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10. Consumption patterns and factors associated with inappropriate prescribing of benzodiazepines in Primary Health Care settings.

Author

Barboza Zanetti, Maria Olívia, dos Santos, Iara, Durante, Júlia Casanova, Varallo, Fabiana Rossi, Pereira, Leonardo Régis Leira, and Miasso, Adriana Inocenti

Subjects
MEDICAL personnel, INDEPENDENT variables, INAPPROPRIATE prescribing (Medicine), PRIMARY health care, OLDER people
Abstract

Background: Benzodiazepines are frequently prescribed to treat anxiety and insomnia, but long-term use has been associated with the development of dependence, tolerance, and cognitive decline, especially among older adults. This study aimed to investigate the pattern of consumption and factors associated with inappropriate prescribing of benzodiazepines in primary health care. Methods: This is a cross-sectional analytical study, using dispensing records of diazepam, clonazepam, and nitrazepam from public pharmacies in a Brazilian municipality between 2018 and 2022. Metrics for benzodiazepine consumption were DDD (Defined Daily Dose) and DDD/1000PD (per 1000 population per day). Long-term/prolonged benzodiazepine use was defined as consuming at least 90 DDD and at least 2 dispensations per year. To ascertain associations between long-term use and predictor variables, a multivariate logistic regression model was utilized. Findings: A total of 40402 participants were included, with an average age of 55 years (SD = 0.30), 38.5% were older aged. Diazepam and nitrazepam exceeded the daily dose recommended. There was a reduction in diazepam consumption during the study period, as calculated by DDD/1.000PD, while the consumption of other benzodiazepines remained stable. However, a significant increase in diazepam consumption is noted when considering the last decade. Prolonged use was observed in 29.1% of participants, with a significant prevalence among the older people (34.8% of them were long-term users) and advancing age was identified as a risk factor for long-term use. Higher PDDs were also associated with long-term use and aging. Participants who used different benzodiazepines during the period had a higher risk of prolonged use. Conclusions: These results provide insights into the prevalence of problematic utilization of benzodiazepines in primary health care. Authorities and health care providers must take steps to encourage gradual cessation of prolonged benzodiazepine prescriptions and the embrace of suitable strategies for addressing anxiety and insomnia within primary health care settings. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Analysis of clinical outcomes in older individuals who received pharmaceutical care and posthospital discharge follow‐up.

Author

de Oliveira, Alan Maicon, Rodrigues, João Paulo Vilela, Campos, Marília Silveira de Almeida, Varallo, Fabiana Rossi, and Pereira, Leonardo Régis Leira

Subjects
ELDER care, PATIENT safety, DRUG side effects, RESEARCH funding, PATIENT readmissions, DISCHARGE planning, MEDICATION reconciliation, MEDICATION error prevention, PATIENT care, PATIENT-centered care, HOSPITAL pharmacies, MEDICAL practice
Abstract

Background: Previous evidence underscores the need to assess potential clinical outcomes resulting from pharmaceutical care interventions and to monitor patient's progress to evaluate their clinical evolution, which is crucial for bolstering the relevance of implementing pharmaceutical care in healthcare services. Aims: To conduct an in‐depth analysis of pharmaceutical care practices in a geriatric ward and monitor the clinical outcomes of older people served. Methods: This interventionist study was conducted in the geriatrics ward of a Brazilian university hospital. The research intervention occurred between January and May 2022, with a follow‐up conducted for up to 90 days after patients' hospital discharge. Older patients in the geriatrics ward received pharmaceutical care, including medication reconciliation, medication review, and pharmacotherapeutic follow‐up, aimed at identifying and resolving drug‐related problems (DRPs). The clinical relevance of DRPs and pharmaceutical recommendations was evaluated. Additionally, analyses were conducted on mortality and rehospitalization outcomes in older patients at 30, 60, and 90 days following initial hospital discharge. Results: Of the patients evaluated, a significant 88.3% exhibited at least one DRP (with an average of 2.6 ± 1.9 DRPs per patient), with the majority classified as need/indication problems (38.9%). The acceptance rate of pharmaceutical recommendations was 80.9%, with the majority categorized as very significant relevance (60.4%). DRPs were predominantly of serious clinical relevance (50.9%). In patients whose clinical indicators could be monitored, 95.5% showed some clinical response (in vital signs, laboratory tests and/or clinical status evolution) potentially related to resolved DRPs. Association analysis revealed that a higher number of medications in use before hospitalization correlated with a greater identification of DRPs during hospitalization (p = 0.03). At hospital discharge, 23.6% of patients were no longer using polypharmacy. In total, 16 patients (26.7%) died during the study period. Among patients who did not die during hospitalization (n = 54), 20 patients (37%) experienced rehospitalizations within 90 days following discharge. Conclusion: This study facilitated the consolidation of pharmaceutical care implementation in a geriatric ward. We conducted identification, evaluation, and proposed evidence‐based solutions, as well as monitored cases for outcome analysis. It is anticipated that this methodology will inspire future research and the implementation of pharmaceutical care‐related services. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Validated medication deprescribing instruments for patients with palliative care needs a systematic review

Author

de Andrade, Frangie Kallas, primary, Nunes, Raziel Prado Ignacio, additional, Zanetti, Maria Olívia Barboza, additional, Zanetti, Ariane Cristina Barboza, additional, dos Santos, Márcia, additional, de Oliveira, Alan Maicon, additional, Carson-Stevens, Andrew, additional, Pereira, Leonardo Régis Leira, additional, and Varallo, Fabiana Rossi, additional

Published
2023
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22. What types of clinical interventions do pharmacists carry out in hospitals for patients receiving palliative care?

Author

Cavalcante-Santos, Lincoln Marques, de Oliveira, Alan Maicon, da Silva, Emília Vitória, Rodrigues, João Paulo Vilela, Pereira, Leonardo Régis Leira, and Varallo, Fabiana Rossi

Subjects
MEDICAL information storage & retrieval systems, CRITICALLY ill, PATIENTS, PALLIATIVE treatment, RESEARCH funding, HOSPITALS, SYSTEMATIC reviews, MEDLINE, PATIENT-centered care, LITERATURE reviews, QUALITY of life, ONLINE information services, QUALITY assurance, HEALTH care teams
Abstract

Palliative care is a multi-dimensional practice that comprises medical, physical, social and spiritual interventions aimed at the improvement of the patient's quality of life. Given the level of reliance on drugs in this care setting, pharmacists are professionals who can promote the rational use of medicines, optimizing symptom management through evidence-based and patient-centered medication therapy. The aim of this study is to identify and map the existing evidence on the types of clinical interventions conducted by pharmacists, whether independently or in collaboration with the multidisciplinary team, within hospital settings and for patients receiving palliative care. A scoping review was conducted using three electronic databases (PubMed, EMBASE, and Virtual Health Library) to search for relevant studies published until January 2022. Three independent reviewers screened all publications to identify interventions conducted by pharmacists in palliative care patients admitted to hospitals. The DEPICT tool was utilized for data extraction and classification to synthesize the interventions. Twenty-eight studies were included in this review. The United States of America and Japan were the countries where most research was conducted (n = 7 for both). Interventions related to pain management were the most common (n = 10), followed by the provision of general drug information (n = 8) and drug recommendations (n = 7). Thirteen studies reported the inclusion of a pharmacist in the multidisciplinary team. The majority of publications (n = 18) concluded that the interventions performed had a relevant impact on patient health, such as pain control, deprescription of inappropriate drugs, and cost reduction. [ABSTRACT FROM AUTHOR]

Published
2024
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29. Apresentação

Author

Melgarejo, Celsa Raquel Villaverde, primary, Mastroianni, Patricia de Carvalho, additional, and Varallo, Fabiana Rossi, additional

Published
2019
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36. Considerações finais

Author

Melgarejo, Celsa Raquel Villaverde, primary, Mastroianni, Patricia de Carvalho, additional, and Varallo, Fabiana Rossi, additional

Published
2019
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42. Experiences and strategies adopted for the implementation of pharmaceutical services in geriatric wards: a scoping review

Author

Rodrigues, João Paulo Vilela, Pereira, Leonardo Régis Leira, Thalita Zago Oliveira, De Souza, Isabella Do Vale, De Oliveira, Alan Maicon, and Varallo, Fabiana Rossi

Subjects
Hospital Pharmacy Services, Pharmaceutical care, Geriatrics, Pharmaceutical Services, Medicine and Health Sciences, Medical Specialties, Pharmacy and Pharmaceutical Sciences
Abstract

This scoping review aims to identify the experiences and strategies used to implement pharmaceutical services in hospital geriatric wards.

Published
2023
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43. Pharmacoresistant epilepsy in adult patients: a cross-sectional study on pharmacotherapeutic characteristics, access, knowledge, and treatment adherence

Author

Mencucini, Paula Sousa França, primary, Campos, Marília Silveira de Almeida, additional, Lopes, Vinícius Detoni, additional, Rodrigues, João Paulo Vilela, additional, Inouye, Fabiana Coelho, additional, Zanetti, Maria Olívia Barboza, additional, Varallo, Fabiana Rossi, additional, and Pereira, Leonardo Régis Leira, additional

Published
2023
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46. Protocolo para la implementación de la atención farmacéutica en geriatría: estrategia de seguridad en la atención sanitaria

Author

Oliveira, Alan Maicon de, Varallo, Fabiana Rossi, Rodrigues, João Paulo Vilela, and Pereira, Leonardo Régis Leira

Subjects
Grupo de atención al paciente, Patient-centered care, Seguridad del paciente, Atención dirigida al paciente, Equipe de assistência ao paciente, Evidence-based pharmacy practice, Patient care team, Práctica farmacéutica basada en la evidencia, Geriatría, Patient safety, Geriatrics, Segurança do paciente, Assistência centrada no paciente, Prática farmacêutica baseada em evidências, Geriatria
Abstract

Objective: To describe the experience of the implementation of pharmaceutical care in a geriatric hospital unit and to propose an instructional protocol for the practice. Methods: Experience report that became the practice manual of pharmaceutical care in geriatrics (MaP-CFarmaGeri) of a Brazilian hospital and was structured in three topics (1. Situational diagnosis; 2. Adequacy of the procedure and service provision; 3. Practice exercise). Results: The situational diagnosis comprised the collection of data on the structure of the ward and the epidemiological profile. The pharmaceutical services provided included pharmacotherapeutic follow-up, medication reconciliation and pharmacotherapy review. The certification of the content of this procedure was attested by specialists from a multiprofessional team and the technique served more than 60 patients in practice, with good acceptance by the participants. Final considerations: The MaP-CFarmaGeri proved to be a satisfactory strategy in the implementation of pharmaceutical care in geriatrics and can support this insertion in similar locations. RESUMEN Objetivo: Describir la experiencia de implementar la atención farmacéutica en una unidad hospitalaria geriátrica y proponer un protocolo instructivo para la práctica. Métodos: Informe de experiencia que se convirtió en el manual de la práctica de la atención farmacéutica en geriatría (MaP-CFarmaGeri) de un hospital brasileño y se estructuró en tres temas (1. Diagnóstico situacional; 2. Adecuación del procedimiento y prestación del servicio; 3. Ejercicio de práctica). Resultados: El diagnóstico situacional comprendió el relevamiento de datos sobre la estructura de la sala y el perfil epidemiológico. Los servicios farmacéuticos ofrecidos incluyeron seguimiento farmacoterapéutico, conciliación de medicamentos y revisión de farmacoterapia. La certificación del contenido de este procedimiento fue certificada por especialistas de un equipo multidisciplinario y la técnica trató a más de 60 pacientes en la práctica, con buena aceptación por parte de los participantes. Consideraciones finales: El MaP-CFarmaGeri demostró ser una estrategia satisfactoria en la implementación de la atención farmacéutica en geriatría y puede apoyar esta inserción en lugares similares. RESUMO Objetivo: Descrever a experiência da implantação do cuidado farmacêutico em uma unidade hospitalar de geriatria e propor um protocolo instrutivo da prática. Métodos: Relato de experiência que se converteu no manual da prática do cuidado farmacêutico na geriatria (MaP-CFarmaGeri) de um hospital brasileiro e foi estruturado em três tópicos (1. Diagnóstico situacional; 2. Adequação do procedimento e oferta do serviço; 3. Exercício da prática). Resultados: O diagnóstico situacional compreendeu o levantamento dos dados sobre a estrutura da enfermaria e o perfil epidemiológico. Os serviços farmacêuticos ofertados incluíram o acompanhamento farmacoterapêutico, com a conciliação de medicamentos e a revisão da farmacoterapia. A certificação do conteúdo desse procedimento foi atestada por especialistas de uma equipe multiprofissional e a técnica atendeu mais de 60 pacientes na prática, com boa aceitação dos participantes. Considerações finais: O MaP-CFarmaGeri mostrou ser uma estratégia satisfatória na implantação do cuidado farmacêutico na geriatria e pode amparar essa inserção em locais semelhantes.

Published
2022

48. Estudo infodemiológico das tendências de buscas relacionadas à COVID-19 no Brasil

Author

Oliveira, Thalita Zago, Cunha, João Paulo Alves, Lopes, Vinícius Detoni, Rodrigues, João Paulo Vilela, Cavalcante Santos, Lincoln Marques, Varallo, Fabiana Rossi, and Pereira, Leonardo Régis Leira

Subjects
Coronavirus, Infodemiología, Vacunas, Coronavírus, Vaccines, Vacinas, COVID-19, Coronavrius, Early treatment, Infodemiology, Infodemiologia, Tratamento precoce, Tratamiento temprano
Abstract

After the World Health Organization (WHO) declared the COVID-19 pandemic, searches related to this subject generated an infodemic. In this sense, the infodemiology field allows understanding the population behavior on the internet. The aims of this study were to analyze, through the application Google Trends, the evolution of internet search trends on medicines related to COVID-19 in the Brazilian context and the impact of specific political, healthcare and scientific events that occurred on this trend. Terms (n=52) and events (n=38) between December 8, 2019 and May 31, 2021 were selected according to the purpose of the study and the researchers' prior scientific knowledge. Statistical analysis was applied to assess interest in the selected terms before and after the events, their association with the predictor variable “percentage of first vaccine doses applied” and the influence of the type of event on the search interest. Our results showed an increase in searches for information related to medicines that are part of the “Kit Covid” or “Tratamento Precoce”, as well as “Vacina” and “Vacinas” shortly after the declaration of the COVID-19 pandemic by the WHO. As for drugs approved for the treatment of COVID-19 in Brazil, the search was greater during the first and second waves of COVID-19 and, with the advancement of vaccination, the searches for “ivermectina” and “hidroxicloroquina” decreased. The data presented bring to light the demand for knowledge about medicines by the Brazilian population in a pandemic scenario where having access to information is immediate, but not always reliable. Después del anuncio de la Organización Mundial de la Salud de la pandemia COVID-19, búsquedas relacionadas con el tema generaron una infodemia. En este contexto, la infodemiologia ofrece uma explicación de la conducta en la internet. Los objectivos del estudio fueron analizar, a traves del Google Trends, la evolución de las tendencias de búsquedas sobre medicamentos relacionados con COVID-19 en Brasil y la repercusión de ciertos eventos políticos, sanitarios y científicos sobre esta tendencia. Los términos (n=52) y los eventos (n=38) entre 08 de diciembre y 31 de mayo de 2021 fueron selecionados de acuerdo con los objectivos del estudio y conocimiento científico previo de los investigadores. El análisis estadístico, fue aplicado para evaluar el interés por los términos antes y después del evento, la asociación con la variable “pocentaje de primeras dosis aplicadas”, así como la influencia de la classe de acontecimiento en la búsqueda. Los resultados indican un aumento de las búsquedas sobre medicamentos del “Kit Covid” o “Tratamento Precoce”, así como “vacina” y “vacinas” luego de la declaración de pandemia COVID-19 por la OMS. Relativo a los fármacos aprobados para el tratamento de la COVID-19 en Brasil, la búsqueda ha sido más grande durante la primeira y segunda olas de la COVID-19, mientras que con el avance de la vacunación, las búsquedas por “ivermectina” y “hidroxicloroquina” disminuyeron. Los datos indicaron un interés por conocimiento sobre medicamentos por los brasileños en una situación de pandemia cuyo acceso a la información es imediato, pero ni siempre confiable. Após o anúncio da Organização Mundial da Saúde (OMS) sobre a pandemia por COVID-19, buscas relacionadas ao tema geraram uma infodemia. Neste contexto, a infodemiologia permite a compreensão da tendência de comportamento na internet. Os objetivos deste estudo foram analisar, por meio do Google Trends, a evolução das tendências de buscas na internet sobre medicamentos relacionados ao COVID-19 no contexto brasileiro e o impacto de determinados eventos políticos, sanitários e científicos que ocorreram sobre essa tendência. Os termos (n=52) e os eventos (n=38) entre 08 de dezembro de 2019 e 31 de maio de 2021 foram selecionados de acordo com o objetivo do estudo e o conhecimento científico prévio dos pesquisadores. Análise estatística foi aplicada para avaliar o interesse nos termos selecionados antes e após o evento, a associação deste com a variável preditora “porcentagem de primeiras doses aplicadas”, além da influência do tipo de evento no interesse pela busca. Nossos resultados mostraram um aumento das buscas sobre informações relacionadas aos medicamentos que fazem parte do “Kit Covid” ou “Tratamento Precoce”, assim como “Vacina” e “Vacinas” logo após a declaração de pandemia por COVID-19 pela OMS. Quanto aos fármacos aprovados para tratamento de COVID-19 no Brasil, a busca foi maior durante a primeira e segunda ondas da COVID-19 e com o avanço da vacinação, as buscas por “ivermectina” e “hidroxicloroquina” diminuíram. Os dados apresentados trazem à tona a procura por conhecimento sobre medicamentos pela população brasileira em um cenário pandêmico cujo acesso à informação é imediato, mas nem sempre confiável.

Published
2022

49. sj-doc-1-opp-10.1177_10781552211073469 - Supplemental material for Can pharmacotherapeutic follow-up after allogeneic hematopoietic stem cell transplantation improve medication compliance?

Author

Zanetti, Maria Ol��via Barboza, Rodrigues, Jo��o Paulo Vilela, Varallo, Fabiana Rossi, Cunha, Renato Luiz Guerrino, Sim��es, Belinda Pinto, and Pereira, Leonardo R��gis Leira

Subjects
FOS: Clinical medicine, 111599 Pharmacology and Pharmaceutical Sciences not elsewhere classified, 111299 Oncology and Carcinogenesis not elsewhere classified
Abstract

Supplemental material, sj-doc-1-opp-10.1177_10781552211073469 for Can pharmacotherapeutic follow-up after allogeneic hematopoietic stem cell transplantation improve medication compliance? by Maria Ol��via Barboza Zanetti, Jo��o Paulo Vilela Rodrigues, Fabiana Rossi Varallo, Renato Luiz Guerrino Cunha, Belinda Pinto Sim��es and Leonardo R��gis Leira Pereira in Journal of Oncology Pharmacy Practice

Published
2022
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50. Impact of the insertion of the clinical pharmacist in the Allogeneic Hematopoietic Stem Cells Transplantation team.

Author

Zanetti, Maria Olívia Barboza, Rodrigues, João Paulo Vilela, Varallo, Fabiana Rossi, Cunha, Renato Luiz Guerrino, Simões, Belinda Pinto, and Pereira, Leonardo Régis Leira

Subjects
GRAFT versus host disease prevention, GRAFT versus host disease, HOMOGRAFTS, RETROSPECTIVE studies, PATIENT readmissions, TREATMENT effectiveness, CELLS, HOSPITAL care, DESCRIPTIVE statistics, RESEARCH funding, HEMATOPOIETIC stem cell transplantation
Abstract

Introduction: Allogeneic Hematopoietic Stem Cells Transplantation (allo-HSCT) is capable of curing patients with neoplastic or non-neoplastic hematologic disorders or of prolonging their survival. This study assessed if the insertion of the clinical pharmacist in the allo-HSCT team modified the outcomes: transplantation-related mortality, grafting failure, incidence of Graft versus Host Disease, hospitalization time, time for grafting, number of readmissions, number of drug-related problems (DRPs), adherence and knowledge about pharmacotherapy. Methods: Interventional study with historical control carried out in an allo-HSCT unit, in which the intervention group (IG) included 33 individuals who received pharmacotherapy follow-up. Control Group (CG) consisted of 28 individuals. Results: A total of 250 DRPs were identified, 59 team's doubts were clarified, and 309 interventions were conducted in the IG. The DRPs mainly arose from safety (51.60%) and effectiveness (38.40%) problems. A mean of 9.36 (SD = 6.97) interventions per patient was obtained, mainly including dose reductions (19.09%), adjustments in administration time (18.12%), educational activities (15.21%) and drug removal (10.68%). Clinical significance of the interventions was considered high (75.7% extremely significant, very significant or significant), as well as their acceptability (89.7% accepted). Each patient attended a mean of 4.68 pharmaceutical consultations (SD = 1.91) after hospital discharge, presenting increase in knowledge (p = 0.0001) and in adherence (p = 0.0115). There was no evidence of differences between the groups in the other outcomes analyzed. Conclusions: The pharmacotherapy follow-up allowed detecting several DRPs and performing interventions of high clinical relevance and acceptability, in addition to improving adherence and individualizing the pharmacotherapy. [ABSTRACT FROM AUTHOR]

Published
2023
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