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Pharmaceutical Consultation in Primary Care Multidisciplinar Team
European Statement
Clinical Pharmacy Services
Author(s)
Claudia Elias, Nadine Ribeiro, Anacleto Mariana, Amaral Daniel, Cimadeira Fátima, Abreu Ana Paula, Vaz Filomena, Martinho Helena , Bernardo Mónica , Mateus Rita , Martins Sandra
Why was it done?
The care of elderly patients with multi-morbidities is a great challenge faced by the our National HealthCare System, due to the complexity of the most vulnerable in society. When the medication risks begin to outweigh benefits, polypharmacy may become inappropriate. Management of polypharmacy is an essential element of patient safety and adherence, preventing medicines harm and infectivity. In the primary care setting there was no integrated multidisciplinary pharmacotherapy management service.
What was done?
Clinical Pharmacist was included in multidisciplinary team in Primary Care for Pharmaceutical Consultation implementation.
How was it done?
The Pharmacy Department and of the Regional Team, supported by the Board of Directors, joined efforts for the implementation of a Program for the Management of Polymedication in Complex and Chronic Fragile. It implies patients with medication problems referral by physicians to the pharmacist. Pharmacist schedules a face-to-face, or telephone, interview, inviting them to bring all drug packages. During consultation, patient’s health literacy, therapeutic adherence and drug management skills are assessed. Doubts are clarified and information on drugs best use and non-pharmacological measures benefits are provided. The pharmacist then makes the pharmacotherapeutic review looking up for any unaddressed medication related problem. In conjunction with the attending physician, they agree in the best pharmacotherapeutic plan for the patient.
What has been achieved?
The project started 2.5 years ago, being implemented in four primary care units. We had 124 patient referrals and made 171 consultations. Before Covid pandemic, all the contacts were face-to-face now 60% are teleconsultation. The median age is 76 years, 59% female with an average of 11 comorbidities and 11 medicines prescribed/patient, being cardiovascular and endocrine pathologies the most commons. Only 33% of patients took medicines has prescribed and of them, only 61% could identify their indication. The most prevalent drug problems were safety (42%) and need (25%). Off the 539 interventions, 48% addressed desprescription, drug substitution and dose adjustment by physicians; 14,3% aimed drug education use by patients or caregivers; 88% of the suggested interventions were accepted.
What next?
We expect to expand the project to other health care units briefly.
Even though the inclusion of a clinical pharmacist in primary care units is currently centered in the management of polypharmacy, it may encourage involvement in other activities that enhance the pharmacist role in the primary care units.