Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2016-10-11T16:44:56Z No. of bitstreams: 1 Marlene Rosimar da Silva Vieira.pdf: 1831416 bytes, checksum: c917182b5f93d4be1e0811b5b97da67d (MD5) / Made available in DSpace on 2016-10-11T16:44:56Z (GMT). No. of bitstreams: 1 Marlene Rosimar da Silva Vieira.pdf: 1831416 bytes, checksum: c917182b5f93d4be1e0811b5b97da67d (MD5) Previous issue date: 2016-06-28 / Universidade Católica de Santos - Católica de Santos / Introduction: The guarantee of the right to health includes access to medicines. In Brazil we can´t consider this access only with the public sector in view; because even being a country with universal health care system, 26% of the population is affiliated to the private health insurance and the drug purchasing expenses correspond to 48.6 % of the average monthly expenditure on health of Brazilian families. Objective: To analyze the use of medication and associated factors for the adult population in the municipality of Praia Grande, Sao Paulo. Methodology: Cross-sectional population-based study that included 985 adults of both sexes. Cluster sampling in two stages, in Praia Grande, São Paulo, 2012. The dependent variables were the use and access to medicines through the public health system. The independent variables were sociodemographic and health status characteristics. The Poisson model with robust variance was the method of analysis. Spending and commitment of the income generated by the acquisition in private pharmacies were also checked, and possible drug interactions. Results: The prevalence of drug use in the population studied was 47.9%. Elderly had a higher prevalence of drug use (61.2%) compared to adults (42.4%). Being woman, having attended a health service in the last year, have chronic disease, more than eight years of study and consider bad health were variables associated with the use of drugs. The drugs used were obtained in its entirety in public pharmacies by 58.7% of users, which was associated to have chronic illness, have attended a health service in the last year, not having private health insurance and being female. The monthly private spending on drugs was on average R$ 17.00 and the commitment of income was higher for males, with higher education, the private health sector as a reference, with health insurance and chronic illness. The possibility to have a drug interaction was associated with the highest number of drugs used and not with the model of health service used, public or private. Conclusions: The prevalence of drug use in the city was similar to the national. The public health system is promoting access to medicines in the city, especially for patients with chronic diseases and women. Private spending on drugs is higher with the share of the population with the highest incomes. Incorporating the practice of assessing possible drug interactions in primary care, especially for some groups of patients, may be a strategy to improve the quality of pharmaceutical care. / Introdução: A garantia do direito à saúde inclui o acesso a medicamentos. No Brasil não podemos pensar neste acesso apenas tendo em vista o setor público, pois mesmo sendo um país com um sistema de saúde universal, 26% da população está afiliada ao setor de saúde suplementar e os gastos com compra de medicamentos correspondem a 48,6% da despesa média mensal com saúde das famílias brasileiras. Objetivo: Analisar a utilização de medicamentos e fatores associados pela população adulta no município de Praia Grande, São Paulo. Metodologia: Estudo transversal de base populacional que incluiu 985 adultos de ambos os sexos. Amostra por conglomerados em dois estágios, em Praia Grande, São Paulo, 2012. As variáveis dependentes foram o uso e o acesso aos medicamentos através do sistema público de saúde. Como variáveis independentes as características sociodemográficas e de condições de saúde. O modelo de Poisson com variância robusta foi o método de análise. Os gastos e o comprometimento da renda gerados pela aquisição em farmácias privadas também foram verificados, assim como possíveis interações medicamentosas. Resultados: A prevalência de utilização de medicamentos na população total estudada foi de 47,9%. Idosos apresentaram uma prevalência maior de uso de medicamentos (61,2%) quando comparados aos adultos (42,4%). Ser do sexo feminino, ter frequentado um serviço de saúde no último ano, ter doença crônica, mais de oito anos de estudo e considerar a saúde ruim foram variáveis associadas à utilização de medicamentos. Os medicamentos utilizados foram obtidos em sua totalidade em farmácias públicas por 58,7% dos usuários, o que se mostrou associado a ter doença crônica, ter frequentado um serviço de saúde no último ano, não ter plano de saúde privado e ser do sexo feminino. O gasto privado mensal com medicamentos foi, em média, R$ 17,00 e o comprometimento da renda foi maior para os indivíduos do sexo masculino, com maior escolaridade, com o setor privado de saúde como referência, com plano de saúde e doença crônica. A possibilidade de acontecer uma interação medicamentosa foi associada com o maior número de medicamentos utilizados e não com o tipo de serviço utilizado, público ou privado. Conclusões: A prevalência de utilização de medicamentos no município foi semelhante à nacional. O sistema de saúde público está promovendo o acesso aos medicamentos no município, principalmente para os portadores de doenças crônicas e mulheres. Os gastos privados com medicamentos são mais elevados com a parcela da população com maiores rendas. A incorporação da prática de avaliar possíveis interações medicamentosas na atenção primária, principalmente para alguns grupos de pacientes, pode ser uma estratégia para melhorar a qualidade da assistência farmacêutica.

This thesis discusses the evolution of the role of the pharmacist in U.S. health care delivery from its early origins to modern day practice. Public policy, education and licensing requirements, and technological advances have substantially shaped the role of the pharmacist and what health care services they provide. Where pharmacists once provided direct patient care when formal modes of pharmacist professionalization did not exist, post-WWII mass production of pharmaceuticals confined pharmacists to dispensing and distribution duties that did not fully utilize their drug knowledge. Consequently, pharmacy educators and leaders have pushed pharmacy practice into an era of “pharmaceutical care,” emphasizing direct patient care activities and the employment of pharmacists’ drug expertise. Pharmacists today have moved back into clinical roles, participating in patient care activities alongside other health care professionals—sometimes even providing primary care services. Due to the U.S.’s growing dependence of prescription drugs and the American public’s continuous demands for high quality care, greater access to health care services, and containment of health care costs, pharmacists will likely acquire greater responsibilities in direct patient care.

Τα τελευταία χρόνια έχει παρατηρηθεί μία αλλαγή ως προς τις ανάγκες που πρέπει να καλύπτει το επάγγελμα του φαρμακοποιού. Με την εισαγωγή της έννοιας της Φαρμακευτικής Φροντίδας, ο φαρμακοποιός καλείται να αναλάβει την ευθύνη για την παροχή κατάλληλης φαρμακοθεραπείας προς τον ασθενή - πελάτη, με στόχο τη βελτίωση της ποιότητας ζωής του. Ταυτόχρονα, το μεταβαλλόμενο εξωτερικό περιβάλλον τον αναγκάζει να παίρνει στρατηγικές αποφάσεις για την επιβίωση της επιχείρησής του. Το γεγονός ότι ο διττός ρόλος του φαρμακοποιού απαιτεί τη συλλογή, επεξεργασία και ανάλυση μεγάλου όγκου δεδομένων και ο περιορισμένος του χρόνος, συμβάλλουν στην ανάγκη για διεύρυνση της χρήσης των Συστημάτων Μηχανογράφησης στα φαρμακεία. Αυτή η εργασία είχε ως στόχο να αξιολογηθούν τα διάφορα Συστήματα Μηχανογράφησης Φαρμακείων. Επίσης, να ερευνηθεί κατά πόσο η Φαρμακευτική Φροντίδα και η Διαχείριση Γνώσης με τη χρήση των συστημάτων αυτών μπορούν να οδηγήσουν στην καλύτερη ικανοποίηση των αναγκών των πελατών – ασθενών και των ιδιαίτερων προτιμήσεών τους και επομένως στην ενδυνάμωση του φαρμακοποιού. Για τη διεξαγωγή της έρευνας μοιράστηκε ερωτηματολόγιο σε 172 φαρμακοποιούς διαφόρων περιοχών της Ελλάδας. Οι ερωτήσεις εστίαζαν στις αντιλήψεις των φαρμακοποιών ως προς την έννοια της Φαρμακευτικής Φροντίδας, στις σχέσεις τους με τους πελάτες, τις φαρμακευτικές εταιρίες και τις φαρμακαποθήκες και στην αξιολόγηση των δυνατοτήτων που προσφέρονται από τα Συστήματα Μηχανογράφησης που χρησιμοποιούσε ο καθένας στο φαρμακείο του. Η έρευνα απέδειξε ότι οι φαρμακοποιοί δεν εκμεταλλεύονται τις δυνατότητες των Συστημάτων για την εφαρμογή της Φαρμακευτικής Φροντίδας. Επιπλέον, αποδείχτηκε ότι η Διαχείριση Γνώσης και η Φαρμακευτική Φροντίδα συμβάλλουν στην ικανοποίηση των αναγκών των πελατών – ασθενών, η οποία τελικά οδηγεί στην ενδυνάμωση του φαρμακοποιού μέσω της επίδρασής του στη διαδικασία λήψης αγοραστικής απόφασης των πελατών - ασθενών. / In recent years there has been a change in the needs that must be covered by the pharmacist profession. By introducing the concept of pharmaceutical care, the pharmacist is called upon to undertake the responsibility to provide the appropriate medication to the patient – client in order to improve the quality of its life. At the same time, the changing external environment forces him to take strategic decisions for the survival of his business. The fact that this dual role of the pharmacist requires, on the one hand, collecting, processing and analyzing large volumes of data and on the other hand its time is limited, contribute to the need for expanded use of computer systems in pharmacies. This Master Thesis aimed to assess the various Pharmacy Management Information Systems. Also, to investigate whether the Pharmaceutical Care and Knowledge Management with the use of these systems can lead to better satisfaction of customers’ - patients’ needs and their particular preferences and thus to strengthen the pharmacist. For the purposes of the survey, a questionnaire was distributed to 172 pharmacists in different areas of Greece. Questions focused on the perceptions of pharmacists regarding the meaning of Pharmaceutical Care in their relations and interactions with customers, pharmaceutical companies and wholesalers. Also, they focused on the evaluation of the possibilities offered by the Pharmacy Management Information Systems that pharmacists use in their pharmacies. The survey proved that pharmacists do not exploit the capabilities of Systems for the implementation of Pharmaceutical Care. Likewise, it was proved that Knowledge Management and Pharmaceutical Care contribute to the satisfaction of patients’ needs, which ultimately leads to the empowerment of the pharmacists through their effect in the purchasing decisions of patients - customers.

The objects of the South African Pharmacy Council in terms of the Pharmacy Act, 1974 (5311974) as amended are, inter alia, "to uphold and safeguard the rights of the general public to universally acceptable standards of pharmacy practice in both the private and the public sector" as well as "to establish, develop, maintain and control universally acceptable standards of practice of the various categories of persons required to be registered.. ." One of the major difficulties health care providers worldwide are faced with is how to maintain a proper balance between the trio goals of health care, namely adequate access, high quality and acceptable costs (Li, 2003:192-193). Relatively little is known about such problems as do exist for patients regarding access to pharmaceutical services (Doucette et al., 1999:1268). Two main objectives were identified for this study, namely to investigate the demographic profile of community and institutional pharmacies registered with the South African Pharmacy Council; and to determine the standard of pharmaceutical services provided by these pharmacies. Inspection results of community and institutional pharmacies were obtained from the South African Pharmacy Council and extracted for the time period 1 January 2004 to 31 May 2005. To determine the demographic and geographic profile of these pharmacies, data of the Register of Pharmacies of the South African Pharmacy Council for August 2003, 2004 and 2005 were merged with the Census data of South Africa of 2001. It was found that the total number of pharmacies in both the public and private sectors increased with 2.1% (n=68) from August 2003 to August 2005. Public and private pharmacies that provided services directly to patients increased with 6.3% (n=33) and 1.3% (n=35) from August 2003 to 2005. It was found that the Gauteng province was the best provided with registered pharmacies in South Africa, as only 0.06% (n=5 783) of the population did not have any registered pharmacy available on municipality level. It was also revealed that the majority of inspections were carried out in Gauteng, whilst this province accounts for only 19.7% of the total population of South Africa. During the study period a total of 1178 community pharmacy inspections were carried out in 1103 community pharmacies (one or more inspections per pharmacy) representing 43% (n=2 550) of the total number of community pharmacies registered with the South African Pharmacy Council during May 2005. Nationally community pharmacies achieved a score of 92.27 (+ 6.65 per cent) for compliance with Good Pharmacy Practice guidelines. The lowest compliance score (73.34 + 27.49 per cent) was obtained for the availability of written standard operating procedures and the highest was for the promotion of public health (99.02 + 6.30 per cent). No practical significant differences (dc0.8) were found between the overall compliance scores obtained by community pharmacies of the different provinces. The highest compliance score was obtained by community pharmacies in the Free State (93.09 + 4.90 per cent), followed by Western Cape, Eastern Cape, Kwazulu Natal, Limpopo, Northern Cape, Gauteng, Mpumalanga and the North West. A total of 343 institutional pharmacy inspections (one or more inspections per pharmacy) were carried out in public and state subsidised institutions (n=245), private institutions (n=90) and mine hospitals (n=5). These pharmacies represented 46% of the total number of institutional pharmacies registered with the South African Pharmacy Council during May 2005. Nationally all institutional pharmacies (both private and public) achieved a score of 92.49 + 8.33 per cent for compliance with Good Pharmacy Practice guidelines for all above-mentioned aspects. Nationally public and state subsidised institutional pharmacies obtained a lower compliance score (91.02 + 9.08 per cent) than private institutional pharmacies (96.39 + 3.91 per cent). Lastly, a grading system was developed that was based on the results obtained through this study, in order to quantify the standard of pharmaceutical services provided by pharmacies in South Africa. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

The global anti-dyslipidemic market grew by 19% from 2000 to 2001, achieving sales of over $21 billion (Smith, 2004: 2). This market is currently well sewed by a number of effective and well-tolerated treatments. Lipid-lowering drugs are considered as the first choice drugs in control of dyslipidemias and they are well tolerated by most patients. As with many drug therapies, there should be a balance between the benefits of cholesterol lowering agents, increased medication cost and the overall risk of adverse drug reactions. According to Ballesteros (2001: 514), hypolipidemic drugs are consumed on a large scale and most consumers are elderly. This warrants a study of expenditure incurred because of inadequate prescribing of these agents. The general objective of this study was to determine the utilisation and cost of hypolipidemic drugs in the private health care environment in South Africa. A quantitative retrospective drug utilisation review was performed using a medicine claims database. Data for twenty-four consecutive months (May 1, 2001 to April 30, 2003) were used to determine and compare the utilisation patterns and cost of drugs associated with the management of dyslipidemia a year before (1st May 2001 to 30 April 2002) and a year after (1st May 2002 to 30 April 2003) the implementation of a medicine reference price system (MPL). Data analysis was done by calculating the average value, the standard deviation, effect size, and cost-prevalence indices. The results of this study revealed that hypolipidemic drugs constituted 2.70% (n = 21820911) and 2.78% (n =27277825) of the total number of all medicine items for the first and the second study years respectively. On the other hand, the total cost of all hypolipidemic drugs accounted for 6.33% (n= R3 097 604 602) and 6.23 % (n= R 4 053 280 295) of the total cost of all medicine items claimed during the first and the second study years respectively. The prevalence of generic hypolipidemic drugs accounted for 0.89% (n=589036) and 4.88% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study year respectively. Innovator drugs, on the other hand, constituted 99.1 1% (n=589036) and 95.11% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study years respectively. It was found that R23 694.5 and R603 277.36 could have been saved for generic bezafibrate and generic simvastatin respectively if they had been sold at ME'L prices. The total cost of generic hypolipidemic drugs accounted for 0.60% and 2.94%. The total cost of innovator hypolipidemic drugs accounted for 99.40% and 97.06% of the total cost of hypolipidemic drugs claimed during the first (n=R 196 076 050) and second (n=R 252 919 285) study year respectively. With respect to the prescribed daily dose, it was found that most prescriptions for individual hypolipidemic drugs did not conform to the defined daily dose. It was, however, found that most prescriptions whose prescribed daily dose was for one tablet once daily and whose strength was similar to the defined daily dose conformed to the defined daily dose. The conclusion is that there was an insignificant difference in both the prevalence and cost of hypolipidemic drugs a year before and after the implementation of MPL. It was further concluded that increased utilisation of generic hypolipidemic medicine items a year after the implementation of the MPL, could have been brought about by the introduction of generic simvastatin into the market as opposed to the implementation of the MPL. Recommendations for further studies will be formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

The objects of the South African Pharmacy Council in terms of the Pharmacy Act, 1974 (5311974) as amended are, inter alia, "to uphold and safeguard the rights of the general public to universally acceptable standards of pharmacy practice in both the private and the public sector" as well as "to establish, develop, maintain and control universally acceptable standards of practice of the various categories of persons required to be registered.. ." One of the major difficulties health care providers worldwide are faced with is how to maintain a proper balance between the trio goals of health care, namely adequate access, high quality and acceptable costs (Li, 2003:192-193). Relatively little is known about such problems as do exist for patients regarding access to pharmaceutical services (Doucette et al., 1999:1268). Two main objectives were identified for this study, namely to investigate the demographic profile of community and institutional pharmacies registered with the South African Pharmacy Council; and to determine the standard of pharmaceutical services provided by these pharmacies. Inspection results of community and institutional pharmacies were obtained from the South African Pharmacy Council and extracted for the time period 1 January 2004 to 31 May 2005. To determine the demographic and geographic profile of these pharmacies, data of the Register of Pharmacies of the South African Pharmacy Council for August 2003, 2004 and 2005 were merged with the Census data of South Africa of 2001. It was found that the total number of pharmacies in both the public and private sectors increased with 2.1% (n=68) from August 2003 to August 2005. Public and private pharmacies that provided services directly to patients increased with 6.3% (n=33) and 1.3% (n=35) from August 2003 to 2005. It was found that the Gauteng province was the best provided with registered pharmacies in South Africa, as only 0.06% (n=5 783) of the population did not have any registered pharmacy available on municipality level. It was also revealed that the majority of inspections were carried out in Gauteng, whilst this province accounts for only 19.7% of the total population of South Africa. During the study period a total of 1178 community pharmacy inspections were carried out in 1103 community pharmacies (one or more inspections per pharmacy) representing 43% (n=2 550) of the total number of community pharmacies registered with the South African Pharmacy Council during May 2005. Nationally community pharmacies achieved a score of 92.27 (+ 6.65 per cent) for compliance with Good Pharmacy Practice guidelines. The lowest compliance score (73.34 + 27.49 per cent) was obtained for the availability of written standard operating procedures and the highest was for the promotion of public health (99.02 + 6.30 per cent). No practical significant differences (dc0.8) were found between the overall compliance scores obtained by community pharmacies of the different provinces. The highest compliance score was obtained by community pharmacies in the Free State (93.09 + 4.90 per cent), followed by Western Cape, Eastern Cape, Kwazulu Natal, Limpopo, Northern Cape, Gauteng, Mpumalanga and the North West. A total of 343 institutional pharmacy inspections (one or more inspections per pharmacy) were carried out in public and state subsidised institutions (n=245), private institutions (n=90) and mine hospitals (n=5). These pharmacies represented 46% of the total number of institutional pharmacies registered with the South African Pharmacy Council during May 2005. Nationally all institutional pharmacies (both private and public) achieved a score of 92.49 + 8.33 per cent for compliance with Good Pharmacy Practice guidelines for all above-mentioned aspects. Nationally public and state subsidised institutional pharmacies obtained a lower compliance score (91.02 + 9.08 per cent) than private institutional pharmacies (96.39 + 3.91 per cent). Lastly, a grading system was developed that was based on the results obtained through this study, in order to quantify the standard of pharmaceutical services provided by pharmacies in South Africa. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

The global anti-dyslipidemic market grew by 19% from 2000 to 2001, achieving sales of over $21 billion (Smith, 2004: 2). This market is currently well sewed by a number of effective and well-tolerated treatments. Lipid-lowering drugs are considered as the first choice drugs in control of dyslipidemias and they are well tolerated by most patients. As with many drug therapies, there should be a balance between the benefits of cholesterol lowering agents, increased medication cost and the overall risk of adverse drug reactions. According to Ballesteros (2001: 514), hypolipidemic drugs are consumed on a large scale and most consumers are elderly. This warrants a study of expenditure incurred because of inadequate prescribing of these agents. The general objective of this study was to determine the utilisation and cost of hypolipidemic drugs in the private health care environment in South Africa. A quantitative retrospective drug utilisation review was performed using a medicine claims database. Data for twenty-four consecutive months (May 1, 2001 to April 30, 2003) were used to determine and compare the utilisation patterns and cost of drugs associated with the management of dyslipidemia a year before (1st May 2001 to 30 April 2002) and a year after (1st May 2002 to 30 April 2003) the implementation of a medicine reference price system (MPL). Data analysis was done by calculating the average value, the standard deviation, effect size, and cost-prevalence indices. The results of this study revealed that hypolipidemic drugs constituted 2.70% (n = 21820911) and 2.78% (n =27277825) of the total number of all medicine items for the first and the second study years respectively. On the other hand, the total cost of all hypolipidemic drugs accounted for 6.33% (n= R3 097 604 602) and 6.23 % (n= R 4 053 280 295) of the total cost of all medicine items claimed during the first and the second study years respectively. The prevalence of generic hypolipidemic drugs accounted for 0.89% (n=589036) and 4.88% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study year respectively. Innovator drugs, on the other hand, constituted 99.1 1% (n=589036) and 95.11% (n=759675) of the total number of hypolipidemic drugs claimed during the first and second study years respectively. It was found that R23 694.5 and R603 277.36 could have been saved for generic bezafibrate and generic simvastatin respectively if they had been sold at ME'L prices. The total cost of generic hypolipidemic drugs accounted for 0.60% and 2.94%. The total cost of innovator hypolipidemic drugs accounted for 99.40% and 97.06% of the total cost of hypolipidemic drugs claimed during the first (n=R 196 076 050) and second (n=R 252 919 285) study year respectively. With respect to the prescribed daily dose, it was found that most prescriptions for individual hypolipidemic drugs did not conform to the defined daily dose. It was, however, found that most prescriptions whose prescribed daily dose was for one tablet once daily and whose strength was similar to the defined daily dose conformed to the defined daily dose. The conclusion is that there was an insignificant difference in both the prevalence and cost of hypolipidemic drugs a year before and after the implementation of MPL. It was further concluded that increased utilisation of generic hypolipidemic medicine items a year after the implementation of the MPL, could have been brought about by the introduction of generic simvastatin into the market as opposed to the implementation of the MPL. Recommendations for further studies will be formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

O incentivo ao uso racional de medicamentos fator importante na melhoria das condições de saúde. A efetivação desta racionalidade, no entanto, esbarra tanto em fatores culturais como em fatores de escassez ou mesmo ausência de informação confiável. Os farmacêuticos, membros indispensáveis de qualquer equipe multidisciplinar de saúde, cumprem papel preponderante na disseminação deste conhecimento especializado. Com o objetivo de suprir as lacunas existentes quanto a qualidade da informação farmacológico-terapêutica existente no Brasil, este trabalho desenvolve um sistema de informações sobre medicamentos cardiovasculares aliado a um Sistema de Suporte a Decisão Baseado em Alertas, utilizando uma arquitetura que combina bases de dados relacionais com Medical Logical Modules. O sistema desenvolvido proporciona, a farmacêuticos e outros profissionais da área da saúde, não apenas consultas a informação, mas também sugestões e alertas contextuais referentes ao uso correto de medicamentos, contribuindo, assim, para o treinamento no próprio trabalho destes. / The rational use of drugs is an important factor to the health conditions improvement. The pharmacists are responsible for advising customers about the rational use of drugs, but this professional effort is limited by cultural factors, absence or lack of reliable infomation. The aim of this work is to support pharmacists through a cardiovascular medicine Information System attached to an Alert-based Decision Support System whose structure combines Medical Logical Modules and relational databases. The developed system not only provides the health professional and pharmacist with drug information, but also suggests or alerts them about the proper use of drugs as well it contributes to their in site training.

Aim/Objectives: There were two aims; improving type II diabetes glycaemic control; and enhancing the role of community pharmacists by engaging them in type II diabetes medicine management. Methods: This quantitative study collected data from both community pharmacists and patients. In a premises survey, 426 self-administered questionnaires were distributed to community pharmacies. In a knowledge survey, 125 questionnaires were distributed to community pharmacists. In a clinical trial, 40 community pharmacies were randomly assigned to be control (18) and intervention (22) premises. Each pharmacy recruited 4 or 5 patients with type II diabetes. 225 patients were recruited and assigned to receive usual pharmacist care (n=100) or a pre-defined pharmacist intervention (n=125). Results: Community pharmacists had good knowledge of diabetes with average scores 21/29 (±3.18). The differences between control and intervention groups in patients' HbA1c and FPG changes were not significant. In the intervention group patients' diabetes knowledge was significantly improved (p=0.031). In the intervention group HbA1c and FPG improved significantly and in the control group FPG improved significantly and HbA1c did not. Patients' self-reported self-management activities improved significantly around blood glucose measurements (p < 0.001) and physical exercising (p=0.001). Attitudes around the value of tight control of diabetes improved (p < 0.001). Conclusion: The findings suggest that community pharmacists in Libya may have the ability to improve type II diabetes care. The primary outcomes were not improved in intervention versus control. The before/after analysis showed significant improvement in primary outcomes in the intervention group and also in one of the primary outcomes in the control group. Patients' self-reported self-care activities and attitudes improved significantly in the intervention group.

Submitted by Stéfany Moreira (stemellra@yahoo.com.br) on 2013-02-08T11:19:30Z No. of bitstreams: 1 DISSERTAÇÃO_EnsaioClínicoControlado.pdf: 982327 bytes, checksum: 6e93cf3dc2df1043dc03ffc015b02c28 (MD5) / Approved for entry into archive by Neide Nativa (neide@sisbin.ufop.br) on 2013-02-14T13:03:29Z (GMT) No. of bitstreams: 1 DISSERTAÇÃO_EnsaioClínicoControlado.pdf: 982327 bytes, checksum: 6e93cf3dc2df1043dc03ffc015b02c28 (MD5) / Made available in DSpace on 2013-02-14T13:09:13Z (GMT). No. of bitstreams: 1 DISSERTAÇÃO_EnsaioClínicoControlado.pdf: 982327 bytes, checksum: 6e93cf3dc2df1043dc03ffc015b02c28 (MD5) Previous issue date: 2011 / O diabetes mellitus é uma doença crônica não transmissível de alta prevalência e responsável por altas taxas de morbidade e mortalidade em vários países. A maior parte dos indivíduos com diabetes não alcança o nível glicêmico recomendado e as intervenções que visam melhorar o cuidado desses indivíduos são tema de grande interesse no estudo das ciências da saúde. O objetivo deste estudo foi avaliar o efeito de um programa de atenção farmacêutica para usuários do Sistema Único de Saúde (SUS) hiperglicêmicos e em tratamento farmacológico para o diabetes mellitus tipo 2. Foi realizado ensaio clínico controlado aleatório, com duração de seis meses, em Ouro Preto, Minas Gerais. Cento e vinte e nove indivíduos em uso de um ou mais antidiabéticos orais, com idade ≥ 18 anos e hemoglobina glicada (A1C) ≥ 7% foram randomizados para receber apenas cuidado usual em saúde ou cuidado usual em saúde e intervenção farmacêutica. O programa de atenção farmacêutica foi caracterizado por consultas mensais individuais para coleta de informações, identificação de problemas relacionados ao uso de medicamentos (PRM) e educação dos participantes para resolução dos PRM. O desfecho primário foi o nível de A1C e os desfechos secundários foram risco de doenças cardiovasculares, índice de massa corporal, número de PRM, glicose plasmática de jejum, perfil lipídico e pressão arterial. Cem (77,5%) participantes completaram o estudo. No grupo intervenção (n = 50) foram identificados em média 5,2 PRM por participante e no grupo controle (n = 50) 4,2 PRM por participante no início do estudo (p = 0,005). No grupo intervenção, comparado ao grupo controle, houve redução significativa dos níveis de A1C (9,3% [IC 95% 8,8 a 9,8] vs. 10,2% [9,5 a 10,8]; p = 0,034), colesterol total (189,3 mg/dl [177,3 a 201,3] vs. 207,8 mg/dl [196,0 a 209,6]; p = 0,029), colesterol LDL (105,3 mg/dl [95,5 a 115,1; n = 49] vs. 123,5 mg/dl [112,0 a 134,0; n = 49]; p = 0,015) e redução do risco de doenças cardiovasculares (14,6% [12,5 a 16,7; n = 45] vs. 19,6% [16,3 a 22,8; n = 50] ; p = 0,034). Não houve diferença significativa entre os grupos para os outros desfechos avaliados. A participação no grupo intervenção e os níveis de GPJ se associaram à variação da A1C na regressão linear múltipla. O programa de atenção farmacêutica foi efetivo para redução dos níveis de A1C, colesterol total e colesterol LDL e para redução do risco de doenças cardiovasculares de usuários do SUS com diabetes mellitus tipo 2. _________________________________________________________________________________ / ABSTRACT: Diabetes mellitus (DM) is a chronic noncommunicable disease with high prevalence and it is a cause of high rates of morbidity and mortality in several countries. Most diabetics individuals do not present adequate glucose level and some improving care interventions to these individuals are a subject of great interest in health sciences. The aim of the this study was to evaluate the effect of a pharmaceutical care program dedicated to subjects of the Brazilian public health system who are hyperglycemic despite optimized drug treatment for type 2 diabetes. A randomized controlled trial was conducted for six months in Ouro Preto, Minas Gerais. One hundred and twenty-nine patients taking one or more oral diabetes medication, ≥ 18 years old with glycated hemoglobin (A1C) levels ≥ 7% were randomized to receive usual care only or usual care and pharmaceutical intervention. The pharmaceutical care program was characterized by individual monthly visits to collect information, identify drug therapy problems and education of the participants in order to solve these problems. The primary outcome was the level of A1C and secondary outcomes were risk of cardiovascular disease, number of drug therapy problems, body mass index, fasting plasma glucose, lipoprotein profile, systolic and diastolic blood pressure. One hundred (77.5%) participants completed the study. In the intervention group (n = 50) 5.2 drug therapy problems per participant were identified and in the control group (n = 50) 4.2 per participant at baseline (p = 0.005). Intervention group compared to the control group presented a significant reduction in A1C levels (9.3% [95% CI 8.8 to 9.8] vs. 10.2% [9.5 to 10.8], p = 0.034), serum total cholesterol (189.3 mg/dl [177.3 to 201.3] vs. 207.8 mg/dl [196.0 to 209.6], p = 0.029), serum LDL cholesterol (105.3 mg/dl [95.5 to 115.1, n = 49] vs. 123.5 mg/dl [112.0 to 134.0, n = 49], p = 0.015) and reduced coronary heart disease risk (14.6% [12.5 to 16.7, n = 45] vs. 19.6% [16.3 to 22.8, n = 50], p = 0.034). There was no significant difference between groups in any other assessed outcomes. The pharmaceutical care program was effective in reducing A1C levels, total and LDL cholesterol and reduced coronary heart disease risk for type 2 diabetes users of the Brazilian public health system.