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      Impact of Pharmaceutical Care interventions in the identification and resolution of drug-related problems and on quality of life in a group of elderly outpatients in Ribeirão Preto (SP), Brazil

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          Abstract

          Objective

          To evaluate the impact of a Pharmaceutical Care service in the identification and resolution of drug-related problems (DRPs) and in quality of life (QoL) of a group of elderly outpatients with chronic health conditions.

          Methods

          30 outpatients (aged 60–75-years old) were followed between August 2003 and July 2004 at a primary health care unit in Ribeirão Preto (SP), Brazil. Patients were scheduled monthly to meet with the researcher, who provided Pharmaceutical Care service (the intervention). Through Pharmaceutical Care, the pharmacist worked with the patient and other care providers to improve outcomes of drug therapy through focused education, care planning, and monitoring. Intervention outcomes were the number of DRPs prevented or resolved, and the impact on QoL. The Short Form-36 health survey was used to measure changes in QoL.

          Results

          The mean age of patients was 66 ± 5 years, 21 of whom had low literacy. During the study, 92 DRP were identified, 3.0 ± 1.5 problems per patient. By the end of the study, the interventions solved 69% of actual DRP and prevented 78.5% potential DRP. In addition, QoL showed improvement in 22 patients after DRP resolution or prevention.

          Conclusion

          Despite the limitations in this study that may affect generalizability of the results, this study demonstrates that humanistic and behavioral interventions based on the Pharmaceutical Care model were capable in reducing DRPs, and improve QoL in patients.

          Most cited references43

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          The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.

          A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
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            Item response theory and health outcomes measurement in the 21st century.

            Item response theory (IRT) has a number of potential advantages over classical test theory in assessing self-reported health outcomes. IRT models yield invariant item and latent trait estimates (within a linear transformation), standard errors conditional on trait level, and trait estimates anchored to item content. IRT also facilitates evaluation of differential item functioning, inclusion of items with different response formats in the same scale, and assessment of person fit and is ideally suited for implementing computer adaptive testing. Finally, IRT methods can be helpful in developing better health outcome measures and in assessing change over time. These issues are reviewed, along with a discussion of some of the methodological and practical challenges in applying IRT methods.
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              Opportunities and responsibilities in pharmaceutical care.

              Pharmacy's opportunity to mature as a profession by accepting its social responsibility to reduce preventable drug-related morbidity and mortality is explored. Pharmacy has shed the apothecary role but has not yet been restored to its erst-while importance in medical care. It is not enough to dispense the correct drug or to provide sophisticated pharmaceutical services; nor will it be sufficient to devise new technical functions. Pharmacists and their institutions must stop looking inward and start redirecting their energies to the greater social good. Some 12,000 deaths and 15,000 hospitalizations due to adverse drug reactions (ADRs) were reported to the FDA in 1987, and many went unreported. Drug-related morbidity and mortality are often preventable, and pharmaceutical services can reduce the number of ADRs, the length of hospital stays, and the cost of care. Pharmacists must abandon factionalism and adopt patient-centered pharmaceutical care as their philosophy of practice. Changing the focus of practice from products and biological systems to ensuring the best drug therapy and patient safety will raise pharmacy's level of responsibility and require philosophical, organizational, and functional changes. It will be necessary to set new practice standards, establish cooperative relationships with other health-care professions, and determine strategies for marketing pharmaceutical care. Pharmacy's reprofessionalization will be completed only when all pharmacists accept their social mandate to ensure the safe and effective drug therapy of the individual patient.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                December 2007
                December 2007
                : 3
                : 6
                : 989-998
                Affiliations
                [1 ]Faculty of Pharmacy, Federal University of Sergipe Aracaju, Sergipe, Brazil
                [2 ]Pharmacy Program, Qatar University Doha, Qatar
                [3 ]Faculty of Pharmaceutical Sciences, University of Ribeirão Preto Ribeirão Preto, São Paulo, Brazil
                [4 ]Faculty of Pharmacy, Tiradentes University Aracaju, Sergipe, Brazil
                [5 ]Nursing College of Ribeirão Preto, University of São Paulo Ribeirão Preto, São Paulo, Brazil
                [6 ]Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo Ribeirão Preto, São Paulo, Brazil
                Author notes
                Correspondence: Divaldo Pereira de Lyra Júnior R. Alferes José Pedro de Brito, 100, Edf Marilia, apto 1604, Farolândia, Aracaju, Sergipe, Brazil Tel +55 02179 3243 1812 Email lyra_jr@ 123456hotmail.com
                Article
                2387287
                18516258
                1f829a80-83fd-4fdf-ac4f-b6b75f66575e
                © 2007 Dove Medical Press Limited. All rights reserved
                History
                Categories
                Original Research

                Medicine
                elderly,quality of life,pharmaceutical care
                Medicine
                elderly, quality of life, pharmaceutical care

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