Programa de Gestão em Farmácia Pública módulo Saúde Mental: ferramenta gerencial para a assistência farmacêutica em um Centro de Atenção Psicossocial Álcool e Drogas

Este trabalho tem por objetivo geral apresentar uma ferramenta computacional auxiliar na gestão dos serviços farmacêuticos bem como alguns resultados alcançados com a sua aplicação na sistematização do atendimento aos usuários do Centro de Atenção Psicossocial álcool e drogas (CAPS ad) do município de Vitória-ES, conhecido como Centro de Prevenção e Tratamento de Toxicômanos (CPTT). O Programa de Gestão em Farmácia Pública (PGFP) Módulo Saúde Mental possui um formato de banco de dados relacional, desenvolvido sob a plataforma Access e possui interface com o gerador de planilhas e gráficos do tipo Excel , aplicáveis a outras farmácias de unidades do tipo CAPS ad. Desde 2004 vem sendo utilizado e aperfeiçoado com uma proposta de informatizar a administração da farmácia, possibilitando a instrumentalização do farmacêutico via emissão de relatórios para a gestão técnica, operacional e estratégica, além de propiciar a avaliação do serviço baseando-se em indicadores sócio demográficos, de morbidade e específicos da Assistência Farmacêutica voltados para o campo da toxicodependência. Para ilustrar o uso do PGFP são apresentados dados pertencentes a 489 prontuários de usuários cadastrados na farmácia no período de janeiro de 2007 a dezembro de 2008, além de 50 prescrições médicas sistematicamente selecionadas para cada ano, coletadas a partir do sistema. Com isso, foi possível elaborar o perfil demográfico, sóciosanitário dos usuários além de aspectos relacionados a Assistência Farmacêutica local. Foi utilizado o programa computacional SPSS 11.5 for Windows para a análise estatística exploratória descritiva (distribuição de freqüências) e inferencial (teste qui-quadrado) dos dados contidos nos prontuários. Dentre algumas dessas análises, observou-se a prevalência do Crack (44%) como substância psicoativa. Revelou que a maioria dos usuários cadastrados são homens (82,4%), com faixa etária prevalente entre 25 e 34 anos (31,7%) e com grau de escolaridade equivalente ao 1 Grau Incompleto (41,3%). Com relação aos aspectos relacionados a Assistência Farmacêutica pode-se observar um No. médio de medicamentos prescritos por receita entre 1,6 1,7 itens/receita; um percentual mínimo de 96% das receitas atendidas na farmácia; e o Clonazepam como o medicamento mais prescrito no período. São citadas algumas limitações do PGFP e dos dados apresentados. Conclui-se o presente estudo fazendo-se alusão a relevância do Programa de Gestão em Farmácia Pública (PGFP), em relação não somente ao seu potencial de uso na gestão estratégica e operacional da Assistência Farmacêutica em Saúde Mental (álcool e drogas), mas fundamentalmente, como importante ferramenta de informação que propicia a elucidação do perfil da drogadição, despertando a percepção para os aspectos ligados à saúde pública e as implicações sócio-econômicas sobre a população em estudo.

Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

ABSTRACT: BACKGROUND: Chronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda. METHODS: A cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data. RESULTS: Overall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37). CONCLUSIONS: Patients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

The need for and appropriate application of spatial data for disaster management and strengthening community resilience

It is only in recent years that the critical role that spatial data can play in disaster management and strengthening community resilience has been recognised. The recognition of this importance is singularly evident from the fact that in Australia spatial data is considered as soft infrastructure. In the aftermath of every disaster this importance is being increasingly strengthened with state agencies paying greater attention to ensuring the availability of accurate spatial data based on the lessons learnt. For example, the major flooding in Queensland during the summer of 2011 resulted in a comprehensive review of responsibilities and accountability for the provision of spatial information during such natural disasters. A high level commission of enquiry completed a comprehensive investigation of the 2011 Brisbane flood inundation event and made specific recommendations concerning the collection of and accessibility to spatial information for disaster management and for strengthening community resilience during and after a natural disaster. The lessons learnt and processes implemented were subsequently tested by natural disasters during subsequent years. This paper provides an overview of the practical implementation of the recommendations of the commission of enquiry. It focuses particularly on the measures adopted by the state agencies with the primary role for managing spatial data and the evolution of this role in Queensland State, Australia. The paper concludes with a review of the development of the role and the increasing importance of spatial data as an infrastructure for disaster planning and management which promotes the strengthening of community resilience.

A study protocol: A community pharmacy-based intervention for improving the management of sleep disorders in the community settings

Background Sleep disorders are very common in the community and are estimated to affect up to 45% of the world’s population. Pharmacists are in a position to give advice and provide appropriate services to individuals who are unable to easily access medical care. The purpose of this study is to develop an intervention to improve the management of sleep disorders in the community. The aims are: (1) to evaluate the effectiveness of a community pharmacy-based intervention in managing sleep disorders; (2) to evaluate the role of actigraph as an objective measure in monitoring certain sleep disorders, and; (3) to evaluate the extended role of community pharmacists in managing sleep disorders. This intervention is developed to monitor individuals undergoing treatment and overcome the difficulties in validating self-reported feedback. Method/design This is a community-based intervention, prospective, controlled trial, with one intervention group and one control group, comparing individuals receiving a structured intervention with those receiving usual care for sleep-related disorders at community pharmacies. Discussion This study will demonstrate the utilisation and efficacy of community pharmacy-based intervention to manage sleep disorders in the community, and will assess the possibility of implementing this intervention into the community pharmacy workflow.

The Project Data Bank approach to an efficient public investment management system

Includes bibliography

Enhancing health care for type 2 diabetes in Northern Brazil: A pilot study of pharmaceutical care in community pharmacy

To evaluate the impact of a medication therapy management (MTM) program on the clinical outcomes and the quality of life (QoL) of a group of elderly patients with type 2 diabetes mellitus (DM). The study was conducted in a community pharmacy in Aracaju, Brazil, from February to November 2009. A quasi-experimental, longitudinal, prospective study was conducted by intervention. The group patients received medication therapy management from a clinical pharmacist. A sample of convenience was obtained for patients of both genders aged from 60 to 75 years. Monthly visits were scheduled over 10 months. At these consultations, sociodemographic, clinical data were obtained. QoL assessment was conducted using a generic instrument-the Medical Outcomes Studies 36-item Short Form Survey (SF-36 (R)). In total, 34 completed the study. The mean age of the patients was 65.9 (4.7) years. In total, 117 DRPs were identified. Patients' baseline and final evaluation measures for glycosylated hemoglobin, capillary blood glucose, blood pressure, and waist circumference were significantly different (p < 0.05). The domains of QoL assessed by the SF-36 (R) also shows significant differences between patients' baseline and final evaluation scores. The co-responsibility and active participation on the part of the elderly may have helped pharmacotherapy achieve its clinical and humanistic aims.

Management of over-the-counter insomnia complaints in Australian community pharmacies: A standardized patient study

Objective To evaluate the current management of over-the-counter (OTC) insomnia complaints in Australian community pharmacies using standardized patient methodology. Methods Trained standardized patients visited a sample of 100 randomly selected South East Queensland community pharmacies in June 2011. The standardized patients enacted two OTC insomnia scenarios: a direct product request (DPR) (n = 50) and a symptom-based request (SBR) (n = 50). Results of the interactions were documented immediately after each visit and evaluated using the Pharmaceutical Society of Australia's WHAT STOP GO protocol as a standard comparison. Key findings Of all DPRs, 30% were handled entirely by the pharmacist, 70% of staff enquired about specific symptoms and 28% investigated the cause of insomnia. No staff investigated the frequency of product use. The DPR scenario resulted in a 92% supply of the requested doxylamine product (Restavit). In the SBR scenario, 18% of requests were handled entirely by the pharmacist, 58% of staff enquired about specific symptoms and 44% investigated the cause of insomnia. Staff recommended medicated products (38%), or herbal (78%) or non-drug techniques (18%). Investigation into smoking and alcohol intake was not undertaken in DPR or SBR interactions, while questioning on caffeine intake was undertaken in 2 and 14% of cases respectively. There were no significant differences found in the handling of sleep requests by pharmacists compared to pharmacy assistants. Conclusion The standardized patient methodology was a successful way to assess the community pharmacy counselling provided with OTC sleep requests and suboptimal staff responses were found when compared with recommended practice standards.

Community-based Data Validation Practices in Citizen Science

Technology-supported citizen science has created huge volumes of data with increasing potential to facilitate scientific progress, however, verifying data quality is still a substantial hurdle due to the limitations of existing data quality mechanisms. In this study, we adopted a mixed methods approach to investigate community-based data validation practices and the characteristics of records of wildlife species observations that affected the outcomes of collaborative data quality management in an online community where people record what they see in the nature. The findings describe the processes that both relied upon and added to information provenance through information stewardship behaviors, which led to improved reliability and informativity. The likelihood of community-based validation interactions were predicted by several factors, including the types of organisms observed and whether the data were submitted from a mobile device. We conclude with implications for technology design, citizen science practices, and research.

An audit of drug shortages in a community pharmacy practice

Background: There are no firm data on drug shortages in Irish community pharmacy. This prospective observational study aimed to characterise the drug shortage problem in an Irish community pharmacy.
Aims: The primary aim was to determine numbers and durations of drug shortages. Secondary aims included comparing these shortages with Irish Pharmacy Union (IPU) drug shortage lists and determining the frequency with which notifications were received prior to shortages. Further secondary aims were to examine relationships between causes of drug shortages and drug costs and between causes of drug shortages and shortage durations.
Methods: The study took place in a community pharmacy in a Limerick City suburb between October 2012 and February 2013. Data were collected daily regarding drugs that were dispensed, but unavailable to purchase. Suppliers/manufacturers provided data on the reasons for shortages.
Results: 65/1,232 dispensed drugs (5.3 %) were in short supply over the study period. Median shortage duration was 13 days (interquartile range 4–32 days) and median cost was €8.10. Numbers of unavailable drugs by month varied from 13 to 38. Monthly IPU drug shortage lists identified between six and eight of these shortages depending on the month. Two notifications were received from suppliers/manufacturers regarding shortages. Parallel exports had the highest mean costs (mean €38.05) and manufacturing problems were associated with the longest durations (mean 57.44 days).
Conclusions: This study highlights the drug shortage problem in an Irish community pharmacy. We propose that enhanced communication between all stakeholders is the most worthwhile solution. Further studies are needed.

Coronary heart disease risk screening: the community pharmacy Healthy Heart Assessment Service

Objectives We examined the characteristics and CHD risks of people who accessed the free Healthy Heart Assessment (HHA) service operated by a large UK pharmacy chain from August 2004 to April 2006. Methods Associations between participants’ gender, age, and socioeconomics were explored in relation to calculated 10-year CHD risks by cross-tabulation of the data. Specific associations were tested by forming contingency tables and using Pearson chi-square (χ2). Results Data from 8,287 records were analysable; 5,377 were at low and 2,910 at moderate-to-high CHD risk. The likelihood of moderate-to-high risk for a male versus female participant was significantly higher with a relative risk ratio (RRR) 1.72 (P < 0.001). A higher percentage of those in socioeconomic categories ‘constrained by circumstances’ (RRR 1.15; P < 0.05) and ‘blue collar communities’ (RRR 1.13; P < 0.05) were assessed with moderate-to-high risk compared to those in ‘prospering suburbs’. Conclusions People from ‘hard-to-reach’ sectors of the population, men and people from less advantaged communities, accessed the HHA service and were more likely to return moderate-to-high CHD risk. Pharmacists prioritised provision of lifestyle information above the sale of a product. Our study supports the notion that pharmacies can serve as suitable environments for the delivery of similar screening services.

Uptake of a free coronary heart disease risk screening programme in community pharmacy: the Healthy Heart Assessment service

Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.