Banca de DEFESA: VALDJANE SALDANHA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : VALDJANE SALDANHA
DATE: 10/03/2020
TIME: 14:30
LOCAL: Sala RUTE do Hospital Universitário Onofre Lopes
TITLE:

Risk factors for drug-related problems in a general hospital: a large prospective cohort.

KEY WORDS:

Drug-related problem, Medical prescription review, General hospital, risk factors, Pharmacist interventions.

PAGES: 139
BIG AREA: Ciências da Saúde
AREA: Farmácia
SUMMARY:

Introduction: Drug-related Problem (DRP) interferes with the patient's ideal therapeutic results and may be associated with greater morbidity, mortality and health costs. Objective: The aim of study is describe incidence of DRP, their types and causes; in addition assess the acceptability of pharmaceutical interventions, identify risk factors in the first 48 hours of admission, develop and validate a DRP risk stratification system. Method: Prospective cohort study carried out in a general university hospital for 2 years, using PCNE 6.2 for classification of DRP detected by review of 100% of medical orders. For the identification of risk factors, logistic regression model was used to determine set of independent predictors in the first 48 hours after admission to the training set comprising 2/3 of the study population. The model was validated in the remaining sample. Results: The patient cohort consisted of 9,303 patients corresponding to 12,286 hospitalization episodes, with a mean age of 52.6 ± 17.7 years and 50.9% of female sex. 3,373 DRP were identified in 1,903 hospital episodes, a cumulative incidence of 15.5%. "Treatment ineffectiveness" (11.5%) and "Treatment cost" (5.90%) were the most common DRP, in addition "Drug use process" (18.4%) and "Treatment duration" (31. 0%) were the main causes of DRPs. The drugs most frequently involved in DRPs were anti-infectious (36.0%) like cephalosporins (20.2%), anti-ulcer (38.6%), analgesics / antipyretics (61.2%), propulsive (51.2%), opioids (38.5%) and antiemetics (57.4%). Of the 1,939 pharmaceutical interventions, at least 21.4% were not approved by the medical team. The study population for determining risk factors was composed of 1686 patients aged between 52.0 and 18.3 years, 51.4% female, mean length of stay of 3.24 days and 4.5% of hospital mortality with a cumulative incidence of potential DRP of 14.5%. Hospitalization for elective surgery and diagnosis of circulatory system disease were associated with reduced risk of DRP (OR 0.41 and 0.57, respectively, p <0.05). On the other hand, heart rate ≥ 80 bpm (OR 1.41, p = 0.05), prescription of seven or more medications on day 2 (OR 1.63, p = 0.05), prescription on day 1 of medications in the Therapeutic Anatomical Code Chemical (ATC) class A (alimentary tract and metabolism, OR 2.24, p = 0.003), prescription on day 2 of two or more ATC class A drugs (OR = 3.52, p <0.001) and on day 1 of class J ATC drugs (anti-infectives for systemic use, OR 1.97, p = 0.001) was associated to increase of DRP occurrence. In the validation set, the c-statistic of the predictive model was 0.65, the sensitivity was 56.1% and the specificity was 65.2%. Conclusion: The DRPs detected by the review of 100% of medical orders by hospital pharmacists occurred in a significant proportion of episodes, highlighting those related to effectiveness and costs of treatment. Cephalosporins, penicillins, antidispeptics, analgesics, antipyretics, opioids and antiemetics medications were the most involved in DRPs. Pharmaceutical interventions by written communication had low acceptability by the medical team. Seven independent risk factors for potential PRD were identified in hospitalized patients who had a fair predictive performance for use in clinical practice.

BANKING MEMBERS:
Externo à Instituição - PABLO MOURA SANTOS - UFBA
Externo à Instituição - ALDAIR DE SOUSA PAIVA - UFRN
Presidente - 1048067 - ANTONIO MANUEL GOUVEIA DE OLIVEIRA
Externa à Instituição - LUCIA DE ARAUJO COSTA BEISL NOBLAT - UFBA
Externo ao Programa - 1868020 - ZENEWTON ANDRÉ DA SILVA GAMA