Pharmacist Insertion in Home Care Service of Palliative ...
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Projeto Gráfico: Seção de Edição Técnico-Científica / DIETC / CEDC / INCA CONCLUSION REFERENCES DISCUSSION RESULTS INTRODUCTION METHOD OBJECTIVE Pharmacist Insertion in Home Care Service of Palliative Care Unit: a Search for Rational Drug Utilization 1 1 1 2 1 Trombini, L.R.B. , Castro, L.S. , Barbosa, M.F , Pereira, L.C. & Lima, S.G.G. 1 National Cancer Institute – Cancer Hospital IV e-mail: [email protected] 2 Pharmacy College - Federal Fluminense University - Specialization Course for Training in Healthcare Services Hospital for pharmacists, in the mold of Residence e-mail: [email protected] SUMMARY Introduction: The Home Care Service in a palliative care unit has to provide a family living with an adequate quality of life for terminals patients. In these patients, polypharmacy is often necessary, however, predisposes them to drug interactions and other adverse events, also facilitated by advanced age and comorbidities. Purpose: To encourage the rational use of medicines, proving the importance of the pharmacist for the home care sector of the palliative care unit. Method: A retrospective study on pilot scale, in the drug utilization in the unit, through the assessment of 192 prescriptions in 2005, comparing the results obtained for consumption in 2006, already with a pharmacist involved in sector. In none of the tests were considered discarding of drugs. Results: We observed a marked reduction in the consumption of some items normally prescribed in home care, some of considerable price, such as fentanyl transdermal. From the comparison between the requirements of 2005 and 2006, we have seen that the overall economy was on the order of 20%, an important value within the Pharmacoeconomics context. Discussion and Conclusion: The pharmacist insertion led to a reduction in the amount of exempted products, providing financial benefits to the institution, and encouraging the rational use of medicines. The proximity between different health care professionals give more dynamism and facilitates the exchange of information, leading to early identification of problems related to drugs or adverse events resulting from treatment, regardless of their nature. The Home Care of the National Cancer Institute (INCA) fits the philosophy of palliative care, to provide a family living with an adequate quality of life, to terminal patients. In these patients, polypharmacy is often necessary, however, predisposes them to drug interactions and other adverse events, also facilitated by advanced age and comorbidities. Since March 2006, the sector of the Home Care INCA has full-time pharmacists to exercise in the screening requirements of medicines and other products, the critical and dynamic participation of pharmacists tend to reduce the number of unnecessary prescriptions. To Encourage the rational use of drugs, proving the importance of the pharmacist for the home care sector of the palliative care unit the National Cancer Institute (INCA). Retrospective study on pilot scale, consumption in the unit, the evaluation of 192 prescriptions in 2005, comparing the results to consumers in 2006, already with a pharmacist involved in sector. In none of the tests were considered discarding of drugs. We observed a marked reduction in the consumption of some items normally prescribed in home care, some of considerable price, such as fentanyl transdermal. From the comparison between the requirements of 2005, 2006 and 2007, you can see that the total economy was the order of 80%, an important figure within the context of Pharmacoeconomics. Table 1 – Comparative consumption monthly expenses 2005 / 2006 Evaluated product Vauer / unit Use - 2005 Costs 2005 Use - 2006 Costs 2006 Bromopride 10 mg R$ 0,06 5920 R$ 355,20 3300 R$ 198,00 Morphine 10 mg R$ 0,12 11930 R$ 1.431,60 11340 R$ 1.360,80 Morphine 30 mg R$ 0,18 3210 R$ 577,80 3960 R$ 712,80 Dexamethasone 4 mg R$ 0,08 6110 R$ 488,80 4200 R$ 336,00 Enoxaparin 20 mg R$ 6,13 15 R$ 91,95 60 R$ 367,80 Enoxaparin 40 mg R$ 5,00 210 R$ 1.050,00 180 R$ 900,00 Fentanyl 25 mcg R$ 31,94 72 R$ 2.299,68 12 R$ 383,28 Fentanyl 50 mcg R$ 59,97 45 R$ 2.698,65 36 R$ 2.158,92 Amitriptyline 25 mg R$ 0,03 2290 R$ 68,70 2430 R$ 72,90 Metronidazole 250 mg R$ 0,03 3280 R$ 98,40 1290 R$ 38,70 Aminocaproic ac 500 mg R$ 0,44 3900 R$ 1.716,00 5046 R$ 2.220,24 Total cost R$ 10.876,78 R$ 8.749,44 The evaluation of the prescription by the pharmacist stimulated the correct use of medicines to decrease the number of medicines dispensed at each visit, which determines the smallest number of errors during treatment. We perceive, therefore, that even with the occasional increase in the consumption of relatively expensive items, the total cost was minimized. Pharmaceutical alternatives were created, such as implementing the use of metronidazole gel 0.8% instead of 250 mg tablet of metronidazole to control odor from infected wounds. Reducing the consumption of this product to approximately 98% compared with the year 2005. Another benefit of the importance of the pharmaceutical sector is the more effective control of materials and medicines that are no longer returned to the pharmacy due to a tightening at the time of dispensing of them were released showing that the items needed for the treatment of the patient at home, being a better management of hospital resources. The pharmacist insertion led to a reduction in the amount of exempted products, providing financial benefits to the institution, and encouraging the rational use of medicines. The proximity between different health care professionals give more dynamism and facilitates the exchange of information, leading to early identification of problems related to drugs or adverse events resulting from treatment, regardless of their nature. 1. WANNMACHER, L.; Erros: evitar o evitável; ISSN 1810-0791, v. 2 (7) p.1-6, 2005. 2. BERNARD, S.A.; BRUERA, E.; Drug Interactions in Palliative Care; Journal of Clinical Oncology, v18(8), p.1780-1799, 2000. 3. GOH,C.R.; Minimizing Polypharmacy – a challenge in palliative care; Sing. Med J., v.43(6), p.273-275, 2002. 4. ROSSIGNOLI, P.S.; GUARIDO, C.F.; CESTARI, I.M.; Ocorrência de interações medicamentosas em unidade de terapia intensiva: avaliação de prescrições médicas. Rev. Bras.Farm., v. 87 (4) p.
Transcript of Pharmacist Insertion in Home Care Service of Palliative ...
Proj
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Grá
fico:
Seç
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Ediç
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Técn
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INCA
CONCLUSION
REFERENCES
DISCUSSION
RESULTS
INTRODUCTION
METHOD
OBJECTIVE
Pharmacist Insertion in Home Care Service of Palliative Care Unit: a Search for Rational Drug Utilization
1 1 1 2 1Trombini, L.R.B. , Castro, L.S. , Barbosa, M.F , Pereira, L.C. & Lima, S.G.G. 1National Cancer Institute – Cancer Hospital IV
e-mail: [email protected] Pharmacy College - Federal Fluminense University - Specialization Course for Training in Healthcare Services Hospital for pharmacists, in the mold of Residence
e-mail: [email protected]
SUMMARY
Introduction: The Home Care Service in a palliative care unit has to provide a family living with an adequate quality of life for terminals patients. In these patients, polypharmacy is often necessary, however, predisposes them to drug interactions and other adverse events, also facilitated by advanced age and comorbidities. Purpose: To encourage the rational use of medicines, proving the importance of the pharmacist for the home care sector of the palliative care unit. Method: A retrospective study on pilot scale, in the drug utilization in the unit, through the assessment of 192 prescriptions in 2005, comparing the results obtained for consumption in 2006, already with a pharmacist involved in sector. In none of the tests were considered discarding of drugs. Results: We observed a marked reduction in the consumption of some items normally prescribed in home care, some of considerable price, such as fentanyl transdermal. From the comparison between the requirements of 2005 and 2006, we have seen that the overall economy was on the order of 20%, an important value within the Pharmacoeconomics context.Discussion and Conclusion: The pharmacist insertion led to a reduction in the amount of exempted products, providing financial benefits to the institution, and encouraging the rational use of medicines. The proximity between different health care professionals give more dynamism and facilitates the exchange of information, leading to early identification of problems related to drugs or adverse events resulting from treatment, regardless of their nature.
The Home Care of the National Cancer Institute (INCA) fits the philosophy of palliative care, to provide a family living with an adequate quality of life, to terminal patients. In these patients, polypharmacy is often necessary, however, predisposes them to drug interactions and other adverse events, also facilitated by advanced age and comorbidities. Since March 2006, the sector of the Home Care INCA has full-time pharmacists to exercise in the screening requirements of medicines and other products, the critical and dynamic participation of pharmacists tend to reduce the number of unnecessary prescriptions.
To Encourage the rational use of drugs, proving the importance of the pharmacist for the home care sector of the palliative care unit the National Cancer Institute (INCA).
Retrospective study on pilot scale, consumption in the unit, the evaluation of 192 prescriptions in 2005, comparing the results to consumers in 2006, already with a pharmacist involved in sector. In none of the tests were considered discarding of drugs.
We observed a marked reduction in the consumption of some items normally prescribed in home care, some of considerable price, such as fentanyl transdermal. From the comparison between the requirements of 2005, 2006 and 2007, you can see that the total economy was the order of 80%, an important figure within the context of Pharmacoeconomics.
Table 1 – Comparative consumption monthly expenses 2005 / 2006
Evaluated product
Vauer / unit
Use - 2005
Costs 2005 Use - 2006
Costs 2006
Bromopride 10 mg
R$ 0,06
5920
R$ 355,20 3300
R$ 198,00
Morphine 10 mg
R$ 0,12
11930
R$ 1.431,60 11340
R$ 1.360,80
Morphine 30 mg
R$ 0,18
3210
R$ 577,80 3960
R$ 712,80
Dexamethasone 4 mg
R$ 0,08
6110
R$ 488,80 4200
R$ 336,00
Enoxaparin 20 mg R$ 6,13 15 R$ 91,95 60 R$ 367,80
Enoxaparin 40 mg
R$ 5,00
210
R$ 1.050,00 180
R$ 900,00
Fentanyl 25 mcg
R$ 31,94
72
R$ 2.299,68 12
R$ 383,28
Fentanyl 50 mcg
R$ 59,97
45
R$ 2.698,65 36 R$ 2.158,92
Amitriptyline 25 mg
R$ 0,03
2290
R$ 68,70 2430 R$ 72,90
Metronidazole 250 mg
R$ 0,03
3280
R$ 98,40 1290 R$ 38,70
Aminocaproic ac 500 mg
R$ 0,44
3900 R$ 1.716,00 5046
R$ 2.220,24
Total cost R$ 10.876,78 R$ 8.749,44
The evaluation of the prescription by the pharmacist stimulated the correct use of medicines to decrease the number of medicines dispensed at each visit, which determines the smallest number of errors during treatment. We perceive, therefore, that even with the occasional increase in the consumption of relatively expensive items, the total cost was minimized. Pharmaceutical alternatives were created, such as implementing the use of metronidazole gel 0.8% instead of 250 mg tablet of metronidazole to control odor from infected wounds. Reducing the consumption of this product to approximately 98% compared with the year 2005. Another benefit of the importance of the pharmaceutical sector is the more effective control of materials and medicines that are no longer returned to the pharmacy due to a tightening at the time of dispensing of them were released showing that the items needed for the treatment of the patient at home, being a better management of hospital resources.
The pharmacist insertion led to a reduction in the amount of exempted products, providing financial benefits to the institution, and encouraging the rational use of medicines. The proximity between different health care professionals give more dynamism and facilitates the exchange of information, leading to early identification of problems related to drugs or adverse events resulting from treatment, regardless of their nature.
1. WANNMACHER, L.; Erros: evitar o evitável; ISSN 1810-0791, v. 2 (7) p.1-6, 2005. 2. BERNARD, S.A.; BRUERA, E.; Drug Interactions in Palliative Care; Journal of Clinical Oncology, v18(8), p.1780-1799, 2000.3. GOH,C.R.; Minimizing Polypharmacy – a challenge in palliative care; Sing. Med J., v.43(6), p.273-275, 2002.4. ROSSIGNOLI, P.S.; GUARIDO, C.F.; CESTARI, I.M.; Ocorrência de interações medicamentosas em unidade de terapia intensiva: avaliação de prescrições médicas. Rev. Bras.Farm., v. 87 (4) p.
