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Costa S, Biscaia JL, Horta MR, Romano S, Guerreiro J, Heudtlass P, Cary M, Romão M, Teixeira Rodrigues A, Miranda A, Martins AP, Bento AS, Pereira J, Mateus C, Helling DK. Real-World Effectiveness in Hypertension and Hyperlipidemia Collaborative Management between Pharmacies and Primary Care in Portugal: A Multicenter Pragmatic Controlled Trial (USFarmácia ®). Int J Environ Res Public Health 2023; 20:6496. [PMID: 37569036 PMCID: PMC10418740 DOI: 10.3390/ijerph20156496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 08/13/2023]
Abstract
There is evidence of the efficacy of collaborative health interventions with pharmacies and primary care providers but little of its real-world effectiveness. We aimed to assess the effectiveness and discuss the design and challenges of hypertension and hyperlipidemia management between pharmacies and primary care providers using real-world data exchange between providers and experimental bundled payment. This was a pragmatic, quasi-experimental controlled trial. We collected patient-level data from primary care prescription claims and Electronic Medical Record databases, a pharmacy claims database, and patient telephone surveys at several time points. The primary outcomes were changes in blood pressure and total cholesterol. We used matched controls with difference-in-differences estimators in a Generalized Linear Model (GLM) and controlled interrupted time series (CITS). We collected additional data for economic and qualitative studies. A total of 6 Primary Care Units, 20 pharmacies, and 203 patients entered the study. We were not able to observe significant differences in the effect of intervention vs. control. We experienced challenges that required creative strategies. This real-world trial was not able to show effectiveness, likely due to limitations in the primary care technology which affected the sample size. It offers, however, valuable lessons on methods, strategies, and data sources, paving the way for more real-world effectiveness trials to advance value-based healthcare.
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Affiliation(s)
- Suzete Costa
- NOVA National School of Public Health (ENSP), Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Institute for Evidence-Based Health (ISBE), 1649-028 Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - José Luís Biscaia
- USF São Julião da Figueira, Agrupamento dos Centros de Saúde (ACeS) do Baixo Mondego, 3080-134 Figueira da Foz, Portugal
| | - Maria Rute Horta
- Centre for Medicines Information and Health Interventions (CEDIME), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Sónia Romano
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - José Guerreiro
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Peter Heudtlass
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Maria Cary
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Mariana Romão
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias, 1249-069 Lisboa, Portugal
| | - Ana Miranda
- Registo Oncológico Nacional, Instituto Português de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisboa, Portugal
| | - Ana Paula Martins
- Institute for Evidence-Based Health (ISBE), 1649-028 Lisboa, Portugal
- Pharmacy, Pharmacology & Health Technologies, Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisboa, Portugal
| | - Ana Sofia Bento
- USF São Julião da Figueira, Agrupamento dos Centros de Saúde (ACeS) do Baixo Mondego, 3080-134 Figueira da Foz, Portugal
| | - João Pereira
- NOVA National School of Public Health (ENSP), Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal
- Public Health Research Centre (PHRC/CISP), Comprehensive Health Research Centre (CHRC), 1600-560 Lisboa, Portugal
| | - Céu Mateus
- Health Economics at Lancaster, Division of Health Research, Lancaster University, Lancaster LA1 4YX, UK
| | - Dennis K. Helling
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, CO 80045, USA
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Romão M, Bulhosa C, Mendes Z, Sousa C, Silva G, Pereira M, Bernardo F, Teixeira Rodrigues A, Fonseca JA, Correia de Sousa J. Characteristics of Oral Corticosteroid Users Among Persons with Asthma on GINA Step 3 Therapy and Above: A Cross-Sectional Study in Portuguese Community Pharmacies. J Asthma Allergy 2022; 15:1579-1592. [PMID: 36387837 PMCID: PMC9656491 DOI: 10.2147/jaa.s377896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/28/2022] [Indexed: 11/26/2023] Open
Abstract
PURPOSE Oral corticosteroids (OCS) are frequently used in asthma management but have an important risk-profile. The aim of the study is to characterize and compare the sociodemographic and clinical characteristics, treatment regimen and asthma control between OCS users and non-users among the population of asthma patients (≥18 years) at GINA step 3 and above treated with a fixed combination of an inhaled corticosteroid and a long-acting beta-agonist (ICS/LABA). METHODS Cross-sectional study in Portuguese community pharmacies. Data was collected via paper-based interview delivered at the pharmacy (sociodemographic characteristics and asthma treatment regimen, namely ICS/LABA and OCS utilization), followed by a telephonic interview collecting smoking history, comorbidities, body mass index (BMI), history of exacerbations and asthma-related healthcare resource utilization (HCRU) in the previous 12 months, as well as asthma control using the Control of Allergic Rhinitis and Asthma Test (CARAT®). RESULTS A total of 347 patients recruited in 98 pharmacies were included in the analysis. Of those, 328 had completed both questionnaires. A quarter of the individuals reported OCS use in the previous 12 months (OCS users), either as add-on therapy (6%) or exacerbation treatment (19%). Patients were mostly females (72%), with an average age of 59.5 years (SD=15.4). OCS users were significantly older and reported more frequently having conjunctivitis (25.9% vs 15.0%), osteoporosis (25.9% vs 13.4%), arthritis (14.6% vs 6.9%), and gastrointestinal disease (16.1% vs 8.1%). OCS users also reported greater urgent HCRU: unscheduled consultations (33.3% vs 9.3%) and emergency department (ED) visits (32.1% vs 12.1%). Both groups presented poor disease control (85.2% of OCS users vs 72.9% of non-OCS users). CONCLUSION These results highlight the burden of OCS therapy to asthma patients and the need to improve asthma management, by adopting OCS sparing strategies in this subgroup of patients.
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Affiliation(s)
- Mariana Romão
- Centre for Health Evaluation & Research/Infosaude (CEFAR/IS), National Association of Pharmacies (ANF), Lisbon, Portugal
| | - Carolina Bulhosa
- Centre for Health Evaluation & Research/Infosaude (CEFAR/IS), National Association of Pharmacies (ANF), Lisbon, Portugal
| | - Zilda Mendes
- Centre for Health Evaluation & Research/Infosaude (CEFAR/IS), National Association of Pharmacies (ANF), Lisbon, Portugal
| | | | - Graça Silva
- Medical Department, AstraZeneca, Barcarena, Portugal
| | - Mariana Pereira
- MEDIDA – Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | | | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research/Infosaude (CEFAR/IS), National Association of Pharmacies (ANF), Lisbon, Portugal
- Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal
| | - João A Fonseca
- MEDIDA – Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- CUF Allergy Unit, Porto Hospital and Institute, Porto, Portugal
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal
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Costa S, Romão M, Mendes M, Horta MR, Rodrigues AT, Carneiro AV, Martins AP, Mallarini E, Naci H, Babar ZUD. Pharmacy interventions on COVID-19 in Europe: Mapping current practices and a scoping review. Res Social Adm Pharm 2021; 18:3338-3349. [PMID: 34924315 PMCID: PMC8670105 DOI: 10.1016/j.sapharm.2021.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 02/07/2023]
Abstract
Background The COVID-19 pandemic has put community pharmacists at the frontline of prevention, preparedness, response, and recovery efforts. Pharmacies had to reorganize and implement several different interventions and measures within a very short time frame. Objectives 1) To map the current reported practice and trends and to review the literature on pharmacy-based interventions on COVID-19 provided in Europe; 2) To identify knowledge gaps and future avenues for pharmacy research, policy, and practice in response to public health emergencies. Methods We used a mixed methods approach combining country mapping of current practices of pharmacy interventions on COVID-19 reported by pharmacy associations in Europe with a scoping review of published literature. Results We mapped current practices on 31 pharmacy interventions on COVID-19 in 32 countries in Europe. Almost all preventive measures to reduce health risks have been provided in most countries. Other frequent interventions reflected preparedness for stockpiling, increased demand for services and products, and important patient care interventions exceeding dispensing role. Expanded powers granted to pharmacies and legislation passed in view of COVID-19 enabled services that improve access to medicines and relevant products, patient screening and referral including point-of-care antigen testing, support to vulnerable patients, and COVID-19 vaccination. We identified 9 studies conducted in pharmacies in 7 countries in Europe. Most studies are cross-sectional and/or descriptive. Pharmacy associations played an important supporting role by developing and updating guidance and emergency plans to assist community pharmacists. Conclusions A wide array of pharmacy interventions on COVID-19 was implemented in several countries within a very short time frame. Research on pharmacy interventions on COVID-19 is still in its infancy but confirmed the wide array of interventions provided and expanded powers granted to pharmacies. These findings may provide a significant impact to improve pharmacy research, policy, and practice in response to future public health emergencies in Europe and globally.
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Affiliation(s)
- Suzete Costa
- Institute for Evidence-Based Health (ISBE), Faculdade de Medicina da Universidade de Lisboa, Edifício Reynaldo dos Santos, Piso 3, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
| | - Mariana Romão
- Institute for Evidence-Based Health (ISBE), Faculdade de Medicina da Universidade de Lisboa, Edifício Reynaldo dos Santos, Piso 3, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias (ANF), R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal.
| | - Maria Mendes
- Institute for Evidence-Based Health (ISBE), Faculdade de Medicina da Universidade de Lisboa, Edifício Reynaldo dos Santos, Piso 3, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Centre for Medicines Information and Health Interventions (CEDIME), Infosaúde, Associação Nacional das Farmácias (ANF), R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal.
| | - Maria Rute Horta
- Institute for Evidence-Based Health (ISBE), Faculdade de Medicina da Universidade de Lisboa, Edifício Reynaldo dos Santos, Piso 3, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Centre for Medicines Information and Health Interventions (CEDIME), Infosaúde, Associação Nacional das Farmácias (ANF), R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal.
| | - António Teixeira Rodrigues
- Institute for Evidence-Based Health (ISBE), Faculdade de Medicina da Universidade de Lisboa, Edifício Reynaldo dos Santos, Piso 3, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Centre for Health Evaluation & Research (CEFAR), Infosaúde, Associação Nacional das Farmácias (ANF), R. Marechal Saldanha, 1, 1249-069 Lisboa, Portugal.
| | - António Vaz Carneiro
- Institute for Evidence-Based Health (ISBE), Faculdade de Medicina da Universidade de Lisboa, Edifício Reynaldo dos Santos, Piso 3, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Institute for Preventive Medicine and Public Health, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal.
| | - Ana Paula Martins
- Institute for Evidence-Based Health (ISBE), Faculdade de Medicina da Universidade de Lisboa, Edifício Reynaldo dos Santos, Piso 3, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Pharmacy, Pharmacology and Health Technologies, Faculdade de Farmácia da Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003 Lisboa, Portugal.
| | - Erika Mallarini
- SDA Bocconi School of Management, Via Sarfati, 10, 20136, Milano, Italy.
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science (LSE), Houghton Street, London WC2A 2AE, UK.
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, HD1 3DH, UK.
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Romão M, Godinho AR, Teixeira PM, Mendes Z, Bernardo F, Teixeira Rodrigues A, Correia de Sousa J. Characteristics of Reliever Inhaler Users and Asthma Control: A Cross-Sectional Multicenter Study in Portuguese Community Pharmacies. J Asthma Allergy 2021; 14:943-954. [PMID: 34354362 PMCID: PMC8331120 DOI: 10.2147/jaa.s315678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE SABA overuse might indicate poorly managed or uncontrolled asthma and be responsible for poor health outcomes. The aim of this study integrated in new fourth multi-design SABINA+ pillar was to characterize the population using short-acting β2-agonists for asthma and examine the patterns of its use among community pharmacy customers in Portugal, as well as identify characteristics associated with disease control and explore potential differences between GINA treatment steps. PATIENTS AND METHODS This cross-sectional multicenter study was conducted in Portuguese community pharmacies between 29 May 2018 and 15 August 2018. Participants were adults (age ≥18 years) self-reporting asthma diagnosis recruited in the context of a short-acting β2-agonist dispense. A two-part questionnaire (pharmacist interview and self-administered) was used to collect information about sociodemographic characteristics, comorbidities, reliever inhaler use, healthcare resource consumption and self-reported disease control (assessed by the Control of Allergic Rhinitis and Asthma Test - CARAT®). Descriptive statistics was done to characterize the study sample. After categorizing patients according to GINA steps, based on their therapeutic regimen, we performed an exploratory subgroup analysis to evaluate if there were any differences between such groups in terms of the variables collected. A logistic regression was used to identify the potential determinants of overall disease control. RESULTS Around 50.8% of patients were male, and the average age was 52 years old. Half of the patients never smoked, and 51.9% were employed. More than half of the patients report inhaler overreliance - purchasing more than 1 pack in 3 months (65.0%) or using the inhaler on more than 8 days over the previous 4 weeks (50.2%). Of the total number of patients in the study, 79.1% had poorly controlled asthma symptoms, and 78.7% had overall poorly controlled respiratory symptoms. We found statistically significant differences between GINA treatment steps in all sociodemographic characteristics (sex, mean age, education level, employment status); maximum number of SABA uses in 24h, CARAT score (total an asthma sub-score); history of exacerbations requiring ED visits or treatment with OCS for at least 3 days in the previous 12 months. Logistic regression revealed that patients reporting SABA use in more than 8 days in the previous 4 weeks and patients with at least 1 exacerbation requiring treatment with OCS for at least 3 days in the previous 12 months have greater odds of poor disease control [adjusted OR (95% CI): 2.6 (1.3-5.2) and 3.0 (1.3-6.6)]. CONCLUSION Based on the results of this study, it can be inferred that the asthma population using SABA is largely uncontrolled and uses reliever inhalers excessively.
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Affiliation(s)
- Mariana Romão
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Ana Rita Godinho
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Pedro M Teixeira
- Life and Health Sciences Research Institute (ICVS)/3B’s-PT Government Associate Laboratory, University of Minho, Braga, Portugal
| | - Zilda Mendes
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | | | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research/Infosaude – National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS)/3B’s-PT Government Associate Laboratory, University of Minho, Braga, Portugal
- Horizonte Family Health Unit, ULS Matosinhos, Matosinhos, Portugal
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Rodrigues AT, Romano S, Romão M, Figueira D, Bulhosa C, Madeira A, Rocha L, Alves J. Effectiveness of a pharmacist-led intervention on inhalation technique for asthma and COPD patients: The INSPIRA pilot cluster-randomized controlled trial. Respir Med 2021; 185:106507. [PMID: 34166959 DOI: 10.1016/j.rmed.2021.106507] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/31/2021] [Accepted: 06/05/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Asthma and COPD are leading causes of disability-adjusted life-years worldwide representing a huge burden on the health system and among patients. One of the reasons for the lack of disease control is poor inhalation technique, with impact on quality of life and symptom control. OBJECTIVE To assess the effectiveness of a community pharmacist-led educational intervention on asthma and COPD patients' inhalation technique. METHODS The INspira study is a 6-month pilot cluster randomized controlled trial, conducted in community pharmacies of Portugal, enrolling adults aged 18 years or older, with a self-reported diagnosis of asthma or COPD and on inhaled therapy. Pharmacies were randomly allocated to Intervention or Control group. Intervention focused mainly on inhalation technique education via demonstration and repetition. Primary outcome was the proportion of patients scoring 100% in at least one inhaler. RESULTS From January to November 2019, 48 pharmacies recruited 201 asthma and COPD patients, of which 132 completed the 6-month follow-up. At the end of follow-up, the odds of intervention group patients score 100% compared to the control group were 5.63 (95% CI, [2.21; 14.35]) in all inhalers in use and 6.77 (95% CI, [2.52; 18.20]) considering at least one inhaler. Intervention group patients reported having a significantly lower number of scheduled appointments compared with the control group (OR = 0.17; 95% CI, [0.037; 0.79]; p = 0.0135). No other significant differences were found between groups. CONCLUSION This pilot study suggested that pharmacist interventions can improve patients' inhalation technique, with possible positive impact in healthcare resource use.
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Affiliation(s)
- António Teixeira Rodrigues
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal.
| | - Sónia Romano
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Mariana Romão
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Débora Figueira
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Carolina Bulhosa
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Lisbon, Portugal
| | - Anabela Madeira
- Medicines Information Centre/Infosaude - National Association of Pharmacies (CEDIME/IS-ANF), Lisbon, Portugal
| | - Luis Rocha
- Pulmonology Department, Portuguese Oncology Institute of Porto, Porto, Portugal; Occupational Health Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - José Alves
- Portuguese Lung Society, Porto, Portugal
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Romão M, Figueira D, Galante H, Guerreiro J, Romano S. Who are the ostomy patients and caregivers attending Portuguese community pharmacies? A cross-sectional study. BMC Health Serv Res 2020; 20:914. [PMID: 33008370 PMCID: PMC7532616 DOI: 10.1186/s12913-020-05765-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2017, ostomy patients gained access to ostomy products in community pharmacies that are fully reimbursed by the Portuguese National Health Service. This impacted the daily lives of people with ostomy and opened a new market of products and services for pharmacies. However, little is known about the sociodemographic and clinical profile of ostomy patients. This study aims to characterize people with ostomy and their caregivers, evaluate access and satisfaction with the pharmacy and explore participants' expectations regarding services and counselling. METHODS This was an observational, cross-sectional, multicentre study involving pharmacy users who acquired ostomy products in Portuguese community pharmacies. Data were collected through a confidential self-report questionnaire between June and August 2019. RESULTS Approximately 56% of the participants were ostomy patients, of whom 65.9% were men. The average age of participating ostomy patients was 65.5 years old (SD = 12.9), and near 80% were retired/pensioners. Caregivers were mostly women (81.7%). More than half of the caregivers were employed and acquired products for a direct family member. Three in every four surgical interventions were consequences of cancer. Intestinal ostomy was the most common intervention (78.3%). More than 93% were satisfied with the acquisition of ostomy products at the pharmacy. Approximately 48.2% of ostomy patients received care from a specialized nurse. CONCLUSION This study describes the profile of people with ostomy and their caregivers who attend community pharmacies in Portugal. Participants' perceptions of the utility of different proposed services and pharmacist knowledge, as well as the low coverage of ostomy nursing care, highlight the opportunity for an extended role of pharmacists among this group.
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Affiliation(s)
- Mariana Romão
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal
| | - Débora Figueira
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal
| | - Heloísa Galante
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal
| | - José Guerreiro
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal
| | - Sónia Romano
- Centre for Health Evaluation & Research/Infosaude - National Association of Pharmacies (CEFAR/IS-ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal.
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Matias ML, Romão M, Weel IC, Ribeiro VR, Nunes PR, Borges VT, Araújo JP, Peraçoli JC, de Oliveira L, Peraçoli MT. Endogenous and Uric Acid-Induced Activation of NLRP3 Inflammasome in Pregnant Women with Preeclampsia. PLoS One 2015; 10:e0129095. [PMID: 26053021 PMCID: PMC4459873 DOI: 10.1371/journal.pone.0129095] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/05/2015] [Indexed: 12/23/2022] Open
Abstract
Preeclampsia (PE) is a specific syndrome of pregnancy, characterized by hypertension and proteinuria. This pathology is associated with hyperuricemia and elevated serum levels of inflammatory cytokines. Uric acid crystals may activate an intracellular complex called inflammasome, which is important for processing and release of inflammatory cytokines. This study investigated the state of monocyte activation, both endogenous and stimulated with monosodium urate (MSU), by gene expression of NLRP1 and NLRP3 receptors as well as their association with inflammatory cytokines expression. Monocytes were obtained from peripheral blood of 23 preeclamptic pregnant women, 23 normotensive pregnant women (NT) and 23 healthy non-pregnant women (NP). Inflammasome activation was evaluated by the gene expression of NLRP1, NLRP3, caspase-1, IL-1β, IL-18 and TNF-α by RT-qPCR in unstimulated monocytes (endogenous expression), or after cell stimulation with MSU (stimulated expression). The concentration of cytokines was assessed by ELISA. In preeclamptic pregnant women, gene expression of NLRP1, NLRP3, caspase-1, IL-1β and TNF-α by monocytes stimulated or not with MSU was significantly higher than in NT and NP groups. Stimulation of monocytes from preeclamptic and non-pregnant women with MSU induced increased gene expression of NLRP3, caspase-1 and TNF-α in relation to the endogenous expression in these groups, while this was not observed in the NT group. The cytokine determination showed that monocytes from women with PE produced higher endogenous levels of IL-1β, IL-18 and TNF-α compared to the other groups, while the stimulus with MSU led to higher production of these cytokines in preeclamptic group than in the NT group. In conclusion, the results showed increased basal gene expression of NLRP1 and NLRP3 receptors in monocytes from PE group. These cells stimulation with MSU demonstrates that uric acid plays a role in NLRP3 inflammasome activation, suggesting the participation of this inflammatory complex in the pathogenesis of preeclampsia.
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Affiliation(s)
- Mariana Leticia Matias
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil
| | - Mariana Romão
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, Botucatu, SP, Brazil
| | - Ingrid Cristina Weel
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, Botucatu, SP, Brazil
| | - Vanessa Rocha Ribeiro
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, Botucatu, SP, Brazil
| | - Priscila Rezeck Nunes
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, Botucatu, SP, Brazil
| | - Vera Therezinha Borges
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil
| | - João Pessoa Araújo
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, Botucatu, SP, Brazil
| | - José Carlos Peraçoli
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil
| | - Leandro de Oliveira
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil
| | - Maria Terezinha Peraçoli
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, Botucatu, SP, Brazil
- * E-mail:
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Costa RA, Peracoli MT, Romão M, Weel IC, Abbade JF, Peracoli JC. [120-POS]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Medeiros LTL, Peraçoli JC, Bannwart-Castro CF, Romão M, Weel IC, Golim MA, de Oliveira LG, Kurokawa CS, Medeiros Borges VT, Peraçoli MTS. Monocytes from pregnant women with pre-eclampsia are polarized to a M1 phenotype. Am J Reprod Immunol 2014; 72:5-13. [PMID: 24689463 DOI: 10.1111/aji.12222] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/03/2014] [Indexed: 01/16/2023] Open
Abstract
PROBLEM This study evaluated whether the monocyte inflammatory state in pre-eclampsia (PE) might be associated with polarization to either M1 classically or M2 alternatively activated monocyte subsets. METHOD OF STUDY Eighty-five women with (PE) and 52 normotensive (NT) pregnant women matched for gestational age were included. Expression of surface receptors characteristic of M1, such as Toll-like receptor (TLR)2, TLR4, and CD64, or M2, such as CD163 and CD206 monocyte subsets were evaluated in peripheral blood monocytes by flow cytometry. Tumour necrosis factor-alpha (TNF-α), interleukin-(IL)-12p40, IL-12p70, and IL-10 were evaluated in the supernatant of monocyte cultures by ELISA. RESULTS Expression of TLR4 and CD64 by monocytes from pre-eclamptic women was significantly higher, while the expression of CD163 and CD206 expression was significantly lower compared with NT pregnant women. Endogenous production of TNF-α, IL-12p40, and IL-12p70 by monocytes was increased, while synthesis of IL-10 was lower in women with PE than in NT pregnant women. CONCLUSIONS Monocytes from women with PE are classically activated, producing higher levels of pro-inflammatory cytokines, and express surface receptors characteristic of the M1 subset. These results provide evidence that the systemic inflammatory environment in PE may differentiate and polarize these cells to the M1 phenotype.
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Affiliation(s)
- Leonardo T L Medeiros
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
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Romão M, Weel IC, Lifshitz SJ, Peraçoli MTS. Elevated hyaluronan and extracellular matrix metalloproteinase inducer levels in women with preeclampsia. Arch Gynecol Obstet 2013; 289:575-9. [PMID: 24022523 DOI: 10.1007/s00404-013-3021-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/28/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE Preeclampsia (PE) is a specific syndrome of pregnancy clinically identified by hypertension and proteinuria from the 20th week of gestation associated with a systemic inflammatory response and oxidative stress. While pro-inflammatory cytokines have been extensively studied in PE, other factors in the circulation that also influence the magnitude of inflammation have received much less attention. The present study compared serum concentrations of five immune-regulatory compounds in normotensive pregnant women and in women with gestational hypertension (GH) or PE. METHODS Sixty women with PE, 53 with GH and 40 normotensive women paired by gestational age were evaluated. Sera were evaluated for concentrations of extracellular matrix metalloproteinase inducer (EMMPRIN), hyaluronan, gelsolin, visfatin and histone 2B by ELISA. Differences between groups were analyzed by nonparametric tests, with a significance level of 5%. RESULTS Increased levels of EMMPRIN and hyaluronan were present in preeclamptic women as compared to the GH and normotensive groups. There was no difference between groups in gelsolin, visfatin or histone 2B. CONCLUSION Increased release of EMMPRIN and hyaluronan may contribute to an elevated pro-inflammatory response and tissue damage in women with PE.
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Bannwart CF, Nakaira-Takahagi E, Golim MA, de Medeiros LTL, Romão M, Weel IC, Serrão Peraçoli MT. Downregulation of nuclear factor-kappa B (NF-κB) pathway by silibinin in human monocytes challenged with Paracoccidioides brasiliensis. Life Sci 2010; 86:880-6. [DOI: 10.1016/j.lfs.2010.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 04/01/2010] [Accepted: 04/02/2010] [Indexed: 10/19/2022]
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Najmudin S, Carvalho A, Romão M, Guerreiro CIPD, Prates JAM, Correia MAS, Alves V, Ferreira LMA, Gilbert H, Bolam DN, Fontes CMGA. Structure and function of PKD-CBM44 and CBM30 modules of the bifunctional Clostridium thermocellumcellulase, CtCel9D-Cel44A. Acta Crystallogr A 2006. [DOI: 10.1107/s0108767306097224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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