Desenvolvimento e validação de instrumento para seleção de pacientes com hipertensão arterial sistêmica não controlada para acompanhamento farmacoterapêutico (ISPHAF-APS).

Abstract

The way pharmaceutical assistance is structured in public health services makes it difficult for pharmacists to work clinically, as they need to reconcile technical-managerial activities with patient care. Furthermore, the high prevalence of cardiovascular diseases, such as Systemic Arterial Hypertension (SAH), together with the increased demand for health services and the limitation of available resources make it impossible to care for the entire population, therefore having screening tools that help identifying priority cases is necessary for health services to function effectively. The existence of few instruments that contribute to defining priority cases for clinical care with the pharmacist reinforces the need for the development of such tools. Therefore, the objective of this study was to develop and validate an instrument that helps in the screening of patients with SAH who require clinical follow-up with a pharmacist. This is a methodological study, carried out in Basic Health Units (BHU) in Belo Horizonte, Minas Gerais, which involves the development and validation of the instrument for selecting patients with SAH who require pharmacotherapeutic monitoring. Qualitative research was carried out with interviews with health professionals and focus groups with people with hypertension, with the aim of identifying the main characteristics that lead to patients being referred for consultation with a pharmacist. All interviews were transcribed and subsequently analyzed using Atlas.ti® software. From the interviews and focus groups, the initial version of the instrument was developed for subsequent validation. Furthermore, the following steps were carried out: evaluation by judges of the importance and relevance of each item of the proposed instrument, in this stage the Content Validity Coefficient (CVC) and the Fleiss Kappa test were calculated; semantic analysis to verify whether the items are understandable to the individuals for whom the instrument is intended; to verify the suitability, the instrument was applied to patients with SAH, whose results were used to evaluate the reliability and validity through Partial Least Squares Structural Equation Modeling - PLS-SEM). Based on the analysis of data collected in interviews and focus groups, the preliminary version of the ISPHAF-APS was developed. To interpret the instrument score, quartiles were established. The instrument analyzed by fourteen judges initially contained 36 items divided into four dimensions, namely: Lifestyles, Comorbidities, Use of health services and Use of medications. After the evaluation, three items were deleted, two were changed in size and eight were revised and rewritten. The value obtained for Fleiss' Kappa was 0.66, which demonstrated agreement between the judges when categorizing the items in the instrument's dimensions. The CVC was calculated regarding the clarity, relevance and simplicity of the instrument items. For clarity, 70.27% of the items presented values greater than 0.80. As for relevance, 91.89% had values above 0.80 and 70.27% had values above 0.80 for simplicity. For semantic analysis, thirteen patients with SAH participated. At this stage, no item was excluded, ten were rewritten and information was included in eight to aid understanding. A sample of 828 patients with SAH responded to the instrument. In the statistical analysis, the items that were essential to the instrument and those that do not effectively influence it were indicated. By calculating composite reliability (rho), the most relevant items for the ISPHAF-APS were identified. The items were deleted one by one until the rho of the general component was above 0.70, its final rho value was 0.99. The final version of the instrument had fourteen items organized into three dimensions (Comorbidities, Use of Health Services and Use of medications). Based on statistical analyses, the instrument presented adequate validity and reliability aspects. The ISPHAF-APS presented adequate psychometric properties and, therefore, is a validated instrument capable of identifying patients with SAH who would benefit most from the clinical service provided by pharmacists. Having a tool that helps in patient selection contributes positively to directing pharmaceutical care to those who need it most.