Introduction: In 2003, Purdue University College of Pharmacy (PUCOP) in West Lafayette, Indiana, began the Purdue Kenya Partnership (PKP) in collaboration with the Academic Model Providing Access to Healthcare, Moi University, and Moi Teaching and Referral Hospital, in Eldoret, Kenya. PUCOP's involvement utilized a tripartite approach of engagement, education, and scholarship to provide and expand sustainable access to high quality care. Objective: This paper discusses outcomes and impacts of this academic partnership. Methods: Purdue Kenya Partnership's progress in achieving its stated mission was evaluated using an outcome-approach logic model. This model highlighted inputs, activities, and results which encompassed outputs, outcomes, and impact. A comprehensive set of ratios were calculated to quantify annual change in PKP investments against estimated metrics for engagement, education, and scholarship. These metrics were weighted by involvement level and pharmacist effort in various clinical domains. Descriptive statistics were completed that identified cumulative and totals per year for each collected data type of data collected. Results: Purdue Kenya Partnership implementation utilized initial inputs of human resources, financial capital, and strategic partnerships. These inputs supported pharmacy involvement in 16 distinct care programs in both inpatient and outpatient settings which supported the care of 457 833 individual patients and grown a clinical pharmacy staff from 0 to 22 practicing clinical pharmacists. Five unique educational programs have been established which have graduated 457 trainees. Purdue Kenya Partnership has generated over $6.2 million in grant funding and disseminated 302 peer reviewed manuscripts, posters, and oral presentations combined. Ratios describing trends in engagement, education, and scholarship as a result of using the locally focused PKP approach highlight higher initial costs compared with much lower costs per outcome several years into the partnership. Conclusion: The PKP's global health approach of prioritizing the population's care needs (“leading with care”) has enabled the development of sustainable engagement, education, and scholarship infrastructure with significant gains in all three domains.

La non-adhésion (NA) est un enjeu majeur en transplantation rénale (TR). Nous avons réalisé une revue systématique dans laquelle les facteurs liés à la NA sont discutés. Et, sachant que la variabilité des taux sanguins d'anti-calcineurine (CNI) pose la question de NA, nous avons essayé d'identifier les facteurs qui lui sont associés. 37 articles sur l'adhésion ou NA en TR, publiés entre 2009 à 2014, ont été analysés. La NA fluctuait entre 2 et 96% et plusieurs facteurs lui étaient associés : a. jeune, homme, faible support social, sans emploi, faible éducation h. >3 mois post Tx, donneur vivant, >6 comorbidités c. >5 médicaments/j, >2 prises/j d. Croyances et/ou comportements négatifs e. Dépression et/ou anxiété. Puis, nous avons réalisé une étude transversale sur une cohorte de patients à 1 an post greffe de rein. . Les données cliniques, de l'entretien du pharmacien clinicien (PC) et de 6 questionnaires ont été collectées. 408 patients ont été inclus (61.2% d'hommes, âge médian 54 ans). Nous avons comparé 2 groupes selon le coefficient de variation (CV) des CNI : CV<30% (n=302) et >30% (n=106). En analyse univariée la distance hôpital-domicile, la ciclosporine, le délai post greffe et la présence de divergences à la conciliation médicamenteuse, étaient associés à un risque élevé de CV>30%. A l'inverse, le tacrolimus LP conférait un risque plus faible. En analyse multivariée, la présence de divergences était significative (OR=3.2 IC95% [1.21-9.01], p=0.02). Un CV>30% des CNI après 1 an de greffe semble refléter un phénomène de NA pouvant être confirmé par l'entretien avec le PC et constituer un outil simple pour la pratique clinique. / Non-adherence (NA) is a major issue after kidney transplantation (Tx). We realized a systematic review, in which criteria related to NA were discussed. And, considering that calcineurin inhibitors (CNI) blood levels variability raises the question of NA, we tried to identify factors associated to it. 37 studies on adherence and NA in TX, published between 2009 and 2014 were reviewed. NA fluctuated from 2 to 96% and sseveral factors were related to NA: a.Young age, male, low social support, unemployed, low education b. >3 months after Tx, living donor, >6 comorbidities c. >5 drugs/d, > 2 intakes/d d. Negative beliefs and/or behaviors e. Depression and anxiety. Then, we realised a cross sectional study on a cohort of kidney recipients grafted for more than 1 year. We recorded: clinical data, data from a clinical pharmacist (CP) interview and from 6 self-reports. 408 recipients were enrolled (61.2% male, median age 54 years old). We compared 2 groups according to a coefficient of variation (CV) for CNI blood levels: CV<30% (n=302) and >30% (n=106). In univariate analysis, the distance hospital-home, cyclosporine, time since Tx, discrepancies in the reconciliation process were associated with a greater risk of CV>30%. By contrast, tacrolimus once daily conferred a lower risk of CV >30%. In multivariate analysis discrepancies remained significant (OR=3.2 CI 95% [1.21-9.01], p=0.02). ACV >30% for CNI blood levels after lyear post Tx seems to reflect NA, and could easily be confirmed by the CP interview. This could be a simple method to detect NA in clinical routine.

Drug-drug interactions (DDI) represent a growing concern for the health units. Therefore, monitoring of pharmaceutical prescriptions in hospitals can rationalize pharmacotherapy. To evaluate the effect of pharmaceutical intervention in identifying and managing drug interactions in an intensive care unit (ICU), in Northeastern of Brazil. Methods: Initially, we performed a systematic review from the search of electronic databases, Jan. 1960 to Aug 2010. After that, we realized a longitudinal study in the ICU, in a private hospital in the city of Aracaju-SE, between 2008 and 2009, which was identified in the prevalence and clinical relevance of the DDI. During the study pharmaceutical interventions were aimed at the management of DDI. The systematic review, only seven articles met all inclusion criteria and the specific sample sizes ranged from 200 to 1785 patients. As for the longitudinal study, 6085 prescriptions were collected, of which 213 contained DDI clinically relevant. Of these 178 were moderate and 35 major severity. The clinical pharmacy interventions consisted in the preparation of reports for physicians, allowing the reduction of 40% of all DDI. The data obtained allow inferring that the participation of clinical pharmacists in the DDIs identification and management may have been essential to promote the safety of ICU patients. / As interações medicamentosas (IM) representam uma crescente preocupação para as unidades de saúde. Por isso, o acompanhamento farmacêutico das prescrições nos hospitais pode racionalizar a farmacoterapia. Avaliar o efeito da intervenção farmacêutica na identificação e manejo de interações medicamentosas em uma unidade de terapia intensiva (UTI), no nordeste do Brasil. Inicialmente, foi realizada uma revisão sistemática sobre a qualidade dos estudos que envolvem o papel do farmacêutico na identificação de IM em hospitais, a partir da busca nos bancos de dados eletrônicos, janeiro de 1960 a agosto de 2010. A revisão utilizou como critérios de inclusão: (i) estudos realizados em hospitais; (ii) identificação de IM com a participação do farmacêutico; (ii) texto em língua inglesa. Em seguida, foi realizado um estudo longitudinal, na UTI, em um hospital privado do município de Aracaju-SE, entre 2008 e 2009, no qual foi identificada a prevalência e relevância clínica das IM do tipo fármaco-fármaco. Durante o estudo foram realizadas intervenções farmacêuticas que visavam o manejo da IM. Na revisão sistemática, apenas seis artigos atenderam a todos os critérios de inclusão específicos e o tamanho das amostras variou de 200 a 1785 pacientes. Quanto ao estudo longitudinal, foram coletadas 6.085 prescrições, sendo que 213 continham IM clinicamente relevantes. Destas 178 apresentaram severidade moderada e 35grave. As intervenções da farmácia clínica consistiram na elaboração de laudos para os médicos, que possibilitaram a redução de 40% de todas as interações. Os dados obtidos permitem inferir que a participação do farmacêutico clínico na identificação e manejo de IM, pode ter sido essencial para promover a segurança de pacientes da UTI.

Erros de medicação e eventos adversos relacionados a medicamentos são comuns em pacientes hospitalizados. O risco de ocorrer problemas com a população pediátrica é cerca de três vezes maior do que com a população adulta, especialmente em unidades de terapia intensiva, onde os pacientes são submetidos a grande número de prescrições de medicamentos intravenosos, com baixo índice terapêutico e formas farmacêuticas adaptadas. A farmácia clínica tem como objetivo introduzir o farmacêutico clínico junto à equipe multidisciplinar de saúde no sentido de intervir, prevenindo problemas relacionados a medicamentos à farmacoterapia (PRF), otimizando-a e contribuindo para a segurança do paciente. O presente estudo teve como objetivo avaliar a implantação e o impacto das intervenções da farmácia clínica no Centro de Terapia Intensiva-Pediátrico (CTIP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). Trata-se de estudo prospectivo, observacional e descritivo que incluiu crianças de zero a dezoito anos, no período de um ano. Foi aplicada a ferramenta Failure Mode and Effects Analysis (FMEA - Análise dos Modos de Falha e seus Efeitos) no início do estudo para avaliar os riscos relacionados aos medicamentos no CTIP e orientar a atuação da farmácia clínica, em que o farmacêutico avaliou as prescrições diárias e realizou intervenções junto à equipe multidisciplinar. Foram acompanhadas 162 crianças e avaliadas 1586 prescrições com uma taxa de PRF de 12,42% (IC95% 10,50-14,04). Foram realizadas 197 intervenções com custo salvo de R$15.118,73. Os principais tipos de intervenções foram relacionados à indicação e necessidade do medicamento. A partir destas, os grupos foram divididos em pacientes com PRF e sem PRF. Foram detectadas diferenças significativas nas seguintes variáveis: peso, idade, tempo de internação, tempo de acompanhamento, custo total, custo salvo pelas intervenções, gravidade dos pacientes avaliada pelo escore PRISM e PELOD, quantidade total de medicamentos utilizados e quantidade de medicamentos potencialmente perigosos e endovenosos contínuos. Além disso, houve diferenças significativas na taxa de óbito e nas categorias diagnósticas entre os grupos. A implantação do serviço de farmácia clínica no CTIP mostrou impacto positivo na redução de riscos relacionados a todo o processo de utilização de medicamentos. As intervenções do farmacêutico clínico identificaram e preveniram PRF, promovendo o uso racional de medicamentos e contribuindo para a redução de custos associados à prescrição médica. / Medication errors and adverse events related to drugs are common in hospitalized patients. The potential risk for medication errors in pediatric patients is about three times higher than in adults, especially in intensive care units, where patients are subjected to a large number of intravenous drug prescriptions, with low therapeutic index and adapted pharmaceutical forms. Clinical pharmacy aims to introduce the clinical pharmacist in a multidisciplinary health team in order to intervene, preventing drug-related problems (DRPs) and optimize pharmacotherapy, contributing to patient safety. This study aimed to assess the implementation and the impact of clinical pharmacy interventions in the Pediatric Intensive Care Unit (PICU) of Hospital das Clinicas of Ribeirao Preto Medical School, University of São Paulo (HCFMRP-USP). This was a prospective, observational and descriptive study which included children from zero to eighteen years of age, over a one year period. Failure Mode and Effects Analysis Tool (FMEA) was applied at the beginning of the study to assess the risks related to medicines in the PICU and to guide clinical pharmacy work, where the pharmacist evaluated daily prescriptions and made interventions along with a multidisciplinary team. One thousand five hundred and eighty-six prescriptions of 162 children were assessed, and a DRPs rate of 12.42% (95% CI - 10.50 to 14.04) was found. One hundred ninety-seven interventions were performed, with a cost saving of R$ 15,118.73. The main types of interventions were related to indication and necessity of the drug. From these, the groups were divided in patients with DRPs and without DRPs. Significant differences were found in weight, age, time of hospitalization, time of follow-up, total cost, costs saved by interventions, severity of patients assessed by PRISM and PELOD scores, total amount of medications used, and number of potentially dangerous and continuous intravenous medications. In addition, there were significant differences in mortality rate and diagnostic categories between groups. The implementation of clinical pharmacy service in the PICU showed a positive impact on patients\' treatment. The clinical pharmacist interventions identified and prevented DRPs, promoting the rational use of medications and contributing to the reduction of costs associated with medical prescription.

Erros de medicação e eventos adversos relacionados a medicamentos são comuns em pacientes hospitalizados. O risco de ocorrer problemas com a população pediátrica é cerca de três vezes maior do que com a população adulta, especialmente em unidades de terapia intensiva, onde os pacientes são submetidos a grande número de prescrições de medicamentos intravenosos, com baixo índice terapêutico e formas farmacêuticas adaptadas. A farmácia clínica tem como objetivo introduzir o farmacêutico clínico junto à equipe multidisciplinar de saúde no sentido de intervir, prevenindo problemas relacionados a medicamentos à farmacoterapia (PRF), otimizando-a e contribuindo para a segurança do paciente. O presente estudo teve como objetivo avaliar a implantação e o impacto das intervenções da farmácia clínica no Centro de Terapia Intensiva-Pediátrico (CTIP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). Trata-se de estudo prospectivo, observacional e descritivo que incluiu crianças de zero a dezoito anos, no período de um ano. Foi aplicada a ferramenta Failure Mode and Effects Analysis (FMEA - Análise dos Modos de Falha e seus Efeitos) no início do estudo para avaliar os riscos relacionados aos medicamentos no CTIP e orientar a atuação da farmácia clínica, em que o farmacêutico avaliou as prescrições diárias e realizou intervenções junto à equipe multidisciplinar. Foram acompanhadas 162 crianças e avaliadas 1586 prescrições com uma taxa de PRF de 12,42% (IC95% 10,50-14,04). Foram realizadas 197 intervenções com custo salvo de R$15.118,73. Os principais tipos de intervenções foram relacionados à indicação e necessidade do medicamento. A partir destas, os grupos foram divididos em pacientes com PRF e sem PRF. Foram detectadas diferenças significativas nas seguintes variáveis: peso, idade, tempo de internação, tempo de acompanhamento, custo total, custo salvo pelas intervenções, gravidade dos pacientes avaliada pelo escore PRISM e PELOD, quantidade total de medicamentos utilizados e quantidade de medicamentos potencialmente perigosos e endovenosos contínuos. Além disso, houve diferenças significativas na taxa de óbito e nas categorias diagnósticas entre os grupos. A implantação do serviço de farmácia clínica no CTIP mostrou impacto positivo na redução de riscos relacionados a todo o processo de utilização de medicamentos. As intervenções do farmacêutico clínico identificaram e preveniram PRF, promovendo o uso racional de medicamentos e contribuindo para a redução de custos associados à prescrição médica. / Medication errors and adverse events related to drugs are common in hospitalized patients. The potential risk for medication errors in pediatric patients is about three times higher than in adults, especially in intensive care units, where patients are subjected to a large number of intravenous drug prescriptions, with low therapeutic index and adapted pharmaceutical forms. Clinical pharmacy aims to introduce the clinical pharmacist in a multidisciplinary health team in order to intervene, preventing drug-related problems (DRPs) and optimize pharmacotherapy, contributing to patient safety. This study aimed to assess the implementation and the impact of clinical pharmacy interventions in the Pediatric Intensive Care Unit (PICU) of Hospital das Clinicas of Ribeirao Preto Medical School, University of São Paulo (HCFMRP-USP). This was a prospective, observational and descriptive study which included children from zero to eighteen years of age, over a one year period. Failure Mode and Effects Analysis Tool (FMEA) was applied at the beginning of the study to assess the risks related to medicines in the PICU and to guide clinical pharmacy work, where the pharmacist evaluated daily prescriptions and made interventions along with a multidisciplinary team. One thousand five hundred and eighty-six prescriptions of 162 children were assessed, and a DRPs rate of 12.42% (95% CI - 10.50 to 14.04) was found. One hundred ninety-seven interventions were performed, with a cost saving of R$ 15,118.73. The main types of interventions were related to indication and necessity of the drug. From these, the groups were divided in patients with DRPs and without DRPs. Significant differences were found in weight, age, time of hospitalization, time of follow-up, total cost, costs saved by interventions, severity of patients assessed by PRISM and PELOD scores, total amount of medications used, and number of potentially dangerous and continuous intravenous medications. In addition, there were significant differences in mortality rate and diagnostic categories between groups. The implementation of clinical pharmacy service in the PICU showed a positive impact on patients\' treatment. The clinical pharmacist interventions identified and prevented DRPs, promoting the rational use of medications and contributing to the reduction of costs associated with medical prescription.