Serviços Farmacêuticos em Doentes com Insuficiência Renal Crónica
Resumo
O papel dos farmacêuticos na assistência a doentes com insuficiência renal crónica tem sido documentado na literatura internacional e este estudo teve como objetivo compilar os serviços farmacêuticos prestados para que possam vir a ser considerados para eventual adaptação à realidade Portuguesa.Conduziu-se uma busca nas fontes secundárias Medline, International Pharmaceutical Abstracts, Pharmacy Abstracts e The Cochrane Library para recolher estudos descrevendo intervenções farmacêuticas em doentes com insuficiência renal crónica. No final, e após aplicação dos critérios de inclusão e exclusão, foram incluídos e analisados 37 estudos (correspondendo a 38 artigos). As intervenções farmacêuticas reportadas nos estudos foram: revisão do perfil farmacoterapêutico para identificação de problemas relacionados com a medicação, ajuste e otimização da terapêutica, identificação e correção de discrepâncias nos processos clínicos, avaliação da adequação da terapêutica durante a admissão e alta hospitalares, monitorização de parâmetros laboratoriais, implementação de protocolos de atuação na anemia, hiperparatiroidismo secundário, e hiperlipidemia, educação dos doentes, promoção da adesão à terapêutica, participação nas visitas médicas e reuniões multidisciplinares, comunicação e interação com outros profissionais de saúde, e fornecimento de informação sobre a escolha de fármacos e regimes terapêuticos.
Em conclusão, a análise da literatura internacional revelou uma multiplicidade de potenciais intervenções farmacêuticas em doentes com insuficiência renal crónica que evidenciam o potencial de atuação do farmacêutico no processo de uso de medicamentos destes doentes e na melhoria dos resultados clínicos.
Referências
National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
Sociedade Portuguesa de Nefrologia. Gabinete de Registo do tratamento da Doença Renal Terminal. 2010 [cited 12-Mar-2012]; Available from: http://www.spnefro.pt/comissoes_gabinetes/ Gabinete_registo_2010/default.asp
Manley HJ, Garvin CG, Drayer DK, Reid GM, Bender WL, Neufeld TK, et al. Medication prescribing patterns in ambulatory haemodialysis patients: comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol Dial Trans- plant. 2004;19(7):1842-8.
Manley HJ, McClaran ML, Overbay DK, Wright MA, Reid GM, Bender WL, et al. Factors associated with medication-related problems in ambulatory hemodialysis patients. Am J Kidney Dis. 2003;41(2):386-93.
Walker R, Whittlesea C. Clinical Pharmacy and Therapeutics. 4th ed. Edinburgh: Churchill Livingstone; 2007.
Didlake RH, Dreyfus K, Kerman RH, Van Buren CT, Kahan BD. Patient noncompliance: a major cause of late graft failure in cyclosporine-treated renal transplants. Transplant Proc. 1988;20(3 Suppl 3):63-9.
Pinsky BW, Takemoto SK, Lentine KL, Burroughs TE, Schnitzler MA, Salvalaggio PR. Transplant outcomes and economic costs associated with patient noncompliance to immunosuppression. Am J Transplant. 2009;9(11):2597-606.
Manley HJ, Cannella CA, Bailie GR, St Peter WL. Medication-related problems in ambulatory he- modialysis patients: a pooled analysis. Am J Kidney Dis. 2005;46(4):669-80.
Schmid H, Hartmann B, Schiffl H. Adherence toprescribed oral medication in adult patients undergoing chronic hemodialysis: a critical review of the literature. Eur J Med Res. 2009;14(5):185- 90.
Beney J, Bero LA, Bond C. Expanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes. Cochrane Database Syst Rev. 2000(3):CD000336.
Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT. Pharmacist care of patients with heart failure: a systematic review of randomized trials. Arch Intern Med. 2008;168(7):687-94.
Saini B, Filipovska J, Bosnic-Anticevich S, Taylor S, Krass I, Armour C. An evaluation of a community pharmacy-based rural asthma management service. Aust J Rural Health. 2008;16(2):100-8.
Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part II: systematic review and meta-analysis in hypertension management. Ann Phar- macother. 2007;41(11):1770-81.
Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta-analysis in diabetes management. Ann Pharmacother. 2007;41(10):1569-82.
Machado M, Nassor N, Bajcar JM, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part III: systematic review and meta-analysis in hyperlipidemia management. Ann Pharmacother. 2008;42(9):1195- 207.
Bajorek BV, Krass I, Ogle SJ, Duguid MJ, Shenfield GM. Optimizing the use of antithrombotic therapy for atrial fibrillation in older people: a pharmacist-led multidisciplinary intervention. J Am Geriatr Soc. 2005;53(11):1912-20.
Samitca S, Huissoud T, Jeannin A, Dubois-Arber F. The role of pharmacies in the care of drug users: what has changed in ten years. The case of a Swiss region. Eur Addict Res. 2007;13(1):50-6.
Salgado TM, Moles R, Benrimoj SI, Fernandez- Llimos F. Pharmacists’ interventions in the management of patients with chronic kidney disease:a systematic review. Nephrol Dial Transplant.
;27(1):276-92.
Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260(12):1743-8.
Donabedian A. The quality of medical care. Science. 1978;200(4344):856-64.
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377- 84.
Thomas SG, Diethelm AG, Keith TD, Simmons SM. Evaluating the quality of patient education in a self-medication teaching program. Hosp Formul. 1983;18(9):871-4, 7-8, 81-2 passim.
Golightly LK, O’Fallon CL, Moran WD, Sorocki AH. Pharmacist monitoring of drug therapy in patients with abnormal serum creatinine levels. Hosp Pharm. 1993;28(8):725-7, 30-2.
Tang I, Vrahnos D, Hatoum H, Lau A. Effectiveness of clinical pharmacist interventions in a hemodialysis unit. Clin Ther. 1993;15(2):459-64.
Kaplan B, Shimp LA, Mason NA, Ascione FJ. Chronic hemodialysis patients. Part II: Reducing drug-related problems through application of the focused drug therapy review program. Ann Pharmacother. 1994;28(3):320-4.
Soler Company E, Faus Soler MT, Olivas Ferran- dis JL, Cuenca Soria A, Sarrio Quiles L. [Intervention of the service of hospital pharmacy for the rational use of erythropoietin: clinical and economic assessment of its dispensing and administration to hemodialyzed patients]. Farm Hosp. 1996;20(6):381-6.
Grabe DW, Low CL, Bailie GR, Eisele G. Evaluation of drug-related problems in an outpatient hemodialysis unit and the impact of a clinical pharmacist. Clin Nephrol. 1997;47(2):117-21.
Anonymous. Pharmacist-run program optimally manages secondary hyperparathyroidism. Hosp Formul. 1998;33:1217-8.
Possidente CJ, Bailie GR, Hood VL. Disruptions in drug therapy in long-term dialysis patients who require hospitalization. Am J Health Syst Pharm. 1999;56(19):1961-4.
Chisholm MA, Vollenweider LJ, Mulloy LL, Jagadeesan M, Wade WE, DiPiro JT. Direct patient care services provided by a pharmacist on a multidisciplinary renal transplant team. Am J Health Syst Pharm. 2000;57(21):1994-6.
Chisholm MA, Vollenweider LJ, Mulloy LL, Wynn JJ, Wade WE, DiPiro JT. Cost-benefit analysis of a clinical pharmacist-managed medication assistance program in a renal transplant clinic. Clin Transplant. 2000;14(4 Pt 1):304-7.
Chisholm MA, Mulloy LL, Jagadeesan M, DiPiro JT. Impact of clinical pharmacy services on renal transplant patients’ compliance with immunosuppressive medications. Clin Transplant. 2001;15(5):330-6.
Quercia RA, Abrahams R, White CM, D’Avella J, Campbell M. Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program. Hosp Pharm. 2001;36(2):169-75.
To LL, Stoner CP, Stolley SN, Buenviaje JD, Ziegler TW. Effectiveness of a pharmacist-implemented anemia management protocol in an outpatient hemodialysis unit. Am J Health Syst Pharm. 2001;58(21):2061-5.
Chisholm MA, Mulloy LL, Jagadeesan M, Martin BC, DiPiro JT. Effect of clinical pharmacy services on the blood pressure of African-American renal transplant patients. Ethn Dis. 2002;12(3):392-7.
Viola RA, Abbott KC, Welch PG, McMillan RJ, Sheikh AM, Yuan CM. A multidisciplinary program for achieving lipid goals in chronic hemodialysis patients. BMC Nephrol. 2002;14;3:9.
Manley HJ, Drayer DK, McClaran M, Bender W, Muther RS. Drug record discrepancies in an outpatient electronic medical record: frequency, type, and potential impact on patient care at a hemodialysis center. Pharmacotherapy. 2003;23(2):231-9.
Manley HJ, Drayer DK, Muther RS. Medication-related problem type and appearance rate in ambulatory hemodialysis patients. BMC Nephrol. 2003 Dec 22;4:10.
Mirkov S, Ball P. Design and Pilot of a Medication Review Clinic in a Dialysis Centre. J Pharm Practice. 2003;33(3):199-203.
Kimura T, Arai M, Masuda H, Kawabata A. Impact of a pharmacist-implemented anemia management in outpatients with end-stage renal disease in Japan. Biol Pharm Bull. 2004;27(11):1831-3.
Salcedo J, Agudelo N, Baena MI. [Pharmaco- therapy follow-up to transplanted patients during hospitalization in Foundation Clinic Valle del Lili (Cali-Colombia)]. Seguim Farmacoter. 2004;2(1):12-8.
Leung WY, So WY, Tong PC, Chan NN, Chan JC. Ef- fects of structured care by a pharmacist-diabetes specialist team in patients with type 2 diabetic nephropathy. Am J Med. 2005;118(12):1414.
Patel HR, Pruchnicki MC, Hall LE. Assessment for chronic kidney disease service in high-risk patients at community health clinics. Ann Pharmacother. 2005;39(1):22-7.
Walton T, Holloway KP, Knauss MD. Pharmacist-Managed Anemia Program in an Outpatient Hemodialysis Population. Hosp Pharm. 2005;40(12):1051-6.
Allenet B, Chen C, Romanet T, Vialtel P, Calop J. Assessing a pharmacist-run anaemia educational programme for patients with chronic renal insufficiency. Pharm World Sci. 2007;29(1):7-11.
Bucaloiu ID, Akers G, Bermudez MC, Mainali R, Brown BL, Roberts SS, et al. Outpatient erythropoietin administered through a protocol-driven, pharmacist-managed program may produce significant patient and economic benefits. Manag Care Interface. 2007;20(6):26-30.
Chisholm MA, Spivey CA, Mulloy LL. Effects of a medication assistance program with medication therapy management on the health of renal transplant recipients. Am J Health Syst Pharm. 2007;64(14):1506-12.
Joy MS, Candiani C, Vaillancourt BA, Chin H, Hogan SL, Falk RJ. Reengineering clinical operations in a medical practice to optimize the management of anemia of chronic kidney disease. Pharmacotherapy. 2007;27(5):734-44.
Sathvik BS, Mangasuli S, Narahari MG, Gurudev KC, Parthasarathi G. Medication knowledge of hemodialysis patients and influence of clinical pharmacist provided education on their knowledge. Ind J Pharm Sci. 2007;69(2):232-9.
Leal S, Soto M. Chronic kidney disease risk reduction in a Hispanic population through pharmacist-based disease-state management. Adv Chronic Kidney Dis. 2008;15(2):162-7.
Wang HY, Chan AL, Chen MT, Liao CH, Tian YF. Effects of pharmaceutical care intervention by clinical pharmacists in renal transplant clinics. Transplant Proc. 2008;40(7):2319-23.
Yokum D, Glass G, Cheung CF, Cunningham J, Fan S, Madden AM. Evaluation of a phosphate management protocol to achieve optimum serum phosphate levels in hemodialysis patients. J Ren Nutr. 2008;18(6):521-9.
Hassan Y, Al-Ramahi RJ, Aziz NA, Ghazali R. Impact of a renal drug dosing service on dose adjustment in hospitalized patients with chronic kidney disease. Ann Pharmacother. 2009;43(10):1598-605.
Mirkov S. Implementation of a pharmacist medication review clinic for haemodialysis patients. N Z Med J. 2009;122(1297):25-37.
Pai AB, Boyd A, Chavez A, Manley HJ. Health-related quality of life is maintained in hemodialysis patients receiving pharmaceutical care: A 2-year randomized, controlled study. Hemodial Int. 2009;13(1):72-9.
Pai AB, Boyd A, Depczynski J, Chavez IM, Khan N, Manley H. Reduced drug use and hospitalization rates in patients undergoing hemodialysis who received pharmaceutical care: a 2-year, randomized, controlled study. Pharmacotherapy. 2009;29(12):1433-40.
Thomas D, Joseph J, Francis B, Mohanta GP. Effect of patient counseling on quality of life of hemodialysis patients in India. Pharm Pract. 2009;7(3):181-4.
Ledger S, Choma G. Medication reconciliation in hemodialysis patients. Cannt J. 2008;18(4):41-3.
Kennie NR, Schuster BG, Einarson TR. Critical analysis of the pharmaceutical care research literature. Ann Pharmacother. 1998;32(1):17-26.
Charrois TL, Durec T, Tsuyuki RT. Systematic reviews of pharmacy practice research: methodologic issues in searching, evaluating, interpreting, and disseminating results. Ann Pharmacother. 2009;43(1):118-22.
Fernandez-Llimos F, Tuneu L, Baena MI, Garcia-Delgado A, Faus MJ. Morbidity and mortality associated with pharmacotherapy. Evolution and current concept of drug-related problems. Curr Pharm Des. 2004;10(31):3947-67.
Somers A, Robays H, Vander Stichele R, Van Maele G, Bogaert M, Petrovic M. Contribution of drug related problems to hospital admission in the elderly. J Nutr Health Aging. 2010;14(6):477- 82.
Fick DM, Mion LC, Beers MH, J LW. Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health. 2008;31(1):42-51.
Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41(2):192-9.
Manley HJ, Carroll CA. The clinical and economic impact of pharmaceutical care in end-stage renal disease patients. Semin Dial. 2002;15(1):45-9.
Moreno F, Aracil FJ, Perez R, Valderrabano F. Controlled study on the improvement of quality of life in elderly hemodialysis patients after correcting end-stage renal disease-related anemia with erythropoietin. Am J Kidney Dis. 1996;27(4):548- 56.
Alexander M, Kewalramani R, Agodoa I, Globe D. Association of anemia correction with health related quality of life in patients not on dialysis.
Curr Med Res Opin. 2007;23(12):2997-3008. Simic-Ogrizovic S, Jemcov T, Pejanovic S, Stosovic M, Radovic M, Djukanovic L. Health-related quality of life, treatment efficacy, and hemodialysis patient outcome. Ren Fail. 2009;31(3):201-6.
Dowling TC. Prevalence, etiology, and consequences of anemia and clinical and economic benefits of anemia correction in patients with chronic kidney disease: an overview. Am J Health Syst Pharm. 2007;64(13 Suppl 8):S3-7; quiz S23- 5.
Ayus JC, Go AS, Valderrabano F, Verde E, de Vinuesa SG, Achinger SG, et al. Effects of erythropoietin on left ventricular hypertrophy in adults with severe chronic renal failure and hemoglobin <10 g/dL. Kidney Int. 2005;68(2):788-95.
Jungers P, Choukroun G, Oualim Z, Robino C, Nguyen AT, Man NK. Beneficial influence of recombinant human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients. Nephrol Dial Transplant. 2001;16(2):307-12.
Fink J, Blahut S, Reddy M, Light P. Use of erythropoietin before the initiation of dialysis and its impact on mortality. Am J Kidney Dis. 2001;37(2):348-55.
London GM, Guerin AP, Marchais SJ, Metivier F, Pannier B, Adda H. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant. 2003;18(9):1731-40.
