Daniela Oliveira de Melo

Non-Communicable Disease Clinical Practice Guidelines in Brazil: A Systematic Assessment of Methodological Quality and Transparency

Background Annually, non-communicable diseases (NCDs) kill 38 million people worldwide, with low and middle-income countries accounting for three-quarters of these deaths. High-quality clinical practice guidelines (CPGs) are fundamental to improving NCD management. The present study evaluated the methodological rigor and transparency of Brazilian CPGs that recommend pharmacological treatment for the most prevalent NCDs. Methods We conducted a systematic search for CPGs of the following NCDs: asthma, atrial fibrillation, benign prostatic hyperplasia, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease and/or stable angina, dementia, depression, diabetes, gastroesophageal reflux disease, hypercholesterolemia, hypertension, osteoarthritis, and osteoporosis. CPGs comprising pharmacological treatment recommendations were included. No language or year restrictions were applied. CPGs were excluded if they were merely for local use and referred to NCDs not listed above. CPG quality was independently assessed by two reviewers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II). Main Findings “Scope and purpose” and “clarity and presentation” domains received the highest scores. Sixteen of 26 CPGs were classified as low quality, and none were classified as high overall quality. No CPG was recommended without modification (77% were not recommended at all). After 2009, 2 domain scores (“rigor of development” and “clarity and presentation”) increased (61% and 73%, respectively). However, “rigor of development” was still rated < 30%. Conclusion Brazilian healthcare professionals should be concerned with CPG quality for the treatment of selected NCDs. Features that undermined AGREE II scores included the lack of a multidisciplinary team for the development group, no consideration of patients’ preferences, insufficient information regarding literature searches, lack of selection criteria, formulating recommendations, authors’ conflict of interest disclosures, and funding body influence.

Methodological quality and transparency of clinical practice guidelines for the pharmacological treatment of non-communicable diseases using the AGREE II instrument: a systematic review protocol

BackgroundNon-communicable diseases (NCDs) are the leading cause of death worldwide. Clinical practice guidelines (CPGs) constitute an important tool for the promotion of evidence-based health, which may improve healthcare outcomes for individuals with NCDs. Studies have shown that many CPGs have poor or moderate quality. Therefore, the aim of the proposed study is to systematically identify and appraise CPGs for pharmacological treatment of the most prevalent NCDs in primary care.MethodsA comprehensive literature search will be conducted in the following databases: MEDLINE, Embase and Cochrane Library. Twelve databases specific to CPGs will also be searched. Three appraisers will assess the quality of the CPGs using the Appraisal of Guidelines Research and Evaluation (AGREE) Instrument, version II. The AGREE II results will be checked for discrepancies. Differences between scores equal than or greater to 2 will be considered discrepant and the appraisers will decide the final score by consensus. If no consensus is reached, a fourth appraiser will decide the score. According to the AGREE II User’s Manual, the six domains of the instrument are independent. Thus, each domain score will be calculated by the sum of the individual item scores and scaling the total as a percentage of the maximum possible score for the domain.DiscussionThe AGREE II instrument will be applied to evaluate the quality of CPGs and contribute to enhance the discussion and development of guidelines of high quality. The findings will be submitted for publication in high-impact, peer-reviewed scientific journals and will also be disseminated at international conferences.Systematic review registrationPROSPERO CRD42016043364

A contribuição do farmacêutico para a promoção do acesso e uso racional de medicamentos essenciais no SUS

Objective: to describe the pharmaceutical inclusion process in a Basic Health Unit multidisciplinary team and evaluate results related to rational use and promotion of access to essential medicines. Methods: This is a descriptive, cross-sectional study conducted in a primary care health unit in the city of São Paulo. Pharmacists activities were evaluated regarding the service structure and organization and prescribing quality improvement, guidance method creation, and implementation of clinical pharmacy service. Data measured before and after the interventions and between 2010 and 2011 were analyzed using Pearson´s chi-square test with a significance level of 5%, and odds ratio. Results: Pharmacists activities had statistically significant result in drug shortage reduction; prescribing quality improvement associated with an increased proportion of prescriptions met; decrease in the total of prescribed drugs among patients receiving pharmacotherapeutic follow-up and, comparing the years 2010 and 2011, changes in the pharmacotherapy recommendations have gained increased acceptance level. Conclusions: Pharmacists activities may effectively provide rational use and promotion of access to essential medicines.Objective: to describe the pharmaceutical inclusion process in a Basic Health Unit multidisciplinary team and evaluate results related to rational use and promotion of access to essential medicines. Methods: This is a descriptive, cross-sectional study conducted in a primary care health unit in the city of Sao Paulo. Pharmacists activities were evaluated regarding the service structure and organization and prescribing quality improvement, guidance method creation, and implementation of clinical pharmacy service. Data measured before and after the interventions and between 2010 and 2011 were analyzed using Pearson´s chi-square test with a significance level of 5%, and odds ratio. Results: Pharmacists activities had statistically significant result in drug shortage reduction; prescribing quality improvement associated with an increased proportion of prescriptions met; decrease in the total of prescribed drugs among patients receiving pharmacotherapeutic follow-up and, comparing the years 2010 and 2011, changes in the pharmacotherapy recommendations have gained increased acceptance level. Conclusions: Pharmacists activities may effectively provide rational use and promotion of access to essential medicines.

Capacitação e intervenções de técnicos de farmácia na dispensação de medicamentos em Atenção Primária à Saúde

Few Brazilian articles discuss the importance of pharmacy technicians who offer direct assistance to patients. This paper describes an experience of the training of pharmacy technicians in drug dispensing. A descriptive, cross-sectional study was conducted in the primary healthcare setting. The technicians were trained by the pharmacist to advise patients at the time of drug dispensing and to screen cases that needed pharmaceutical consultation. Problems were identified by verifying the prescription and return date for dispensing the medication as well as through direct questioning of the patients. Flowcharts for problem identification and intervention were created for use by the technicians. After training, pharmacy technicians identified 3944 problems, the most common of which were the use of a lower dosage than that prescribed (26%) and non-adherence to pharmacological treatment. The findings of the present study demonstrate the importance of training pharmacy technicians with regard to dispensing drugs so that they can assist pharmacists in the process of identifying and solving drug-related problems, thereby making them active members of the care process in the public health system.Few Brazilian articles discuss the importance of pharmacy technicians who offer direct assistance to patients. This paper describes an experience of the training of pharmacy technicians in drug dispensing. A descriptive, cross-sectional study was conducted in the primary healthcare setting. The technicians were trained by the pharmacist to advise patients at the time of drug dispensing and to screen cases that needed pharmaceutical consultation. Problems were identified by verifying the prescription and return date for dispensing the medication as well as through direct questioning of the patients. Flowcharts for problem identification and intervention were created for use by the technicians. After training, pharmacy technicians identified 3944 problems, the most common of which were the use of a lower dosage than that prescribed (26%) and non-adherence to pharmacological treatment. The findings of the present study demonstrate the importance of training pharmacy technicians with regard to dispensing drugs so that they can assist pharmacists in the process of identifying and solving drug-related problems, thereby making them active members of the care process in the public health system.

Avaliação de indicadores de qualidade de prescrição de medicamentos em uma unidade de atenção primária com diferentes modelos de atenção

OBJETIVO: descrever os indicadores de prescricao de medicamentos em uma unidade de atencao primaria com diferentes modelos de atencao a saude. METODOS: estudo descritivo, com dados secundarios das prescricoes em uma unidade com tres modelos de atencao a saude - Assistencia Medica Ambulatorial (AMA); Unidade Basica de Saude (UBS); Estrategia Saude da Familia (ESF) - AMA/UBS Vila Nova Jaguare, Sao Paulo-SP, em julho-outubro/2011, sobre indicadores de qualidade. RESULTADOS: foram estudadas 16.720 prescricoes; a proporcao de medicamentos da Relacao Municipal de Medicamentos Essenciais (Remume) foi maior em prescricoes da ESF (98,9%), em relacao a UBS (95,6%) e a AMA (95,7%); igualmente, tanto o emprego do nome generico dos medicamentos quanto a proporcao de medicamentos fornecidos foi superior, comparando-se as prescricoes da ESF (98,9% e 96,1%, respectivamente) com as da UBS (94,4% e 92,9%) e da AMA (94,0% e 92,7%). CONCLUSAO: todos os indicadores de prescricao apresentaram resultados melhores para a ESF.OBJECTIVE to describe drug prescription indicators in a primary health care facility with different models of health care. METHODS this was a descriptive study using secondary data of prescriptions with regard to quality indicators in a health facility that has three health care models: Outpatient Medical Care (OMC), Primary Health Care Unit (PHU) and Family Health Strategy (FHS) in Vila Nova Jaguaré OMC/PHU in São Paulo-SP, Brazil, from July to October 2011. RESULTS 16,720 prescriptions were studied; the proportion of drugs provided through the Municipal List of Essential Drugs (Remume) was higher for FHS prescriptions (98.9%), compared to PHU (95.6%) and OMC (95.7%); similarly, both the use of the generic name of the drugs and the proportion of drugs provided was higher among ESF prescriptions (98.9% and 96.1%, respectively), compared with PHU (94.4 % and 92.9%) and OMC (94.0% and 92.7 %). CONCLUSION all the prescription indicators show better results for FHS.