Reduction of cardiovascular risk in patients with metabolic syndrome in a community health center after a pharmaceutical care program of pharmacotherapy follow-up

Abstract

The objective of this study was to determine the impact of a pharmaceutical care (PC) program in a sample of public outpatients with metabolic syndrome (MS) who were being treated in Brazil's health system; the patients were randomized into PC or standard care. The pharmacotherapy follow-up (PF) was performed in a total of 120 patients with type 2 diabetes for 6 months. Adherence to treatment (measured with the Morisky test), negative outcomes associated with medication (NOM) and anthropometric and biochemical parameters were measured before and after PF. The Framingham scoring method was used to estimate changes in 10-year coronary heart disease risk scores in all patients. Ninety-six of 120 patients had characteristics of MS and were randomized into two groups (G): the control group (CG: 36) and the intervention group (IG: 38). Among the MS patients, 100% were taking a glucose-lowering drug; many were also taking anti-hypertensive drugs (CG: 72%; IG: 73%), and some patients were also taking hypolipemic drugs (CG: 12.0%; IG: 14.7%). Only 20.7% of the IG patients were considered adherent to their prescribed drugs. In the CG, an increase of coronary heart disease (CHD) risk (22±2 to 26±3; p<0.05) was observed, while in the IG, there was a reduction in CHD risk (22±2 to 14±2%; p<0.01). The PC program administered to patients with MS monitored through the primary healthcare services of the Brazilian public health system improved patient health, resulting in clinical improvements and a decrease in cardiovascular risk in IG patients over a period of ten years.<br>O objetivo deste estudo foi o de determinar o impacto de um Programa de atenção Farmacêutica (AF) em uma amostra de pacientes ambulatoriais de Sistema Público de Saúde do Brasil portadores de Síndrome Metabólica, randomizados em AF ou atenção à saúde usual. Realizou-se o seguimento farmacoterapêutico com 120 pacientes com diabetes tipo 2 durante seis meses. Avaliou-se o nível de aderência ao tratamento (teste Morisky), resultados clínicos negativos associados a medicamentos (RNM), parâmetros bioquímicos e antropométricos, antes e após o seguimento. O método de Framingham foi usado para calcular as variações no risco de doenças coronarianas em 10 anos em todos os pacientes. Dos 120 pacientes, 96 tiveram características de SM e foram então randomizados em dois grupos (G): Controle (GC: 36) e Intervenção (GI: 38). Entre os pacientes com SM, 100% faziam uso de medicamentos para diminuir a glicose, anti-hipertensivos (GC: 72%; GI: 73%) e hipoglicemiantes (GC: 12.0%; GI: 14.7%). Apenas 20,7% do GI foram considerados aderentes aos fármacos prescritos. No GC foi observado aumento do risco de Doença Arterial Coronariana (DAC) (22±2 para 26±3; p<0,05), enquanto no GI foi observado redução (22±2 para 14±2%; p<0,01). O Programa de AF para pacientes com SM monitorados na atenção primária do Sistema de Saúde Pública brasileiro melhora o funcionamento do serviço resultando na melhoria clínica dos pacientes com redução do risco de doença cardiovascular em um período de dez anos

Cardiovascular risk rate in hypertensive patients attended in primary health care units: the influence of pharmaceutical care

“…These results were shared by other studies that evaluated the effect of a pharmaceutical intervention on cardiovascular risk in other countries (Al Mazroui et al, 2009;Zhao et al, 2012;Amariles et al, 2012) and in Brazil (Lyra Junior et al, 2011;Firmino et al, 2012;Plaster, Melo, 2012;Martins, Aquino, 2013).…”

“…In turn, the "control" group showed no reduction in the systolic blood pressure. One can then infer that the pharmaceutical care was able to positively influence the reduction of systolic blood pressure values of the assisted patients/users, as inferred in previous studies (Lyra Junior et al, 2011;Firmino et al, 2012;Plaster, Melo, 2012;Zhao et al, 2012;Morgado, Rolo, Castelo-Branco, 2011).…”

“…In the "control" group, reductions in average of total cholesterol and its LDL fraction were also identified; however, the average of HDL had a minimal variation to below the initial value, unlike the group under PTF. Unfortunately, none of these changes achieved statistical significance, going against the results reported in a review (Eizerik, Manfroi, 2008) and more recent studies done in the country (Lyra Junior et al, 2011;Plaster, Melo, 2012).…”

“…This fact hinders the observation of sufficiently large difference between the values so that there was statistical significance, considering the number of study patients. Probably in a study with a larger number of participants or that included only hypertensive patients with both uncontrolled systolic and diastolic blood pressure levels a statistically significant difference would have been observed as showed in previous studies (Lyra Junior et al, 2011;Plaster, Melo, 2012;Morgado, Rolo, CasteloBranco, 2011). Although this fact was also reported before (Firmino et al, 2012;Al Mazroui et al, 2009).…”

Pharmacotherapy follow-up in elderly in a public outpatient clinic in Brasilia, Brazil

“…Integrating a clinical pharmacist to the staff has shown to reduce the number of prescribed medications, to improve the adhering profile to the therapeutic scheme, to reduce the number of admissions due to NOM and adverse drug reactions (ADR). Moreover, it has shown to decrease health assistance costs, fostering improvement of the patient's quality of life altogether (Aguiar et al, 2012;Balisa-Rocha et al, 2014;Castro et al, 2006;Chisholm-Burns et al, 2010;Correr et al, 2011;Hayward et al, 2015;Lyra Jr et al, 2008;Mansoor et al, 2014;Morgado et al, 2011;Plaster et al, 2012;Scotti et al, 2013;Souza et al, 2007;Stewart et al, 2014).…”