Orientadores: Priscila Gava Mazzola, Patricia Moriel / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:32:30Z (GMT). No. of bitstreams: 1 Costa_CarolinedeGodoiRezende_M.pdf: 3126877 bytes, checksum: 97128de773972dad8f95a4242353e863 (MD5) Previous issue date: 2012 / Resumo: Muitos fatores contribuem para a resposta do paciente à terapia antirretroviral (TARV), incluindo adesão, efetividade farmacológica e tolerância. A TARV é complexa e longa, e o risco de falha virológica, comumente associada à resistência antirretroviral, aumenta quando a adesão diminui. Neste contexto, a presença do farmacêutico, como o profissional capaz de orientar o paciente em relação à terapia medicamentosa e realizar o acompanhamento farmacoterapêutico, estimula os pacientes a estarem familiarizados com seus próprios esquemas terapêuticos, tornando mais simples a compreensão da importância do uso correto do medicamento, aumentando a adesão à terapia, efetividade e tolerância. Este trabalho teve como objetivo avaliar a efetividade da Intervenção Farmacêutica (IF) na resolução dos Problemas Farmacoterapêuticos (PFTs) e na melhora dos parâmetros clínicos dos pacientes com HIV/AIDS. Foi realizado um estudo prospectivo controlado intervencionista, com amostra consecutiva e de conveniência com controles de reposição emparelhados segundo gênero e valores iniciais de linfócitos T CD4+. Do total de pacientes selecionados para o estudo (n=143), 57 (39,86%) pacientes foram descontinuados e 86 pacientes finalizaram o estudo de 1 ano, sendo 43 pacientes do controle (GC) e 43 do grupo intervenção (GI). Os pacientes do GI receberam acompanhamento farmacoterapêutico por meio de método próprio baseado no método Pharmacotherapy workup. Durante o período de 1 ano foram realizadas 202 Intervenções ou Orientações Farmacêuticas no GI, com uma redução de 38,43% (p=0,0001) do total de PFTs. O GI apresentou aumento médio da variação de CD4 1,84 vezes maior que o aumento observado GC, com média de 154,66 para o GI e 83,80 para o GC. Apesar da carga viral média final do GI ser maior do que aquela observada no GC (17394,51 e 12921,53 cópias/mL, respectivamente), para o GI foi observada uma redução 3 vezes maior da carga viral do que para o GC: GI variou em média 23517,67 e GC, 6226,51. Os resultados deste estudo indicam que as Intervenções Farmacêuticas proporcionaram redução PFTs principalmente aqueles relacionados às reações adversas e interações medicamentosas, promoveram a adesão, aumentaram a efetividade da terapia antirretroviral, constatada com maior elevação da contagem de CD4 e redução da carga viral em comparação com o grupo controle / Abstract: Many factors contribute to the patient's response to antiretroviral therapy (ARVT), including adhesion, drug effectiveness and tolerance. Antiretroviral therapy is complex and lengthy, and the risk of virologic failure commonly associated with antiretroviral resistance increases when adhesion decreases. In this context, the presence of the pharmacist as a professional capable of guiding the patient in relation to drug therapy and follow up drug use, encourages patients to be familiar with their own therapeutic regimens, making it easier to understand the importance of using correct medicine, increasing adherence to therapy, effectiveness and tolerance. This study aimed to evaluate the effectiveness of pharmaceutical intervention (PI) in solving drug related problems (DRPs) and improvement of HIV/ AIDS patients clinical parameters. We conducted a prospective controlled intervention study, with a consecutive and convenience sampling with replaced controls paired by gender and initial T CD4+ lymphocytes values. Out of the total patients enrolled in the study (n=143), 57 (39,86%) patients were discontinued and 86 patients completed the 1-year study, with 43 patients in the control group (CG) and 43 in the intervention group (IG). Patients from de IG received pharmacotherapeutic follow up through a method developed in this work and some Pharmacotherapy workup method features. Over the period of 1 year were performed 202 interventions or counselling on Pharmaceutical IG, with a decrease of 38.43% (p = 0.0001) of total PFTs. The IG showed a mean improvement variation of 1.84 times CD4 greater than the increase observed CG with an average of 154.66 for IG and 83.80 for CG. Although the final viral load mean of IG found were greater than that observed in the CG (17394.51 and 12921.53 copies / mL, respectively), IG presented a reduction of three times greater than that in the CG: IG had mean range of 23517.67 and CG, 6226.51. The results of this study indicate that pharmacist interventions led to lower DRPs especially those related to adverse reactions and drug interactions, promoted adherence, increased the effectiveness of antiretroviral therapy, verified with greater elevation of CD4 count and viral load reduction compared with the control group / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

A dignidade humana é diretamente proporcional ao direito à saúde e este princípio está constitucionalmente previsto pelo Estado brasileiro. Alia-se a este direito, o acesso a medicamentos como itens indispensáveis à saúde e que não devem ser negados. Como objetivo do presente estudo, buscou-se caracterizar o perfil das demandas judiciais em Imperatriz-MA, especialmente no tocante ao acesso aos medicamentos e Política de Assistência Farmacêutica, conhecendo para tal, as decisões judiciais datadas no período de janeiro de 2012 a dezembro de 2014, ajuizadas contra a Secretária Municipal de Saúde em Imperatriz-MA, identificando os medicamentos e programas alojados dentro da Política de Assistência Farmacêutica, alvos em maior grau de demandas judiciais e apresentando as principais negativas ao acesso de medicamentos no âmbito da Assistência Farmacêutica. A metodologia utilizada baseia-se em uma pesquisa exploratória e descritiva, aliadas a um levantamento bibliográfico, abordagem quantitativa e pesquisa documental. Realizou-se um levantamento documental em busca da caracterização de 673 demandas ajuizadas contra o Sistema Único de Saúde de Imperatriz-MA e das caracterizações das demandas ajuizadas por medicamentos, que totalizaram 257 apresentações farmacêuticas. Os resultados demonstraram que sobre os tipos de demandas, aquelas por medicamentos e leitos de Unidades de Terapia Intensiva representaram os principais motivos de tutela judicial. As crianças, adolescentes e idosos, representaram a população mais defendida por meio das demandas e quando o foco passou a ser apenas os medicamentos, foi possível identificar que entre as 257 apresentações identificadas e judicializadas, 102 (39,3%) não estavam inclusas em nenhuma das listas do SUS, 111(43,2%) inclusos na Relação Nacional de Medicamentos e apenas 44 (17,1%) na Relação Municipal de medicamentos. Visualizou-se ainda que o componente da Assistência Farmacêutica que mais sofreu judicializações foi o Básico (60,3%), seguido de 37,8% do Componente Especializado e apenas 1,8% do Estratégico. Notou-se também a tendência de prescrições pelo nome comercial de fármacos, bem como solicitações por medicamentos sem registro sanitário no Brasil, com prescrições equivocadas ou uso off label, cujo não possuem registro no Brasil, ou não têm comercialização autorizada. Conclui-se, que a partir destes conhecimentos, novas estratégias e modelos de gestão, ou novos canais de diálogos que envolvam Poder Público, Judiciário e população, possam ser criados e/ou reformulados, tendo como bases maiores a diminuição das demandas judiciais em Imperatriz-MA, a melhoria das Políticas Públicas de Saúde e a ampliação do direito constitucional ao acesso à saúde e a todos os outros direitos que este vier a incluir. / Human dignity is directly proportional to the right to health and this principle is constitutionally provided by the Brazilian government. Joins this right, access to medicines and items essential to health and should not be denied. The objective of the present study, we sought to characterize the profile of litigation in Imperatriz-MA, especially regarding access to medicines and Pharmaceutical Care Policy, meeting for such judgments dated from January 2012 to December 2014, filed against the Municipal Health Secretary in Imperatriz-MA, identifying drugs and programs housed within the Pharmaceutical Care Policy, targets a greater degree of process and presenting the main negative to access medicines under the Pharmaceutical Services. The methodology is based on an exploratory and descriptive research, combined with a literature review, quantitative approach and documentary research. We conducted a documentary survey seeking the characterization of 673 lawsuits filed against the National Health System Imperatriz-MA and characterizations of claims by drugs, which totaled 257 pharmaceutical presentations. The results showed that on the types of demands, those for medicines and beds Intensive Care Units represented the main reasons of judicial protection. Children, adolescents and the elderly accounted for the population most defended by the demands and when the focus became only medicines, were identified that among the 257 submissions identified and judicialized, 102 (39.3%) were not included in none of the lists of SUS 111 (43.2%) included in the National List of Medicines and only 44 (17.1%) in the Municipal Register of medicines. It is also envisioned that the pharmaceutical services component that suffered most was the judicialization Basic (60.3%), followed by 37.8% of the Specialized Component and only 1.8% of Strategic. It was noted also tend to prescriptions for brand-name drugs, as well as requests for drugs without health registration in Brazil, wrong prescriptions or off label use, which not formally registered in Brazil, or have authorized marketing. It follows that from this knowledge, new strategies and business models, or new channels of dialogue involving government, judiciary and population, can be created and / or reformulated, with the largest bases the reduction of litigation in Imperatriz -MA, improvement of Public Health Policies and expansion of the constitutional right of access to health and all other rights to this were to include.

L’atteinte d’un soulagement adéquat de la douleur garantissant aussi une utilisation sécuritaire des opioïdes et répondant aux attentes des patients s’est beaucoup complexifiée dans le contexte d’une attention accrue à l’utilisation et aux effets néfastes des opioïdes. Cette attention a remis en question les pratiques de prescription et distribution de médicaments visant le soulagement de la douleur. En tant que dispensateurs de médicaments, les pharmaciens assument un rôle central pour en assurer leur utilisation sécuritaire et appropriée. L’objectif général de ce travail est de décrire les pratiques pharmaceutiques portant sur le soulagement de la douleur dans le contexte actuel en Amérique du Nord en général et au Québec en particulier, et mieux comprendre les facteurs facilitants et les barrières à l’amélioration de ces pratiques au Québec. Ce projet a été mené en deux parties. Tout d’abord, une revue de la littérature a été effectuée pour recenser les publications examinant les pratiques pharmaceutiques visant le soulagement de la douleur et la gestion des opioïdes en lien avec une préoccupation généralisée sur l’usage des opioïdes. Les objectifs étaient d'identifier ces pratiques et d'évaluer si elles avaient été amenées à évoluer suite à ces préoccupations. Pour la deuxième partie du projet, qui visait à approfondir les perceptions des pratiques pharmaceutiques portant sur la douleur au Québec, des entrevues semi-structurées ont été menées avec des pharmaciens (n = 8) oeuvrant dans divers milieux cliniques (pharmacie communautaire, pharmacie en établissement de santé et groupe de médecine de famille). Alors que les pharmaciens ont exprimé le désir de jouer un rôle central dans l'atteinte des objectifs de traitement de la douleur tout en assurant l’utilisation sécuritaire des opioïdes, ils ont rapporté plusieurs obstacles dans leur pratique. De plus, la prestation des soins pharmaceutiques visant le soulagement de la douleur pourrait être améliorée en tirant parti des facilitateurs de chaque milieu de pratique et en favorisant les partenariats intraprofessionnels à travers les différents milieux de pratique. / Providing adequate pain relief while ensuring safe opioid use and managing patient expectations has become an intricate endeavor in the context of increased attention to opioid use and its harms. This attention has put into question the practices of prescribing and dispensing medications for pain relief. As the dispensers of medications, pharmacists play a crucial role in ensuring their safe and proper use. The general objective of this work is to describe the pharmaceutical practices encompassing pain relief in the current context in North America in general, and in Quebec in particular, and to better understand the facilitating factors and the barriers to the improvement of these practices in Quebec.This project was conducted in two parts. First, a scoping review of the literature was conducted for publications examining pharmaceutical practices aimed towards pain relief and opioid management in the context of widespread concern about opioid use. The objectives were to identify these practices and assess whether they had been called on to evolve as a result of these concerns. For the second part of the project, which aimed to deepen the perceptions of pharmaceutical practices relating to pain in Quebec, semi-structured interviews were conducted with pharmacists (n = 8) working in various clinical settings (community pharmacy, health facility pharmacy and family medicine group). While pharmacists have expressed a desire to play a central role in achieving pain treatment goals while ensuring the safe use of opioids, they reported several barriers in their practice. Lack of time to perform adequate follow-ups, gaps in pain assessment and pharmacotherapy knowledge, and communication skills tailored to patients who suffer were the main barriers mentioned by pharmacists. Adjustments to teaching and practice curricula, standardized assessment and monitoring tools, and increased patient involvement in decision-making could prove beneficial. In addition, delivery of pharmaceutical care for pain relief could be improved by leveraging facilitators from each practice setting and fostering intraprofessional partnerships across different practice settings.

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.

No description available.

L’hypothèse de cette thèse est qu’une pratique collaborative médecins de famille-pharmaciens communautaires (PCMP) où le pharmacien fournit des soins pharmaceutiques avancés avec ajustement posologique d’une statine permettrait aux patients avec une dyslipidémie une réduction plus importante de leur LDL et augmenterait le nombre de patients atteignant leurs cibles lipidiques. Dans une étude clinique contrôlée et randomisée en grappe visant à évaluer une PCMP pour des patients ayant une dyslipidémie (l’étude TEAM), une journée de formation basée sur un protocole de traitement et des outils cliniques a été offerte aux pharmaciens PCMP pour les préparer à fournir des soins pharmaceutiques avancés. Les connaissances des pharmaciens sur les dyslipidémies étaient faibles avant la formation mais se sont améliorées après (moyenne de 45,8% à 88,2%; p < 0,0001). Après la formation, les pharmaciens avaient un haut niveau d’habiletés cliniques théoriques et pratiques. Bref, une journée de formation basée sur un protocole de traitement et des outils cliniques était nécessaire et adéquate pour préparer les pharmaciens à fournir des soins pharmaceutiques avancés à des patients ayant une dyslipidémie dans le contexte d’une étude clinique. Dans l’étude TEAM, 15 grappes de médecins et de pharmaciens (PCMP : 8; soins habituels (SH) : 7) ont suivi pendant un an, 225 patients (PCMP : 108; SH : 117) à risque modéré ou élevé de maladie coronarienne qui débutaient ou étaient déjà traités par une monothérapie avec une statine mais qui n’avaient pas atteint les cibles lipidiques. Au départ, par rapport aux patients SH, les patients PCMP avaient un niveau de LDL plus élevé (3,5 mmol/L vs 3,2 mmol/L) et recevaient moins de statine à puissance élevée (11,1 % vs 39,7 %). Après 12 mois, la différence moyenne du changement de LDL entre les groupes était égale à -0,2 mmol/L (IC95%: -0,3 à -0,1) et -0,04 (IC95%: -0,3 à 0,2), sans ajustement et avec ajustement, respectivement. Le risque relatif d’atteindre les cibles lipidiques était 1,10 (IC95%: 0,95 à 1,26) et 1,16 (1,01 à 1,32), sans ajustement et avec ajustement, respectivement. Les patients PCMP ont eu plus de visites avec un professionnel de la santé et d’analyses de laboratoire et étaient plus enclins à rapporter des changements de style de vie. La PCMP a amélioré l’adhésion aux lignes directrices en augmentant la proportion de patients aux cibles lipidiques. Les données intérimaires de l’étude TEAM (PCMP : 100 patients; SH : 67 patients) ont permis d’évaluer les coûts directs annuels du suivi du pharmacien du groupe PCMP (formation, visites, laboratoire), du médecin (visites, laboratoire) et du traitement hypolipémiant. Le suivi du pharmacien a coûté 404,07$/patient, incluant 320,67$ pour former les pharmaciens. Le coût global incrémental était 421,01$/patient. Une pratique collaborative pour des patients ayant une dyslipidémie engendre un coût raisonnable. / The hypothesis was that a family physician-community pharmacist collaborative care (PPCC) model where the pharmacist provides advanced pharmaceutical care including statin dosage adjustment would provide a greater LDL reduction to dyslipidemia patients and increase the number of patients reaching their target lipid levels. . In a cluster randomised controlled trial to evaluate a PPCC model for patients with dyslipidemia (TEAM study), a one-day workshop based on a treatment protocol and specific clinical tools was offered to prepare PPCC pharmacists to provide advanced pharmaceutical care to dyslipidemia patients. Pharmacists knowledge on dyslipidemia was low before the workshop but significantly improved thereafter (overall score from 45,8% to 88,2%; p < 0,0001). After the workshop, pharmacists showed a high level of theoretical and practical skills. Finally, a one-day workshop based on a treatment protocol and clinical tools was necessary and adequate to prepare pharmacists to provide advanced pharmaceutical care to patients with dyslipidemia in the context of a clinical trial. In the TEAM study, 15 clusters of physicians and pharmacists (PPCC: 8; usual care (UC) : 7) followed for 1 year, 225 patients (PPCC: 108; UC:117) at moderate or high risk of coronary heart disease who initiated or were already treated with a statin monotherapy but who did not achieved target lipid levels. At baseline, compared to UC patients, PPCC patients had a higher level of LDL (3.54 mmol/L vs 3.22 mmol/L) and were prescribed less high-potency statin (11,1% vs 39,7%). At 12 months, the crude and adjusted between group-differences in the mean change in LDL-C were equal to -0.2 mmol/L (95%CI: -0.3 to -0.1) and -0.04 (95%CI: -0.3 to 0.2), respectively. The crude and the adjusted relative risk of achieving lipid targets were equal to 1.10 (95%CI: 0.95 to 1.26) and 1.16 (1.01 to 1.32), respectively. PPCC patients had more health-professional visits and laboratory tests, were more likely to have their lipid-lowering treatment changed, and to report lifestyle changes. PPCC improved adherence to treatment-guideline recommendations with higher proportion of patients achieving their target lipid levels. From an interim analysis of the TEAM study (PPCC: 100 patients; UC: 67 patients) the annual direct costs for the pharmacist follow-up in the PPCC group (training, visits, laboratories), physician follow-up (visits, laboratories) and lipid-lowering treatment were evaluated. The cost for the pharmacist follow-up was $404.07/patient, including $320.67 to train pharmacists. The incremental overall cost was $421.01/patient. Finally, a PPCC for patients with dyslipidemia entails a reasonable cost.

O objetivo desse estudo foi avaliar o impacto da atenção farmacêutica em desfechos clínicos e na qualidade de vida de pacientes portadores de diabete melito tipo 2 (DM2) atendidos em um hospital de nível terciário de atenção à saúde. O estudo foi clínico controlado randomizado com 70 pacientes portadores de DM2, com mais de 45 anos, em uso de insulina e hemoglobina glicada (HbA1c) 8%. Os pacientes do grupo controle (GC) (n=36) receberam tratamento usual e os do grupo intervenção (GI) (n=34) receberam acompanhamento farmacoterapêutico individualizado e educação para o DM2. A amostra total foi composta principalmente por mulheres (61,4%), com uma média de idade aproximada de 61 anos e tempo de DM2 de cerca de 14 anos, sendo que os grupos eram homogêneos quanto a essas características (p>0,05). Após seis meses de intervenção, os conhecimentos sobre o diabetes e sobre os medicamentos aumentaram significativamente no GI, de 9,91±2,69 para 15,74±3,03 e de 4,47±0,84 para 6,58±1,29, respectivamente, ambos permanecendo inalterados no GC. A adesão ao tratamento farmacológico, para o GI, segundo o questionário Morisky-Green e o Questionário de Adesão a Medicamentos passou de 17,6% para 70,6% e de 29,4% para 52,9%, respectivamente (p<0,05), permanecendo inalterada no GC. Houve aumentos significativos na realização correta das técnicas de aplicação de insulina e de monitorização de glicemia capilar ao final após a intervenção. No início do estudo, a média de HbA1c era para o GC 9,61±1,38 e, para o GI 9,78±1,55 (p>0,05). Após a intervenção, a média de HbA1c do GI diminuiu significativamente para 9,21±1,41, o que não ocorreu para o GC (9,53±1,68) (p>0,05). Ao final do estudo houve melhora significativa da qualidade de vida relacionada ao diabete no GI enquanto que para o GC esse desfecho piorou significativamente. A atenção farmacêutica resultou em melhora significativa de desfechos clínicos e humanísticos dos pacientes com DM2 após seis meses de intervenção / The aim of this study was to evaluate the impact of a pharmaceutical care program on health outcomes and quality of life in patients with type 2 diabetes mellitus (T2DM) attending in a tertiary care center. The study was a randomized controlled, parallel-group trial with a 6-month follow-up carried out with 70 adults (45 years of age) with T2DM, taking insulin, with an HbA1c 8%. Patients in control group (CG) (n=36) received usual care and for those patients in intervention group (IG) (n=34) an individualized pharmacotherapeutic care plan and diabetes education were provided. Total sample was composed primarily of women (61,4%), with mean age of 61 years and duration of T2DM of 14 years and these characteristics were similar in the groups (p>0,05). After a 6-month follow-up, diabetes knowledge and medication knowledge significantly improved in IG, from 9,75±2,69 to 15,74±3,03 and from 4,47±0,84 to 6,58±1,29, respectively, and both outcomes remained unchanged in the CG. Adherence to medication for the IG according to the Morisky-Green questionnaire and to the Questionário de Adesão a Medicamentos varied, respectively, from 17,6% in baseline to 70,6% at end of the study and from 29,4% to 52,9% (p<0,05), with no changes in CG. There were significant improvements in the correct execution of insulin injections and home blood glucose monitoring techniques in the IG at the end of the study. At the beginning of the study HbA1c mean values were 9,61±1,38 in the CG and 9,78±1,55 in the IG (p>0,05). After the intervention, HbA1c mean values was reduced significantly to 9,21±1,41 in the IG and remained unchanged in the CG (9,53±1,68) (p>0,05). After the intervention the diabetes related quality of life significantly improved in IG while it worsened significantly in the CG. Pharmaceutical care resulted in significant improvement in health outcomes in patients with T2DM after 6-month follow-up

INTRODUÇÃO:Os medicamentos pertencentes à RENAME têm sua eficácia comprovada são embasados sob critérios técnicos e científicos, e quando prescritos assumem profunda relevância dentro do contexto da saúde pública brasileira, por facilitarem o acesso aos medicamentos.OBJETIVO: Avaliar a associação entre acesso a medicamentos e prescrição segundo a Relação Nacional de Medicamentos Essenciais (RENAME). METODOLOGIA: Foram analisadas cópias de receitas médicas obtidas da pesquisa intitulada Experiência de Acesso da População de Baixa Renda a Medicamentos e Genéricos, Município de São Paulo 2005; para as análises estatísticas, foram utilizados os programas Epi-Info 2000 e OpenEpi. RESULTADOS: A média de medicamentos com receita foi de 2,5 / desvio padrão: 1,5479; o percentual de nenhum acesso e acesso parcial ás prescrições, juntos, foi de 54por cento ; nas Unidades Básicas de Saúde foram realizadas mais da metade das prescrições analisadas; a forma farmacêutica predominante foi comprimidos; cerca de 75por cento dos medicamentos estava presente nas listas de medicamentos essenciais, nacional ou municipal; dos medicamentos prescritos, 78por cento foram obtidos e 41por cento , dos que não estavam prescritos, também foram obtidos. CONCLUSÃO: Do total de medicamentos analisados, 65por cento estavam prescritos segundo a RENAME, e desses, 78por cento , foram obtidos; as Unidades Básicas de Saúde foram responsáveis por fornecer mais da metade das receitas; a quantidade de medicamentos prescritos mostrou-se negativamente correlacionada ao percentual de acesso aos mesmos; as prescrições quando seguem a RENAME têm a chance de acesso entre 4 a 6 vezes maior de se obter os medicamentos / INTRODUCTION: The medicaments belonging to RENAME have their eficiency verified, under technical and cientific criteria and when they are prescribed they become a matter of great concern regarding the Brazilian Publich Health because they facilitate the access to medicaments. OBJECTIVE: Evaluate the association between access to medicaments and prescription according the National List of Essential Medicaments (RENAME). METHODOLOGY : Copies of the medical prescriptions obtained from the research called Experience in Access to medicament and Generic of Low income population, Sao Paulo Municipal Discrict, 2005,and also the Programs Epi-Info 2000 and OpenEpi because of the statistic analysis. RESULTS: The average of medicament with prescription was 2,5 / Standard Deviation: 1.5479, the percentage of no access and partial access together was 54per cent. More than a half of the analysed prescriptions were done at the Health Fundamental Units. Also, among the pharmaceutical kinds, tablets and pills were the dominant ones and around 75per cent of the medicaments were present in the lists of essential medicaments in the country and districs. Among the prescribed medicaments, 78per cent were obtained while 41per cent of the non-prescribed ones were also obtained. CONCLUSION: From a total of the analysed medicaments, 65per cent of them were prescribed observing RENAME, and 78per cent of them were obtained. The Health Fundamental Units were responsible for providing more than a half of the prescriptions. The amount of medicaments involved were negatively correlated to the number of medicaments. The prescriptions that observe RENAME have 4 to 6 times more chances to be successful when it comes to obtaining medicines

Introdução: A asma e a DPOC são doenças crônicas inflamatórias que afetam a qualidade de vida dos pacientes. O tratamento medicamentoso é feito, em sua maioria, por via inalatória utilizando para isso os dispositivos inalatórios. O uso incorreto dos dispositivos inalatórios diminui a eficácia dos medicamentos, o que pode ocasionar a não aderência dos pacientes ao tratamento. Vários tipos de programas educativos para asma e DPOC têm sido desenvolvidos, diferenciando-se quanto à forma de abordagem, à situação em que a doença é atendida e aos desfechos considerados. O farmacêutico por meio de um programa educacional pode orientar os pacientes sobre a técnica correta dos dispositivos inalatórios e auxiliar este paciente na adesão ao tratamento. Objetivos: Realizar a compilação e sistematização dos resultados dos trabalhos apresentados pelo programa de atenção farmacêutica aos pacientes asmáticos e portadores de DPOC do ICHC FMUSP e do programa de pós-graduação de Fisiopatologia Experimental. Método: estudo retrospectivo e descritivo dos trabalhos de conclusão dos alunos do Curso de Aprimoramento Profissional em Farmácia Hospitalar e Introdução a Farmácia Clínica da Divisão de Farmácia do ICHC FMUSP e do programa de pós-graduação de Fisiopatologia Experimental da Faculdade de Medicina da USP. Estes estudos desenvolveram a temática da atenção farmacêutica e educação em asma e em DPOC, apresentados entre os anos de 2004 a 2012 que não tiveram artigos ou capítulos de livros publicados. Resultados: Foram enviados três capítulos para publicação no livro Atenção Farmacêutica - Gestão e Prática do HCFMUSP e um artigo será publicado no Jornal Brasileiro de Pneumologia. Conclusão: Publicações acadêmicas com o tema atenção farmacêutica ao paciente portador de doenças respiratórias crônicas demonstram a importânica da orientação/ educação desses pacientes quanto ao tratamento de suas doenças respiratórias / Introduction: Asthma and COPD are chronic inflammatory diseases that affect the quality of life of patients. Drug treatment is done mostly by inhalation, using for it inhalation devices. Incorrect use of inhalers decreases the effectiveness of medications which can cause non-adherence of patients to treatment. Various types of educational programs for asthma and COPD have been developed, differing on the mode the approach, the situation in which the disease is answered and the outcomes considered. The pharmacist through an educational program can educate patients about the proper technique of inhalation devices and assisting the patient to adhere to treatment. Objectives: Perform the compilation and systematization from studies data submitted by the pharmaceutical care program for patients with asthma and COPD developed by pharmacists from course of improvement of the Division of Pharmacy ICHC USP and also by the program of graduate Experimental Pathophysiology, Faculty of Medicine, USP. Method: A retrospective, descriptive study with the outcomes of studies of the students that completed the course in Professional Development Course in Hospital Pharmacy and Introduction to Clinical Pharmacy, of Division of Pharmacy of ICHC USP and the program graduate in Experimental Pathophysiology, Faculty of Medicine of USP. The studies show the theme of pharmaceutical care and asthma education and COPD, submitted between the years 2004 to 2012 and who had no articles or book chapters related books published. Results: three book chapters were sent for publication in the book Pharmaceutical Care - Management and Practice HC FMUSP and one article will be published in the Brazilian Journal of Pulmonology. Conclusion: academic publications on the theme pharmaceutical care to patients with chronic respiratory diseases shows the importance orientation/education of patients regarding the treatment of their respiratory diseases

L'influence européenne, notamment politique et juridique, la globalisation des échanges de médicaments de même que les conséquences de la globalisation - des crises sanitaires, économiques, financières - affectent les modalités d'organisation et d'exercice de la pharmacie d'officine française, italienne et anglaise. La convergence étant généralement présentée comme figurant au titre des conséquences possibles de l'européanisation et de la globalisation, les régimes français, italien et anglais de distribution de médicament à l'officine évoluent-ils vers une forme de « modèle juridique » commun, dépassant leur opposition historique ? En réalité, non seulement l'on assiste à l'émergence de modèles juridiques d'organisation et d'exercice de la pharmacie qui ne sont pas porteurs d'une unité susceptible de réduire de manière significative les différences entre les législations nationales, mais encore, cette unité n'est pas opportune. En effet, le maintien de spécificités nationales ainsi que l'adaptation des réglementations aux contextes nationaux apparaissent comme des éléments garants de l'efficacité des régimes nationaux de distribution officinale des médicaments. Pour autant, l'efficacité des réglementations ne se résume pas à la garantie des spécificités nationales de l'encadrement du secteur, comme l'illustrent les obstacles à la réparation des dommages imputables aux médicaments et à la protection du monopole pharmaceutique. Si certains apparaissent justement liés aux caractéristiques nationales, d'autres concernent de manière spécifique la lutte contre les ventes illégales de médicaments / European influence, especially political and legal, the globalisation of drug trade as well as the consequences of the globalisation of health, economic and financial crises impact the organisation and practice of French, Italian and English retail pharmacy. Convergence is generally presented as one of the possible consequences of europeanisation and globalisation. In effect, are the legal regimes of drug distribution in retail pharmacies in France, Italy and England evolving towards a common « legal model », beyond their historical opposition ? In reality, not only are we witnessing the emergence of organisational and operational retail pharmacy legal models that do not carry a unicity that would enable significantly reducing differences between national legislations, but this unicity would not be timely. Indeed, the preservation of national specificities, as well as the adaptation of regulations to national contexts appear as key guarantors of the efficacy of retail pharmacy drug distribution national legal regimes. However, the efficacy of regulations cannot be summarised to guaranteeing the sector’s national specificities, as illustrated by the obstacles to compensation for damages attributable to medicines and to the protection of the pharmaceutical monopoly. While some of these obstacles appear precisely linked to national characteristics, others relate specifically to the war against illegal drug sales