Analgesic products can produce serious side effects. Because potent analgesics are not under medical surveillance but are available to the public without a medical prescription, any attempt to influence consumer behaviour in relation to these products must be via interventions at pharmacist level. The Australian government is now pressuring the pharmacy profession to monitor effectively the use of such non-prescription medication. The aim of this study was to train community pharmacists on brief intervention strategies for use in a pharmacy setting in relation to combination analgesic products. Focus groups showed that participants had concerns about adopting confrontational counselling styles, as they feared this would antagonise consumers leading to loss of patronage without having an impact on consumer behaviour. This concern was later reinforced by consumer interviews, which showed that a significant proportion of respondents thought that the use of non-prescription analgesics was their responsibility. A protocol for the sales of analgesic products was designed with these issues in mind. The transtheoretical model of change (TTM) and motivational interviewing were selected as theoretical frameworks, as they take into account differences among consumers in motivation and in intention to change behaviour and are congruent with pharmacists' concerns. Consumer-centred intervention strategies were tailored to the individual consumer according to his/her readiness to change. This approach was borrowed from the area of smoking secession in which it has been related to positive clinical outcomes. The assumption was made that TTM-based intervention would also be effective in a pharmacy setting in relation to analgesic products. In the initial pilot study, community pharmacists who simply attended a workshop in the cognitive-behavioural intervention strategies failed to incorporate the newly acquired skills to their practice and consequently lost their proficiency. In the subsequent pilot study, when the workshop was followed by ongoing on-site training with immediate feedback and coaching through the use of pseudo-patron visits, the investigator was able to shape community pharmacists' practice behaviour in relation to the monitoring of pharmacist only analgesic products. The methodology was then refined and in the final study trained pharmacists were significantly more likely than control pharmacists and baseline to engage in a number of behaviours related to the study intervention. These included handling the sales of pharmacist only analgesics themselves, identifying inappropriate use, assessing readiness to change, and delivering an intervention according to the consumer's readiness to change. The results suggested that in pharmacy practice post qualifying therapeutic skill transfer is not achieved by workshop presentation alone. Modelling of the desired behaviour involving reinforcement and feedback is necessary.

Community pharmacy practice is moving towards patient care and away from the mere dispensing of medicines. In this movement, which is guided by the philosophy of Pharmaceutical care (PC), new counselling services emerge. The purpose of the thesis was to add knowledge about the real-world provision of PC services by studying a defined PC service in Swedish pharmacies. Specific aims of this thesis were to investigate the experiences of professionals working with or close to the service and to describe the content of consultations, counselling behaviour and patterns of follow-up. Further aims were to characterise patients receiving the service and describe their perceived outcomes, in relation to standard service. Data were collected via focus groups, telephone interviews, observations, a patient medication record database and a cross-sectional survey. The practitioners reported greater use of their pharmaceutical knowledge and provision of more thorough patient support. Perceived barriers in delivering the service included difficulties in documenting and getting commitment from colleagues, managers and prescribers. Doctors working close to PC pharmacies held varying opinions about the service. Consultations dealt with issues potentially improving the outcomes of medical treatment, but the level of patient centredness varied and was limited by the practitioners’ focus on the computer screen. The rate of follow-up evaluations was modest, but was higher at pharmacies with a high volume of patients receiving the service. PC patients were mostly elderly and female, using about 10 prescription drugs. In comparison to patients receiving standard service, they were more worried, vulnerable and information-seeking. At the same time, their feelings of safety following the pharmacy visit were more pronounced than those of patients receiving standard service. They also felt better prepared for doctor visits. In order for community pharmacy to better meet patients’ needs and optimise PC services, increased attention should be given to implementation strategies, interprofessional collaboration and educational efforts focusing on patient centredness.

Οι έννοιες της φαρμακευτικής φροντίδας (pharmaceutical care) και του relationship marketing εφαρμόζονται όλο και περισσότερο στην σύγχρονη φαρμακευτική πρακτική. Η φαρμακευτική φροντίδα (ΦΦ) αναφέρεται στην υπεύθυνη παροχή φαρμακοθεραπείας, με στόχο την βελτίωση ή διατήρηση της ποιότητας ζωής του ασθενή, ενώ το relationship marketing στοχεύει στην εγκαθίδρυση μακροπρόθεσμων και ποιοτικών σχέσεων με τον ασθενή-πελάτη. Τις στάσεις και συμπεριφορές σε σχέση με τις παραπάνω έννοιες στόχευε να διερευνήσει η παρούσα ερευνητική μελέτη, σε δείγμα Ελλήνων φαρμακοποιών. Το ερευνητικό εργαλείο ήταν ερωτηματολόγιο με ενότητες που διερευνούσαν τις συμπεριφορές που οι φαρμακοποιοί θεωρούν σχετικές με την ΦΦ, την στάση τους απέναντι στην επικοινωνία με τους ασθενείς-πελάτες, τις αποδόσεις ισχύος στον πελάτη ή στον εαυτό τους, καθώς και την ικανοποίηση που αντλούν από το επάγγελμά τους. Τα ευρήματα έδειξαν ότι υπάρχει σημαντική σύγκλιση των απόψεων των Ελλήνων φαρμακοποιών σχετικά με την ΦΦ και των όψεών της όπως προκύπτουν από την βιβλιογραφία. Επιδράσεις των στάσεων διαπιστώθηκαν στις συμπεριφορές και στις αποδόσεις ισχύος, και των αποδόσεων ισχύος στην ικανοποίηση από το επάγγελμα. Η έννοια της «απόδοσης ισχύος» στον πελάτη-ασθενή εκ μέρους του φαρμακοποιού, όπως αυτή προέκυψε από τα ευρήματα, συζητείται εκτενέστερα. / -

Η έννοια της φαρμακευτικής φροντίδας, καθώς και αυτή του relationship marketing, αποκτούν όλο και μεγαλύτερο ρεύμα στην διεθνή βιβλιογραφία και πρακτική. Παράλληλα έρευνες διεθνώς καταδεικνύουν τις στάσεις και τις προθέσεις των φαρμακοποιών για τον μελλοντικό τους ρόλο, στα πλαίσια των μεταβολών που υφίσταται το επάγγελμα του φαρμακοποιού και η διεθνής αγορά εργασίας. Ωστόσο τα δεδομένα αυτά δεν έχουν διερευνηθεί προηγουμένως σε ελληνικά πλαίσια. Η έρευνα που παρουσιάζεται στην εργασία αυτή είχε σαν στόχο να διερευνήσει τις στάσεις δείγματος Ελλήνων φαρμακοποιών σχετικά με διάφορες όψεις του επαγγέλματός τους, όπως τις προβλέψεις τους για το μέλλον του επαγγέλματος του φαρμακοποιού, και τις κρίσεις τους για φαινόμενα που μπορεί να απειλήσουν μελλοντικά το επάγγελμα καθώς και για μέτρα αντιμετώπισής τους. Παράλληλος στόχος ήταν η διερεύνηση της συσχέτισης των παραπάνω στάσεων με τις απόψεις των φαρμακοποιών για την φαρμακευτική φροντίδα, και με τις στάσεις και συμπεριφορές σχετικά με αυτήν. Τα αποτελέσματα της έρευνας έδειξαν αυξημένο βαθμό ενημερότητας των φαρμακοποιών για τις μελλοντικές προκλήσεις στον ρόλο τους, καθώς για το μοντέλο της φαρμακευτικής φροντίδας. Σημαντική ωστόσο κρίνεται η παροχή κατάρτισης, και ο σχεδιασμός προγραμμάτων εφαρμογής της ΦΦ σε κρατικό και τοπικό επίπεδο. / -

Analgesic products can produce serious side effects. Because potent analgesics are not under medical surveillance but are available to the public without a medical prescription, any attempt to influence consumer behaviour in relation to these products must be via interventions at pharmacist level. The Australian government is now pressuring the pharmacy profession to monitor effectively the use of such non-prescription medication. The aim of this study was to train community pharmacists on brief intervention strategies for use in a pharmacy setting in relation to combination analgesic products. Focus groups showed that participants had concerns about adopting confrontational counselling styles, as they feared this would antagonise consumers leading to loss of patronage without having an impact on consumer behaviour. This concern was later reinforced by consumer interviews, which showed that a significant proportion of respondents thought that the use of non-prescription analgesics was their responsibility. A protocol for the sales of analgesic products was designed with these issues in mind. The transtheoretical model of change (TTM) and motivational interviewing were selected as theoretical frameworks, as they take into account differences among consumers in motivation and in intention to change behaviour and are congruent with pharmacists' concerns. Consumer-centred intervention strategies were tailored to the individual consumer according to his/her readiness to change. This approach was borrowed from the area of smoking secession in which it has been related to positive clinical outcomes. The assumption was made that TTM-based intervention would also be effective in a pharmacy setting in relation to analgesic products. In the initial pilot study, community pharmacists who simply attended a workshop in the cognitive-behavioural intervention strategies failed to incorporate the newly acquired skills to their practice and consequently lost their proficiency. In the subsequent pilot study, when the workshop was followed by ongoing on-site training with immediate feedback and coaching through the use of pseudo-patron visits, the investigator was able to shape community pharmacists' practice behaviour in relation to the monitoring of pharmacist only analgesic products. The methodology was then refined and in the final study trained pharmacists were significantly more likely than control pharmacists and baseline to engage in a number of behaviours related to the study intervention. These included handling the sales of pharmacist only analgesics themselves, identifying inappropriate use, assessing readiness to change, and delivering an intervention according to the consumer's readiness to change. The results suggested that in pharmacy practice post qualifying therapeutic skill transfer is not achieved by workshop presentation alone. Modelling of the desired behaviour involving reinforcement and feedback is necessary.

A Atenção Farmacêutica é a interação direta do farmacêutico com o usuário, visando uma farmacoterapia racional e obtenção de resultados definidos e mensuráveis, voltados para a melhoria da qualidade de vida. Em 2002, no Consenso Brasileiro de Atenção Farmacêutica foram propostos macro-componentes para a sua prática. Esta pode contribuir para diminuição da não-adesão e de erros de medicação, mas em que grau cada um dos macro-componentes atua ainda é parâmetro a ser estabelecido. A hipertensão arterial sistêmica é um problema de saúde pública, sendo que a prevalência na população varia de 22% a 44%. Vários estudos demonstram que a prevalência de não-adesão aos anti-hipertensivos varia de 20 a 90%. Mesmo em nível internacional, as pesquisas em Atenção Farmacêutica são de menor qualidade ou possuem vieses, não descrevendo o método de atendimento adotado. Baseado nisto, se propôs a realização de um ensaio clínico randomizado aberto, em paralelo, onde foram analisados três macro-componentes da atenção farmacêutica (grupos intervenção): seguimento farmacoterapêutico; orientação farmacêutica; dispensação de medicamentos. Os estudos foram desenvolvidos em farmácias-escola sendo 3 em Unidades Básicas de Saúde e uma localizada nas imediações de um hospital universitário e de uma unidade básica de saúde, sendo o grupo controle o atendimento usual em cada uma delas. Foram incluídos hipertensos não-controlados que compareceram para retirar medicamentos nos locais previstos para atendimento. O tempo de acompanhamento dos pacientes foi de 8 meses. Os desfechos primários analisados foram: hipertensão arterial, medida com aparelho automático, por meio de no mínimo duas leituras. e adesão ao tratamento, sendo esta verificada por método direto (medida dos níveis plasmáticos de hidroclorotiazida no início e fim do estudo) e indireto (controle de comparecimento para retirada de medicamentos durante o período de estudo). Como desfecho secundário, foi computado o número de problemas relacionados a medicamentos identificados e solucionados em cada grupo e a capacidade de cada centro executar as intervenções propostas, por meio de visitas no fim do estudo, relatos e preenchimento das fichas de coleta de dados. O processamento dos dados foi realizado pelo investigador principal no centro coordenador e exportado para SPSS para análise estatística. Foram randomizados 301 pacientes, entre setembro de 2006 e janeiro de 2008. Destes, 79 foram alocados ao grupo seguimento, 66 à orientação, 78 à dispensação e 78 ao controle. Não houve diferença estatisticamente significativa entre os deltas dos níveis pressóricos dos grupos estudados em relação ao grupo controle. A orientação foi a intervenção que apresentou diminuição bruta mais acentuada, em comparação com o grupo controle: ΔPA sistólica = -4,0 e ΔPA diastólica = - 0,8. Para as análises de adesão, foi excluído um dos centros, por não ter realizado estas medidas. A hidroclorotiazida foi detectada em 135 dos 174 pacientes que realizaram a medida final, porém não se observou diferença estatística entre os grupos de intervenção (P = 0,378), o mesmo ocorrido no método indireto (P = 0,188). Entre os pacientes estudados 124 (41,2%) tiveram PRMs detectados. Foram identificados 257 PRMs, sendo 115 resolvidos. A PA sistólica baixou 7,0 mmHg a mais no grupo em que se solucionaram PRMs em relação ao grupo que não teve PRM resolvidos (P = 0,041). Nos centros do Rio de Janeiro e Ijuí, a estrutura, que compreende a parte física, acesso aos médicos e prontuários, além da existência de recursos humanos qualificados e com capacidade operacional otimizada, era deficitária frente aos dois outros centros. Os centros de Porto Alegre e Araucária desenvolveram satisfatoriamente o estudo. Apesar de não se haver detectado diferenças entre os grupos, o processo de se solucionar PRMs pode ajudar na redução dos níveis pressóricos em hipertensos não-controlados usuários de farmácias-escola comunitárias ligadas a Unidades Básicas de Saúde. A fim de se aumentar a efetividade dos métodos de atenção farmacêutica descritos sugere-se melhorias na estrutura das farmácias, bem como disponibilidade de recursos humanos com treinamento adequado. / Pharmaceutical Care is the direct interaction of the pharmacist with the patient, aiming at a rational pharmacotherapy and attainment of definite and measurable results, toward the improvement of the quality of life. In 2002, in the Brazilian Consensus of Pharmaceutical care macro-components for their practical were developed. They can contribute for reduction of non adherence and medication errors, but in which degree each one of the macro-components still acts yet has to be established. Hypertension is a problem of public health, being that the prevalence in the population varies from 22% to 44%. Several studies demonstrate that the prevalence of non adherence to antihypertensives varies from 20% to 90%. Even on an international level, the pharmaceutical care research has poor quality or high prevalence of bias, without describing the intervention method adopted. Based in this, we proposed a open randomized clinical trial, in parallel, developed in pharmacies of Brazilian Basic Units of health, controlled by the current system of medicine distribution. To be included, the individuals must had their blood pressure levels uncontroled, and appeared to remove medicines in the places foreseen for attendance. They had been placed randomly in one of the groups: pharmacotherapy follow-up; pharmaceutical counseling; medicines dispensing and control, for 8 months. The analyzed primary outcomes had been: blood pressure, measured by an automatic device, within at least two readings and adherence to the hypertensive treatment, being this verified by a direct method (hydrochlorothiazide plasma levels at the beginning and end of the study) and a indirect one (control of attendance for medicine withdrawal during the period of study). As secondary outcomes, the number of drug related problems identified and solved was computed, as well as the capacity of each center of execute the interventions, analized by visits in the end of the study, questionaries and by the case report forms notes. The processing of the data was carried through by the main investigator and exported to SPSS and WinPEPI for the statistical analysis. 301 patients had been randomized, between September of 2006 and January of 2008. Of these, 79 had been placed to the pharmacotherapy follow-up group, 66 to the pharmaceutical counseling, 78 to medicines dispensing and 78 to the control group. The pharmaceutical counseling was the intervention that best improved BP, having as comparison the control group: Sistolic ΔBP = -4.0 and diastolic ΔBP = - 0.8, however without statistical significance. For the adherence analyses, one of the centers had been excluded, for not having carried through these measures. The presence of hydrochlorothiazide levels was detected in 135 of the 174 patients who had carried through the final measure, however without statistical significance between the groups (P = .378), with the same occurrence from the indirect method (P = .188). 124 subjects (41.2%) had had DRP detected. 257 had been identified, being 115 of them solved. The sistolic BP had lowered 7.0 mmHg more in the group of individuals who had their DRP solved in relation to the group that did not have DRP solved (P = .041). On the centers of Rio de Janeiro and Ijuí , the structure , what it comprises the physics part, access to practictioners and records , beyond from existence of human resources qualified and with optimized operating capacity, was deficient. The centers of Porto Alegre and Araucária had satisfactorily developed the survey. Although we didn’t have detected differences between the groups, the process of solving drug related problems could help in the reduction of blood pressure levels in communitary pharmacies of the Brazilian Basic Units of Health. In order to increase the effectiveness of the described methods, one suggests improvements in the pharmacies structure, as well as more human resources with adequate training.

Charles University, Faculty of Pharmacy in Hradec Kralove Department of Social and Clinical Pharmacy Student David Suchánek Supervisor PharmDr. Jan Kostřiba, Ph.D. Title of Diploma Thesis Selected medicinal products Introduction: According to market authorisation selected medicinal products (SMP) have been sold outside pharmacies without prescription since 1998. Medicinal products containing paracetamol and ibuprofen belong to this category among others. There were 2368 vendors of SMP in 2017 in the Czech Republic. Objectives: The main purpose of this thesis was to analyse time and local availability, financial affordability of SMP and to analyse safety of selling SMP outside pharmacies. Methods: The research was performed between 12th March 2018 and 16th March 2018 in regions: Chrudim, Hradec Kralove, Pardubice and Rychnov nad Kneznou. 50 vendors of SMP were selected from the database of State Institute for Drug Control regarding proportional representation on the market in the Czech Republic. Subject of research was a 24-year-old male demanding SMP to treat acute toothache. Obtained data were filled in a prepared form. Results were processed by means of descriptive statistics. Results: Time availability was increased, especially in gas stations. 97.6% of vendors had extended opening hours on...

No período de 2008 a 2010, foi realizado o estudo de Atenção Farmacêutica, prospectivo longitudinal, com a participação de 104 pacientes diagnosticados com hipertensão arterial sistêmica, oriundos de duas unidades de saúde, do Distrito Sanitário Oeste da Cidade de Ribeirão Preto/SP. Após seis meses de estudo houve redução estatística significativa nos valores de Pressão Arterial Sistólica e Diastólica com menor dispersividade dos valores e clínica. A adesão ao tratamento aumentou ao longo do acompanhamento. Apresentou-se reduzido risco cardiovascular, com uma redução estatisticamente significativa do escore de risco Framingham. Discreta redução dos atendimentos de emergência. Apesar do sucesso deste estudo, fica em aberto se os benefícios alcançados são considerados transitórios ou permanentes. Para tanto, os pacientes foram reavaliados quanto aos parâmetros: pressão arterial sistólica e diastólica; valores de colesterol total; HDL; LDL, triglicerídeos, número de consultas em geral realizadas nessas unidades de saúde, e número de princípios ativos utilizados. Comparados os dados no período durante e após a Atenção Farmacêutica observou se que houve um aumento estatisticamente significante nos valores de pressão arterial sistólica e diastólica Com relação aos números de medicamentos prescritos houve também um aumento estatisticamente significativo, mas justificável devido à alteração na relação municipal de medicamentos essenciais entre os anos de 2009 e 2012. Quanto ao número de consultas e os resultados dos exames laboratoriais não houve diferença estatisticamente significante. Diante disso, pode se concluir que a Atenção Farmacêutica foi importante para a manutenção e manejo dos pacientes hipertensos e que o período de 30 meses após a Atenção Farmacêutica apresentou discretas alterações, principalmente nos valores de pressão arterial sistólica e diastólica e número de princípios ativos utilizados. / In the period from 2008 to 2010, a longitudinal and prospective Pharmaceutical Care study was conducted with 104 patients diagnosed with hypertension, from two health units, from the West Sanitary District of the municipality of Ribeirão Preto/SP. In this study, in the first six months of follow-up was observed a statistically and clinically significant reduction in the values of systolic and diastolic blood pressure, and with less dispersivity values. Medication adherece increased during the follow-up, a lower coronary risk was presented, with a statistically significant reduction in the Framingham Risk Score. A slight reduction in the emergency room visits was also observed. Considering the success of this study, was not decide whether the benefits obtained were considered transitory or permanent. Therefore patients were reassessed for the parameters: systolic and diastolic blood pressure; total cholesterol; HDL, LDL, triglycerides, number of consultations in general performed in those health units, and number of active moieties. Comparing data from the period during and after the Pharmaceutical Care, it was observed that there was a statistically significant increase in systolic and diastolic blood pressure. Regarding the number of prescribed medications statistically significant increase was also observed, but justifiable due to changes in the municipal list of essential medicines between the years of 2009 and 2012. Regarding the number of medical appointments and the results of laboratory tests there was no statistically significant difference. Thus, it can be concluded that Pharmaceutical Care was important for the maintenance and management of hypertensive patients and that the period of 30 months after the Pharmaceutical Care showed slight alterations, mainly in systolic and diastolic blood pressure and number of active moieties used.

A Atenção Farmacêutica é a interação direta do farmacêutico com o usuário, visando uma farmacoterapia racional e obtenção de resultados definidos e mensuráveis, voltados para a melhoria da qualidade de vida. Em 2002, no Consenso Brasileiro de Atenção Farmacêutica foram propostos macro-componentes para a sua prática. Esta pode contribuir para diminuição da não-adesão e de erros de medicação, mas em que grau cada um dos macro-componentes atua ainda é parâmetro a ser estabelecido. A hipertensão arterial sistêmica é um problema de saúde pública, sendo que a prevalência na população varia de 22% a 44%. Vários estudos demonstram que a prevalência de não-adesão aos anti-hipertensivos varia de 20 a 90%. Mesmo em nível internacional, as pesquisas em Atenção Farmacêutica são de menor qualidade ou possuem vieses, não descrevendo o método de atendimento adotado. Baseado nisto, se propôs a realização de um ensaio clínico randomizado aberto, em paralelo, onde foram analisados três macro-componentes da atenção farmacêutica (grupos intervenção): seguimento farmacoterapêutico; orientação farmacêutica; dispensação de medicamentos. Os estudos foram desenvolvidos em farmácias-escola sendo 3 em Unidades Básicas de Saúde e uma localizada nas imediações de um hospital universitário e de uma unidade básica de saúde, sendo o grupo controle o atendimento usual em cada uma delas. Foram incluídos hipertensos não-controlados que compareceram para retirar medicamentos nos locais previstos para atendimento. O tempo de acompanhamento dos pacientes foi de 8 meses. Os desfechos primários analisados foram: hipertensão arterial, medida com aparelho automático, por meio de no mínimo duas leituras. e adesão ao tratamento, sendo esta verificada por método direto (medida dos níveis plasmáticos de hidroclorotiazida no início e fim do estudo) e indireto (controle de comparecimento para retirada de medicamentos durante o período de estudo). Como desfecho secundário, foi computado o número de problemas relacionados a medicamentos identificados e solucionados em cada grupo e a capacidade de cada centro executar as intervenções propostas, por meio de visitas no fim do estudo, relatos e preenchimento das fichas de coleta de dados. O processamento dos dados foi realizado pelo investigador principal no centro coordenador e exportado para SPSS para análise estatística. Foram randomizados 301 pacientes, entre setembro de 2006 e janeiro de 2008. Destes, 79 foram alocados ao grupo seguimento, 66 à orientação, 78 à dispensação e 78 ao controle. Não houve diferença estatisticamente significativa entre os deltas dos níveis pressóricos dos grupos estudados em relação ao grupo controle. A orientação foi a intervenção que apresentou diminuição bruta mais acentuada, em comparação com o grupo controle: ΔPA sistólica = -4,0 e ΔPA diastólica = - 0,8. Para as análises de adesão, foi excluído um dos centros, por não ter realizado estas medidas. A hidroclorotiazida foi detectada em 135 dos 174 pacientes que realizaram a medida final, porém não se observou diferença estatística entre os grupos de intervenção (P = 0,378), o mesmo ocorrido no método indireto (P = 0,188). Entre os pacientes estudados 124 (41,2%) tiveram PRMs detectados. Foram identificados 257 PRMs, sendo 115 resolvidos. A PA sistólica baixou 7,0 mmHg a mais no grupo em que se solucionaram PRMs em relação ao grupo que não teve PRM resolvidos (P = 0,041). Nos centros do Rio de Janeiro e Ijuí, a estrutura, que compreende a parte física, acesso aos médicos e prontuários, além da existência de recursos humanos qualificados e com capacidade operacional otimizada, era deficitária frente aos dois outros centros. Os centros de Porto Alegre e Araucária desenvolveram satisfatoriamente o estudo. Apesar de não se haver detectado diferenças entre os grupos, o processo de se solucionar PRMs pode ajudar na redução dos níveis pressóricos em hipertensos não-controlados usuários de farmácias-escola comunitárias ligadas a Unidades Básicas de Saúde. A fim de se aumentar a efetividade dos métodos de atenção farmacêutica descritos sugere-se melhorias na estrutura das farmácias, bem como disponibilidade de recursos humanos com treinamento adequado. / Pharmaceutical Care is the direct interaction of the pharmacist with the patient, aiming at a rational pharmacotherapy and attainment of definite and measurable results, toward the improvement of the quality of life. In 2002, in the Brazilian Consensus of Pharmaceutical care macro-components for their practical were developed. They can contribute for reduction of non adherence and medication errors, but in which degree each one of the macro-components still acts yet has to be established. Hypertension is a problem of public health, being that the prevalence in the population varies from 22% to 44%. Several studies demonstrate that the prevalence of non adherence to antihypertensives varies from 20% to 90%. Even on an international level, the pharmaceutical care research has poor quality or high prevalence of bias, without describing the intervention method adopted. Based in this, we proposed a open randomized clinical trial, in parallel, developed in pharmacies of Brazilian Basic Units of health, controlled by the current system of medicine distribution. To be included, the individuals must had their blood pressure levels uncontroled, and appeared to remove medicines in the places foreseen for attendance. They had been placed randomly in one of the groups: pharmacotherapy follow-up; pharmaceutical counseling; medicines dispensing and control, for 8 months. The analyzed primary outcomes had been: blood pressure, measured by an automatic device, within at least two readings and adherence to the hypertensive treatment, being this verified by a direct method (hydrochlorothiazide plasma levels at the beginning and end of the study) and a indirect one (control of attendance for medicine withdrawal during the period of study). As secondary outcomes, the number of drug related problems identified and solved was computed, as well as the capacity of each center of execute the interventions, analized by visits in the end of the study, questionaries and by the case report forms notes. The processing of the data was carried through by the main investigator and exported to SPSS and WinPEPI for the statistical analysis. 301 patients had been randomized, between September of 2006 and January of 2008. Of these, 79 had been placed to the pharmacotherapy follow-up group, 66 to the pharmaceutical counseling, 78 to medicines dispensing and 78 to the control group. The pharmaceutical counseling was the intervention that best improved BP, having as comparison the control group: Sistolic ΔBP = -4.0 and diastolic ΔBP = - 0.8, however without statistical significance. For the adherence analyses, one of the centers had been excluded, for not having carried through these measures. The presence of hydrochlorothiazide levels was detected in 135 of the 174 patients who had carried through the final measure, however without statistical significance between the groups (P = .378), with the same occurrence from the indirect method (P = .188). 124 subjects (41.2%) had had DRP detected. 257 had been identified, being 115 of them solved. The sistolic BP had lowered 7.0 mmHg more in the group of individuals who had their DRP solved in relation to the group that did not have DRP solved (P = .041). On the centers of Rio de Janeiro and Ijuí , the structure , what it comprises the physics part, access to practictioners and records , beyond from existence of human resources qualified and with optimized operating capacity, was deficient. The centers of Porto Alegre and Araucária had satisfactorily developed the survey. Although we didn’t have detected differences between the groups, the process of solving drug related problems could help in the reduction of blood pressure levels in communitary pharmacies of the Brazilian Basic Units of Health. In order to increase the effectiveness of the described methods, one suggests improvements in the pharmacies structure, as well as more human resources with adequate training.

No período de 2008 a 2010, foi realizado o estudo de Atenção Farmacêutica, prospectivo longitudinal, com a participação de 104 pacientes diagnosticados com hipertensão arterial sistêmica, oriundos de duas unidades de saúde, do Distrito Sanitário Oeste da Cidade de Ribeirão Preto/SP. Após seis meses de estudo houve redução estatística significativa nos valores de Pressão Arterial Sistólica e Diastólica com menor dispersividade dos valores e clínica. A adesão ao tratamento aumentou ao longo do acompanhamento. Apresentou-se reduzido risco cardiovascular, com uma redução estatisticamente significativa do escore de risco Framingham. Discreta redução dos atendimentos de emergência. Apesar do sucesso deste estudo, fica em aberto se os benefícios alcançados são considerados transitórios ou permanentes. Para tanto, os pacientes foram reavaliados quanto aos parâmetros: pressão arterial sistólica e diastólica; valores de colesterol total; HDL; LDL, triglicerídeos, número de consultas em geral realizadas nessas unidades de saúde, e número de princípios ativos utilizados. Comparados os dados no período durante e após a Atenção Farmacêutica observou se que houve um aumento estatisticamente significante nos valores de pressão arterial sistólica e diastólica Com relação aos números de medicamentos prescritos houve também um aumento estatisticamente significativo, mas justificável devido à alteração na relação municipal de medicamentos essenciais entre os anos de 2009 e 2012. Quanto ao número de consultas e os resultados dos exames laboratoriais não houve diferença estatisticamente significante. Diante disso, pode se concluir que a Atenção Farmacêutica foi importante para a manutenção e manejo dos pacientes hipertensos e que o período de 30 meses após a Atenção Farmacêutica apresentou discretas alterações, principalmente nos valores de pressão arterial sistólica e diastólica e número de princípios ativos utilizados. / In the period from 2008 to 2010, a longitudinal and prospective Pharmaceutical Care study was conducted with 104 patients diagnosed with hypertension, from two health units, from the West Sanitary District of the municipality of Ribeirão Preto/SP. In this study, in the first six months of follow-up was observed a statistically and clinically significant reduction in the values of systolic and diastolic blood pressure, and with less dispersivity values. Medication adherece increased during the follow-up, a lower coronary risk was presented, with a statistically significant reduction in the Framingham Risk Score. A slight reduction in the emergency room visits was also observed. Considering the success of this study, was not decide whether the benefits obtained were considered transitory or permanent. Therefore patients were reassessed for the parameters: systolic and diastolic blood pressure; total cholesterol; HDL, LDL, triglycerides, number of consultations in general performed in those health units, and number of active moieties. Comparing data from the period during and after the Pharmaceutical Care, it was observed that there was a statistically significant increase in systolic and diastolic blood pressure. Regarding the number of prescribed medications statistically significant increase was also observed, but justifiable due to changes in the municipal list of essential medicines between the years of 2009 and 2012. Regarding the number of medical appointments and the results of laboratory tests there was no statistically significant difference. Thus, it can be concluded that Pharmaceutical Care was important for the maintenance and management of hypertensive patients and that the period of 30 months after the Pharmaceutical Care showed slight alterations, mainly in systolic and diastolic blood pressure and number of active moieties used.