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Moreira PR, de Farias LT, Feitosa AR, Silva LT, Ferreira TXAM, Provin MP, Amaral RG, Modesto ACF. Concordance analysis of two databases to search for potential drug interactions in onco-hematologic patients. J Oncol Pharm Pract 2024:10781552231225187. [PMID: 38291674 DOI: 10.1177/10781552231225187] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Potential drug interactions exert a significant impact on patient safety, especially within intricate onco-hematological treatments, potentially resulting in toxicity or treatment failures. Despite the availability of databases for potential drug interaction investigation, persistent heterogeneity in concordance rates and classifications exists. The additional variability in database agreement poses further complexity, notably in critical contexts like onco-hematology. AIM To analyze the concordance of two databases for researching potential drug interaction in prescriptions for hematological patients at a University Hospital in the Midwest region of Brazil. METHOD Cross-sectional study developed in a Brazilian hospital. The search for potential drug interaction was conducted in Micromedex® and UpToDate®. The variables were: the presence of potential drug interaction, severity, mechanism, management, and documentation. Data was analyzed in terms of frequency (absolute and relative), Cohen's kappa, and Fleiss kappa. RESULTS The presence of potential drug interaction, showed a lack of concordance between the databases (k = -0.115 [95% CI: 0.361-0.532], p = 0.003). Regarding the mechanism, a strong agreement was observed (k = 0.805, p < 0.001 [95% CI: 0.550-0.941]). The management concordance showed a fair agreement, 46.8% (k = 0.22, p < 0.001 [95% CI: 0.099-0.341]). Stratifying the categories, significant concordance was observed in "Adjustment of dose + Monitoring" (k = 0.302, p = 0.018) and "Monitoring" (k = 0.417, p = 0.001), while other categories did not reach statistical significance. CONCLUSION Our study emphasizes the variability in potential drug interaction research, revealing disparities in severity classification, management recommendations, and documentation practices across databases.
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Affiliation(s)
- Pryscila Rodrigues Moreira
- Postgraduate Program in Healthcare and Assessment, School of Pharmacy, Federal University of Goiás, Goiânia, GO, Brazil
| | - Leonardo Teodoro de Farias
- Postgraduate Program in Healthcare and Assessment, School of Pharmacy, Federal University of Goiás, Goiânia, GO, Brazil
| | - Amanda Ribeiro Feitosa
- Multiprofessional Health Residence, Hospital of Clinics - UFG/EBSERH, Federal University of Goias, Goiania, GO, Brazil
| | - Lunara Teles Silva
- Post-Graduate Program in Health Sciences, School of Medicine, Goiania, Federal University of Goias, Goiania, GO, Brazil
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Soares AQ, Melo MA, Silva PID, Chagas VO, Provin MP, Silva MMD, Vila VDSC, Amaral RG. "A lack of information keeps us from medicine, well-being, harmony…": a mixed method study with plaintiffs requesting medicines in administrative cases. Cien Saude Colet 2022; 27:1205-1221. [PMID: 35293456 DOI: 10.1590/1413-81232022273.04122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/22/2021] [Indexed: 11/22/2022] Open
Abstract
The need to request public health managers to ensure the right of access to medicines characterizes an administrative case and the method to do so is called the administrative route. This mixed method study aimed to analyze the perceptions of plaintiffs requesting medications by the administrative route about barriers to access medicines in the Brazilian public health sector. Data were gathered through focus groups and questionnaires. The results point to the interdependence of pharmaceutical services with the interfacing areas to ensure access. The barriers related to individuals reflect the commitment to develop citizenship, justifying the cost of the medicine to motivate the demand. Barriers to service provision include irregular availability of medicines, insufficient resources, and unsatisfactory quality of services. The difficulty in obtaining medical consultations and prescriptions originating in the public sector are barriers to the health sector. The barriers above the health sector are compliance with administrative procedures, corruption, and clientelism. The administrative route intensifies inequities in access to healthcare in Brazil.
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Affiliation(s)
- Amanda Queiroz Soares
- Hospital das Clínicas, Universidade Federal de Goiás. Setor de Farmácia Hospitalar, 1ª Avenida s/n, Setor Leste Universitário, 74605-020. Goiânia GO Brasil.
| | | | - Pedro Ivo da Silva
- Hospital Municipal de Aparecida, Secretaria Municipal de Aparecida de Goiânia. Aparecida de Goiânia GO Brasil
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Silva GS, Modesto ACF, Provin MP, Nahas LC, Barbosa MS, Tavares RS, Ferreira TXAM. ATUAÇÃO DO FARMACÊUTICO NA EQUIPE MULTIPROFISSIONAL DE SAÚDE – UM RELATO DE CASO DE FALHA TERAPÊUTICA POR POSSÍVEL INTERAÇÃO MEDICAMENTOSA E ARMAZENAMENTO INADEQUADO DO MEDICAMENTO EM UM PACIENTE PORTADOR DE LEUCEMIA MIELOIDE CRÔNICA. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.791] [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: 11/30/2022] Open
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Chagas VO, Provin MP, Mota PAP, Guimarães RA, Amaral RG. Institutional strategies as a mechanism to rationalize the negative effects of the judicialization of access to medicine in Brazil. BMC Health Serv Res 2020; 20:80. [PMID: 32013963 PMCID: PMC6998206 DOI: 10.1186/s12913-020-4929-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/05/2019] [Accepted: 01/24/2020] [Indexed: 12/02/2022] Open
Abstract
Background Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, has created challenges and required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. Methods A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs’ disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. Results A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Nonstandardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. Conclusion The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.
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Affiliation(s)
| | - Mércia Pandolfo Provin
- Federal University of Goiás, Goiânia, 38 Luzia Miranda St. Jataí, Goiás, 75800-000, Brazil
| | | | - Rafael Alves Guimarães
- Federal University of Goiás, Goiânia, 38 Luzia Miranda St. Jataí, Goiás, 75800-000, Brazil
| | - Rita Goreti Amaral
- Federal University of Goiás, Goiânia, 38 Luzia Miranda St. Jataí, Goiás, 75800-000, Brazil
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Modesto ACF, Ribeiro AM, Pereira JL, Silva LT, Provin MP, Ferreira PSLAI, Amaral RG, Ferreira TXAM. Evaluation of a method for drug-related problems identification and classification in hospital setting: applicability and reliability. Int J Clin Pharm 2019; 42:193-200. [PMID: 31865595 DOI: 10.1007/s11096-019-00957-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 12/14/2019] [Indexed: 11/26/2022]
Abstract
Background Prescription evaluation by pharmacists has potential to improve pharmacotherapy management. It requires the use of robust methods to identify drug-related problems (DRP), which are important issues in pharmacotherapy. Objective To evaluate the applicability and reliability of Grupo de Investigação em Cuidados Farmacêuticos (GIGUF) method for prescription analysis, identification and classification of drug-related problems in inpatients prescriptions. Setting Department of Medical Clinic of a tertiary and teaching Brazilian hospital. Method An observational and retrospective study of identification and classification of drug-related problems. GIGUF method was used to evaluate prescriptions of hematological patients hospitalized between August and October 2015. The problems were categorized using GICUF-method classification. Three pharmacists performed inter-rater agreement analysis of the method using Kappa. Differences in prevalence of DRP was calculated by age, sex, pharmacotherapy complexity, length of stay and number of drugs. Main outcome measure (a) frequency and characteristics and (b) inter-rater agreement in identification and classification of the drug-related problems. Results A total of 211 problems were identified and 'inadequate dosing' was the most common problem. There was an association between the occurence of a drug-reklated problem and complexity of pharmacotherapy (p = 0.001) and number of drugs used (p = 0.010). The overall inter-rater agreement was moderate (k = 0.44 IC 95% 0.34-0.55) and the problem 'not suitable drug' (k = 0.55 IC 95% 0.44-0.66) had greater inter-rater agreement. Conclusion The method "Evaluation Drug Use Process" was useful for prescription analysis since it made the identification and classification of DRPs possible. The method demonstrated a moderate inter-rater agreement, and can contribute to pharmacotherapy management by hospital pharmacists.
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Affiliation(s)
- Ana Carolina Figueiredo Modesto
- Hospital of Clinics, Federal University of Goiás - UFG/EBSERH, First Avenue, East University District, Goiânia, Goiás, 74605-020, Brazil.
| | - Allyne Marques Ribeiro
- Multiprofessional Health Residence, Federal University of Goiás - UFG/EBSERH, Hospital, First Avenue, East University District, Goiânia, Goiás, 74605-020, Brazil
| | - Jhonata Lima Pereira
- Multiprofessional Health Residence, Federal University of Goiás - UFG/EBSERH, Hospital, First Avenue, East University District, Goiânia, Goiás, 74605-020, Brazil
| | - Lunara Teles Silva
- School of Pharmacy, Federal University of Goiás - UFG, Street 240, Corner with Fifth Avenue, East University District, Goiânia, Goiás, 74605-170, Brazil
| | - Mércia Pandolfo Provin
- School of Pharmacy, Federal University of Goiás - UFG, Street 240, Corner with Fifth Avenue, East University District, Goiânia, Goiás, 74605-170, Brazil
| | | | - Rita Goreti Amaral
- School of Pharmacy, Federal University of Goiás - UFG, Street 240, Corner with Fifth Avenue, East University District, Goiânia, Goiás, 74605-170, Brazil
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Araújo ES, Modesto ACF, Ferreira TXAM, Provin MP, Lima DM, Amaral RG. Pharmaceutical intervention in the rational use of intravenous omeprazole. Einstein (São Paulo) 2019; 18:eAO4433. [PMID: 31939523 PMCID: PMC6924820 DOI: 10.31744/einstein_journal/2020ao4433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/16/2019] [Indexed: 11/05/2022] Open
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Chagas VO, Provin MP, Amaral RG. Administrative cases: an effective alternative to lawsuits in assuring access to medicines? BMC Public Health 2019; 19:212. [PMID: 30786892 PMCID: PMC6381663 DOI: 10.1186/s12889-019-6529-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/11/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although public policy in Brazil supports access to essential medicines, the health system cannot meet all demand. Increasingly, the population has used legal demands to seek access to medicines, an approach that can undermine equitable access by creating policy inconsistencies (e.g., granting access to medicines outside the SUS formulary). In response, the Executive Branch has signed institutional agreements to create an administrative case for submitting requests for medicines directly to the Executive Branch. The objective of this study was to assess the degree to which the administrative cases for requests are in accordance with public policies and guidelines, e.g., if administrative cases results in fewer decisions to purchase outside the SUS formulary. METHODS This descriptive study used secondary data from lawsuits filed against the Executive Branch from 2003 to 2015 and from administrative cases granted by the Executive Branch from 2010 to 2015 in the capital of a state located in the central-western region of Brazil. The variables included plaintiffs' sociodemographic characteristics and diseases as well as the characteristics of the medical products sought via the processes. RESULTS Comparing the requests submitted through lawsuits and the administrative cases revealed differences in the incomes of plaintiffs and the costs of medicines. Both methods for submission recorded requests for medicines for diseases of endocrine and circulatory systems; the only difference was the prevalence of diseases of the genitourinary system in the lawsuits. A higher proportion of lawsuits sought medicines outside the SUS formulary with therapeutic alternatives, while medicines outside the SUS formulary without an alternative were more commonly requested in administrative cases. CONCLUSION Administrative cases adhere to the public policies and guidelines of the SUS. The administrative cases results in fewer decisions to purchase outside the SUS formulary with alternative, and more decisions to purchase drugs for which there is a formulary alternative. In addition, administrative cases provide greater equity by favoring lower income applicants. However, administrative cases also reveal deficiencies in the State's implementation of existing pharmaceutical policies. The public pressure for effective implementation of existing policies may help expand access to medicines.
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Affiliation(s)
- Virginia Oliveira Chagas
- Federal University of Goiás, 388 Residential Breeze from the Woods 37 St. apt 201 Jataí, Goiás, 75800-000 Brazil
| | - Mércia Pandolfo Provin
- Federal University of Goiás, 388 Residential Breeze from the Woods 37 St. apt 201 Jataí, Goiás, 75800-000 Brazil
| | - Rita Goreti Amaral
- Federal University of Goiás, 388 Residential Breeze from the Woods 37 St. apt 201 Jataí, Goiás, 75800-000 Brazil
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Ferreira TXAM, Prudente LR, Dewulf NDLS, Provin MP, Cardoso TC, Silveira ÉAD, Amaral RG. Impact of a drug dispensing model at a Community Pharmacy in Goiânia, Goiás, Brazil. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000400143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Santos TRA, Silveira EA, Pereira LV, Provin MP, Lima DM, Amaral RG. Potential drug-drug interactions in older adults: A population-based study. Geriatr Gerontol Int 2017. [DOI: 10.1111/ggi.13070] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Erika Aparecida Silveira
- Medical School, Post-graduation Program in Health Science; Federal University of Goiás; Goiás Brazil
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Ferreira TXAM, Prudente LR, Dewulf NDLS, Provin MP, Mastroianni PDC, Silveira EAD, Amaral RG. Medication dispensing as an opportunity for patient counseling and approach to drug-related problems. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000100017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The objective was to describe and evaluate a model of drug dispensing developed and implemented in a community pharmacy in Brazil. This was a descriptive, observational, quasi-experimental study performed in the period between 21 January 2013 and 20 April 2013. The model was evaluated and described in terms of three parameters: structure, process and outcome. The description and assessment of each parameter was performed as follows: (I) Structure: profile of patients, pharmacist's professional profile, physical facility, informational material; (II) Process: drug-related problems, pharmaceutical interventions performed, results of pharmaceutical interventions; (III) Outcome: patient knowledge of medications. Dispensing service improved patient knowledge of medications (p < 0.05), which was associated with pharmacotherapy complexity (p < 0.05). The main problems identified were related to lack of patient knowledge regarding their medication (52.9%). Pharmaceutical interventions were mostly performed directly to the patients (86.3%) by verbal (95.4%) and written (68.2%) information, and most of the problems were completely solved (62.7%). The medicine dispensing model was able to identify and solve drug-related problems and promote an improvement in patient knowledge about medication.
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Martins BPR, Aquino ATD, Provin MP, Lima DM, Dewulf NDLS, Amaral RG. Pharmaceutical Care for hypertensive patients provided within the Family Health Strategy in Goiânia, Goiás, Brazil. BRAZ J PHARM SCI 2013. [DOI: 10.1590/s1984-82502013000300023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of Pharmaceutical Care programs is to improve patients' quality of life, and such programs are particularly effective in the case of chronic diseases such as hypertension. The objective of this longitudinal study was to analyze a Pharmaceutical Care model for hypertensive patients receiving care within the Family Health Strategy (FHS). All patients were being seen by an FHS team affiliated to a primary healthcare unit in Goiânia, Goiás, Brazil. Fourteen patients participated in the study, with each patient receiving six home visits during the Pharmaceutical Care. Overall, 142 drug-related problems were reported, the most common concerning the ineffectiveness of treatment (33.8%). A total of 135 pharmaceutical interventions were performed, 92.6% of which involved pharmacist-patient communication, with 48.8% of these interventions being implemented. Cardiovascular risk decreased in three patients and remained unchanged in nine. In hypertensive patients with diabetes, fasting glucose levels were reduced in six out of nine cases. The Pharmaceutical Care model proposed here was effective in detecting drug-related problems and in proposing interventions to resolve or prevent these problems. Consequently, this may have contributed towards improving clinical parameters, such as fasting glucose levels and cardiovascular risk in hypertensive patients receiving care within the FHS.
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Abstract
The aim of this study was to characterize the lawsuits requesting drugs considering the economic profile of their petitioners. All lawsuits (1378) accepted against Goiânia, GO from 2003 to 2007 were analyzed. Petitioners' demographic characteristics, reported diseases, requested drugs, origin of healthcare service, and lawsuit agent were described. Complainants' addresses were georeferenced and distributed into 4 regional groups classified in accordance with the population's average income. Dwellers of wealthier regions filed court actions requesting drugs more frequently, with an average rate of 1.7 lawsuits/1000 inhabitants versus 0.55/1000 in the poorer region. Lawsuit costs were 4-fold higher in wealthier regions compared with the poorest region. Chronic diseases were involved in most lawsuits, where acute and low complexity diseases predominated among complainants living in poorer regions. Thus, social differences were reflected in the granting of health rights.
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Carapinha J, Provin MP, Pinheiro R, Ziganshina L, Khaziakhmetova VN, Chandy SJ, Ishaq GM, Sun J, Zhang L, Suleman F, Pharasi B. Introduction to the new column of the BRICS Medicines Alliance. J Evid Based Med 2013; 6:2-3. [PMID: 23557522 DOI: 10.1111/jebm.12019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Jing Sun
- National Hospital Administration of MOH, China
| | - Lingli Zhang
- West China Second University Hospital, Sichuan University, China
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Abstract
Com vistas no estabelecido na Política Nacional de Medicamentos, a Faculdade de Farmácia da UFG implantou, em parceria com a Secretaria Municipal de Saúde de Goiânia/Goiás, projeto de extensão universitária que propõe a inserção do farmacêutico na Estratégia Saúde da Família. Encontros foram realizados para sensibilização e apresentação do projeto às respectivas unidades de saúde, e a equipe de farmacêuticos local foi treinada para o exercício da atenção farmacêutica. Em 12 meses de desenvolvimento do projeto, 50 pacientes (70% femininos), com idade média de 50 anos, foram assistidos. Entre estes, 40 (80%) apresentavam mais de uma enfermidade associada e 46 (92%) faziam o uso de dois ou mais fármacos, simultaneamente prescritos. Foram detectados 154 Problemas Relacionados com Medicamentos (PRM), com incidência de 3,1 PRM por paciente. O PRM mais frequente foi a falta de efetividade na terapêutica (49%), sendo 26,3% desses devido à falta de adesão ao tratamento. Conclui-se que a problemática envolvida na assistência à saúde devido à falta de eficiência da farmacoterapia assume dimensões importantes. Atenção Farmacêutica como estratégia de Assistência Farmacêutica mostrou-se, potencialmente, capaz de melhorar a assistência à saúde dos usuários do SUS.
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