The impact of the pharmacist in elderly patient healthcare management is developing. In our study, the interventions made by community pharmacists in the RESPECT study (Randomised Evaluation of Shared Prescribing for Elderly people in the Community over Time) were analysed and evaluated. In our study, the study sample was chosen according to specific criteria. The outcomes of these pharmacist interventions were measured by a clinical panel which scored and categorised each intervention into one of five categories. The study also investigated the percentage of interventions implemented or not implemented by GPs. In our study, initially 398 patients and of these 52 were excluded because their files did not contain the entry criteria information, leaving 346 patients who were identified with a mean (SD) of 8.9 (3.3) pharmaceutical care plans which contained mean (SD) 8.2(7.2) pharmaceutical care issues. Of these 43% were males and 57% were females with a mean (SD) age of 81(3.7) years. There were many missing data about drugs prescribed due to poor documentation by community pharmacists in the RESPECT study particularly at post study period (T5). The mean (SD) for all drugs prescribed was 35.9 (12.38) for each patient and for the whole study period including the post period (T5). In our study a total of 2879 individual pharmaceutical care issues were identified. A clinical panel judged that 43% of the interventions prevented harm, 31% improved the efficacy of management, 3% were detrimental to the patient's management plan, 12% only provided information and there was insufficient information to make a decision on the remaining 11%. For the classifications prevented harm to the patient and improve efficacy of management, the panel gave a score of 7 or more to 264 and 103 respectively which were classed as potential prevented hospital admissions. The outcome of 1628 could not be determined from the data and the pharmacist did not intervene on 361 occasions. Of the remaining 890 (30.9%) GPs accepted 715 and did not accept 175. The cost effectiveness of providing pharmaceutical care to older people by community pharmacists could be estimated (£620,000) by calculating reduction in expenditure of hospital admissions. In addition, there would be the possibility of reduced pressure on other NHS resources such as availability of hospital beds. The involvement of a clinical pharmacist in elderly patient health care, within the setting of a community pharmacy, provided positive healthcare outcomes and therefore should be encouraged in line with the new white paper for England "Building on strengths-delivering the future" (2008). The study emphasises the importance of revising the nature and period of postgraduate training for community pharmacists who are going to provide pharmaceutical care for elderly patients. This raises the possibility of specialised competency based postgraduate training for community pharmacists with a special interest in the care of older people (PhwSI). This would enable community pharmacists practising as generalists to become advanced practitioners in the specialist clinical area of older people and ensure a consistent level of service for elderly patients in line with government expectations.

Analysis of care in patients at risk for arterial hypertension in pharmacy IV. Author: Lada Kotlanová Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague Introduction and aim: Arterial hypertension (AH) belongs due to its pressure and atherosclerotic complications among very serious global health problems. The main goal of the therapy of AH is to prevent these complications, comprising early diagnosis and proper treatment plan. The aim of the study was to realize counselling in a pharmacy focused on clients with the risk of AH or already diagnosed AH. Metodology: Data were collected in a community pharmacy in Kralovice from September 2014 to January 2015. Prior to blood pressure measurement, the controlled interview was conducted with each client using special form which enabled to obtain important data from clients' history. Following data were obtained: socio-demographic characteristics of each client; their relationship to blood pressure measurement; risk factors of AH or atherosclerosis, respectively; disease history and use of drugs including food supplements. Results of blood pressure measurement, proposed intervention, or drug related problems were also subsequently recorded into the form thus...

Drug interactions of cardiovascular drugs and their analysis in the patients of community pharmacy Author: Zuzana Vávrová1 Tutor: PharmDr. Josef Malý, Ph.D.1 1 Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Introduction: Drug interactions represent a serious health problem and they cause many hospitalizations. Although their identification and documentation received a considerable attention, they remain unrecognized for many patients. Objectives: The goal of the thesis was to analyze serious drug interactions between cardiovascular drugs, to describe their management in clinical practice, which is useful during dispensation, and to evaluate occurrence of these drug interaction in a community pharmacy. Methodology: The information was gained from several databases and compared, and afterwards management of major drug interactions of betablockers and calcium channel blockers was created. Patients of a community pharmacy were screened for these drug interactions. The data were processed by frequency analysis. Results: In the theoretical part, 94 drug interactions were analysed. The total number of patients who received betablockers or calcium channel blockers in the community pharmacy was 525. Serious drug interactions described in this...

Drug interactions of gastrointestinal remedies Author: Marek Lapka Tutor: Josef Malý1 1 Department of Clinical and Social Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Background: Drug interactions may be a serious cause of toxicity and undesirable drug effects. There is a direct proportion to side effect incidence caused by drug interactions and number of used drugs. The issue is a significant constituent of pharmaceutical care. The aim of dissertation: The aim of the thesis was to process available information, suggest a posible solution and create compact overview which can be taken into consideration by pharmacist in order to achieve optimal pharmacotherapy. Methods: Drug combinations, which interactions had clinical evaluation from "moderate severity" to "major severity" were collected from the fundamental information source, Vademecum infopharm aplication. Only currently registered drugs to 1st September 2013 by State Institute for Drug Controle were chosen and then medicinal products of which route of administration enables systemic effect. Furthermore the combination was compared with Micromedex database or Stockley's Drug Interactions Pharmaceutical Press, or both. Pubmed database (www.pubmed.gov) with entering key words "drug interaction", "basic drug" and...

Analysis of care in patients at risk for arterial hypertension in pharmacy III. Author: Petra Smíšková Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague Introduction: Arterial hypertension belongs to the most common diseases of cardiovascular system, not only in the Czech Republic. Therefore it is very important to focus on its prevention and early diagnostics before the stage of health complications shows up. Objectives: The aim of this thesis was to realize and evaluate consulting activities in pharmacy focused on patients who have high risks of arterial hypertension or have been already diagnosed with it. Methodology: Data were collected in a public pharmacy in Prague from the end of April 2013 until the beginning of April 2014. The actual blood pressure measurement was preceded by obtaining of answers to selected questions through controlled interview. Acquired statements were written into the printed forms. It was focused on particicipant's socio-demographic characteristics, his relationship to the blood pressure measurement; occurrence of risk factors of arterial hypertension, it means atherosclerosis; disease in the anamnesis and the usage of drugs including food supplements. The results of blood...

Drug interactions of cardiovascular drugs and their analysis in the patients of community pharmacy II. Author: Lenka Skořepová1 Tutor: PharmDr. Josef Malý, Ph.D.1 1 Department of Social and Clinical Pharmacy, Charles university in Prague, Faculty of Pharmacy in Hradec Králové Introduction: Drug interactions are a major cause of toxicity, side effects of drugs and increase the risk of harm to the patient. The pharmacist has an indispensable role in the process of minimizing risks and resolving of drug interactions. Objectives: The aim of the thesis was to carry out a research focused on drug interactions of selected groups of cardiovascular drugs and to describe their management in clinical practice, which could be used during dispensing medicine. Then was evaluated occurrence of these drug interactions in pharmacotherapy of community pharmacy patients. Methods: With the help of selected databases were described individual drug interactions of ACEI and created their management in clinical practice. Sample of patients of community pharmacy was screened for drug interactions. The data were processed by retrospective analysis. For 12 patients with drug interactions were processed case reports and tested solution of drug interactions with using of described management of drug interactions during the...

Atualmente, o diabetes mellitus (DM) é uma doença onerosa para cofres públicos, devido às complicações micro e macrovasculares usualmente devido a não adesão à terapêutica. Tornando importante identificar novas variáveis que influenciam a não adesão à farmacoterapia, principalmente na atenção primária, onde os estudos no Brasil são escassos. Objetivo: Avaliar os fatores que influenciam a adesão a farmacoterapia em pacientes com diabetes tipo 1 (T1DM) e diabetes tipo 2 (T2DM) atendidos em uma unidade básica de saúde. Métodos: Esse é um estudo transversal realizado em pacientes com T1DM e T2DM com idades entre 18 a 90 anos, usuários de insulina e agentes anti-diabéticos selecionados de uma unidade básica de saúde do município de Franca - SP. Os instrumentos MedTake (MT), Morisky-Green (TMG), Índice de Complexidade da Farmacoterapia (ICFT), Índice de Complicações do Diabetes (CDI) e Teste Auto-Compliance (ACT) foram aplicados em todos pacientes por um único pesquisador do estudo. Os pacientes foram divididos em T1DM e T2DM com pontuações no TMG>80 para o grupo aderente e TMG<=80 para o grupo não aderente. Uma análise de regressão logística foi realizada para avaliar o efeito das variáveis na adesão ao tratamento, assim usamos como variável dependente o TMG e as variáveis independentes foram: clínicas, sociodemográficas, relacionadas aos medicamentos, CDI e Auto-Compliance. Esse modelo produziu odds ratio (OR) com medidas de associação com seus respectivos intervalos de confiança (IC). Os IC que não incluíram 1 foram considerados estatisticamente significantes (p<0.05). Para controlar os possíveis efeitos de confusão do sexo, idade e tempo de diagnóstico, o modelo de regressão logística múltipla produziu OR ajustadas. Resultados: Houve forte associação entre depressão e não adesão a farmacoterapia nos pacientes com T1DM nas faixas etárias de 41-60 anos, OR=4.6(1.4-14.2) fato que não ocorrem nas outras faixas etárias. A insuficiência cardíaca congestiva (ICC) foi associada a não adesão à farmacoterapia em pacientes com T2DM OR=2.3(1.1-5.1).9 Conclusão: Equipes multidisciplinares, gestores e formuladores de políticas públicas de saúde devem considerar a depressão e ICC no manejo dos pacientes com DM em relação a não adesão à farmacoterapia / Currently, diabetes is disease onerous to public safes due to micro and macrovasculares complications and non-adherence to therapeutic. In this sense, is crucial to identify new variables that influence the non-adherence to pharmacotherapy, mainly in the primary care, where the studies in Brazil are scared. Objective: To evaluate the factors that influence the adherence to pharmacotherapy in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) attended in the a primary health care unit. Methods: This is a cross-sectional study in patients with T1DM and T2DM aged 18-90 years, insulin and anti-diabetic drugs users selected from a primary health care unit in Franca-SP. The MedTake (MT), Morisky-Green (TMG), Pharmaco-Complexity Index (CPI), Diabetes Complication Index (CDI) and Self-Compliance Test (ACT) instruments were applied in all patients by a single study investigator. Patients were divided into T1DM and T2DM with scores in the TMG > 80 for the adherent group and TMG <= 80 for the non-adherent group. A logistic regression analysis was performed to evaluate the effect of the variables on the adherence to the treatment, so we used as a dependent variable the TMG and the independent variables were: clinical, sociodemographic, drug related, CDI and AutoCompliance. This model produced odds ratios (OR) with measures of association with their respective confidence intervals (CI). The CI that did not include 1 were considered statistically significant (p <0.05). To control the possible confounding effects of gender, age and time of diagnosis, the multiple logistic regression model produced adjusted OR. Results:There was a strong association between depression and non-adherence to pharmacotherapy in patients with T1DM in the age groups of 41-60 years, OR = 4.6 (1.4- 14.2), a fact that does not occur in other age groups. Congestive heart failure (CHF) was associated with non-adherence pharmacotherapy in patients with T2DM OR = 2.3 (1.1- 5.1). Conclusions: Multidisciplinary teams, managers and formulators of public health policies should consider depression and CHF in the management of patients with DM in relation to non-adherence to pharmacotherapy

Resumo Na década de 90 se inicia um debate nos países de língua inglesa sobre uma nova forma de relação entre a indústria e a doença. O novo fenômeno em questão foi batizado de disease mongering (mercantilização da doença), no qual a estratégia básica da indústria é a ampliação dos limites da doença para o aumento de seu mercado consumidor. O debate deste fenômeno se estende com publicações pela década de 2000 discutindo como a indústria faz alianças com o governo, médicos e meios científicos que fortalecem o estabelecimento de concepções de doença que favorecem a venda de seus tratamentos. Propõe-se discutir esse fenômeno articulando-o a outros três conceitos: o uso racional de medicamentos, a medicalização e a racionalidade técnica. O primeiro para definir os critérios do uso racional de medicamentos e verificar se o fenômeno da mercantilização da doença proporciona relação de afastamento ou de a aproximação com esses critérios. O segundo para estabelecer a relação entre a mercantilização da doença e a medicalização da sociedade, a partir dos termos do próprio debate que definem a mercantilização da doença como uma forma de medicalização. O terceiro para se aprofundar naquilo que está na base do fenômeno da mercantilização da doença: a sobreposição de lógicas. Principalmente a sobreposição da lógica mercantil à lógica sanitária. Para isto, o estudo faz uma incursão pelos referenciais teóricos que examinam a racionalidade técnica, sobretudo a tradição crítica de Marcuse e Horkheimer. Na raiz dessas formulações, encontram-se o conceito de reificação, de Lukács, e o conceito de fetichismo da mercadoria, de Marx. Esses referenciais teóricos permitem discutir o sentido e o alcance da sobreposição de lógicas subjacente à mercantilização da doença. Como resultados, a pesquisa mostra que a mercantilização da doença desvirtua progressivamente os parâmetros fixados para o URM e que reforça a medicalização da sociedade. Nesse processo, a racionalidade técnica reconfigura a prática e o saber médicos. A mercantilização da doença permite vislumbrar, ainda, a colonização econômica de outras esferas da sociedade, tais como a educação, a política e a ciência, possibilitando que a esfera econômica colonize o sistema de saúde da sociedade contemporânea. / A debate on a new form of relation between industry and disease is started during the 90s in English speaking countries. The new phenomenon in question was then called disease mongering, whose basic industry strategy was to expand disease boundaries in order to grow its consumer market. In the 2000s, publications widen the debate on such phenomenon and discuss how alliances between drug industry and government, doctors and the scientific community are formed, strengthening conceptions about diseases which promote treatment sale. I aim to discuss such phenomenon through its articulation with three conceptions: drug rational use, medicalization and technical rationality. The first one defines the criteria for drug rational use and verifies if the disease mongering phenomenon promotes an independent or a close relationship with such criteria. The second one establishes the relation between disease mongering and society medicalization from data provided by the debate itself, which defines disease mongering as a way of medicalization. The third one goes deep into what the basis of the disease mongering phenomenon is: logical overlapping, especially that of mercantile logic over sanitary logic. Thus, this study promotes a reflection on the theoretical references that assess technical rationality, especially Marcuse and Horkheimers critical tradition. In the root of such formulations there are Lukács reification concept, and Marxs concept of goods fetishism. Such theoretical references allow discussing the sense and the reach of logical overlapping underlying disease mongering. The results of this research show that disease mongering tends to progressively misrepresent the established parameters for URM and reinforce society medicalization. In this process, technical rationality reshapes medical practice and knowledge. Disease mongering also allows analyzing the economical colonization of other society spheres, such as education, politics and science, making it possible for the economical sphere to colonize the health system in the contemporary society.

Os serviços farmacêuticos envolvem ações integradas do farmacêutico com a equipe de saúde, focadas no usuário, por meio dos serviços de clínica farmacêutica, atividades de gestão e técnico-pedagógicas. A implantação destes serviços na Atenção Básica deve buscar a adaptação e a reorganização do processo de trabalho dos farmacêuticos. Um dos serviços farmacêuticos mais complexos e completos é o acompanhamento farmacoterapêutico de pacientes. O objetivo do trabalho foi desenvolver uma proposta de sistemática para o acompanhamento farmacoterapêutico de pacientes atendidos nas Redes de Atenção Básica e de Especialidades no Município de São Paulo. Para isso foi realizado um estudo observacional descritivo por meio de um diagnóstico situacional dos serviços farmacêuticos realizados em unidades de saúde de SP e propondo-se critérios de seleção de pacientes e uma sistemática de acompanhamento farmacoterapêutico. O diagnóstico situacional foi realizado utilizando publicações da SMS-SP e as respostas auto-referidas de 45 farmacêuticos que atuam em unidades de saúde de SP a um questionário aplicado on line. A proposição dos critérios de seleção de pacientes baseou-se em dados disponíveis na literatura e na avaliação do diagnóstico situacional. A proposta da sistemática para o acompanhamento farmacoterapêutico foi elaborada tendo como base a revisão da literatura, o modelo adotado pelo MS e o modelo empregado na FARMUSP. No diagnóstico situacional observou-se que 64% dos farmacêuticos realizam atividades clínicas mas que somente 38% utilizavam algum tipo de formulário específico; 75% participam de grupos terapêuticos/ educacionais e 88% desenvolvem alguma atividade de educação em saúde. Os farmacêuticos que trabalham em unidades AMA/UBS e UBS tiveram cerca da metade do tempo de trabalho destinado a atividades técnicopedagógicas, seguidas das atividades de gestão (40%) e clínicas (10%). O principal critério de seleção relatado foi o encaminhamento por outros profissionais de saúde, seguido pelos pacientes que participam de algum grupo terapêutico da unidade. Foi proposta uma sistemática de acompanhamento farmacoterapêutico em 4 etapas com o apoio de formulários para o registro e análise de dados. Concluiu-se que as atividades clinicas são realizadas, mas não são de forma sistmática e documentada e que o número inadequado de recursos humanos e a estrutura inadequadadas unidades de saúde são barreiras para a implantação das atividades clínicas. A proposta elaborada é o início do processo de implantação do serviço de acompanhamento farmacoterapêutico, sendo a capacitação dos farmacêuticos fundamental para o desenvolvimento das habilidades necessárias para a realização deste serviço. / The pharmaceutical services involve integrated actions of the pharmacist with the health team, focused on the user, through the services of pharmaceutical clinic, management, and technical-pedagogical activities. The implementation of these services in Primary Care should seek the adaptation and reorganization of the work process of pharmacists. One of the most complex and complete services of the pharmaceutical care is the pharmacotherapeutic follow-up. The objective of the project was developing a systematic method for the pharmacotherapeutic follow-up to patients of the Primary Helth Care of the city of São Paulo. For this, a situational diagnosis of the pharmaceutical services performed in health centers was developed and a selection criteria of patients and a systematic pharmacotherapeutic follow-up was proposed. The situational diagnosis was carried out using the SMS-SP publications and information obtained through the responses of 45 pharmacists who work in health care centers to the questionnaire applied on line. The selection criteria of patients was based on data available in the literature, on the situational diagnosis, in the criteria used in a project developed by MS and in the practice adopted in some health centers in the city of São Paulo. The systematic method proposed for the pharmacotherapeutic follow-up was elaborated based on the literature review and the models adopted by the MS and FARMUSP. The situational diagnosis observed that 64% of pharmacists performed clinical activities, but only 38% use standard form; 75% participate in educational groups and 88% participated in health educational activities. Pharmacists working in AMA / UBS and UBS units had about half the time spent working on technical-pedagogical activities, followed by management activities (40%) and clinical activities (10%). The main selection criterion reported was referral by other health professionals, followed by patients participating in some therapeutic groups. A systematic pharmacotherapeutic follow-up method was proposed in 4 stages with the support of forms for data recording and analysis. It was concluded that clinical activities are performed, but are not in a systematic and documented way. The inadequate number of human resources and inadequate structure of health units are barriers to the implementation of clinical activities. The proposal elaborated is the beginning of the process of implementation of the pharmacotherapeutic follow-up, and the qualification of pharmacists is fundamental for the development of the necessary skills to carry out this service.

Desde a sua descoberta, no início da década de 80, o HIV/aids, constituiu-se como uma doença que ultrapassa os limites da dimensão biomédica, apresentando diversos desafios à sociedade. No Brasil, estima-se que aproximadamente 734 mil pessoas vivem com HIV/aids. Foram desenvolvidas diferentes classes de drogas antirretrovirais para seu tratamento; as quais são eficazes para o controle parcial da replicação viral. Sem a descoberta da cura, é imprescindível que as pessoas vivendo com HIV/aids sigam as recomendações da equipe de saúde, aderindo ao tratamento proposto; aumentando sua qualidade de vida, bem como contribuindo para a diminuição da transmissão do vírus. Durante o tratamento, algumas dificuldades podem surgir, determinando momentos de maior ou menor adesão ao mesmo e os profissionais de saúde, dentre eles, os farmacêuticos, devem estar atentos a estes momentos. Este estudo transversal teve como objetivo analisar a retirada do TARV nos últimos 24 meses e investigar os possíveis fatores que levam a retirada desta medicação de forma irregular na Unidade Especial de Tratamento de Doenças Infecciosas (UETDI) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo. Participaram 250 pessoas que vivem com HIV/aids que retiram a medicação na Farmácia do local do estudo. Os participantes foram separados em dois grupos: Grupo em Atraso e Grupo Controle segundo seus históricos de dispensação da TARV nos vinte e quatro meses anteriores a realização das entrevistas. Predominaram participantes do sexo masculino (57,6%), com mais de 40 anos (76%), brancos (51,6%), com baixa escolaridade (48,4%), sem parceiro fixo (52,4%), residentes em Ribeirão Preto (63,6%). Todas as variáveis foram relacionadas em um estudo univariado e aquelas com um valor de \"p\" igual ou menor que 0,2 foram selecionadas para análise multivariada. As associações entre variáveis selecionadas e a retirada irregular comparada com a retirada regular, foi estimada pela estimativa com intervalo de confiança de 95%. As variáveis que mostraram associação com a retirada da TARV em atraso foram: fazer uso de outro medicamento além da TARV, apresentar resultado de exame de carga viral como detectável, ter, no início do período analisado, contagem de linfócitos T CD4 menor que 200 células /mm3 e ter baixa adesão como resultado do Teste de Morisky- Green / Since its discovery in the early 80s, HIV / AIDS was established as a disease that pushes the boundaries of biomedical dimension, presenting many challenges to the society. In Brazil, there are almost 734,000 people carrying HIV / AIDS. Different classes of antiretroviral drugs were developed for their treatment, which are effective in partial control of viral replication. Yet incurable disease it is essential that people living with HIV / AIDS follow the recommendations of the health care agents, adhering to the proposed treatment, increasing their quality of life, and contributing to the reduction of transmission of the virus. During treatment, some difficulties may arise, determining moments of greater or lesser adherence, and pharmacists among other health professionals, should be aware of these moments. This cross-sectional study aimed to analyze the withdrawal of ART in the last 24 months, and investigate the possible factors that lead the medication withdrawal erratically on Special Treatment of Infectious Diseases Unit (UETDI) of the Clinics Hospital - School of Medicine of Ribeirao Preto, University of São Paulo. Two hundred and fifty people living with HIV / AIDS got medication in the study site pharmacy. Participants were divided into two groups: Group Control and Group Delay, according to their historical dispensing of ART in twenty-four months prior to the interviews; predominant male participants (57.6%) with more than 40 years (76%), white (51.6%), with low education (48.4%), with no steady partner (52.4%), residents in Ribeirão Preto (63.6%). All variables related in a univariate analysis, and those with a value of \"p\" equal to or smaller than 0.2 were selected for multivariate analysis. The associations between selected variables, and the irregular removal compared to regular withdrawal were estimated with 95% confidence interval. The variables that were associated with the withdrawal of ART arrears, and making use of another drug in addition to HAART, presented results of viral load test as detectable, having the beginning of period analyzed, CD4 lymphocyte count less than 200 cells / mm3, and have low compliance as a result of Morisky- Green test.