Impacto clínico de um serviço de gerenciamento da terapia medicamentosa oferecido na atenção primária do município de Lagoa Santa

Abstract

Primary health care is an organization strategy that health systems use where a high prevalence of chronic diseases and patients using multiple medications is identified. In this context, it is necessary to implement the Comprehensive Medication Management (CMM) service that uses the pharmaceutical care framework to prevent, identify and solve drug therapy problems (DTP). In this perspective, the main objective of this work is to evaluate the clinical impact of the CMM service in primary health care in the city of Lagoa Santa, Minas Gerais, Brazil. For this reason, a quasi-experimental study is being performed with patients of the service between July 2014 and November 2016. Factors associated with DTP detection in the initial assessment was evaluated by performing univariate and multivariate analyzes. To evaluate the impact of the CMM service, a linear regression model was constructed from the difference between the initial and final values of the clinical and laboratory parameters adjusted by the following variables, duly centralized according to their mean: sex, age, number of drugs used in the initial query and number of queries. For all analyzes, a statistical significance level of 5% was adopted. A total of 1,642 DTPs were identified, the most prevalent being non-adherence (31.9%) and the need for additional medication (22.9%). The use of 5 or more drugs and the presence of 3 or more diseases were positively associated with the identification of 3 or more DTPs in the final multivariate model. Even after multiple adjustment, a statistically significant reduction was observed in the values of glycated hemoglobin, systolic blood pressure, low density cholesterol (LDLc) and total cholesterol. The CMM service contributed to the resolution of PRM and improved the clinical outcomes of the patients, proving to be an effective clinical service in primary health care.