BackgroundClinical Pharmacy Services (CPS) are a reality in many health systems around the world. However, there are few studies that discuss the facilitators and the strategies to implement CPS in healthcare systems. In this way, the objective of this study was to identify the facilitators and strategies involved in the CPS implementation process in some public health units in a metropolis in the Northeast Brazil.MethodsA qualitative study was carried out with health-system pharmacists and managers who experienced the implementation of CPS. Therefore, focus groups were conducted with pharmacists, and the interviews with the managers. The discussions were carried out through semi-structured scripts and were recorded in audio and videos, after the signature of the consent form. The recordings were transcribed and analyzed independently through content analysis, followed by consensus meetings between researchers.ResultsTwo focus groups were conducted, with an average of seven pharmacists per group, and five interviews with local health managers. Participants reported 39 facilitators who were related to the categories: local healthcare network, healthcare team, pharmacists and implementation process of the CPS. And 21 strategies attributed to the following categories: local healthcare network, pharmacists and implementation process of the CPS.ConclusionsThis study identified facilitators and strategies of the implementation of CPS. Most of the positive experiences were related to the clinical skills and proactive attitudes of pharmacists. These findings may support pharmacists and health managers to implement CPS in health systems.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3403-4) contains supplementary material, which is available to authorized users.

BackgroundCLinical pharmacy services (CPS) are professional services provided by pharmacists, who use their skills and knowledge to take an active role in patient health. These services have expanded in health systems around the world. However, it is important to have a comprehensive understanding of factors that may hinder the implementation of CPS in health systems.ObjectiveTo identify pharmacists’ and managers’ perceptions of barriers regarding the implementation of CPS in some public health units in a metropolis in Northeast Brazil.MethodsThis is a qualitative study based on focus groups and semi-structured, face-to-face, in-depth interviews. Participants were health-system pharmacists and managers, selected based on their direct participation in the implementation process. Focus groups were carried out with the pharmacists, and interviews were carried out with managers. The audio and videos were transcribed verbatim in full, and were independently analyzed using content analysis. This study was approved by the Brazilian Committee of Ethics in Research and all participants signed informed consent forms.FindingsThere were two focus groups and five interviews. The discussions generated 240 minutes of recordings. The health-system pharmacists and managers expressed barriers were allocated into five categories to facilitate a comprehensive understanding of the implementation of CPS; these barriers were related to: the local healthcare networks, the healthcare team, the pharmacists, the implementation process, and the patients.ConclusionsThis study revealed the perceptions of barriers associated with the participants involved in the implementation of CPS in some public health units in a metropolis in Northeast Brazil. The barriers reflect the challenges to be overcome in the CPS implementation process in the health systems.

No abstract

No abstract

No abstract

Introduction Adverse drug reactions (ADRs) to antiinfectives affect especially hospitalized children and contribute to increased morbidity, mortality, length of stay, and costs in healthcare systems. Objective To assess ADRs associated with antiinfectives use in Brazilian hospitalized children. Methods A prospective cohort study was conducted in five public hospitals over six months. Children aged 0 to 11 years and 11 months who were hospitalized for more than 48 hours and prescribed antiinfectives for over 24 hours were included. Results A total of 1.020 patients met the inclusion criteria. Of these, 152 patients experienced 183 suspected ADRs. Most reactions were related to the gastrointestinal system (65.6%), followed by skin reactions (18.6%). Most reactions were classified as probable causality (58.5%), moderate severity (61.1%), and unavoidable (56.2%). Our findings showed that ADRs were associated with increased length of stay (p < 0.001), increased length of therapy (p <0.015), increased days of therapy (p = 0.038), and increased number of antiinfectives prescribed per patient (p < 0.001). Conclusion Almost 15% of hospitalized children exposed to antiinfectives presented suspected ADRs. Their occurrence was classified as probable, of moderate severity, and unavoidable. ADRs were significantly influenced by the length of hospital stay and the number of antiinfectives prescribed per patient.

Introdução: As Reações Adversas a Medicamentos (RAM) em crianças são consideradas importantes problemas para a segurança dos pacientes e para os sistemas de saúde, pois contribuem para o aumento da morbimortalidade e os custos de hospitalização. Dentre os medicamentos, os antibióticos sistêmicos são os principais agentes envolvidos nas reações em crianças hospitalizadas. Assim, conhecer o perfil clínico e epidemiológico dessa população pode contribuir na elaboração de estratégias para melhorar a segurança dos pacientes. Objetivo: Caracterizar o perfil clínico-epidemiológico de crianças com reações adversas a antibióticos internadas em cinco hospitais públicos brasileiros. Metodologia: Foi realizado um estudo de coorte prospectivo, em cinco hospitais públicos no Brasil. Foram incluídas crianças de 0 a 12 anos, em uso de antibióticos por mais de 24 horas e hospitalizadas por no mínimo 48 horas. A coleta de dados foi realizada diariamente, durante seis meses de 2019. Os dados relacionados ao perfil clínico e epidemiológico foram coletados em uma ficha desenvolvida pela equipe de pesquisa. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos de cada centro responsável (SE:2.801.684; CE:3.027.780; RJ:3.264.238; DF:4.273.903; RGS: 3.782.762). Resultados: Durante o período de acompanhamento, 152 crianças apresentaram pelo menos uma RAM causada por antibiótico. A maioria dos pacientes era do sexo masculino 54% (n=83), com idade entre 28 dias e dois anos 57% (n=87). Quanto as características prévias a internação, 30% (n=45) dos pacientes possuíam alguma comorbidade e apenas 9% (n=14) reportaram histórico prévio de alergia a medicamentos. Quanto aos diagnósticos destes pacientes, a maioria tinha uma doença relacionada ao sistema respiratório 58% (n=88), outras infecções 29% (n=44) e doenças de pele 13% (n=20). Quanto ao tempo de hospitalização, apenas 20% (n=31) ficaram hospitalizados entre dois a sete dias, 30% (n=45) entre sete a 15 dias, e metade 50% (n=76) dos pacientes ficaram por um período superior a 15 dias, com média de 48 dias. Em relação ao número de antibióticos prescritos, apenas 25% (n=38) dos pacientes usou um único antibiótico e quase metade 46% (n=70) utilizaram três ou mais antibióticos durante a hospitalização. Conclusão: A maioria dos pacientes que apresentaram uma RAM era do sexo masculino, com idade entre 28 dias a dois anos. Além disso, possuíam uma doença relacionada ao sistema respiratório, ficaram hospitalizados por mais de 15 dias e utilizaram três ou mais antibióticos durante a hospitalização. Esses dados sugerem a necessidade de maior atenção para pacientes com determinadas características, a fim de manter a segurança dos mesmos durante a hospitalização.

No abstract