Drug therapy problems for patients with tuberculosis and HIV/AIDS at a reference hospital

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

ABSTRACT

Objective:

To determine the frequency of drug therapy problem in the treatment of patients with tuberculosis and HIV/AIDS.

Methods:

Data were obtained through a cross-sectional study conducted between September 2015 and December 2016 at a reference hospital in infectious diseases in Belo Horizonte (MG), Brazil. Sociodemographic, clinical, behavioral and pharmacotherapeutic variables were evaluated through a semi-structured questionnaire. Drug-related problems of pharmaceutical care were classified using the Pharmacotherapy Workup method. Factors associated with indication, effectiveness, safety and compliance drug therapy problem were assessed through multiple logistic regression.

Results:

We evaluated 81 patients, and 80% presented at least one drug therapy problem, with indication and adherence drug therapy problem being the most frequent. The factors associated with drug therapy problem were age, marital status, new case, ethnicity, time of HIV diagnosis and time to treat tuberculosis.

Conclusion:

The frequency of drug therapy problem in coinfected patients was high and the identification of the main drug therapy problem and associated factors may lead the multiprofessional health team to ensure the use of the most indicated, effective, safe and convenient medicines for the patients clinical condition. Tuberculosis and HIV/AIDS coinfected individuals aged over 40 years are more likely to have drug therapy problems during treatment; in that, the most frequente are those that signal toward need of medication for an untreated health condition and non-compliance to treatment. Thus, older patients, unmarried or married, who have treated tuberculosis before, with a shorter time to tuberculosis treatment and longer time to diagnose HIV/AIDS, should receive special attention and be better followed by a multiprofessional health team because they indicate a higher chance of presenting Problems related to the use of non-adherent drugs.

Related collections

Most cited references 25

Record: found
Abstract: found
Article: found

Is Open Access

Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System

Djenane Ramalho de Oliveira, Amanda R. Brummel, David B. Miller (2010)

BACKGROUND: Medication therapy management (MTM) was officially recognized by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which requires Medicare Part D plans that offer prescription drug coverage to establish MTM programs (MTMPs) for eligible beneficiaries. Even though the term MTM was first used in 2003, pharmacists have provided similar services since the term pharmaceutical care was introduced in 1990. Fairview Health Services, a large integrated health care system, implemented a standardized pharmaceutical care service system in 1998, naming it a pharmaceutical care-based MTM practice in 2006. OBJECTIVES: To present the clinical, economic, and humanistic outcomes of 10 years of delivering MTM services to patients in a health care delivery system. METHODS: Data from MTM services provided to 9,068 patients and documented in electronic therapeutic records were retrospectively analyzed over the 10-year period from September 1998 to September 2008 in 1 health system with 48 primary care clinics. Patients eligible for MTM services were aged 21 years or older and either paid for MTM out of pocket or met their health care payer's criteria for MTM reimbursement; the criteria varied for Medicaid, Medicare, and commercially insured enrollees. All MTM was delivered face to face. Health data extracted from the electronic therapeutic record by the present study's investigators included patient demographics, medication list, medical conditions, drug therapy problems identified and addressed, change in clinical status, and pharmacist-estimated cost savings. The clinical status assessment was a comparison of the first and most recent MTM visit to measure whether the patient achieved the goals of therapy for each medical condition (e.g., the blood pressure of a patient with diabetes and hypertension will be less than 130/80 millimeters mercury [mmHg] in 1 month; the patient with allergic rhinitis will be relieved of his complaints of nasal congestion, runny nose, and eye itching within 5 days). Goals were set according to evidence-based literature and patient-specific targets determined cooperatively by pharmacists, patients, and physicians. Cost savings calculations represented MTM pharmacists' estimates of medical services (e.g., office visits, laboratory services, urgent care visits, emergency room visits) and lost work time avoided by the intervention. All short-term (3-month) estimated health care savings that resulted from addressing drug therapy problems were analyzed. The expenses of these avoided services were calculated using the health system's contracted rates for services provided in the last quarter of 2008. The return on investment (ROI) was calculated by dividing the pharmacist-estimated savings by the cost of MTM services in 2008 (number of MTM encounters times the average cost of an MTM visit). The humanistic impact of MTM services was assessed using the results from the second patient satisfaction survey administered in 2008 (new patients seen from January through December 2008) for the health systems MTM program. RESULTS: A total of 9,068 patient records were in the documentation system as of September 30, 2008. During the 10-year period, there were 33,706 documented encounters (mean 3.7 encounters per patient). Of 38,631 drug therapy problems identified and addressed by MTM pharmacists, the most frequent were a need for additional drug therapy (n = 10,870, 28.1%) and subtherapeutic dosage (n = 10,100, 26.1%). In the clinical status assessment of the 12,851 medical conditions in 4,849 patients who were not at goal when they enrolled in the program, 7,068 conditions (55.0%) improved, 2,956 (23.0%) were unchanged, and 2,827 (22.0%) worsened during the course of MTM services. Pharmacist-estimated cost savings to the health system over the 10-year period were $2,913,850 ($86 per encounter) and the total cost of MTM was $2,258,302 ($67 per encounter), for an estimated ROI of $1.29 per $1 in MTM administrative costs. In the patient satisfaction survey, 95.3% of respondents agreed or strongly agreed that their overall health and wellbeing had improved because of MTM. CONCLUSIONS: Pharmacist estimates of the impact of an MTM program in a large integrated health care system suggest that the program was associated with improved clinical outcomes and cost savings. Patient satisfaction with the program was high.

0 comments Cited 81 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Association of age with polypharmacy and risk of drug interactions with antiretroviral medications in HIV-positive patients.

Leah Szadkowski, Janet Raboud, Irving Salit … (2013)

Interactions between antiretroviral (ARV) therapy and medications to treat age-related comorbidities are a growing concern in the aging HIV population. To investigate the association of age with potential drug-drug interactions (PDDIs) involving ARVs. We studied ARV-treated patients attending a tertiary care center. PDDIs were classified as "red flag" (contraindicated) or "orange flag" (use with caution or dose adjustment). Logistic regression was used to determine the association of age with the occurrence of ≥1 PDDI. Of 914 patients (78% male, median age 49 years), older patients (age ≥50 years) were on more drugs than younger patients (total 9 vs 7; P < .0001) and were more likely to be on ritonavir-boosted protease inhibitors (PIs), integrase inhibitors, and non-ARV medications. Older patients were more likely to have ≥1 orange flag PDDI (71% vs 55%, P < .0001) and to have a red flag PDDI (5% vs 2%, P = .07), although the latter did not reach statistical significance. A 10-year increase in age was associated with an increased likelihood of ≥1 PDDI (odds ratio [OR] = 1.72; P < .0001) after adjusting for gender, race and number and class of ARVs. The effect of age was diminished after adjusting further for the number of non-ARV medications (OR = 1.28; P = .02) and use of cardiovascular drugs (OR = 1.16; P = .21). In our clinic population, older patients were more likely to have a PDDI because of the greater number of non-ARV medications, particularly cardiovascular agents.

0 comments Cited 42 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Antituberculosis drugs: drug interactions, adverse effects, and use in special situations. Part 1: first-line drugs.

Marcos Abdo Arbex, Marília Varella, Helio Ribeiro de Siqueira … (2015)

The main objectives of tuberculosis therapy are to cure the patients and to minimize the possibility of transmission of the bacillus to healthy subjects. Adverse effects of antituberculosis drugs or drug interactions (among antituberculosis drugs or between antituberculosis drugs and other drugs) can make it necessary to modify or discontinue treatment. We briefly review the new guidelines for the pharmacological treatment of tuberculosis, introduced by the Brazilian National Ministry of Health in 2009, and describe the general mechanism of action, absorption, metabolization, and excretion of the first-line drugs used in the basic regimen. We describe adverse drug reactions and interactions (with other drugs, food, and antacids), as well as the most appropriate approach to special situations, such as pregnancy, breastfeeding, liver failure, and kidney failure. We also describe the mechanisms by which the interactions among the antituberculosis drugs used in the basic regimen can cause drug-induced hepatitis, and we discuss the alternatives in this situation.

0 comments Cited 38 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Einstein (Sao Paulo)

Journal ID (iso-abbrev): Einstein (Sao Paulo)

Journal ID (publisher-id): EINS

Title: Einstein

Publisher: Instituto Israelita de Ensino e Pesquisa Albert Einstein

ISSN (Print): 1679-4508

ISSN (Electronic): 2317-6385

Publication date (Electronic, pub): 19 August 2019

Publication date (Electronic, collection): 2019

Volume: 17

Issue: 4

Electronic Location Identifier: eAO4696

Affiliations

[1 ] Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

[2 ] Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, MG, Brasil

[1 ] Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

[2 ] Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, MG, Brasil

Author notes

Corresponding author: Natália Helena de Resende Avenida Antônio Carlos, 6,627 – Pampulha Zip code: 31270-901 – Belo Horizonte, MG, Brazil Phone: (55 31) 2510-6390 E-mail: nataliaresende@ 123456yahoo.com.br

Conflict of interest: none.

CONTRIBUTIONS

N. H. Resende, S. S. Miranda, M. G. B. Ceccato, A. M. M. Reis, D. I. Silva and W. S. Carvalho designed the study, interpreted the results, wrote, read and approved the final manuscript. J. P. A. Haddad made the analysis of data.

Autor correspondente: Natália Helena de Resende Avenida Antônio Carlos, 6.627 – Pampulha CEP: 31270-901 – Belo Horizonte, MG, Brasil Tel.: (31) 2510-6390 E-mail: nataliaresende@ 123456yahoo.com.br

Conflitos de interesse: não há.

COLABORADORES

N. H. Resende, S. S. Miranda, M. G. B. Ceccato, A. M. M. Reis, D. I. Silva e W. S. Carvalho construíram o desenho do estudo, interpretaram os resultados, redigiram, leram e aprovaram o manuscrito final. J. P. A. Haddad realizou a análise dos dados.