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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.

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          Most cited references 41

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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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            Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist.

            Polypharmacy in the elderly complicates therapy, increases cost, and is a challenge for healthcare agencies. In the context of the evolving role of the pharmacist, this systematic review examines the effectiveness of interventions led by pharmacists in reducing polypharmacy. A computerised search was conducted using Medline, Embase geriatrics and gerontology (2001 edition), the Cochrane Library and International Pharmaceutical Abstracts (IPA) databases. A manual search of articles on polypharmacy and the role of pharmacists in the therapy of the elderly and of the reference sections of all retrieved articles was also carried out. Search terms used were 'polypharmacy', 'elderly', 'aged', 'intervention' and 'pharmacist(s)'. Articles that fulfilled the following criteria were included: only elderly people were included in the study, or all ages were included but the study gave separate results for the elderly; the outcome was expressed as a reduction in the number of medications; a pharmacist participated in the study; and the study was a controlled or a randomised controlled study. We initially identified 106 articles, but only 14 studies met our four inclusion criteria. Reduction in the number of medications was not the major purpose of most selected studies but often a secondary outcome. Objectives differed, the general aim being to enhance the quality of prescribing in elderly patients. These controlled studies argued in favour of the effectiveness of pharmacists' interventions, even though the number of medications eliminated was small. Most studies were not designed to demonstrate the impact of reducing the number of drugs on the clinical consequences of polypharmacy (nonadherence, adverse drug reactions, drug-drug interactions, increased risk of hospitalisation, and medication errors). The most frequently reported outcome related to cost savings. It was therefore difficult to assess whether the interventions benefited the patient. The methodological quality of many identified studies was poor. In particular, the study objectives were often very broad and ill-defined. Polypharmacy itself has been defined in different ways and the appropriate definition may differ according to the patient population and the study setting. Further studies are needed to find the most effective way to reduce polypharmacy, especially in the frail elderly population, and to quantify the real advantages of simplifying their drug regimens in terms of improved quality of life.
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              Improving blood pressure control in a pharmacist-managed hypertension clinic.

               Eva Vivian (2002)
              To determine whether pharmaceutical care provided by a pharmacist-managed hypertension clinic results in better treatment outcomes when compared with traditional health care from a primary care physician. Prospective, controlled study Veterans Affairs Medical Center, Philadelphia, Pennsylvania. Fifty six patients with essential hypertension; 27 were randomly assigned to the intervention group and 29 to the control group. Patients in the intervention group were scheduled monthly to meet with a clinical pharmacist who made appropriate changes in prescribed drugs, adjusted dosages, and provided drug counseling in accordance with the hypertension guidelines in the sixth report of the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Patients in the control group received standard care from their physicians. The study period was 6 months. Treatment outcomes were measured by changes in compliance, blood pressure, and patient satisfaction. The Short Form-36 health survey and a patient satisfaction survey were used to measure changes in patient satisfaction, and a compliance evaluation survey measured compliance. Twenty-one (81%) patients in the intervention group attained their blood pressure goal of below 140/90 mm Hg at the completion of the study versus only eight (30%) in the control group (p < 0.0001). Of 11 patients with diabetes in the intervention group, 10 (91%) attained their blood pressure goal (< 130/80 mm Hg) versus only two (12 %) of 16 patients with diabetes in the control group (p < 0.0001). No significant differences in patient satisfaction or compliance were reported between the intervention and control groups. Pharmaceutical care improves blood pressure control and results in more patients with hypertension reaching their blood pressure goal.
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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
                © 2007 Dove Medical Press Limited. All rights reserved
                Categories
                Original Research

                Medicine

                pharmaceutical care, quality of life, elderly

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