The incidence of DDI-related ADRs in elderly outpatients is high; most events presented important clinical consequences and were preventable or ameliorable.

The greater prevalence of chronic diseases like systemic arterial hypertension among elderly people results in an increase of drugs use. Therefore, the incidence of a lot of drug-related problems (DRP) rises, and this leads to many health problems in the population. Based on literature, authors emphasize the multidisciplinary team approach (physicians, nurses and pharmacists) to activities directly related with pharmacotherapy for hypertension, granting elderly persons a better comprehension about taking care of their own health, to reduce DRP and achieve satisfactory adherence.

-Purpose. To examine the effect of an implemented pharmaceutical care program on coronary heart disease risk in elderly diabetic and hypertensive patients. Methods. A total of 200 elderly (≥60 years) diabetic and/or hypertensive patients were recruited into a randomized, controlled, prospective clinical trial with a 36-month follow-up, developed in a public primary health care unit in a municipality in the Brazilian State of Sao Paulo. A range of clinical measurements was evaluated at baseline and for 36 months. The intervention-group patients received pharmaceutical care from a clinical pharmacist, whereas the control-group patients received their usual care from the medical and nursing staff. The Framingham scoring method was used to estimate changes in the 10-year coronary heart disease risk of all patients. Results. A total of 194 patients completed the study. Significant reductions (P < 0.05) in the mean values (baseline vs. 36 months) of systolic blood pressure (156.7 mmHg vs. 133.7 mmHg; P < 0.001), diastolic blood pressure (106.6 mmHg vs. 91.6 mmHg; P < 0.001), fasting glucose (135.1 mg/dL vs. 107.9 mg/dL; P < 0.001), hemoglobin A1C (7.7% vs. 7.0%; P < 0.001), triglycerides (206.0 mg/dL vs. 152.5 mg/dL; P < 0.001), low-density lipoprotein (LDL) cholesterol (112.4 mg/dL vs. 102.0 mg/dL; P < 0.001), high-density lipoprotein cholesterol (55.5 mg/dL vs. 65.5 mg/dL; P < 0.001), total cholesterol (202.5 mg/dL vs. 185.9 mg/dL; P < 0.001), body mass index (26.2 kg/m 2 vs. 26.1 kg/m 2 ; P < 0.001), and abdominal circumference (103.2 cm vs. 102.5 cm; P = 0.001) were observed in the intervention group, whereas no significant changes were verified in the control group. The mean Framingham risk prediction score in the intervention group was 6.8% at baseline and decreased to 4.5%; P < 0.001) after 36 months, but remained unchanged in the control group. Conclusion. The pharmaceutical care program resulted in better clinical measurements and reduced the cardiovascular risk scores in elderly diabetic and hypertensive patients over a 36-month period.

Purpose. The primary objective of this study was to investigate the incidence of drug-drug interactions (DDIs) related to adverse drug reactions (ADRs) in elderly outpatients who attended public primary healthcare units in a southeastern region of Brazil. The secondary objective was to investigate the possible predictors of DDI-related ADRs. Methods. A prospective cohort study was conducted between November 1, 2010, and November 31, 2011, in the primary public healthcare system in the Ourinhos micro-region in Brazil. Patients who were at least 60 years old, with at least one potential DDI, were eligible for inclusion in the study. Eligible patients were assessed by clinical pharmacists for DDI-related ADRs for 4 months. The causality of DDI-related ADRs was assessed independently by four clinicians using three decisional algorithms. The incidence of DDI-related ADRs during the study period was calculated. Logistic regression analysis was used to study DDI-related ADR predictors. Results. A total of 433 patients completed the study. The incidence of DDI-related ADRs was 6.5%. A multivariate analysis indicated that the adjusted odds ratios (ORs) rose from 0.91 (95% confidence interval [CI] = 0.75-1.12, p = 0.06) in patients aged 65-69 years to 4.40 (95% CI = 3.00-6.12, p < 0.01) in patients aged 80 years or older. Patients who presented two to three diagnosed diseases presented lower adjusted ORs (OR = 0.93 [95% CI = 0.68-1.18, p = 0.08]) than patients who presented six or more diseases (OR = 1.12 [95% CI = 1.02-2.01, p < 0.01]). Elderly patients who took five or more drugs had a significantly higher risk of DDI-related ADRs (OR = 2.72 [95% CI = 1.92-3.12, p < 0.01]) than patients who took three to four drugs (OR = 0.93 [95% CI = 0.74-1.11, p = 0.06]). No significant difference was found with regard to sex (OR = 1.08 [95% CI 0.48-2.02, p = 0.44]). Conclusion. The incidence of DDI-related ADRs in elderly outpatients was significant, and most of the events presented important clinical consequences. Because clinicians still have difficulty managing this problem, highlighting the factors that increase the risk of DDI-related ADRs is essential. Polypharmacy was found to be a significant predictor of DDI-related ADRs in our sample. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

IntroductionMedication review (MR) is a pharmacy practice conducted in different settings that has a positive impact on patient health outcomes. In this context, systematic reviews on MR have restricted the assessment of this practice using criteria such as methodological quality, practice settings, and patient outcomes. Therefore, expanding research on this subject is necessary to facilitate the understanding of the effectiveness of MR and the comparison of its results.AimTo examine the panorama of systematic reviews on pharmacist-participated MR in different practice settings.MethodsA literature search was undertaken in Biblioteca Virtual em Saúde (BVS), Embase, PubMed, Scopus, The Cochrane Library, and Web of Science databases through January 2018 using keywords for "medication review", "systematic review", and "pharmacist". Two independents investigators screened titles, abstracts, full texts; assessed methodological quality; and, extracted data from the included reviews.ResultsSeventeen systematic reviews were included, of which sixteen presented low to moderate methodological quality. Most of reviews were conducted in Europe (n = 7), included controlled primary studies (n = 16), elderly patients (n = 9), and long-term care facilities (n = 8). Seven reviews addressed MR as an intervention and thirteen reviews cited collaboration between physicians and pharmacists in the practice of MR. In addition, thirteen terminologies for MR were used and the main objective was to identify and solve drug-related problems and/or optimize the drug use (n = 11).ConclusionThere is considerable heterogeneity in practice settings, population, definitions, terminologies, and approach of MR as well as poor description of patient care process in the systematic reviews. These facts may limit the comparison, summarization and understanding of the results of MR. Furthermore, the methodological quality of most systematic reviews was below ideal. Thus, international agreement on the MR process is necessary to assess, compare and optimize the quality of care provided.

Rationale, aims, and objectives:Counselling is essential in drug dispensing, since it enables patients to receive and understand the information to correctly use their medicines. Although counselling is a quality indicator on drug dispensing, models that guide pharmacists in this practice are scarce. Thus, this study aimed to develop and validate the content of an instrument to support pharmaceutical counselling for dispensing of prescribed medicines. Method:A two-stage validation study was conducted out from February to October 2017. The first stage involved the development of the instrument, and the second involved content validation. Instrument development included the following three steps: (1) drafting of the prototype; (2) an academic brainstorming meeting, and (3) a pre-Delphi process. Content validation was then conducted using the Delphi technique. At this stage, 40 pharmacists who were experts in drug dispensing, were invited to assess the instrument. Consensus among experts was calculated according to the content validity index (CVI). Results:The development stage generated three versions of the instrument: the prototype, Version 1 (modified after brainstorming meeting), and Version 2 (modified after the pre-Delphi process). Version 2 underwent the content validation process, in which 29 pharmacists participated during the first round (rate of return: 72.5%) and 23 of these during the second round (rate of return: 79.31%). All items obtained CVI > 0.82 and were thus considered to be validated. The final instrument comprised three components: suggestions for questions, dispensing process reasoning, and suggestions for counselling, and other conduct in 11 stages, each representing a step in the clinical reasoning process. Conclusions:An instrument was developed to support pharmaceutical counselling for dispensing of prescribed medicines, suggesting main questions, counselling, and conduct to be taken by pharmacists, and its content validity was verified.

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Background Drug dispensing aims to promote rational medicine use. However, in many countries, the work processes are still not well defined. In this sense, the perception of pharmacists about dispensing practices presents an overview of how the service is being performed in the country and its main challenges. Thus, the purpose of this study was to determine the self-reported work process of Brazilian community pharmacists in relation to drug dispensing, challenges, and strategies for carrying out the service. Method A cross-sectional survey was conducted between May and July 2021, with community pharmacists from all regions of Brazil. Pharmacists were invited to answer a validated, self-administered questionnaire, implemented through Google Forms, containing 33 questions related to the steps of drug dispensing (questions and counseling) and the main challenges and strategies to perform the service. The data were exported to Microsoft Office Excel and SPSS®. Multiple linear regression analysis was used to assess the association between responses and demographic information, with a significance level of less than 5% (p < 0.05). This study was approved by the Research Ethics Committee (number: 4.295.171). Results A total of 625 community pharmacists responded to the survey. Most pharmacists reported always or frequently performing 17 (54%) of the 31 steps described in the instrument. The steps that pharmacists reported performing more frequently were forming the medication name (n = 569, 91.04%), verifying the completeness and adequacy of the prescription according to current legislation (n = 567, 90.72%) and providing counseling on dosage (n = 549, 87.84%). Documentation was the main step in which pharmacists reported never or rarely performing (n = 424, 67.84%). The results showed that there was a significant influence of the variables of public education institution, age, and postgraduate education on the frequency of dispensing steps (F(3, 621) = 14.884, p < 0.001; R2ajdusted = 0,063). Conclusion This study showed that most pharmacists reported always or frequently asking most of the questions and performing counseling contained in the instrument during drug dispensing. These results can contribute to an understanding of current dispensing practices and generate insights for developing strategies to qualify the service.