < 0.05) in intervention patients when compared with control group patients at the end of the study. The enhanced patient outcomes as a result of the pharmaceutical care programme in the present study demonstrate the value of an enhanced clinical pharmacy service in achieving the desired health outcomes for patients with COPD.

PMS42 Cost-Effectiveness of Increasing Bisphosphonates Adherence for Osteoporosis in Community Pharmacies

OBJECTIVES: Increasing real-life adherence to bisphosphonates therapy is important to achieve the clinical benefits of reducing fractures reported in randomized clinical trials (RCTs). The aim of this pharmacoeconomic analysis was to determine the cost-effectiveness of a pharmaceutical care intervention program in community pharmacies, aimed to increase bisphosphonates adherence for the prevention of osteoporotic fractures. METHODS: A decision analytical model was constructed with a time horizon of three years, discounting at 4.0% and 1.5% annually for costs and effects, respectively. A Dutch healthcare provider's perspective was adopted. Adherence and efficacy data were gathered from a Dutch pharmaceutical care program in community pharmacies (the MeMO intervention). The association between bisphosphonate adherence and osteoporotic fractures was modelled using Dutch clinical studies. Recent and upcoming reimbursement policy changes in The Netherlands were modelled with a scenario of therapeutic substitution, characterized by drastically lower drug prices. RESULTS: Adherence to bisphosphonates therapy in The Netherlands was 68.3%. The pharmaceutical care intervention program increased bisphosphonates adherence to 83.9% (P

Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients

The primary objective of this study was to evaluate the effect of a pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients. The clinical outcomes of this pharmacotherapy adherence approach were the secondary objective of the study. Public Primary Health Care Unit in a municipality in the Brazilian State of Sao Paulo. A 36-month randomized, controlled, prospective clinical trial was carried out with 200 patients divided into two groups: control (n = 100) and intervention (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultancies). The patients randomized into the intervention group received pharmaceutical care intervention besides the usual care offered. Pharmacotherapy adherence (Morisky-Green test translated into Portuguese and computerized dispensed medication history) and clinical measurements (blood pressure, fasting glucose, A1C hemoglobin, triglycerides and total cholesterol) were evaluated at the baseline and up to 36 months. A P value <0.05 was considered statistically significant. A total of 97 patients from the intervention group and 97 patients from the control group completed the study (n = 194). Significant improvements in the pharmacotherapy adherence were verified for the intervention group according to the Morisky-Green test (50.5% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001) and the computerized dispensed medication history (52.6% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001); no significant changes were verified in the control group. Significant improvements in the number of patients reaching adequate values for their blood pressure (26.8% at baseline vs. 86.6% after 36-months; P < 0.001), fasting glucose (29.9% at baseline vs. 70.1% after 36 months; P < 0.001), A1C hemoglobin (3.3% at baseline vs. 63.3% after 36 months; P < 0.001), triglycerides (47.4% at baseline vs. 74.2% after 36 months; P < 0.001) and total cholesterol (59.8% at baseline vs. 80.4% after 36 months; P = 0.002) were verified in the intervention group, but remained unchanged in the control group. These results indicated the effectiveness of pharmaceutical care in improving pharmacotherapy adherence, with positive effects in the clinical outcomes of the patients studied.

Effects of pharmaceutical care interventions on blood pressure and medication adherence of patients with primary hypertension in China

The objective of this study was to assess the effects of pharmaceutical care interventions on blood pressure (BP) and medication adherence of patients with primary hypertension in China. A total of 60 patients with primary hypertension were enrolled in the trial for a 12-month period. Participants were randomized to either control group or intervention group in a 1:1 ratio. During the follow-up period, patients in the control group were given regular medi-care, while patients in the intervention group accepted pharmaceutical care. The dates of baseline demographics, medication lists, measurement of medication adherence, and BP values were collected. Statistical analyses were conducted using t-test or χ2 test. After 12 months follow-up, 24-h BP was significantly decreased by 9.75 mmHg (7.1%) for systolic blood pressure (SBP) and 5.88 mmHg (6.6%) for diastolic blood pressure (DBP) in the intervention group (p < 0.05) compared with their initial visit, while there was no significant change in the control gro...

Effect of Pharmaceutical Care Programs on Glycemic Control in Patients with Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

Background: Diabetes mellitus is a common disease that has an increasing influence on the health of human beings. While the role of pharmaceutical care (PC) programs in the treatment of patients with diabetes mellitus is well established, there is little research that quantitatively and comprehensively assesses the impact of PC programs on glycemic control in diabetics. Objective: To evaluate the effect of PC programs on glycemic control in patients with diabetes mellitus. Methods: Publications on PC programs and randomized controlled trials (RCTs) of glycemic control were retrieved by searching MEDLINE, Embase, Cochrane, Elsevier, Chinese Biomedicine Database, and Chinese Journal Full-Text Database databases from January 1996 through February 2010. Data were extracted by 2 reviewers independently, based on their correlation with this project, and then evaluated with meta-analysis. The meta-analysis was conducted using STATA version 10.1. Begg-Mazumdar's funnel plot was generated to determine the potential impact of publication bias. Results: Fourteen RCTs, with a total of 1770 patients with diabetes mellitus, were included in this meta-analysis. Pharmacists were involved in all of these PC interventions. The average ± SD study period of included trials was 9.5 ± 4.1 months. Drug counseling, drug therapy management, lifestyles education, self-monitoring, and recommendations of drug therapy changes were the most frequently used interventions. All of the trials reported the reduction of hemoglobin A1c (A1C) as the primary clinical outcome of PC intervention. Compared with the usual-care control groups, the PC intervention groups had significant reduction in A1C levels (weighted mean difference −0.68; 95% CI-1.03 to −0.34; p = 0.000). Conclusions: PC programs delivered separately or in combination by pharmacists and other health professionals can lead to an improvement in glycemic control. The incorporation of PC programs into disease management should be strongly considered.

Outcomes of pharmaceutical care intervention to hypertensive patients in a Nigerian community pharmacy

AbstractObjectiveTo describe pharmaceutical care interventions provided to hypertensive patients in a Nigerian community pharmacy setting, and to assess the impact of the practice on selected patient outcomes.MethodA non-randomised, single-site study was conducted using community-dwelling patients with hypertension. A pharmaceutical care intervention, which consisted mainly of verbal counselling, provision of an information leaflet, and subsequent monitoring with reinforcement, was provided. Parameters assessed at baseline and end of investigation included blood pressure control, body mass index determination, level of medication adherence, patient knowledge of the disease, and patient satisfaction.Key findingsForty-two (42) patients were recruited and 36 completed the study, 26 (73%) were males, and 33 (92%) were married. Twenty (20, 58%) had post-secondary education. About three-quarters (27, 81%) were either overweight or obese (BMI &amp;gt;25). There was a significant difference between mean systolic blood pressure at baseline (187.67 ± 29.46 mmHg) and at the end of the study (137.22 ± 21.65 mmHg), P&amp;lt; 0.0001. Changes in mean diastolic blood pressure at baseline (117.56 ± 21.65) and end of study (89 ± 17.23), were also significant (P&amp;lt; 0.0001). Some 27 (75%) reached systolic blood pressure goals while 25 (69%) attained diastolic blood pressure goals. Prior to the pharmaceutical care intervention, 27 (75%) were not aware that salt intake was a risk factor in hypertension, and a similar proportion thought that hypertension was curable. The pharmaceutical care intervention produced a significantly higher patient-reported satisfaction rating than baseline: 3.48 ± 0.83 (49%) versus 3.92 ± 0.62 (74%); t = 2.548; P=0.013 and 3.30 ± 0.72 (41%) versus 4.27 ± 0.56 (87%); t= 6.381, P&amp;lt; 0.0001 on the subscales respectively.ConclusionPharmaceutical care provided to hypertensive patients in a Nigerian community pharmacy setting improved blood pressure control and overall patient satisfaction with pharmaceutical services.

Pharmaceutical care services: a systematic review of published studies, 1990 to 2003, examining effectiveness in improving patient outcomes

AbstractObjectiveTo systematically review the evidence for the effect of pharmaceutical care practice on patient outcomes.SettingCommunity and outpatient setting.MethodRandomised controlled trials (RCTs) published in English between 1990 and 2003 were identified through a systematic literature search. To be included, studies had to assess the effect of a pharmaceutical care intervention, defined as a one-to-one consultation between each patient and a pharmacist with a focus on managing health or resolving drug-related problems, development of a care plan and follow-up.Key findingsTwenty-two RCTs met the review criteria. Studies targeted general patient populations at risk of drug-related problems, disease-specific target groups or patients with risk factors including hypertension and raised cholesterol. While a number of trials have been undertaken, the variability in the application of endpoints utilised means the evidence for effectiveness of single endpoints apart from quality of life is generally limited to one or two controlled trial results. Collectively, the studies provide evidence that the service improves signs and symptoms for people with asthma, surrogate endpoints such as blood pressure, cholesterol levels and glycosylated haemoglobin and medication use, but do not provide evidence supporting improved health-related quality of life. One study showed an improvement in combined all-cause mortality and non-fatal heart failure-related events in patients with heart failure.ConclusionPharmaceutical care services are effective in improving medication use and surrogate endpoints, but improvement in other outcomes is less conclusive. Given that the focus of the service is to resolve medication-related problems, consideration should be given to the use of adverse drug events and resolution of medication-related problems as an outcome measure in future studies.

Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk.

Studies on the prevalence and impact of psychiatric disorders among headache patients have yielded findings that have clarified the relationship between migraine and major affective disorders, anxiety, illicit drug abuse, nicotine dependence, and suicide attempts. Studies in both clinical and community-based settings have demonstrated an association between migraine and a number of specific psychiatric disorders. In large-scale population-based studies, persons with migraine are from 2.2 to 4.0 times more likely to have depression. In longitudinal studies, the evidence supports a bidirectional relationship between migraine and depression, with each disorder increasing the risk of the other disorder. Although a strong association has been demonstrated consistently for migraine and major depression, especially for migraine with aura, there has been less systematic research on the links between migraine and bipolar disorder. This review will focus on the way in which psychiatric disorders decrease the quality of life and result in a worse prognosis, chronicity of the disease, and a worse response to treatment. Short-term pharmaceutical care intervention improves the patients’ mental health, but it does not significantly change the number and severity of headaches. The increase in self-efficacy and mental health associated with pharmaceutical care may be instrumental in improving the long-term pharmacotherapy of patients with migraine and headache.

The WHO UNESCO FIP Pharmacy Education Taskforce

Pharmacists' roles are evolving from that of compounders and dispensers of medicines to that of experts on medicines within multidisciplinary health care teams. In the developing country context, the pharmacy is often the most accessible or even the sole point of access to health care advice and services.Because of their knowledge of medicines and clinical therapeutics, pharmacists are suitably placed for task shifting in health care and could be further trained to undertake functions such as clinical management and laboratory diagnostics. Indeed, pharmacists have been shown to be willing, competent, and cost-effective providers of what the professional literature calls "pharmaceutical care interventions"; however, internationally, there is an underuse of pharmacists for patient care and public health efforts. A coordinated and multifaceted effort to advance workforce planning, training and education is needed in order to prepare an adequate number of well-trained pharmacists for such roles.Acknowledging that health care needs can vary across geography and culture, an international group of key stakeholders in pharmacy education and global health has reached unanimous agreement that pharmacy education must be quality-driven and directed towards societal health care needs, the services required to meet those needs, the competences necessary to provide these services and the education needed to ensure those competences. Using that framework, this commentary describes the Pharmacy Education Taskforce of the World Health Organization, United Nations Educational, Scientific and Cultural Organization and the International Pharmaceutical Federation Global Pharmacy and the Education Action Plan 2008–2010, including the foundation, domains, objectives and outcome measures, and includes several examples of current activities within this scope.

電子カルテ導入後の調剤業務における薬学的介入の検討

At Kyoto University Hospital,we introduced an electronic medical recording system in October 2005.We then investigated interventions in the dispensing room as well as the usage of electronic medical records in our satellite-like pharmacy from June through August 2007.The number of prescriptions in this period was 29,618,and we had questions concerning 840 of them,a quarter of which could be answered using electronic medical records.Of the 640 prescriptions that we contacted physicians about,either asking questions or making recommendations,82.5% were changed.On comparing the pharmaceutical interventions in the dispensing room made this time with those made in the course of conducting pharmaceutical care services in our previous report of 2003,when an electronic medical recording system had not be introduced,pharmacists mainly made recommendations to physicians based on standard pharmacotherapy,such as those concerning inappropriate dosages,indications and drug interactions (69%),and pointed out errors in prescriptions (15%).However,pharmaceutical care interventions had also been based on standard therapy in consideration of individual patient backgrounds,such as those concerning dosage adjustment in view of patient renal function,and adverse effects.For dispensing,our findings suggested that though the intervention rate was not very high,hospital pharmacists had been able to conduct interventions based on standard pharmacotherapy covering all types of patient.In addition,ward pharmacists had been able to conduct pharmaceutical care interventions for specific patients based on individual situations.In conclusion,the results of our investigation show that clinical pharmacists in the dispensing room and wards are able to work together in promoting optimal pharmacotherapy which prevents various risks.

Pharmaceutical Care for Migraine and Headache Patients: A Community-Based, Randomized Intervention

Despite the high prevalence of headache and migraine in the general population, many people do not receive adequate medical attention and treatment. To evaluate the effects of pharmaceutical care (defined as intensified structured counseling between patient and pharmacist, including the use of drug databases), for patients with headache or migraine, on both clinical and psychological endpoints. A prospective, randomized, controlled intervention study was conducted using pharmacies in Northern Germany. A total of 112 pharmacies (26% of all pharmacies in the study region) recruited 410 patients with headaches. Pharmacies were randomly assigned to an intervention or control group. Patients were interviewed by telephone prior to the intervention and again after 4 months. Primary endpoints were number of days with headache, number and severity of headaches, self-efficacy, and the patients' perceptions of their health-related quality of life. Each pharmacy treated an average of 4.6 patients (total time effort 9 h). The intervention group consisted of 201 patients who received pharmaceutical care, whereas the control group comprised 209 patients who received standard counseling. In both groups, the number of headache attacks and intensity of pain in treated headache attacks did not change significantly between the first and second interviews. However, a statistically significant improvement in mental health and self-efficacy was shown in the intervention group. Intensity of pain in untreated headache attacks and the number of days with headache decreased in both groups. Most participants described this intervention as helpful and effective and 90% reported that they would recommend pharmaceutical care to other patients with headache. A short-term pharmaceutical care intervention improved patients' mental health and self-efficacy, although it did not significantly change the number and severity of headaches. The increase in self-efficacy and mental health associated with pharmaceutical care may be instrumental in improving long-term pharmacotherapy of patients with migraine and headache. To fully assess the effects of pharmaceutical care, a longer study may be required.

Effect of pharmaceutical care intervention on blood pressure of elderly outpatients with hypertension

The purpose of this study was to evaluate the effect of pharmacist intervention on the prevention and solution of drug therapy-problems (DTP), Body Mass Index (BMI), and blood pressure control in elderly outpatients with hypertension. The instruments were applied to 30 elderly outpatients assisted at the pharmacy of a primary health care unit in Ribeirao Preto (SP), Brazil. The group of patients received follow-up during a period of 12 months. It was observed that Pharmaceutical Care intervention optimized the medication use; reduced symptoms caused by drug therapy and improved the elderly patients' health conditions. The Pharmaceutical Care intervention influenced the care given to elderly people as well as the achievement of positive health outcomes. After this study, the researcher gave training about practice of Pharmaceutical Care to 38 dispensing pharmacists from the Public Health-System of Ribeirao Preto. Nowadays, these pharmacists are perpetuating the practice introduced in the region.

Effects of Pharmaceutical Care Intervention by Clinical Pharmacists in Renal Transplant Clinics

Renal transplantation is an established treatment for end-stage renal disease. Most renal transplant patients take multiple medications for a long period of time to maintain immunosuppression as well as to treat concomitant chronic diseases. Since some medications prescribed for these patients have narrow therapeutic ranges, optimal pharmacotherapy is vital. However, pharmacists can qualify the role in assisting patients and physicians to solve and reduce drug-related problems. The purpose of this trial was to investigate the effects on treatment outcomes by clinical pharmacists joining renal transplant clinics to provide pharmaceutical care. We enrolled 37 renal transplant patients who visited the renal transplant clinic in our medical center from May 2005 through August 2006. The responsibility of the clinical pharmacist was to interview patients, review medication regimens, and make therapeutic recommendations for 3 hours every Tuesday morning. According to potential clinical impacts, pharmacist recommendations were divided into 6 scales, evaluating physician acceptance of pharmacist recommendations and impact on treatment outcomes. Fifty-five pharmacotherapy recommendations were made for the 37 renal transplant patients during the trial period, of which 81.8% were classified as clinically significant. The drug classes most commonly involved were cardiovascular medications, immunosuppressants, and antimetabolites (32.6%, 23.9%, and 26.1%, respectively). Physician acceptance rates of recommendation types and drug classes were 96.0% and 97.1%, respectively. Among the cases in which the recommendations were accepted, 94.2% of patients showed improved conditions. We concluded that clinical pharmacists joined to renal transplant clinics provide pharmaceutical care with a positive potential impact on physician prescriptions and patient outcomes.