Objective:To evaluate the clinical impact of a comprehensive medication management (CMM) service in a Brazilian primary health-care setting.Methods:A quasi-experimental study has been carried out between July 2014 and November 2016 with patients who received the service in the primary care setting of a Brazilian city (n = 1057). Factors associated with drug therapy problems (DTP) detection in the initial assessment were evaluated by performing univariate and multivariate analyzes. To evaluate the impact of the CMM service, a linear regression model was constructed from the difference between the initial and final values of the clinical and laboratory parameters adjusted by multiple variables.Results:A total of 1642 DTPs was identified, the most prevalent one being “nonadherence” (31.9%) and the “need for additional drug therapy” (22.9%). The use of 5 or more medications and the presence of 3 or more diseases were positively associated with the identification of 3 or more DTPs during the initial assessment. Even after multiple adjustments, a statistically significant reduction has been observed in the values of glycated hemoglobin, systolic blood pressure, low-density cholesterol, and total cholesterol.Conclusion:The CMM service contributed to the resolution of DTP and showed positive clinical impact in primary health care in the studied setting.

Objective: To estimate the prevalence of drug interactions and associated factors among older adults followed up in a Comprehensive Medication Management Service at Primary Care. Methods: Firstly, the Beers criteria 2015 was used to define drug interactions; later, drug interactions proposed by Dumbreck for patients with diabetes, depression, and heart failure were evaluated. The associated factors were assessed by univariate (Pearson's χ 2 ) and multivariate analyses (logistic regression). The significance level of 5% was set for all analyses. Results: The mean age of the studied population was 70.2±7.8 years; 52.2% were between 60 and 69 years, and 61.3% were female. Among the older adults, 94.5% used two or more drugs (condition for the occurrence of drug-drug interaction). The prevalence of drug interaction according to the Beers criteria was 4.9%. After multivariate analysis, diseases of the central nervous system, arrhythmia, number of medications, and female sex were positively associated with drug interaction. The prevalence of drug interaction according to Dumbreck was 27.2%. After multivariate analysis, the number of medications, the presence of heart failure, and Charlson comorbidity index greater than 1 were conditions positively associated with drug interactions. Conclusion: The holistic and individualized approach used in comprehensive medication management services for older patients is important, considering the prevalence of drug interactions and the need to minimize adverse events.

O armazenamento correto tem por finalidade o fornecimento de medicamentos com parâmetros adequados de qualidade e na quantidade e tempo oportunos para a população. Nesse sentido, o objetivo desse trabalho foi avaliar as condições de armazenamento de medicamentos no almoxarifado e nas Unidades Básicas de Saúde (UBS) do Distrito Sanitário Nordeste de Belo Horizonte. O estudo foi descritivo e quantitativo, realizado no almoxarifado e em 20 UBS. A coleta de dados foi por meio de observação direta, utilizando indicadores propostos pela Organização Mundial de Saúde (OMS). A proporção de alcance de requisitos de condições adequadas de armazenamento foi em média de76,7% por farmácia de UBS e de 83,3% para o almoxarifado. Não foram encontrados medicamentos vencidos. Os itens com pior avaliação foram relativos à estrutura física das unidades e os melhor avaliados se referiram ao processo de trabalho. São recomendadas medidas para que a qualidade dos medicamentos seja preservada e que seu uso racional contribua para a saúde da população, como aumento de investimentos para a estruturação da área física de estocagem dos produtos farmacêuticos.

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Objetivos: Descrever casos de pacientes com coinfecção tuberculose (TB) e HIV/aids acompanhados em um Hospital Referência em doenças infecciosas. Identificar, classificar e resolver os Problemas Relacionados ao uso de Medicamentos (PRM). E classificar a situação clínica e farmacoterapêutica. Métodos: Para a identificação, classificação e resolução do desfecho de PRM bem como a classificação da situação clínica e farmacoterapêutica, utilizou-se a metodologia Pharmacotherapy Workup. Trata-se um estudo observacional, descritivo, longitudinal, do tipo série de casos realizado em Hospital de Referência terciária em Belo Horizonte, seguindo as diretrizes CARE da Enhancing the QUAlity and Transparency Of health Research (EQUATOR). Foram incluídos pacientes coinfectados com TB e HIV/ aids, expostos ao tratamento preconizado pelo Ministério da Saúde, com 18 anos ou mais, de ambos os sexos, acompanhados por um período mínimo de seis meses. Resultados: Foram descritos seis casos de pacientes coinfectados com tuberculose e HIV/aids. A média de encontros com o farmacêutico foi de 6,33 (desvio padrão=0,82). Foram identificados 69 PRM, dos quais 40/69 (58,0%) relacionados à adesão, 17/69 (24,6%) à indicação, 8/69 (11,6%) à segurança e 4/69 (5,8%) à efetividade. Do total de pacientes 4/6 (66,6%) apresentaram hepatotoxicidade durante o acompanhamento. A situação clínica e farmacoterapêutica foi classificada como positiva para todos os pacientes. Conclusão: Houve alto número de PRM de adesão e indicação nos pacientes coinfectados. O monitoramento da efetividade e segurança dos tratamentos deve ser realizado, devido à maior susceptibilidade de reações adversas, como a hepatotoxicidade.

Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy and the stigma related to both diseases are complex. The patients’ subjective experiences with diseases and medications are of utmost importance in pharmaceutical care practice. This study aimed to understand the subjective medication experience of TB and HIV/AIDS coinfected patients. The study was based on descriptive research of a qualitative and quantitative nature using data collected during pharmaceutical care appointments and from medical records from September 2015 to December 2016 at a tertiary infectious diseases referral hospital in Southeastern Brazil. Data from 81 patients were analyzed. Regarding patient subjective medication experience, the following responses to the quantitative questionnaire were most frequent: preference for a route of administration (12.4%) and for non-pharmacological therapy (50.6%); concerns about price (11.1%) and adverse effects (18.5%); and association of a worsening of their health status with a change in medication dosage (23.5%). In the thematic analysis, adversity and socially constructed aspects were more prominent. Resolvability, associated with the patient’s understanding of relief from signs and symptoms and health recovery, was observed; however, feelings of ambivalence permeated the other aspects, hence leading to treatment abandonment. The evaluation of patient medication experience can be a path to understanding and intervening in the phenomenon of treatment abandonment among TB and HIV/AIDS coinfected individuals.

Tennis is the most popular of racket sports, and is practiced by people of all ages with recognised health benefits. As the number of practitioners is growing, more attention should be given to injury patterns, prevention and treatment in professional and non-professional players. According to the few published studies, lower limb injuries are the most common overall, and acute injuries are more common in the lower limbs whereas chronic overuse injuries occur more frequently in the upper limbs and trunk. Wrist lesions are considered relatively rare in tennis. Ulnar pain in this context is caused by injuries of extensor carpi ulnaris (ECU), triangular fibrocartilage, triquetrum-lunate ligament or bone fractures (lunatum, triquetrum and hook of the hamate). ECU tendon disease includes tenosynovitis, tendinopathy, rupture and instability, and these conditions can occur alone or concomitantly.We present a case of sudden onset of ulnar pain during practice, and its diagnostic investigation, treatment plan and process of returning to play. 15 year-old right-handed male, who is an elite junior tennis player (2-3 hours of daily practice), felt sudden ulnar side pain in his right hand after hitting a backhand on practice. There was a moderate amount of swelling and he stopped playing. After 3 days of rest and analgesia (ice, topical and oral NSAIDs), he tried to return to play but he couldn’t, because he was unable to hit backhands. He was referred to us and, on physical examination, pain was elicited on resisted extension combined with ulnar deviation. Ultrasound examination was performed, and on dynamic evaluation (at rest and during supination) ECU tendon instability was identified.The goal of the rehabilitation program was to have him ready to play 12 weeks from the observation, since there was an important tournament then. Cast immobilisation in pronation and extension was recommended, but after 10 weeks (when the cast was removed) pain was still present on hitting the backhand stroke, and so return to play had to be delayed. After 14 weeks the second cast was removed and he started a rehabilitation program including manual therapy, stretching and progressive strengthening of the wrist (from isometric to eccentric exercises), and a program to maintain aerobic conditioning. Return to practice was achieved after 4.5 months and competitive return on 5.5 months after beginning of rehabilitation.Ulnar pain associated with professional or non-professional tennis practice has been described elsewhere, and ECU tendon abnormalities are the most common causes.ECU instability results from disruption or dysfunction of its subsheath, and there is particular risk of injury when the wrist moves from pronation to supination (fixed in flexion and ulnar deviation). In tennis, a two-handed backhand stroke is the shot that is most associated with its injury. Other risk factor identified for ECU injuries was the Western or semi-Western grip, because of the larger amount of top spin used in the backhand shot. In the present case, we believ...

A atenção farmacêutica é a provisão responsável da farmacoterapia e tem o objetivo de alcançar resultados definidos que melhorem a qualidade de vida. Os pacientes com tuberculose, HIV/aids e coinfectados utilizam uma grande quantidade de medicamentos, o que aumenta o risco de apresentarem problemas relacionados ao uso de medicamentos. O objetivo desse trabalho foi verificar as evidências disponíveis na literatura sobre os problemas relacionados ao uso de medicamentos no acompanhamento farmacoterapêutico de pacientes que recebem tratamento para tuberculose, HIV/aids e na coinfecção. Trata-se de estudo de revisão integrativa da literatura, com busca de artigos nas bases de dados literatura latina-americana em ciências e saúde e PubMed. Foram selecionados 18 artigos relacionados ao tema. Em relação à metodologia, oito utilizaram o método Dáder, sete o pharmacist’s workup of drug therapy e três utilizaram outros métodos de classificação de problemas relacionados ao uso de medicamentos. Foram encontrados resultados positivos quando a atenção farmacêutica foi aplicada ao cuidado dos pacientes, identificando menor ocorrência de problemas relacionados ao uso de medicamentos quando havia uma intervenção do farmacêutico com a equipe clínica. Foi observado que a maioria dos problemas relacionados ao uso de medicamentos relatados eram relacionados à segurança do medicamento, seguido de indicação. Estes estudos reforçam a ideia de que a intervenção farmacêutica pode reduzir o número de problemas relacionados ao uso de medicamentos e aumentar a qualidade do cuidado aos pacientes.