Divaldo P. Lyra

Virtual patients in pharmacy education.

A review of the literature relating to the use of virtual patients in teaching pharmaceutical care to pharmacy students was conducted. Only 7 articles met the inclusion criteria for the review and 4 of the studies were conducted in North America. Few articles identified by the review used virtual patient technology that was true-to-life and/or validated.

Analysis and detection of dental prescribing errors at Primary Health Care Units in Brazil

Aim of study To analyze dental prescribing errors in Aracaju, Brazil, and to suggest feasible improvements for patient safety. Methods A descriptive study was conducted at nine Primary Health Care Units (PHCUs) in the northeast region of Brazil. A convenience sample of 300 dental prescriptions was selected during the period February–May 2007. The World Health Organization (WHO) prescribing criteria were used to measure the quality of the prescriptions. Main outcome measures All medications were prescribed by generic name; 98.3% of prescription information contained abbreviations and 26% of them were classified as having low legibility or as being illegible. The most commonly prescribed medications were diclofenac (35%), both sodium and potassium, and amoxicillin (26%). Conclusions Dental prescribing errors should be considered as a potential area for improvement in the medication management process and patient safety. We suggest that a pharmacist should be available for medication dispensing at all units and that dentists are trained continuously so that medication orders may become more legible and complete. Improving the quality of dental prescriptions will reduce the risks for medication errors and will promote the rational use of pharmacotherapy, and patient safety.

Pharmaceutical care program for elderly patients with uncontrolled hypertension

OBJECTIVE To evaluate the effect of a pilot pharmaceutical care program developed for elderly patients with uncontrolled hypertension. METHODS Nonrandomized single intervention pre/posttest blood pressure study in a community pharmacy in Aracaju, Brazil. This study enrolled elderly patients diagnosed with essential hypertension and uncontrolled blood pressure. Monthly visits were scheduled during a 10-month period. Pharmaceutical interventions were focused on health education and monitoring of drug-related problems. Primary outcomes included target blood pressure control, reduction in blood pressure, pulse pressure, medication adherence, and reduction of anthropometric indices. RESULTS 35 of 51 patients completed the study. After 10 months of intervention, 57.2% of elderly patients achieved blood pressure control (P = 0.000) and the mean reduction was 26.6 mm Hg (P < 0.0001) for systolic blood pressure, 10.4 mm Hg (P < 0.0001) for diastolic blood pressure, and 15.7 mm Hg (P < 0.0001) for pulse pressure. Medication adherence also improved (P = 0.0000); however, anthropometric indices remained unchanged. CONCLUSION The pharmaceutical care program improved outcomes by reducing and controlling blood pressure and improving medication adherence among elderly patients with uncontrolled hypertension.

Investigating Sources of Heterogeneity in Randomized Controlled Trials of the Effects of Pharmacist Interventions on Glycemic Control in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis

Objective To assess the effect of pharmacist interventions on glycemic control in type 2 diabetic patients and to examine factors that could explain the variation across studies. Methods A comprehensive literature search was performed in PubMed, Scopus, and LILACS databases for randomized controlled trials (RCTs) published up to July 2015. The search strategy included the use of MeSH terms or text words related to pharmacist interventions, type 2 diabetes, and randomized controlled trials. RCTs published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on glycemic control in type 2 diabetic outpatients were included. Two independent authors executed study selection, data extraction, and risk of bias assessment. Mean differences in glycosylated hemoglobin (HbA1c) were estimated using random-effect models, and heterogeneity was evaluated by subgroup and meta-regression analyses. Results The literature search yielded 963 records of potential interest, of which 30 were included in the systematic review and 22 in the meta-analysis. Most of these RCTs were conducted in the United States in patients in outpatient clinics using face-to-face contact only. All RCTs performed patient education, and most executed the medication review. The appraised sample showed uncertain or high risk of bias in most of the items evaluated, resulting in low-quality studies. In comparison with usual care, pharmacist interventions were associated with significant reductions in HbA1c levels (-8.5% [95% CI: -1.06, -0.65]; P < 0.0001; I2 = 67.3%). Subgroup analysis indicated differences of heterogeneity by country, baseline HbA1c levels, setting, intervention frequency, and random allocation. Age and HbA1c levels partly explained the variability across studies by meta-regression. Conclusions Our findings confirmed that pharmacist interventions improve glycemic control in patients with type 2 diabetes compared with usual care and suggest that younger patients or with higher baseline HbA1c levels may be the main beneficiaries of pharmacist care. Protocol PROSPERO Registration Number CRD42014007457

ANALYSIS OF RESEARCH QUALITY REGARDING PHARMACEUTICAL INTERVENTION IN ELDERLY RESIDENTS OF LONG-TERM CARE FACILITIES: A SYSTEMATIC REVIEW

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Kitchen T: initial draft of manuscript, critical revision of manuscript. Coles R and Smith A: conception and design, critical revision of manuscript. Baglioni P: critical revision of manuscript, management of patient. Okosieme OE: conception and design, management of patient, critical revision and final draft of manuscript. Sponsor’s Role: None.

Conceptualizing and measuring potentially inappropriate drug therapy.

Elderly people are the principal consumers of prescription drugs. The more the medication used by the patient, the greater the likelihood there is of the patient being subjected to potentially inappropriate drug therapy (PIDT). PIDT has been measured in the literature with both implicit and explicit tools. The purpose of this review was to assess the use of tools to detect PIDT in various studies and to determine which terms are used to refer to PIDT in practice.

Establishment, Implementation, and Consolidation of Clinical Pharmacy Services in Community Pharmacies Perceptions of a Group of Pharmacists

When pharmacists incorporate clinical practice into their routine, barriers and facilitators influence the implementation of patient care services. Three focus groups were conducted with 11 pharmacists who were working for the Farmácia Popular do Brasil program on the establishment, implementation, and consolidation of clinical pharmacy services. The perception of the pharmacists in Brazil about the program was that it facilitated access to health care and medication. The distance between neighboring cities made it difficult for patients to return for services. Lack of staff training created a lack of communication skills and knowledge. The pharmacists wanted to have increased technical support, skill development opportunities, and monitoring of researchers who assessed progress of the service. Pharmacists overcame many of their insecurities and felt more proactive and committed to quality service. Positive experiences in service implementations have shown that it is possible to develop a model of clinical services in community pharmacies.

Pharmacist–physician collaborative care model for patients with uncontrolled type 2 diabetes in Brazil: results from a randomized controlled trial

RATIONALE, AIMS AND OBJECTIVES This study aimed to evaluate the effect of a pharmacist-physician collaborative care model on clinical outcomes in patients with uncontrolled type 2 diabetes and determine characteristics that influence this effect. METHODS A randomized controlled trial was conducted in a secondary care clinic for 80 patients with type 2 diabetes, aged 40-79 years and glycosylated haemoglobin (A1C) level ≥ 7.0%. The intervention group received individual, face-to-face pharmaceutical consultations and remote telephone support after a routine visit. The main measures were clinical outcomes (A1C, blood pressure, LDL cholesterol) and process indicators (medication adherence, medication regimen complexity, use of medicines). Multiple regression models were used to determine the variables that could explain the reduction and individualized control of A1C. RESULTS From the initial sample of 80 patients, 73 completed this study. Compared with usual care, patients in the intervention group showed greater reduction in A1C (-0.79 vs. -0.16; P = 0.010); and an increase in the percentage of patients achieving the individualized goal of A1C (25.0% vs. 5.4%; P = 0.020). In addition, there was an increase in the percentage of adherent patients and in the average scores of medication adherence. Participation in the intervention group, higher baseline A1C levels and greater change in medication adherence were all significant predictors of improvement in A1C levels. CONCLUSIONS The results suggest that the collaborative care model proposed is feasible and more effective than the usual care in the reduction and individualized control of A1C levels in patients with uncontrolled type 2 diabetes.

Quality analysis of research on the use of benzodiazepines by elderly patients in the emergency room:a systematic review

PurposeTo analyze the quality of research on the use of benzodiazepines (BZDs) in the emergency room by the elderly population through the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative.MethodsA systematic review was carried out according to the following steps: (1) identification of studies, in which studies were selected from different combinations of the descriptors “elderly–aged,” “benzodiazepines,” and “emergency room” in the EMBASE–MEDLINE, SciELO, Scopus, and Web of Science databases; (2) evaluation of studies, in which the title, abstract, and full text of the studies were assessed; (3) evaluation of the methodological quality of the studies. The criteria used were those included in the STROBE recommendations.ResultsAt the end of the selection process, only six articles were identified which met the specific criteria. The sample sizes in these studies varied from 118 to 1,611 patients. More than half (4) of the studies did not describe the type of design used, whereas all collected demographic data and analyzed details on the use of BZDs, such as type administered and/or its relationship to the symptoms, were shown. No article fully complied with the STROBE criteria.ConclusionsThis review shows a lack of methodological quality in the studies performed to date that have evaluated the use of BZDs in elderly patients in emergency rooms. These findings should guide future research in this subject area, providing a more complete approach on aspects related to the use of medications by this specific population.

Risk factors for unintentional medication discrepancies at hospital admission: A matched case-control study

Unintentional medication discrepancies (UMD) are defined as erroneous and unjustified medication changes between the medication use history and the admission medication orders. UMD (e.g., medication omissions, incorrect doses, incorrect frequencies of administration, therapeutic duplications, among others) are distinguished from intentionalmedication discrepancies inwhich adjustments guided by the patients clinical condition are made at the time of admission [1]. Previous studies observed that 14.7% to 66.2% of identified UMD at admission or discharge are able to cause potential damage to patients [1–3]. Discrepancies between the medications patients taken before admission and those listed in their admission orders range from 50% to 70% [1,4–6]. Several studies have investigated the prevalence of UMD, but few have focused on its causes [4,6,7]. Until this date, there are no casecontrol or cohort studies of risk factors for UMD. Therefore, using a prospective case–control study design, we examined potential risk factors for unintended medication discrepancies (UMD) identified at admission among a random sample of hospitalized adult and children patients in the Federal University of Sergipe teaching hospital HU/UFS, in Aracaju, Brazil, betweenApril and July 2013. Patients with at least 1UMD identified at admission were recruited as the case group. Patients without UMD at admission were recruited as the control group. The two groups were matched in terms of age (±2 years, for children;±5years, for adults). At least 1 control patientwas selected for each case patient andmatched on day of hospital admission. Our study included only patients admitted fromMonday to Friday in the surgical, medical and pediatric wards, which remained hospitalized for longer than 24 h. We excluded patients for whom it was not possible to conduct the interview (e.g., the patient was in isolation or unattended) and those whose medical records were not available at the time of evaluation. In the study hospital there were no admissions on weekends. The information collected for each participant included sociodemographic characteristics, medication use and hospitalization related data. A clinical pharmacist and three pharmacy students analysed the data and assessed the presence of UMD. If necessary, a second clinical pharmacist analysed the case until consensus was reached. The evaluation was made in the first 36 h after admission. We did not perform the medication reconciliation process in our study, once it aimed to identify risk factors for UMD. A total of 514 patients were selected for the study, of whom 358 eligible subjects were analysed for this report (113 patients were discharged in b24 h; 30 patients it was not possible to interview and 13 patients there were no access to their medical records). There were