It is estimated that around five to 10.0% of hospital admissions occur due to clinical conditions resulting from pharmacotherapy. Clinical pharmacist's activity can enhance drug therapy's effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by clinical pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP. A single-arm trial included adults admitted in the referred Unit from 2012 July to 2015 June. Patients were evaluated during their hospitalization period and PIs were performed based on trigger DRPs that were detected in medication reconciliation (admission or discharge) or during inpatient follow-up. Student's t-test, Chi-square test, Pearson and Multiple logistic regression models to analise the association among age, number of drugs, hospitalization period, and number of diagnoses with occurrence of DRPs. Analyses level of significance was 5%. In total 409 inpatients were followed up [51.1% male, mean age of 49.1 (SD 16.5)]. Patients received, on average, 11.9 (SD 5.8) drugs, ranging from two to 38 drugs per patient, and 54.3% of the sample presented at least one DRP whose most frequent description was "untreated condition". From all 516 performed PIs that resulted from DRPs, 82.8% were accepted and the majority referred to "drug introduction" (27.5%). Multiple logistic regression showed that age, length of hospital stay, number of drugs used, diagnosis of epilepsy, multiple sclerosis and myasthenia gravis would be clinical variables associated with DRP (p < 0,05). Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational pharmacotherapy.

IntroductionAlmost 50% of the 17.5 million deaths worldwide from cardiovascular disease have been associated with systemic arterial hypertension (SAH). Into this scenario, Pharmaceutical Care (PC) has been inserted in order to improve the management of SAH and reduce its risks.ObjectiveTo evaluate the outcomes and healthcare assistance achieved after discharge of hypertension patients from the PC program.MethodsThis is a quasi-experimental study with historical controls. Retrospective data collection from 2006 to 2012 was begun in 2013 and included a PC program performed over one year. PC was performed in two basic units of the public health system in Ribeirão Preto-SP, Brazil, where the pharmacist followed up 104 hypertensive patients. The clinical indicators of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, total-cholesterol, high and low density lipoprotein cholesterol were collected, as well as care indicators related to the number of consultations (basic, specialized and emergency care) and antihypertensive drugs used. The coronary risk of patients by the Framingham risk score was also calculated. For the analysis, the data were divided into three periods, 2006–2008 as pre-PC, 2009 as PC and 2010–2012 as post-PC.ResultsIn the pre-PC period, 54.4%, 79.0% and 27.3% of patients presented satisfactory levels of SBP, DBP and total-cholesterol, respectively. In the post-PC period, the percentages were 93.0% for SBP and DBP [p <0.001] and 60.6% for total-cholesterol [p <0.001]. The average number of consultations per patient/year in primary care was 1.66 ± 1.43 and 2.36 ± 1.73, [p = 0.012]; and for emergency care was 1.70 ± 1.43 and 1.06 ± 0.81, [p = 0.002] in the pre-PC and post-PC periods, respectively. The pre-PC Framingham risk in the last year was 14.3% ± 10.6 and the average post-PC was 10.9% ± 7.9.ConclusionPC was effective in the control of blood pressure and total-cholesterolafter discharge of the hypertensive patients from PC program.

Introduction: Managed Entry Agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high-and middle-income countries. Methods: An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior level co-authors including key South American markets. Afterall, involved senior level decision makers and advisers providing guidance on potential advantages and disadvantages of MEAs and ways forward. Results: 25 studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%), and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. Conclusion: We are likely to see a growth in MEAs with the continual launch of new high priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome based MEAs could be an important tool to improve access to new innovative medicines there are critical issues to address. Comparing knowledge, experiences and practices across countries is crucial to guide high-and middle-income countries when designing their future MEAs.

IntroductionOnly 20% of patients with systemic arterial hypertension (SAH) have blood pressure within recommended parameters. SAH has been the main risk factor for morbidity and mortality of cardiovascular diseases, which affects the burden of the Public Health System (PHS). Some studies have shown the effectiveness of Pharmaceutical Care (PC) in the care of hypertensive patients.ObjectiveTo perform a cost-effectiveness analysis to compare SAH treatment with PC management and conventional treatment for hypertensive patients offered by the PHS.MethodsA cost-effectiveness study nested to a quasi-experimental study was conducted, in which 104 hypertensive patients were followed up in a PC program. Blood pressure control was considered as the outcome for the economic analysis and the costs were direct and non-direct medical costs.ResultsPC was dominant for two years in the post-PC period compared with the pre-PC year. The mean cost effectiveness ratio (CER) for the CERPre-PC, CERPC, and CERPost-PC periods were: US$ 364.65, US$ 415.39, and US$ 231.14 respectively. The incremental cost effectiveness ratio (ICER) analysis presented ICER of US$ 478.41 in the PC period and US$ 42.95 in the post PC period. Monte Carlo sensitivity analysis presented mean ICERPC and ICERPost-PC equal to US$ 605.09 and US$ 128.03, reaching US$ 1,725.00 and US$ 740.00 respectively.ConclusionEven for the highest ICER, the values were below the cost effectiveness threshold, which means that PC was a cost effective strategy for the care of hypertensive patients in the PHS.

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CONTEXT AND OBJECTIVE: Dementia is a syndrome characterized by functional and cognitive decline. Alzheimer's disease (AD) is one of the most common causes of dementia and has high prevalence among the elderly. It is known that there is no drug capable of interfering with the course of the disease. Research on treatments for AD has been marked by the appearance of new drugs and their abandonment. This study aimed to describe drugs that have been studied with regard to treating AD and which are capable of influencing the course of the disease. DESIGN AND SETTING: Narrative review on original articles published worldwide. METHODS: A systematized search was conducted in the PubMed/MEDLINE, Cochrane Library/Cochrane and SciELO/Bireme databases. The descriptors "Molecular Mechanisms of Pharmacological Action" and "Drug Therapy" were each combined with the descriptor "Alzheimer disease". All of these can be found in MeSH and DeCS. These descriptors were used alone or in combination, and a filter specifying publication between January 2009 and October 2015 in English, Spanish or Portuguese was set. RESULTS: 6,888 articles were found, of which 37 were included in this review; 70.3% of the articles selected were of good quality with low or unclear risk of bias. 86 drugs were considered promising for AD treatment and these were classified into 20 pharmacological categories. CONCLUSION: There are no drugs capable of influencing the course of AD such that treatments are safe and effective. However, immunomodulators stood out as promising, given their effectiveness and quality in the articles analyzed. RESUMO CONTEXTO E OBJETIVO:A demência é uma síndrome caracterizada por declínio funcional e cognitivo, sendo a doença de Alzheimer (DA) uma das causas mais comuns e de alta prevalência em idosos. Sabe-se que não há medicamento capaz de interferir no curso da doença e as pesquisas para o tratamento da DA têm sido marcadas pelo surgimento e abandono de novas drogas. O objetivo deste estudo foi descrever as drogas capazes de influenciar o curso da DA que têm sido estudadas para o tratamento da doença.

In Brazil, 80% of hypertensive patients have no blood pressure controlled, this fact has caused severe financial consequences for the public health system (PHS) and the Pharmaceutical Care (PC) has emerged as an effective alternative. The aim of this study was to analyze the costs and outcomes of systemic arterial hypertension (SAH) for conventional assistance compared to assistance with PC in the PHS. This is a pharmacoeconomic study with cost-consequence analysis nested to clinical trial. Hypertensives patients were followed-up from 2006 to 2012. During 2009 they were assisted by the PC program in Ribeirão Preto-SP, Brazil. Clinical indicators, systolic and diastolic blood pressure (SBP and DBP), triglycerides, total cholesterol (TC) and its fractions and healthcare indicators, consumption of antihypertensive medication and consultations were analyzed. Costs were listed as direct medical and direct non-medical. The average cost of conventional care for 104 patients followed-up was US$ 198.97, in the PC period and after discharge was US$ 407.91 and US$ 214.96 patient/year. After discharge of patients from PC there was reduction of SBP, DBP, TC and cardiovascular risk, 9.4 mmHg, 4.6 mmHg, 12.0 mg/dL, and 23% [p<0.005], respectively. The PC program optimized clinical and healthcare indicators and impacted in the SAH costs for the PHS.