Impacto do serviço de gerenciamento da terapia medicamentosa em pacientes transplantados renais em uso de tacrolimo.

Abstract

Introduction: The renal transplant patient has a complex pharmacotherapy and in this perspective, the Medication Therapy Management (MTM) service comes to meet the pharmacotherapeutic needs in order to contribute to the improvement of health outcomes. To date, there are few studies in Brazil and in the world reporting the clinical impact of the Outpatient Medication Therapy Management service for renal transplant patients. Objective: To analyze this service impact on clinical outcomes in renal transplant patients and their satisfaction with the service. Local: Transplant Outpatient Clinic of a large general Hospital in Belo Horizonte, Brazil. Methodology: Pre-post intervention study with forty-two patients, followed by two pharmacists, using the Pharmaceutical Workup method, and in the last appointment, the service satisfaction was evaluated. Main outcomes: number, type, and drug-related problems proportion, interventions and clinical status. Results: Most patients followed were men (57,1%), mean age of 44,1 (±13,9) years, corresponding to 35,7%. Were performed a mean of 3,1±1,1 appointments per patients, with the mean follow-up time of 8 ± (4,1) months. All patients reported having a family history kidney disease, and in its majority, the diagnosis was about 10 years (40,5%). Most patients had 3 months to 1 year of transplantation (62,0%) and 85,7% underwent hemodialysis as pre-transplant renal replacement therapy. It was observed that 54,8% of patients had up to 2 concomitant diseases, in addition to transplantation. Among them, systemic arterial hypertension (47,6%), gastric disorders (11,9%), diabetes (7,1%), hypercholesterolemia (7,1%) and epilepsy (2,4%). Hypertension was the main known cause of chronic kidney disease that took 40.5% of patients in this study to kidney transplantation. Other causes for the transplantation were glomerulonephritis (11,9%) and diabetes (11,9%). Were identified 39 drug-related problems, with 64.3% of the patients presenting at least one, of which 79,5% were resolved (p = 0.001). The most frequent were use of unnecessary medications (26,5%) and non-adherence (22,4%). Most patients (97,6%) used 3 drugs for transplantation and the average number of drugs to treat other health problems was 3.7 ± 2.1. Polymedicated patients presented more drug-related problems (p = 0.001). There were 49 interventions, 53% of which were accepted. The most frequent interventions were recommendation to adhere to treatment (30,0%) and suspend the pharmacological treatment (26,5%). At the end, the proportion of patients with stable clinical condition increased from 35,7% to 83,3% (p = 0.001). After the last appoitment, the satisfaction questionnaire with the pharmaceutical services (QSSF) was applied. The patients rated the service as very good. Conclusion: The Medication Therapy Management (MTM) service positively impacted the patient clinical situation, demonstrated to be effective in solving drug-related problems and was very well evaluated by the group. Polipharmacy should be a priority criterion for the service.