An exploratory study was conducted to present the approach of Brazilian hospital pharmacists to registering, documenting, archiving and disseminating clinical practice. The data were collected using an electronic questionnaire (n=348). In fact, 97.41% of pharmacists record their clinical practice, out of which 64.01% (n=217) do in electronic form, mainly in private hospitals (p<0.000), in the central, southern and southeastern regions (p=0.040), and by professionals with 1-5 years of experience (p=0.001). The main software used is non-specific to clinical practice: an electronic spreadsheet (47.93%; n=104) and text editor (13.37%; n=29). The archiving of records is performed by 87.61% (n=297) of professionals, where 80.13% (n=238) do so in physical form; however, 77.31% (n=184) of these files are kept for less than the standard recommended time. Documentation in medical records is carried out by 55.17% (n=192) of pharmacists, increasing among those with 1-5 years of clinical practice (p=0.001), and dissemination is performed by 74.71% (n=260) of hospital pharmacists, with a lower frequency in public hospitals (p=0.012) and among professionals with fewer hours dedicated exclusively to clinical pharmacy (p=0.012). These results can undergird the revision of competency-based training programs of Brazilian clinical pharmacists to remain pharmacists as a valuable health team member.

Background: Multiple reviews have evaluated the impact of pharmacist-delivered patient care on health-related outcomes. However, it is unclear which of the pharmacist-delivered interventions in these services are the most effective. Aim of the review: To gather the evidence of the impact of clinical pharmacy services on the medication use process or on patient outcomes using an overview of systematic reviews. Methods: PubMed was searched to retrieve systematic reviews published between 2000 and 2010 that assessed the impact of clinical pharmacy services on the medication use process or patient outcomes. Two independent reviewers evaluated the study eligibility and one extracted the description and results of the services. The methodological quality of each review was assessed with the R-AMSTAR tool. Results: Of the 343 potentially relevant records identified, 49 systematic reviews, comprising a total of 269 randomized controlled trials, met the selection criteria. Clinical pharmacy services that focused on specific medical conditions, such as hypertension or diabetes mellitus, revealed a positive impact of pharmacists’ interventions on patient outcomes. For other medical conditions, however, the results were inconclusive (e.g., dyslipidemia or thromboprophylaxis). Interventions that targeted medication adherence and assessed the impact of clinical pharmacy services in prescription appropriateness also produced inconclusive results because of the variability of methods used to assess both medication adherence and medication appropriateness. Conclusions: Systematic reviews that assessed clinical pharmacy services targeting specific conditions were more conclusive given that the intervention was well defined, and the measured outcomes were unequivocal and tangible. Conversely, the results were inconclusive for interventions with a broader target and with monitoring parameters that were unclearly established or inconsistently assessed across studies. These findings emphasize the need to better define clinical pharmacy services and standardize methods that assess the impact of these services on patient health outcomes.

Objective: To establishing, implement and consolidate clinical pharmacy services in units of Farmácia Popular do Brasil program in state of Sergipe. Methods: Initially, systematic review was performed in the databases PubMed, Scopus, EMBASE using the key words "community pharmacy services", "quality assurance health care", "outcome assessment". A longitudinal study of three units of the Farmácia Popular do Brasil in the state of Sergipe on the establishment was carried out (2012), implementation (2013) and consolidation of clinical pharmacy services (2014). The structure of pharmacies was evaluated for physical structure, through the RDC 44/2009, and human resources, the technique of simulated patient. Then three focus groups were conducted (2012, 2013 and 2014) for the perceptions of pharmacists. Finally, we used the coaching technique for establishment, implementation and consolidation of services: dispensing, measurement of blood pressure and blood capillary glucose, medication review and medication therapy management. Results: In the systematic review 42 articles met the inclusion criteria. It was observed that the most valued results were glycosylated hemoglobin (clinical), quality of life (humanistic) and analysis of the cost-effectiveness of the service relationship (economic). In assessing the structure, interventions enabled improvements on all items that were considered non-compliant. However, the overall impression of the pharmaceutical skills for clinical services was considered regular (3) on a scale from 1 to 5. Regarding the focus groups, pharmacists reported expectations in technical support to develop skills, gain knowledge and have a constant monitoring of the researchers, also identified 13 types of barriers. Finally, was designed 520 hours of coaching in place to implement flows and processes, development of standard operating procedures and preparation of strategic plans. In the education training, pharmacists underwent 176 hours of theoretical and practical training and employees to 24h. After the coaching interventions the numbers of services were expanded: there was 767 dispensations in 2012, 1444 in 2013 and 2537 in 2014; 714 measurements of blood pressure and blood capillary glucose in 2012, 2375 in 2013 and 5039 to 2014; 49 consultations of medication review in 2012, 87 in 2013 and 355 in 2014; 15 consultations of medication therapy management in 2012, 33 in 2013 and 271 in 2014. Conclusion: From the good situational diagnosis, the coaching can be considered a technique that assists in establishment, implementation and consolidation of clinical pharmacy services. Combined with a professional training, it allows the individual follow-up in steps as: definition of services and processes, selection of indicators for the assessment and development of strategic plans. In this perspective, this results may support the construction of a differentiated and replicable model of clinical services in community pharmacies.

Clinical Pharmacy Services (CPS) are a reality in many health systems around the world. Thus, it is important to understand the CPS implementation process so that new opportunities for care delivery are offered. However, there are few studies that address in depth the facilitators and the strategies that ensure the implementation of CPS in healthcare systems. Objective: to identify the facilitators and strategies involved in the CPS implementation process in the Brazilian healthcare system. Methods: a qualitative study was carried out with health-system pharmacists and local health managers who experienced the implementation of CPS, carried out by the Brazilian Ministry of Health. Therefore, focus groups were conducted with pharmacists, and the interviews with the managers. The discussions were carried out through semi-structured scripts and were recorded in audio and videos, after the signature of the consent form. The recordings were transcribed and analyzed independently through content analysis, followed by consensus meetings between researchers. The study was approved by the Brazilian Committee of Ethics in Research. Findings: two focus groups were conducted, with an average of seven pharmacists per group, and five interviews with managers that generated 240 minutes of recordings. Pharmacists and managers reported 39 facilitators who were related to the four categories: "local healthcare network”, "health team", "pharmacists" and “Implementation process of the CPS”. The strategies were attributed to the following categories: "local healthcare network", "pharmacists" and “implementation process of the CPS”. Conclusions: this study identified facilitators and strategies of the implementation of CPS in the Brazilian Healthcare System. Most of the positive experiences were related to the clinical skills and proactive attitudes of pharmacists. These findings may direct pharmacists, health managers, and policy makers to implement CPS in healthcare systems.

Introduction: The process of implementing clinical pharmacy services, including drug dispensing, is complex and multifactorial. Thus, it is necessary to understand in depth the process for implementing this service. Objective: To understand the process of implementation of drug dispensing in community pharmacies. Methods: The study is being conducted from July 2019 to December 2021. In the first step, a cross-sectional survey was carried out to understand the self-reported work process of Brazilian community pharmacists in relation to drug dispensing. In the second step, two qualitative study was carried out with pharmacists from a private chain community pharmacy to understand their perceptions about drug dispensing and the factors that can influence the implementation of the service. The factors were categorized according to the Apoteca framework. In the third steep, a study was carried out to describe the strategies used to implement the drug dispensing. This study was approved by the Research Ethics Committee (number 3.698.806). Results: In the first step, a total of 625 community pharmacists answered the survey. Most pharmacists reported always or frequently performing 17 (54%) steps described in the instrument. The stage that pharmacists reported performing most frequently was informing the name of the drug (n=569, 91.04%) and documentation was the main stage that pharmacists reported never or rarely performing (n=424, 67.84%). In the second step, 18 interviews were conducted, and the perceptions of pharmacists were divided into three categories: characteristics of the service, importance of the service, and ethical conflict. Regarding the factors, 47 factors that can influence the implementation of the dispensing were identified. These factors were allocated to seven categories: support from community pharmacy chain, pharmacy infrastructure, pharmacy characteristics, medicines and other health products, pharmacist, dispensing work process, pharmacy team, and patient. These factors were divided into seven categories: community pharmacy network support, pharmacy infrastructure, pharmacy characteristics, medicines and other health products, pharmacist, drug dispensing work process, pharmacy staff, and patient. The factors were allocated to the four domains of the Apoteca framework, with emphasis on the administrative (14) and technical (15) domains. In step three, political-administrative interventions were carried out to sensitize the pharmacy team and organize the flows and processes within the community pharmacies. The technical intervention consisted of theoretical-practical training for pharmacists, with training of 32 hours. Attitudinal interventions occurred mainly through motivational lectures. Conclusion: Most pharmacists in the study reported performing most of the dispensing steps contained in the instrument. Most pharmacists are aware of the main importance of the service and the factors identified highlight the multifactorial nature of the implementation process. In addition, it was possible to describe the process of implementation of the dispensing. These results can serve as a model for future implementations of clinical pharmacy services.

Background: Unintentional discrepancies in pharmacotherapy are conceptualized as incorrectand unjustified errors between the history of drug use and prescriptions during care transitions, an example of hospital admission. These discrepancies when not taking the risk and taking the risk have been a problem with prevent the deficiency or ineffective, incontinent precarious to the treatment and discontinuity of treatment. As children are more susceptible to drug treatment, the analysis of discrepancies in pharmacotherapy may be a relevant strategy to improve communication between health professionals and prescribers in this population. In this sense, the objective of this study was to analyze discrepancies in pharmacotherapy during the admission and internal transference of a hospital of high complexity. Method: Patients from 0 to 12 years of age were not evaluated without admission to the pediatrics. Data collection was performed between August 2017 and March 2018 and the following steps: 1- The collection of sociodemographic data; 2 - clinical interview with the patient's caregiver; 3 - registration of the patient's prescription of admission and the first prescription made after an internal registration; 4 assessments of patient records for the history of pharmacotherapy registered by nursing staff. The discrepancies were classified as intentional, when there was documented justification for changes in pharmacotherapy, and not intentional. The following were classified as: omission of drugs; dose, rate or route of administration other than previous history; once different from previous history and therapeutic duplicity. Results: A total of 136 patients participated in the study, of which 72 (53%) were males and 64 (47%) were females, with a mean age of six years. Of these, 20 (14.7%) elderly health problems and 116 (85.3%) acute problems. 21 (15.4%) patients discrepancies on hospital admission and 70 (51.5%) patients on transfer to the ward. As for drugs that unintentional discrepancies, 24 were created on admission and 74 on transfer. The effects of the medication were more intense in omission (70.8%) and dose (20.8%) in the internal dose by default (52.7%) and dose (35.5%). Conclusion: The majority of patients hospitalized for acute health problems, which explains the use of hospitalization rates and justifies the rate of discrepancy during hospitalization when compared to an internal transfer rate. This may be the indicator of communication difficulties between health teams and low process management. As a consequence, they may trigger discontinuities in treatment of adverse reactions or adversities due to errors in dosages, routes of administration, frequency of administration or prescription of different drugs.

Polypharmacy – a frequent situation found among the elderly, related to their physiological changes and multiple morbidities – increases the risk of adverse reactions, interactions, drugs misuse and drug-related problems. Knowing that non-steroidal anti-inflammatory drugs (NSAIDs) are widely used among the elderly, the aims of the present study were to assess the potential interactions that may occur between prescribed NSAIDs and other drugs and to create a list of recommendations for monitoring elderly patients taking NSAIDs, in order to prevent or minimize those negative outcomes. With this purpose, a retrospective study was performed at Centro de Saúde de Eiras (Coimbra, Portugal). The study involved the systematic analyses of the medication regimens of a sample of elderly patients selected from the elderly population of this primary health care unit. Eligible subjects were patients aging 65 or more years and at least with one NSAID included in their therapeutic schemes in the last three months. A total of 37 prescribed NSAIDs were found in the 29 patients of the sample. 125 potential NSAID-drug interactions were found: 2 minor and 123 moderate. Most interactions occurred between NSAIDs and anti- hypertensive drugs, such as diuretics (17.6%), angiotensin receptor blockers (14.4%), calcium channel block- ers (12.0%) and angiotensin converting enzyme inhibitors (8.8%). The prevalence of interactions between NSAIDs was 12.8%. These interactions can cause adverse effects with particular manifestations in the elderly, such as renal impairment and increased blood pressure. The pharmacist can develop a relevant role in services such as medication review, to identify these potential interactions, or pharmacotherapy follow-up, in the management of these situations when properly identified. Stresses the importance of positive interaction with General and Family Practice for the safe and efficiency of therapies.