Mestrado em Assistência Farmacêutica
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- ItemAvaliação do impacto do acompanhamento farmacoterapêutico a pessoas com hipertensão arterial em um município sul-capixaba : ensaio clínico pragmático(Universidade Federal do Espírito Santo, 2024-03-15) Alencar, Taiana de; Co-orientador1; https://orcid.org/; http://lattes.cnpq.br/; Co-orientador2; https://orcid.org/; http://lattes.cnpq.br/; Santos Júnior, Genival Araujo dos ; https://orcid.org/; http://lattes.cnpq.br/; Orientador2; https://orcid.org/; http://lattes.cnpq.br/; https://orcid.org/; http://lattes.cnpq.br/; Oliveira Filho, Alfredo Dias de; dc.contributor.referee1ID; http://lattes.cnpq.br/; Severi, Juliana Aparecida; https://orcid.org/; http://lattes.cnpq.br/; Silva, Rafaella de Oliveira Santos; https://orcid.org/; http://lattes.cnpq.br/; 4º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 5º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 6º membro da banca; https://orcid.org/; http://lattes.cnpq.br/; 7º membro da banca; https://orcid.org/; http://lattes.cnpq.br/Introduction: Arterial hypertension (AH) is a chronic health condition that may require changes in lifestyle and the use of medication. However, this use is not without risks. In this context, the Pharmacotherapeutic Follow-up Service (FHS) has emerged as a strategy capable of improving the health outcomes of people with AH. However, there are few high-research studies on this subject. Objective: To assess the impact of FAS on the health outcomes of patients with AH in the health care network in the municipality of Alegre/ES. Method: This is an experimental single-blind randomized controlled clinical trial. People with hypertension who met the eligibility criteria (over 18 years of age, with self-reported hypertension, taking medication for hypertension for at least 6 months) were randomized in a 1:1 ratio to the intervention and control groups. They received FAS and usual care, respectively, for a period of 12 months. The study was conducted in the Health Care Network of the municipality of Alegre, Espírito Santo, Brazil, from January 2022 to November 2023. In both groups, primary outcomes (blood pressure and quality of life) and secondary outcomes (knowledge about hypertension, anthropometric profile and clinical examinations) were assessed at three points in time, six months apart. Ethical considerations were observed (CAAE registration number 13586319.6.0000.8151 | Opinion no. 4.732.878). Results: 128 patients were allocated to the intervention group (64) and the control group (64). Statistically significant differences were observed in the intra-group analysis in the intervention group, including SBP (∆ = -9.47 mmHg, p = 0.014), Total Cholesterol (∆ = -18.93 mg/dL, p = 0.001), LDL (∆ = -15.70 mg/dL, p < 0.001), non-HDL cholesterol (∆ = -19.76 mg/dL, p < 0.001) and cardiovascular risk (∆ = -1.82 points, p < 0.001). There was an increase in the score for knowledge about hypertension (∆ = 1.39 points, p < 0.001), an improvement in quality of life in the mental state subdimension (∆ = -2.76 points, p = 0.020) and somatic manifestations (∆ = -1.5 points, p = 0.012). In the control group, it was possible to observe an increase in the score for knowledge about hypertension (∆ = 1.52 points, p = 0.001) and an improvement in the VAS of the EQ5D (∆ = 10.33 points, p = 0.067). In addition, almost all the patients were satisfied or very satisfied with the service provided by the pharmacists. Conclusion: The results show a promising positive impact of FAS on clinical and humanistic parameters, as well as a reduction in cardiovascular risk for negative events over the next ten years. This study was registered with The Brazilian Clinical Trials Registry (ReBEC) under registration number: RBR-4c53f3m.
- ItemImplementação de serviços clínicos providos por farmacêuticos na atenção primária à saúde: uma revisão de escopo(Universidade Federal do Espírito Santo, 2024-02-16) Paolinelli, João Pedro Vasconcelos; Pereira, Mariana Linhares; https://orcid.org/0000-0002-3214-2789; Santos Júnior, Genival Araújo dos; https://orcid.org/0000-0002-5618-1846; http://lattes.cnpq.br/; https://orcid.org/; http://lattes.cnpq.br/; Reis, Tiago Marques dos; dc.contributor.referee1ID; http://lattes.cnpq.br/; Baldoni, André de Oliveira; https://orcid.org/; http://lattes.cnpq.br/Introduction: The implementation of Clinical Pharmacy Services in management and clinical practice settings is a strategic action to improve clinical, economic and humanistic outcomes in various health conditions and in different contexts. However, such services are not uniformly disseminated in health systems around the world, and when they are, they often do not complete their implementation process or are not sustained in the long term, as it is difficult to ensure the effectiveness of these services in the "real world". Thus, there is a need to comprehensively understand and characterize how the process of implementing these services takes place, especially in Primary Health Care. Objective: To map the studies on the implementation of Clinical Pharmacy Services in the context of Primary Health Care. Methods: A scoping review was developed and presented in two chapters. Chapter 01 deals with the scoping review protocol, which was written following the recommendations of the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The review protocol was registered with the Open Science Framework under the number 10.17605/OSF.IO/N25EA. Chapter 2 deals with the scoping review. A search was carried out in six electronic databases, in the gray literature and in the references of the selected studies, until May 2023. Original studies describing the process of implementing Clinical Pharmacy Services in Primary Health Care were eligible. Two researchers independently screened, selected and extracted data from the selected articles. The variables collected were: author(s), country; objective(s); study design; participants; type of clinical pharmacy service; use of models as an implementation guide; implementation phase; place of service provision; implementation outcomes. The data was presented in descriptive form. Results: The protocol was developed and submitted to a scientific journal. For the scoping review, 97 studies were included, the majority 85.6% (n=83) carried out in developed countries. There was a strong focus on qualitative and mixed-methods research, 46.4% (n=45). Only 22.7% (n=22) used theoretical models as a research guide, and the majority 96.9% (n=94) did not report the implementation phase. Comprehensive medication management 36.8% (n=35) was the most cited type of service. The most highly rated implementation outcome was feasibility 73.2% (n=71). Almost half (47.4%, n=46) evaluated clinical, economic and/or humanistic outcomes. Conclusion: This study has shown, in general terms, how Clinical Pharmacy Services are implemented in the different realities of Primary Health Care around the world. There was a need to redirect the evaluation focus of these studies towards measures that assess coverage, cost-effectiveness, as well as clinical and humanistic outcomes, in order to achieve sustainability in the future. Furthermore, future research into the implementation of these services should use conceptual models and quality reporting tools in order to have a greater chance of success at all stages of the implementation process and the ability to replicate/adapt the evidence generated.
- ItemImpacto do serviço de acompanhamento farmacoterapêutico nos desfechos em saúde de pacientes com hipertensão arterial: protocolo de ensaio clínico e dados preliminares(Universidade Federal do Espírito Santo, 2023-08-21) Vieira, Maria Paula Debona; Santos Junior, Genival Araújo dos; https://orcid.org/0000000256181846; http://lattes.cnpq.br/5917097187533724; https://orcid.org/0009-0003-0261-6239; http://lattes.cnpq.br/6124466867030276; Borba, Helena Hiemisch Lobo; https://orcid.org/0000-0001-9723-584X; http://lattes.cnpq.br/9205414489911034; Batista, Tatianne Mota; https://orcid.org/0000-0003-3240-2613; http://lattes.cnpq.br/2980899910202014Introduction: Hypertension is a chronic health condition that usually requires the use of medication; however, this use is not risk-free. In this scenario, medication therapy management. is a strategy that can improve the health outcomes of people with hypertension. Despite this, there are few studies with high scientific evidence on this topic. Objective: To evaluate preliminary data on the impact of the Comprehensive Medication Therapy service on the health outcomes of patients with hypertension. Methods: This study was carried out in two stages. The first consisted of the elaboration of a protocol for a randomized clinical trial, from June to December 2021. The second stage was the preliminary six-month evaluation of patients with hypertension. The patients who met the eligibility criteria were randomly allocated in a 1:1 ratio to the intervention or control group, who received medication therapy management and usual care, respectively, for 12 months. Both groups had their primary outcomes (baseline blood pressure and quality of life) and secondary outcomes (knowledge about pharmacotherapy; knowledge about hypertension and medication adherence; anthropometric profile, and clinical outcomes) assessed at two time points with a six-month interval between them. Ethical considerations were observed (CAAE: 13586319.6.0000.8151 | Approval nº 4.732.878). Statistical analyzes were performed using Student's t test for independent samples, investigating the difference in the means of the outcomes evaluated between the intervention and control groups at T0 (baseline) and T6. Results: In the first stage, a single-blind randomized clinical trial protocol was proposed, following the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials and the Consolidated Standards of Reporting Trials, which was registered in The Brazilian Clinical Trials Registry (ReBEC) (registration number RBR-4c53f3m). In the second stage, the preliminary evaluation showed that six months after the start of the study, no significant differences were found in any of the studied variables when comparing the control group and the intervention group. However, when performing intragroup analyses, it was possible to observe that patients in the intervention group had improvements in laboratory tests and quality of life after six months of follow-up, with a decrease in systolic blood pressure (-8.50 mmHg, p=0.04), total cholesterol (-11.94 mg/dL, p=0.05), and LDL (-12.21 mg/dL, p=0.01). They also had an increase in knowledge about hypertension (1.62, p=0.001), and improvement in quality of life (MINICHAL) in two parameters, mental (2.79 p=0.02) and somatic manifestations (1.62 p=0.03). Conclusion: In the preliminary 6-month analysis, statistically significant differences were found when comparing the control and intervention groups. The changes observed in the intervention group indicate a positive outcome related to the pharmacotherapeutic follow-up service, with the potential for further improvement in the results when the analysis is performed at 12 months.
- ItemPerfil clínico e humanístico de pacientes com hipertensão arterial da Rede de Atenção à Saúde de um município no Sul-Capixaba(Universidade Federal do Espírito Santo, 2023-08-11) Mendes, Mayra Cardozo; Santos Júnior, Genival Araujo dos; https://orcid.org/0000000256181846; http://lattes.cnpq.br/5917097187533724; https://orcid.org/0009-0003-4358-6603; http://lattes.cnpq.br/6949871999044526; Santana, Rafael Santos; https://orcid.org/0000-0003-4481-210X; http://lattes.cnpq.br/6970798378260844; Santos, Sabrina Cerqueira; https://orcid.org/0000-0001-6748-727X; http://lattes.cnpq.br/8757541282986479Introdução. Hypertension is the most prevalent chronic condition in primary care and the leading preventable cause of cardiovascular death worldwide. However, information about the clinical and humanistic profile of individuals with hypertension treated in a municipality in southern Espírito Santo, Brazil, is limited. Objective. To characterize the clinical and humanistic profile of patients with Arterial Hypertension within the healthcare network of a municipality in southern Espírito Santo. Method. A descriptive cross-sectional study with a quantitative approach conducted between January 2022 and July 2022 in the municipality of Alegre-ES. Study participants were individuals over 18 years of age, diagnosed with hypertension, and using at least one medication for hypertension. Data collection was performed using a structured form created by the author. Sociodemographic data, anthropometric profile, lifestyle, clinical profile, and pharmacotherapeutic profile were collected. Adherence to pharmacotherapy, knowledge about hypertension, overall quality of life, and quality of life related to hypertension were assessed using validated questionnaires. The study was approved by the Ethics Committee of the Federal University of Espírito Santo (CAAE: 13586319.6.0000.8151). Data were presented using descriptive statistics. Results: The study included 129 participants, of whom 74.41% (n=96) were women, with an average age of 59.83 ± 11.15 years, married (58.13%; n=75), self-identified as non-white (73.64%; n=95), did not engage in physical activity (75.2%; n=97), denied alcohol consumption (80.6%; n=104) and nicotine use (60.5%; n=78), and reported having two or more health conditions (69.76%; n=90). Women had an average weight of 75.16 ± 14.24 kg, and men had an average weight of 77.86 ± 13.79 kg. In clinical data, the lipid profile showed that 47.29% (n=61) had total cholesterol and 48.84% (n=63) had triglycerides above recommended levels. Regarding blood pressure, 34.89% (n=45) had systolic blood pressure greater than 140 mmHg, and 25.58% (n=33) had diastolic blood pressure greater than 90 mmHg. The majority were on polypharmacy (58.91%; n=76), and treatment adherence was considered high in 86.82% (n=123) of evaluated patients. Furthermore, 50.38% (n=65) had good knowledge about hypertension, and 68.22% (n=88) stated that hypertension does not influence their quality of life. Conclusion. Most participants exhibited clinical profiles in line with guidelines and clinical protocols, as well as positive results for the humanistic profile, potentially contributing to future studies.
- ItemQualidade de vida relacionada à saúde e fatores associados em um município de pequeno porte durante a pandemia de COVID-19(Universidade Federal do Espírito Santo, 2023-08-16) Pezzin, Josiane; Silva, Michael Ruberson Ribeiro da; https://orcid.org/0000000325507249; http://lattes.cnpq.br/2822520981120774; https://orcid.org/0009-0009-8339-0561; http://lattes.cnpq.br/9172067654108376; Bortoli, Valquíria Camin de; https://orcid.org/0000-0001-5801-8447; http://lattes.cnpq.br/3992098322056730; Gomes, Rosângela Maria; https://orcid.org/0000-0001-8299-4835; http://lattes.cnpq.br/8395018794734460Quality of Life (QL) is about the individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. For healthcare applications, the term HealthRelated Quality of Life (HRQoL) is often used. Research in this area is of great relevance to aid in the development of public policies, evaluation of outcomes in clinical trials and economic analysis. However, population-based research on HRQoL, conducted in different sociocultural settings, is scarce. In this sense, this work aimed to evaluate HRQoL and its associated factors in a small brazilian municipality during the period of the COVID-19 pandemic. This is an epidemiological, cross-sectional, population-based study carried out through a household survey, during the period from november to december 2021 in the city of Alegre/ES, Brazil. The sample was representative of the city's urban population and consisted of individuals aged ≥ 18 years. Through face-to-face interviews, self-reported sociodemographic data, life habits, health-related characteristics, comorbidities and an assessment of HRQoL were collected using the EQ-5D-3L instrument. Data were submitted to statistical analysis and presented in the form of graphs and tables. The association between HRQoL levels and the explanatory variables collected using the Tobit regression model was tested. The study was approved by the UFES Research Ethics Committee under Opinion nº 3,428,060. 694 individuals were interviewed, predominantly female (72.9%) and mean age was 53 years (SD = 18.9). The most prevalent comorbidities were high blood pressure and anxiety. In the analysis of the EQ-5D, 43.23% of the interviewees reported the absence of problems in all dimensions. The dimension with the highest frequency of problems was pain/discomfort, followed by anxiety/depression. The mean HRQoL value obtained was 0.818 (SD = 0.195) on the EQ-5D descriptive system and 77.8 (SD = 18.9) on the EQ-VAS visual analogue scale. The correlation between these values was positive and moderate. The factors that maintained an association with HRQoL in the final Tobit regression model (p ≤ 0.05) were: self-perceived health, disability, polypharmacy, hospitalization in the last year, anxiety, rheumatoid arthritis, obesity and medication adherence problems. In general, the influence of these factors on HRQoL is already well discussed in the literature, except for problems with medication adherence. Along with polypharmacy, this factor highlights the importance of strengthening pharmaceutical care services and multidisciplinary teams in health care in Alegre/ES. The profile of reporting problems in the dimensions of the EQ-5D3L is consistent with that found in national and international studies. The results of this study present a health assessment of a small municipality, useful for local health managers, and which enriches the literature in the area with data on HRQoL in settings and contexts that have been little studied.