Department of Pharmacy and Nutrition, Federal University of Espírito Santo, Espírito Santo, Brazil.
Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Sergipe, Brazil.
J Eval Clin Pract. 2021 Apr;27(2):391-403. doi: 10.1111/jep.13448. Epub 2020 Aug 13.
RATIONALE, AIMS, AND OBJECTIVES: The growth of clinical pharmacy services (CPS) has positively impacted clinical, economic, and humanistic health outcomes. However, detailed studies on the process of implementing CPS in healthcare systems are incipient. Thus, the present study aimed to evaluate the CPS implementation in certain public health units in a metropolis in northeast Brazil.
A quasi-experimental before-and-after study was carried out in Recife City, from July 2015 to March 2016. The study was carried out using the Methodology of Problematization with Maguerez Arc and was divided into: initial evaluation (before), planning, interventions, and preliminary evaluation (after). The participants were pharmacists, patients, health professionals, and local health managers. Descriptive statistics were used to report data. The statistical significance of the comparison between variables was evaluated using the Wilcoxon test (95% CI; P ≤ .05).
Initial evaluation: Identified incipient CPS, a lack of structure and work process of pharmacists. Planning: Sixteen brainstorming meetings were held with the different actors resulting in a strategic plan.
Twenty-two political-administrative meetings were held with managers and health teams and 768 hours of theoretical and practical training with mentoring for pharmacists. Preliminary evaluation: Structure indicators presented a statistically significant difference, differently from the process indicators. Pharmacists attended 842 patients and performed 1465 pharmaceutical consultations in 6 months. Regarding the outcome indicators, it was possible to identify changes in the clinical status of the most prevalent diseases among those patients who attended three pharmaceutical consultations.
It was possible to evaluate the CPS implementation in certain public health units in a metropolis in Brazil, through the Methodology of Problematization with Maguerez Arc. This methodology may be part of models for future implementations of CPS in health systems.
背景、目的和目标：临床药学服务（CPS）的发展对临床、经济和人文健康结果产生了积极影响。然而，关于在医疗保健系统中实施 CPS 过程的详细研究还处于初期阶段。因此，本研究旨在评估巴西东北部一个大都市的某些公共卫生单位中 CPS 的实施情况。
在累西腓市进行了一项准实验性前后研究，时间为 2015 年 7 月至 2016 年 3 月。该研究采用了 Maguerez Arc 的问题化方法学，并分为：初步评估（前）、规划、干预和初步评估（后）。参与者包括药剂师、患者、卫生专业人员和当地卫生管理人员。使用描述性统计来报告数据。使用 Wilcoxon 检验（95%置信区间；P ≤.05）评估变量之间比较的统计显著性。
初步评估：确定了初步的 CPS，缺乏药剂师的结构和工作流程。规划：与不同的参与者进行了 16 次头脑风暴会议，制定了战略计划。
与管理人员和卫生团队举行了 22 次政治管理会议，并对药剂师进行了 768 小时的理论和实践培训及辅导。初步评估：结构指标呈现出统计学上的显著差异，而过程指标则不同。在 6 个月内，药剂师共接待了 842 名患者并进行了 1465 次药学咨询。关于结果指标，可以发现参加了三次药学咨询的患者中最常见疾病的临床状况发生了变化。
通过 Maguerez Arc 的问题化方法学，可以评估巴西一个大都市中某些公共卫生单位的 CPS 实施情况。该方法学可以成为未来在卫生系统中实施 CPS 的模型的一部分。
