Identificação e desenvolvimento de indicadores de qualidade para serviços de revisão da farmacoterapia

• Ano de defesa: 2017
• Autor(a) principal: Silva, Rafaella de Oliveira Santos
• Orientador(a): Lyra Júnior, Divaldo Pereira de
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Programa de Pós-Graduação: Pós-Graduação em Ciências Farmacêuticas
• Palavras-chave em Português: Serviços farmacêuticos; Controle de qualidade; Farmacologia; Medicamentos; Serviços de saúde; Revisão da farmacoterapia; Pesquisa de implementação em serviços de saúde; Indicador de qualidade; Garantia da qualidade
• Palavras-chave em Inglês: Medication review; Implementation research in health services; Quality indicator; Quality assurance
• Área do conhecimento CNPq: CIENCIAS BIOLOGICAS::FARMACOLOGIA
• Link de acesso: http://ri.ufs.br/jspui/handle/riufs/7252

Introduction. Drug-related problems are frequent in clinical practice and are related to increased morbidity and mortality as well as health care costs. In this context, Medication Review (MR) services may be key elements in improving the use of medicines. However, there are few studies on implementation, monitoring, evaluation and improvement of the quality of such services. Therefore, there is a need for further research with focus on the subject with the aim of defining scientific models for these services. Aim. To develop quality indicators for Medication Review services. Methods. Initially, an overview of systematic reviews was performed in the databases Embase, LILACS, PubMed, Scopus, The Cochrane Library and Web of Science using the key words "medication review", "pharmacist" and "systematic review". Subsequently, a methodological development study was realized in two subsequent steps. In the first step, variables used to describe MR practices with potential to constitute indicators were identified through the reviews included in the overview. In the second step, a panel of experts categorized the variables in structure, processes and outcomes; choosen variables that could give support to the development; and, developed quality indicators for MR services. The quality indicators were reviewed and ranked by a senior-evaluator as the approach, source and pre-specification. Results. In the overview, 11 systematic reviews met the inclusion criteria. It was observed that MR is approached as both clinical service and pharmaceutical intervention adopting ten different terminologies. Regardless of terminologies, the main objective of MR practice is to identify and solve drug-retated problems. Most of the reviews presented methodological quality below ideal. In addition, none of the reviews focused on quality assessment of the MR practice. In the methodological development study, 272 variables were extracted from the reviews; 253 variables were chosen for the development of indicators; and, 71 quality indicators for MR services were developed. Of these, four were of structure, 45 of processes and 22 of outcomes. In addition, most indicators were classified as explicit (n = 55), empirical (n = 7) and quantitative (n = 61). Conclusion. Heterogeneity of terminologies, definitions and approach of MR as well as the low methodological rigor of the studies limit the comparison of this practice. Thus, it is necessary an international agreement on the MR process and to stablish minimum quality standards for the MR practice, which can be done through quality indicators. In this scenario, the combination of scientific evidence and a panel of experts may assist in the development of indicators for MR services. Given the above, the results obtained in conjunction with indicators developed from other sources could support the construction of scientific models to implement, assess, optimize and compare quality of MR practices.