Com o aumento na prevalência das doenças crônicas, pesquisadores têm feito reflexões e investigações sobre a necessidade de novas abordagens para o cuidado dos pacientes. Neste contexto, o algoritmo seria uma ferramenta interessante, com informações precisas para a harmonização das condutas clínicas dos farmacêuticos na prática da Atenção Farmacêutica. Os algoritmos constituem o núcleo dos protocolos clínicos, que retratam o fluxo principal do atendimento e são representados graficamente por meio de fluxograma, estruturado em etapas que se inter-relacionam, apresentando pontos de decisão. O objetivo deste trabalho foi identificar a percepção de farmacêuticos sobre a utilização de algoritmos na prática da Atenção Farmacêutica, sendo classificado como um estudo descritivo, quantitativo, baseado em levantamento de dados em uma população composta por 20 farmacêuticos. Para a coleta dos dados foi utilizada a técnica Delphi, que consiste num processo de comunicação em grupo visando à convergência de opiniões, obtidas em três interações, por meio de questionários. O primeiro questionário forneceu 181 opiniões e destas, 58 (32%) foram consideradas válidas, ao término da terceira interação, pois apresentaram 100% de concordância entre os participantes do estudo. Em seguida, as opiniões foram separadas por semelhança para a composição das categorias, com o intuito de homogeneizar as informações e, assim, identificar as ideias relacionadas à importância, às vantagens e desvantagens, bem como, o interesse da aplicabilidade de algoritmos na prática clínica farmacêutica. Desta maneira, foram obtidas 19 categorias, sendo seis para o questionamento sobre a importância, cinco sobre as vantagens, duas sobre as desvantagens e seis relacionadas ao interesse da aplicabilidade desta ferramenta na prática clínica. Posteriormente, pôde-se identificar em três das quatro perguntas iniciais, uma categoria em comum, reconhecida por \"facilitar a prática da Atenção Farmacêutica\". Esta foi considerada a categoria central por representar 40% das opiniões válidas ao longo do estudo. Isto evidencia que as justificativas sobre o interesse da utilização baseiam-se nas vantagens, bem como, na importância que o instrumento oferece. Portanto, a percepção dos farmacêuticos sobre a utilização de algoritmos na prática da Atenção Farmacêutica considera o instrumento um facilitador das ações relacionadas à promoção da saúde, podendo proporcionar também, a comunicação e a interação multiprofissional, além de harmonizar as condutas clínicas, bem como diminuir potenciais erros técnicos e gastos desnecessários. / The increase in the prevalence of chronic diseases have been taken researchers to reflect and explore new strategies to deal in practice involving patient care. In this context, the algorithm would be an interesting tool, which works with accurate and quick information and would help in the harmonization of the conducts, i. e., in the pharmacotherapeutic follow-up, at the Pharmaceutical Care.The algorithms are the core of clinical protocols that reflect the mainstream of the service and are represented by a structured flowchart, which steps are interrelated, showing the decision points. The objective of this study was identify the perception of pharmacists regarding algorithms use in the practice of Pharmaceutical Care. The research was classified as a descriptive, quantitative, based on data collection and was conducted in a population consisting of 20 pharmacists. Delphi technique was used for data collection, which consists on a group communication process. This group is composed by experts and aims to the convergence of opinions, obtained in three interactions, using questionnaires. The first questionnaire provided 181 opinions and 58 (32%) of them were considered valid, at the end of the third interactions, because they presented 100% of agreement among study participants. Then, the views were separated by similarity to form categories, in order to homogenize the information and identify the main ideas about the importance, advantages and disadvantages and the possibility of using algorithms in the clinical practice of pharmacy. Thus, there were obtained 19 categories: six related with the importance of this tool, five with the advantages, two with the disadvantages and six were related to interests of the applicability of this tool in clinical practice. Later, it was possible to identified in three of the four initial questions, a common category, recognized for \"facilitating the practice of Pharmaceutical Care\". This was considered the main category, which represented 40% of valid opinions throughout the study. The explanation for this is the fact that to adopt a new instrument of work, it is needed to be based on the importance and the advantages that this can provide. This shows that the justifications about the interest of use based on the benefits, as well as on the importance that the instrument provides. Therefore, the perception of pharmacists about the use of algorithms in the practice of Pharmaceutical Care considers the instrument a facilitator of actions related to the promotion of health, and can also provide communication and multidisciplinary interaction, in addition to harmonize conduct clinics, as reduction potential of technical errors and unnecessary expenses.

No Brasil, o câncer atualmente é a segunda causa de morte e algumas das explicações devem-se ao fato do melhor controle das doenças infectocontagiosas e ao envelhecimento populacional global, uma vez que o câncer é considerado uma doença cuja idade média está acima de 60 anos. As comorbidades as quais estão diretamente associadas ao envelhecimento e o uso de diversos medicamentos são necessários para o controle adequado das outras patologias, por outro lado, representa um importante fator de risco para resultados negativos de saúde. A conciliação de medicamentos visa a redução de medicamentos desnecessários, com uma avaliação criteriosa do farmacêutico, que pode ajudar a otimizar a terapia medicamentosa, reduzir custos, aumentar a conformidade e reduzir a toxicidade e eventos adversos relacionados aos medicamentos. OBJETIVO: Avaliar a prevalência da polifarmácia, automedicação, a adesão e conhecimento da farmacoterapia domiciliar; as principais dúvidas e as necessidades de orientação em relação à farmacoterapia em geral; harmonização farmacoterapêutica, discrepâncias, interações medicamentosas, medicamentos inapropriados para idosos e duplicidade terapêutica. CASUÍSTICA E MÉTODOS: Pacientes admitidos dos pelo Serviço de Oncologia Clínica e Ginecologia do HCFMRPUSP com idade igual ou superior a 60 anos e diagnóstico confirmado de neoplasia maligna. Foram aplicados os testes de adesão e conhecimento da farmacoterapia domiciliar e após a saída hospitalar do paciente realizada a revisão das farmacoterapias (domiciliar e hospitalar) e a conciliação de medicamentos. RESULTADOS: Foram incluídos 157 pacientes, idade média 68,4 anos, maioria do gênero feminino (60,5%), raça branca (84,1%), ensino básico (40,1%), neoplasia maligna em mama feminina (26,1%), em uso de polifarmácia (70,7%) e adepto de automedicação (50,3%), em que o uso de medicamentos (p= 0,01) e a automedicação (p= <0,01) foram significativamente correlacionados com o gênero feminino. Na farmacoterapia domiciliar, a média de conhecimento total foi de 62,9% e maioria caracterizada como não aderente (73,4%), o armazenamento dos medicamentos foi prevalente na cozinha (51%) e as principais dúvidas relacionam-se à caligrafia (79%). A harmonização farmacoterapêutica foi observada em 82,3% dos pacientes. A discrepância foi observada em 90,5% dos pacientes, prevalecendo a omissão (304). Foi significativamente diferente a interação medicamentosa quando comparada as farmacoterapias, domiciliar e hospitalar (p <0,01). Em ambas farmacoterapias, a maioria dos pacientes fez uso de medicamentos inapropriados para idosos, 84,1% (132 pacientes) e 85,3% (134 pacientes), respectivamente. A duplicidade terapêutica observada foi mínima, 18 pacientes (11,7%) na farmacoterapia domiciliar e 29 pacientes (18,8%) na hospitalar. CONCLUSÃO: a inserção do cuidado farmacêutico pode contribuir na educação do paciente em relação aos riscos da automedicação, melhoria no conhecimento, adesão e armazenamento dos medicamentos; e o processo de conciliação de medicamentos pode auxiliar a prática clínica na harmonização farmacoterapêutica e reduzir as discrepâncias, principalmente em relação à omissão. A inclusão de sistemas de alertas na prescrição médica pode reduzir os riscos de interações medicamentosas e uso de medicamentos inapropriados para idosos. / In Brazil, cancer is currently the second cause of death and some of the explanation is due to better control of infectious diseases and global aging, since cancer is considered a disease whose average age is over 60 years. Comorbidities that are directly associated with aging and the use of several medications are necessary for the adequate control of other pathologies, on the other hand, it represents an important risk factor for negative health outcomes. Medication reconciliation is aimed at reducing unnecessary medications, with careful evaluation by the pharmacist, which can help optimize drug therapy, reduce costs, increase compliance, and reduce toxicity and drug-related adverse events. OBJECTIVE: To evaluate the prevalence of polypharmacy, self-medication, adherence and knowledge of home pharmacotherapy; the main doubts and orientation needs regarding pharmacotherapy in general; pharmacotherapeutic harmonization, discrepancies, drug interactions, inappropriate medications for the elderly and therapeutic duplicity. MATERIALS AND METHODS: Patients admitted to the HCFMRP-USP Clinical Oncology and Gynecology Service aged 60 years or older and confirmed diagnosis of malignant neoplasia. The adherence tests and knowledge of home pharmacotherapy were applied and after the patient\'s hospital discharge, the pharmacotherapies (home and hospital) and medication reconciliation were reviewed. RESULTS: A total of 157 patients, mean age 68.4 years old, female (60.5%), Caucasian (84.1%), primary education (40.1%) and malignant neoplasia (P = 0.01) and self-medication (p = <0.01), using polypharmacy (70.7%) and adept of self-medication (50.3%), Were significantly correlated with the female gender. In home pharmacotherapy, the mean total knowledge was 62.9% and most characterized as non-adherent (73.4%), drug storage was prevalent in the kitchen (51%) and the main doubts related to calligraphy (79%). Pharmacotherapeutic harmonization was observed in 82.3% of the patients. The discrepancy was observed in 90.5% of the patients, with omission prevailing (304). Drug interaction was significantly different when compared to pharmacotherapies, home and hospital (p <0.01). In both pharmacotherapies, the majority of patients used drugs inappropriate for the elderly, 84.1% (132 patients) and 85.3% (134 patients), respectively. The therapeutic duplicity observed was minimal, 18 patients (11.7%) in the home pharmacotherapy and 29 patients (18.8%) in the hospital. CONCLUSION: the insertion of pharmaceutical care can contribute to the education of the patient in relation to the risks of self-medication, improved knowledge, adherence and storage of medications; and the medication reconciliation process can help clinical practice in pharmacotherapeutic harmonization and reduce discrepancies, especially in relation to omission. The inclusion of alert systems in the medical prescription can reduce the risks of drug interactions and the use of drugs inappropriate for the elderly.

A partir da hipótese de que pessoas leigas, ou seja, “não profissionais” de saúde, apresentam baixo conhecimento sobre medicamentos, o estudo teve por objetivo identificar por meio de uma revisão integrativa as variáveis que interferem no letramento em saúde relacionado ao uso de medicamentos por pacientes atendidos em serviços de saúde. Trata-se de uma revisão integrativa que por definição sintetiza resultados obtidos em pesquisas oferecendo informações amplas sobre um tema, e pode ter diferentes finalidades, como definir conceitos, revisar teorias ou analisar métodos de estudos, permite a inclusão simultânea de pesquisa quase-experimental e experimental e combinando dados de literatura teórica e empírica. Realizada no período de janeiro a abril de 2016, foram utilizadas as bases de dados MEDLINE/PubMed, LILACS, SciELO, Google Acadêmico e BDTD. O levantamento abrangeu publicações nacionais e internacionais, em português, inglês ou espanhol, no intervalo de janeiro/1996-janeiro/2016, usando as palavras chave “health literacy”, “health education”, “medication knowledge”, “patient medication knowledge”, “patient”, “medication”, “education” e “patient*participation”. Os critérios de inclusão foram: idade >18 anos, ambos os sexos, qualquer país ou nível socioeconômico; usar técnicas de medir letramento e os de exclusão: estudos com grupos étnicos e camadas sociais pré-definidos; crianças ou seus cuidadores, gravidez, doenças específicas, etc. Foram identificados 637 estudos e excluídos 609 por diversos motivos, restando 28 na amostra final. Os países com maior número de estudos recuperados foram Estados Unidos, Brasil e Espanha, respectivamente, sendo a maior concentração a partir de 2009. Em relação ao delineamento científico dos estudos: 23 eram de natureza quantitativa, 3 qualitativos e 2 mista (quali-quantitativo). As principais questões sobre medicamentos estudadas foram: relação entre o nível educacional e o letramento funcional em saúde, a relação entre conhecimento de medicamentos, adesão à terapia e intervenções educativas. Sobre os métodos para identificar/avaliar o letramento em saúde o TOFHLA, a sua versão reduzida (S-TOFHLA) e REALM foram usados em dois estudos cada um deles. Em 17 estudos os questionários foram desenvolvidos pelos próprios pesquisadores e em três estudos foi também avaliada a adesão pelo Morisky-Green. A pesquisa de letramento em saúde pode auxiliar em programas sobre o uso racional de medicamento, pois parece existir uma correlação positiva entre letramento funcional em saúde e conhecimento sobre medicamentos, e este conhecimento está positivamente relacionado à adesão à terapia medicamentosa. / Based on the hypothesis that lay people, i.e. "non-professionals" of health, have low knowledge regarding medicines, this study aimed to identify, through an integrative review, the variables that affect the health literacy related to the use of medicines by patients treated in health services. This is an integrative review which summarizes results obtained in scientific researches offering comprehensive information on a topic and can have different purposes, such as defining concepts, revising theories or analyzing study methods, it allows the simultaneous inclusion of quasi-experimental research and experimental, combining data from the theoretical and empirical literature. The research was carried out from January to April 2016, during this period, the database from MEDLINE/PubMed, LILACS, SciELO, Google Academic and BDTD were used. The search included national and international publications, in Portuguese, English or Spanish, in the period from January 1996 to January 2016, using the keywords "health literacy", "health education", "medication knowledge", "patient medication knowledge", "Patient", "medication", "education "and" patient*participation". The inclusion criteria were: age>18 years old, both sexes, any country or socioeconomic level; to use literacy and exclusion techniques: studies with pre-defined ethnic groups and social strata; children or their caregivers, pregnancy, specific diseases, etc. 637 studies were identified and 609 were excluded for several reasons, leaving 28 in the final sample. The countries with the highest number of studies recovered were the United States, Brazil and Spain, respectively, with the highest concentration starting from 2009. Regarding the scientific design of the studies: 23 were quantitative, 3 qualitative and 2 mixed (qualitative-quantitative). The main questions related to the studied drugs were: the relationship between educational level and functional literacy in health, the relationship between knowledge of medicines, adherence to therapy and educational interventions. On methods to identify/evaluate health literacy in health, TOFHLA, its reduced version (S-TOFHLA) and REALM were used in two studies each of them. In 17 studies the questionnaires were developed by the researchers themselves and in three studies the adhesion by Morisky-Green was also evaluated. The health literacy research can assist programs on the rational use of medicines since there seems to be a positive correlation between functional literacy in health and knowledge about medicines, and this knowledge is positively related to adherence to drug therapy.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / The high prevalence of poorly controlled asthma and the associated high morbimortality have been shown to be related mainly to under-diagnosis and inadequate treatment of this condition. This present significant cost adding further burden on the healthcare budget The consequences of poorly controlled asthma are repeated clinic visits repeated emergency room admissions and repeated hospital admissions In extreme but numerous occasions asthma attacks resulting from poor management lead to deaths Therefore it had been stated that a key component of many asthma management guidelines is the recommendation for patient education and regular medical review These (patient education and regular medication/medical reviews) are primary areas for the pharmacist to make an impact Objective To describe and to analyze the influence of a Pharmaceutical Care (PC) service in the clinical and humanistic outcomes through the pharmacotherapeutic follow-up (PF) of a group of asthmatic patients attending an ambulatory care facility by hospital referral in the State of the Cearà Methods Thirty patients participated of this longitudinal prospective and descriptive study in the period from August 2006 to May 2007 Instruments used to collect information from patients were an asthma-specific quality of life questionnaire (The Brazilian version of the Asthma Quality of Life Questionnaire AQLQ) daily records of symptoms of the asthma and a questionnaire to assess satisfaction with Pharmaceutical Care services The PF and the classification of drug related problems (DPR) followed Cipolle et al criteria (2004) and adopted a systematic PWDT (Pharmacistâs Work up of Drug Therapy) approach in identifying and resolving DPR Results The majority of patients were females (80%) 10% completed primary school level only mean age was 46  x 11 9 30% were on married social pension and with income of two minimum salaries Patients used an average of two inhaled medications (corticosteroids and bronchodilator) /day and more than 50% of patients did not use their inhaler medication devices correctly Sixty four DPR were identified, of which 31 25% were related to poor compliance with drug therapy After the provision of Pharmaceutical Care and through following a PWDT strategy 66 6% of the patients did not report nocturnal symptoms of asthma and did not have to use short-acting bronchodilator for asthma symptoms By the conclusion of the study a significant improvement (p< 0 05) was observed in the four domains of the AQLQ In the questionnaire assessing satisfaction with the Pharmaceutical Care services a superior index of 95% was observed in all its domains Conclusion The improvement seen in all aspect of the outcomes measured including clinical and humanistic outcomes after the provision of PC has provided evidence for the role of the pharmacist in asthma management using a structured approach to educate the patient about the pharmacotherapy regimen address compliance issues and making drug therapy interventions that lead to rationalizing therapy and minimizing DPR

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-03-02T13:36:08Z No. of bitstreams: 2 Tese - Jaqueline Gleice Aparecida de Freitas - 2014.pdf: 840515 bytes, checksum: 47bbdaf98472f6008469d57a953f816f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-03-04T12:59:32Z (GMT) No. of bitstreams: 2 Tese - Jaqueline Gleice Aparecida de Freitas - 2014.pdf: 840515 bytes, checksum: 47bbdaf98472f6008469d57a953f816f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-03-04T12:59:32Z (GMT). No. of bitstreams: 2 Tese - Jaqueline Gleice Aparecida de Freitas - 2014.pdf: 840515 bytes, checksum: 47bbdaf98472f6008469d57a953f816f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-11-04 / Outros / Adherence is the behavior of a patient before the doctor or other health professional recommendation regarding the use of medicines, adoption of diets or lifestyle changes. Thesis built in the form of scientific articles. The first article is titled: “Adherence to pharmacological treatment in hypertensive elderly: An integrative literature review”. The second one is titled: "The impact of the clinical pharmacist in the adherence to the pharmacological treatment of elderly hypertensive patients". Objectives: First Article: studying concepts of adherence, factors for adherence, and causes of abandonment and methods for assessing adherence. Second article: Assessing the impact of the clinical pharmacist in pharmacological treatment of elderly hypertensive patients. Method: In the review article the search was conducted in MEDLINE, LILACS, Cochrane, IBECS, SciELO and PubMED, studies published between 1979 to 2014 data. The following Descriptors in Health Sciences were used (DeCS): Hypertension, Elderly, Adherence, Factors for adherence, Assessment Methods. The second article is a prospective study, exploratory and quantitative with 26 elderly hypertensive patients, performed at the Family Health Basic Unit in the northern part of the city of Goiânia-GO. The patients of microarea A were followed by the pharmacist and patients of microarea B were visited by community health agent for six months. In both microareas assessment of sociodemographic profile, evaluation of pharmacological treatment and measurement of blood pressure of patients were carried out. Results: The first article described the difficulty of conceptualizing adherence as well as the main factors that influence adherence. There are several direct and indirect methods for evaluation of pharmacological treatment; all methods have advantages and disadvantages. In the second article: There was a predominance of female patients, age ranging between 60 -69 years old, primary / secondary education, earning 2-4 minimum wages, married, white and retired. Patients reported no alcohol use, no physical activity and no salt/ sugar restriction. Patients of the micro areas A and B are similar in sociodemographic characteristics. At the beginning of the study the adherence to pharmacological treatment and blood pressure had the same distribution in the two micro areas. At the end, the microarea A presented variation in the rate of total adherence which rose from 66.7% to 87.5% patients and there was significant reduction in blood pressure levels. Conclusions: The adherence to treatment is a complex issue, multifactorial, and is essential to obtain the reduction of blood pressure levels and decrease in complications in elderly hypertensive patients. Adherence to treatment is not related to sociodemographic variables. In the microarea A, through pharmaceutical intervention, it was observed that there was increase in adherence to pharmacological treatment with a significant reduction in blood pressure levels. / A adesão é o comportamento de um paciente diante das recomendações médicas ou de outros profissionais de saúde quanto ao uso de medicamentos, adoção de dietas ou mudanças do estilo de vida. Tese construída na modalidade de artigos científicos. O primeiro artigo tem como título: “Adesão ao tratamento farmacológico em idosos hipertensos: uma revisão integrativa da literatura”. O segundo tem como título: “O impacto do farmacêutico clínico na adesão ao tratamento farmacológico de pacientes idosos hipertensos” Objetivos: Primeiro artigo: estudar conceitos de adesão, os fatores de adesão e causas de abandono e os métodos para avaliação da adesão. Segundo artigo: Avaliar o impacto do farmacêutico clínico na adesão ao tratamento farmacológico de pacientes idosos hipertensos. Método: No artigo de revisão a busca foi realizada nas bases de dados MEDLINE, LILACS, Cochrane, IBECS, SciELO e PubMED, estudos publicados no período entre 1979 a 2014. Foram utilizados os seguintes Descritores em Ciências da Saúde (DeCS): Hipertensão arterial sistêmica, Idosos, Adesão, Métodos de Avaliação, Fatores de adesão. O segundo artigo é um estudo prospectivo, exploratório e quantitativo com 26 pacientes idosos hipertensos da Unidade Básica de Saúde da Família na região Norte do Município de Goiânia – GO. Os pacientes da microárea A foram acompanhados pelo farmacêutico e os pacientes da microárea B foram visitados pelo agente comunitário de saúde, durante seis meses. Nas duas microáreas foram realizadas avaliação do perfil sociodemográfico, avaliação da adesão ao tratamento farmacológico e medida da pressão arterial dos pacientes. Resultados: No primeiro artigo descreveu a dificuldade de conceituar adesão, assim como os principais fatores que interferem na adesão. Existem vários métodos diretos e indiretos para avaliação da adesão ao tratamento farmacológico, sendo que todos os métodos apresentam vantagens e desvantagens. No segundo artigo: Houve predomínio de pacientes do sexo feminino, idade entre 60 a 69 anos, ensino fundamental/médio, com renda de 2 a 4 salários mínimos, casado, cor branca e aposentado. Os pacientes relataram não utilizar bebidas alcoólicas, não praticar atividade física e que não faziam nenhuma restrição de sal/açúcar. Os pacientes das microáreas A e B são semelhantes quanto às características sociodemográficas. No início do estudo a adesão ao tratamento farmacológico e a pressão arterial teve a mesma distribuição nas duas microáreas. Ao final a microárea A apresentou mudança na taxa de adesão total que passou de 66,7% para 87,5% dos pacientes e houve redução significativa dos níveis tensionais. Conclusões: A adesão ao tratamento é uma questão complexa, multifatorial, e é fundamental para se obter a redução dos níveis pressóricos e diminuição de complicações em pacientes idosos hipertensos. A adesão ao tratamento não está relacionado com as variáveis sociodemográficas. Na microárea A, através da intervenção farmacêutica, observou-se que houve aumento da adesão ao tratamento farmacológico com redução significativa dos níveis tensionais.

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.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-17T21:44:34Z No. of bitstreams: 1 ClemilsonSilvaBarros.pdf: 3746819 bytes, checksum: 3083b6b09f87ef3bd885880557df0540 (MD5) / Made available in DSpace on 2017-05-17T21:44:34Z (GMT). No. of bitstreams: 1 ClemilsonSilvaBarros.pdf: 3746819 bytes, checksum: 3083b6b09f87ef3bd885880557df0540 (MD5) Previous issue date: 2016-05-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) / Introduction: Systemic arterial hypertension (SAH) and diabetes mellitus (DM) are among the most prevalent chronic diseases in Brazil and are considered important public health problem and are responsible for heavy costs for countries, due to the high consumption of medicines and hospital admissions. The objective of this study is to Characterize the use of polypharmacy and associated factors in hypertensive and diabetic, assisted by the Health Strategy of the Family. Methodology: The study was a cross-sectional, descriptive, focused on achieving more cost-effective therapeutic results for the health of participants. The sample was not probabilistic and comprised 171 patients, both genders, above 18 years and patients with hypertension and /or DM, linked to a Basic Health Unit of São Luís, BR. Results: The study showed a female predominance (69.59%), self-declared brown color (56.14%), average age of 60.53 (± 11.41) years, with the most prevalent age group of 61-70 years (34.50%), incomplete primary education (47.37%), household income of ½ to 1 minimum wage salary (44.44%) and married (38.59%) and also indicated increased prevalence of cardiovascular risk. It was also produced a list of 85 drugs in use, with an average of 5.31 (± 11.56), where most of the population uses 1-4 drugs 88.88% with daily intaking of 1 to 4 times (84.79%), most of them purchase the product (49.12%). The most prevalent drugs were: Losartan 74.11%, 67.05% metformin, glibenclamide HCTZ 55.65% and 44.18%. The study also included 19 (11.11%) polymedicated, of these, 11 (9.6%) are non-adherent and 10 (33.33%) take 5-8 medications per day, and 14 (16.1%) do not consider themselves healthy. The most significant IMC in this study was 18-25 kg / m² with 11 (14.5%). Discussion: The knowledge of sociodemographic characteristics and health, community health indicators and their priority needs is important to draw health action steps that become safe and cost effective treatment in patients on polypharmacy. Conclusion: Knowing the profile of these users is critical to adjust the services offered and develop cost-effective measures to respond positively to their major requirements, improving services to the population, reducing the morbidity and mortality rates and increasing the quality of life. / Introdução: A Hipertensão Arterial Sistêmica (HAS) e o Diabetes Mellitus (DM) estão entre as doenças crônicas mais prevalentes no Brasil e são considerados importante problema de saúde pública e motivadores de fortes despesas para o país, devido ao elevado consumo de medicamentos e de internações hospitalares. Objetivo: Caracterizar o uso de polifarmácia e seus fatores associados em hipertensos e diabéticos, assistidos pela Estratégia de Saúde da Família. Metodologia: O estudo é do tipo transversal, focado em atingir resultados terapêuticos mais custo-efetivos para a saúde dos participantes. A amostra foi não probabilística e composta por 171 pacientes, de ambos os sexos, maiores de 18 anos e portadores de HA e/ou DM, vinculados a uma Unidade Básica de Saúde de São Luís. Resultados: O estudo mostrou predominância do sexo feminino (69,59%), cor auto declarada parda (56,14%), média de idade de 60,53 (± 11,41) anos, tendo como faixa etária mais prevalente de 61 a 70 anos (34,50%), ensino fundamental incompleto (47,37%), renda familiar baixa de ½ a 1 salário mínimo (44,44%) e casados (38,59%). Ocorreu, também, prevalência de risco cardiovascular para ambos os sexos. Obteve-se, ainda, uma relação de 85 medicamentos em uso, com média de 5,31(± 11,56), onde a maioria da população faz uso de 1 a 4 medicamentos (88,88%), com quantidade de tomada/dia de 1 a 4 vezes/dia 84,79%, a maioria compra o medicamento 49,12%. Os medicamentos mais prevalentes foram: a Losartana 74,11%, a metformina 67,05%, hidroclorotiazida 55,65% e Glibenclamida 44,18%.O estudo contou ainda com 19(11,11%) de usuários polimedicados,destes,11(9,6%) não são aderentes, 10(33,33%) tomam de 5 a 8 medicamentos por dia e 14(16,1%) não se consideram saudáveis. O índice de massa corporal (IMC) mais expressivo nesse estudo foi de 18-25 kg/m² com 11(14,5%). Discussão: O conhecimento das características sociodemográficas e de saúde, dos indicadores de saúde da comunidade e sua necessidades prioritárias são importantes para traçar medidas de ação em saúde que torne seguro e custo efetivo o tratamento em pacientes em polifarmácia. Conclusão: Conhecer o perfil desses usuários é fundamental para ajustar os serviços oferecidos e desenvolver medidas custo-efetivas que respondam positivamente às necessidades majoritárias deles, melhorando o atendimento a população, diminuindo as taxas de morbimortalidade e aumentando a qualidade de vida.

<p>Professionals and researchers have developed a number of strategies aimed at improving the quality and safety of medication use. However, studies continue to demonstrate persistent problems. For instance, the first paper in this thesis reveals the prevalence of potentially harmful drug combinations among elderly people in Europe. The following four papers focus on two professional groups and how they have approached safety and quality issues related to medication use: 1) the Swedish drug and therapeutics committees (DTCs) and 2) pharmacist involved in pharmaceutical care, an international movement. Qualitative research approaches were applied.</p><p>Papers II and III focus on the DTCs: analyses indicate a development of the perception of the DTC role over time. The focus of the activities was broadened – from targeting prescribing physicians to incorporating decision-makers and patients. However, a clear patient-centered perspective was generally lacking. Moreover, the findings indicate a shift in focus from cost aspects of medication use to an increased focus on quality and safety aspects. </p><p>In the studies addressing pharmaceutical care (Papers IV and V), the findings propose that different classification systems for drug-related problems had different characteristics which reflected differences in goals in the pharmaceutical care process. It was also found that the concept of pharmaceutical care was understood in different ways and that the perceptions were based on at least two different understandings of health and illness. First, a patient-centered perspective characterized by a <i>holistic</i> understanding of health and illness, and, second, an “EBM perspective” primarily based on a <i>biomedical</i> understanding of health and illness. </p><p>This thesis has disclosed new aspects of how two groups of professionals perceive their work towards improved quality and safety of medication use. A patient-centered perspective among healthcare collectives is not obvious; therefore, efforts and comprehensive strategies supporting change are necessary. Strategies should focus on challenging the traditional thought patterns and care approaches among professionals and students. </p>

L'évolution des soins médicaux en milieu hospitalier se caractérise par une intensité accrue des soins et de l'utilisation des médicaments, ces derniers étant de plus en plus nombreux et souvent onéreux. De plus, les personnes âgées, en nombre croissant dans notre société, souffrent fréquemment de pathologies concomitantes et nécessitent donc une polythérapie. Il devient dès lors de plus en plus complexe d'assurer un usage optimal (efficace, non toxique, et économique) des médicaments, et également d'assurer un suivi adéquat du traitement lorsque ces patients sont transférés entre milieux de soins aigus et chroniques. De nombreuses publications ont mis en évidence, à l'étranger, une prévalence élevée d'utilisation inappropriée des médicaments en gériatrie (sous forme d'overuse, de misuse, et d'underuse). Les facteurs explicatifs d'une utilisation inappropriée n'ont cependant jamais été étudiés dans cette population. Or, cette étape d'identification est indispensable pour le développement d'interventions appropriées. Elle a donc constitué la première partie du travail de recherche (1). Ensuite, certaines études ont tenté d'évaluer l'impact de diverses approches permettant d'améliorer la prescription (y compris la pharmacie clinique), mais peu ont utilisé une méthodologie robuste. De plus, l'intérêt de cette approche de pharmacie clinique n'a jamais été évaluée en Belgique, alors qu'il existe un potentiel certain pour la développer. C'est dans ce cadre que s'est effectuée la deuxième partie du travail (2). (1) Pour répondre au premier objectif, une étude qualitative combinant des données issues d'entretiens et d'observations avec des professionnels et patients au sein de services de gériatrie a été réalisée. Trois grandes catégories de facteurs sous-jacents à une utilisation inappropriée des médicaments ont été identifiés : référence au modèle de soins de santé aigus pour des adultes en général ; attitude d'apprentissage passive; prise de décisions paternaliste. A l'inverse la prise en charge par un gériatre et la communication multidisciplinaire permettent une meilleure utilisation des médicaments. Les mesures d'optimisation potentielles devraient donc entre autres concerner les compétences individuelles, les relations médecin-patient et médecin-médecin, et les systèmes de transfert d'informations entre milieux de soins. (2) Afin de quantifier la qualité de prescription, et l'impact d'une collaboration avec un pharmacien clinicien, une étude randomisée contrôlée a été réalisé, et a inclus 200 patients hospitalisés au sein d'un service de gériatrie. Les résultats montrent que l'intervention d'un pharmacien clinicien permet de réduire de façon significative l'overuse, l'underuse et le misuse des médicaments. L'acceptation des interventions est excellente, et leur pertinence clinique élevée.Enfin, l'intervention s'accompagne d'une tendance à une diminution de la mortalité et de la morbidité des patients, un an après leur sortie de l'hôpital. Ce travail démontre donc l'intérêt de la pharmacie clinique dans le contexte belge, et ouvre plusieurs perspectives, dont une évaluation de la généralisation à d'autres services cliniques, et une évaluation de son rapport coût-efficacité.

Professionals and researchers have developed a number of strategies aimed at improving the quality and safety of medication use. However, studies continue to demonstrate persistent problems. For instance, the first paper in this thesis reveals the prevalence of potentially harmful drug combinations among elderly people in Europe. The following four papers focus on two professional groups and how they have approached safety and quality issues related to medication use: 1) the Swedish drug and therapeutics committees (DTCs) and 2) pharmacist involved in pharmaceutical care, an international movement. Qualitative research approaches were applied. Papers II and III focus on the DTCs: analyses indicate a development of the perception of the DTC role over time. The focus of the activities was broadened – from targeting prescribing physicians to incorporating decision-makers and patients. However, a clear patient-centered perspective was generally lacking. Moreover, the findings indicate a shift in focus from cost aspects of medication use to an increased focus on quality and safety aspects. In the studies addressing pharmaceutical care (Papers IV and V), the findings propose that different classification systems for drug-related problems had different characteristics which reflected differences in goals in the pharmaceutical care process. It was also found that the concept of pharmaceutical care was understood in different ways and that the perceptions were based on at least two different understandings of health and illness. First, a patient-centered perspective characterized by a holistic understanding of health and illness, and, second, an “EBM perspective” primarily based on a biomedical understanding of health and illness. This thesis has disclosed new aspects of how two groups of professionals perceive their work towards improved quality and safety of medication use. A patient-centered perspective among healthcare collectives is not obvious; therefore, efforts and comprehensive strategies supporting change are necessary. Strategies should focus on challenging the traditional thought patterns and care approaches among professionals and students.