Desenvolvimento de um instrumento de priorização de pacientes para serviços de farmácia clínica hospitalar.

Abstract

Medications offer significant health benefits and are the most common intervention in health care. Faced with the scarcity of resources in health systems, hospital pharmacy services encounter challenges, such as a limited number of pharmacists. At the same time, there is an increasing number of hospital admissions whose patients need pharmacotherapy optimization. This setting makes it difficult for the pharmacist to provide adequate care for all patients during hospitalization, is necessary to evaluate and prioritize patients who most need the pharmacist's intervention. One way to prioritize is by creating patient selection criteria for follow-up by clinical pharmacists, for which instruments have been developed using consensus methods and predictive models. Artificial intelligence has also been used as a strategy to achieve better patient outcomes, making it faster and easier to perform clinical activities and identify target patients. Development of patient prioritization instruments for clinical pharmacy services in hospital care can contribute to increasing the efficiency of pharmaceutical care in hospitals. The objective of this study was to develop a Patient Prioritization instrument for Hospital Clinical Pharmacy Services (PrioFarClinH)A. PrioFarClinH was developed using a design multi step: scope review to identify prioritization criteria/sub-criteria; Delphi technique to obtain consensus on identified criteria/subcriteria; Survey to assess the criteria/sub-criteria applicability obtained from Delphi study, as well as understanding the reality of prioritization in the clinical pharmacists care practice of hospital in Brazil; content validation and standardization of the instrument to define the criteria/sub-criteria to be included in PrioFarClinH and attribution of scores. A total of 19 criteria and 230 sub-criteria were included for expert evaluation and consensus based on the scoping review. Twenty-nine, 22 and 17 experts participated per round, respectively. After completing the three rounds, experts suggested the inclusion of one criterion, the exclusion of one criterion, and the inclusion of 29 sub-criteria. The final list consisted of 18 criteria and 28 groups of sub-criteria encompassing 177 sub-criteria. During the Survey, 89 (74.2%) of the 120 evaluations of the criteria/sub-criteria obtained agreement above 70% regarding their applicability in clinical practice. A total of 149 pharmacists accepted to participate in the Survey. In A Brazilian Portuguese acronym. clinical practice, 94 (63.1%) participants use prioritization criteria to select patients for clinical pharmacy care, and 55 (36.9%) employ prioritization using an interface with some computerized hospital system. The PrioFarClinH final version presents four aspects of prioritization: patient factors; health problems; therapeutic classes; laboratory parameters. It includes 51 criteria with specific scores with simple total calculation. Data were collected from 393 patients eligible for the study. The P90 percentile in the three moments of hospitalization (24 hours, 72 hours and median) was found, respectively, in the following scores: 18,0; 20,0; 22,6. The PrioFarClinH development showed to be robust. PrioFarClinH provided evidence of content validity and aims to prioritize adult patients most likely to benefit from clinical pharmacy service. Future studies, in addition to internal and external validation is required to establish the performance of PrioFarClinH.