Cuidados Farmacêuticos Caminhos para o futuro · MTM definition (J Am Pharm Assoc. 2008;48(3):341-353) • Medication therapy management (MTM) is a distinct service or group of services

Cuidados Farmacêuticos –Caminhos para o futuro

Fernando Fernandez-Llimos

Universidade de Lisboa

sumário

• Futuro ?

• Cuidados Farmacêuticos ?

• Tem futuro os cuidados farmacêuticos ?

Conflicto de intereses:

• Sim, tenho.

de 1922 a 1969

O farmacêutico tinha proibido:

“to comment the therapeutical effects or thecomposition of a prescription with patients”

Código ético da American Pharmaceutical Association.

1970

Brodie DC. Drug utilization – Public health probelm. Drug Intell Clin Pharm 1970;4:203.

Brodie DC. Drug utilization – Public health probelm. Drug Intell Clin Pharm 1970;4:203.

1970

Francke DE. The clinical pharmacist. Drug Intell 1967;1:243

1967

Francke DE. The clinical pharmacist. Drug Intell 1967;1:243

1967

1950

Rudi FM. The future of pharmacy as a profession may lie in hospital and clinical practice. Mod Hosp. 1950;75(3):100-2.

1950

Rudi FM. The future of pharmacy as a profession may lie in hospital and clinical practice. Mod Hosp. 1950;75(3):100-2.

PubMed 4-Fev-2017

PubMed 4-Fev-2017

Leitura recomendada

A leiteira. Everest Editora; 2005. ISBN: 9789895002757

Difussão das inovações

Rogers EM. Diffusion of Innovations, 4th ed. New York: The Free Press; 1995.

Difussão das inovações

Difussão das inovações

Rogers EM. Diffusion of Innovations, 4th ed. New York: The Free Press; 1995.

Failed innovation

Cuidados Farmacêuticos –Caminhos para o futuro

Fernando Fernandez-Llimos

Universidade de Lisboa

O que são os

Cuidados Farmacêuticos?

Linha histórica

1950

Linha histórica

1967

Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-43.

Cuidados Farmacêuticos

Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-43.

Cuidados Farmacêuticos

Linha histórica

Farmácia clínica

1990

J Am Pharm Assoc. 2005;45:566–572

MTM definition(J Am Pharm Assoc. 2008;48(3):341-353)

• Medication therapy management (MTM) is a distinct service or group of services that optimize therapeutic outcomes for individual patients.

• MTM services are independent of, but can occur in conjunction with, the provision of a medication product.

• MTM encompasses a broad range of professional activities and responsibilities within the licensed pharmacist’s or other qualified health care provider’s scope of practice.

Linha histórica

2005

Linha histórica

Farmácia clínica Pharmaceuticalcare

Comprehensive Medication Management

Cobb CD. Optimizing medication use with a pharmacist-provided comprehensive medication management service forpatients with psychiatric disorders. Pharmacotherapy. 2014;34(12):1336-40.

Dvoracek JJ, Cook KM, Klepser DG. Student-run low-incomefamily medicine clinic: controlling costs while providingcomprehensive medication management. J Am Pharm Assoc(2003). 2010 May-Jun;50(3):384-7.

Comprehensive Medication Management

https://www.accp.com/docs/positions/misc/CMM%20Brief.pdf

Linha histórica

Linha histórica

Farmácia clínica Pharmaceuticalcare MTM

CMM

O.M.G.!!!

Diferenças?

Dreischulte T, Fernandez-Llimos F. Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy. Int J Clin Pharm. 2016 Dec;38(6):1445-1456.

Clinical Pharmacy & Pharmaceutical Care

Dreischulte T, Fernandez-Llimos F. Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy. Int J Clin Pharm. 2016 Dec;38(6):1445-1456.

Clinical Pharmacy & Pharmaceutical Care

Dreischulte T, Fernandez-Llimos F. Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy. Int J Clin Pharm. 2016 Dec;38(6):1445-1456.

Clinical Pharmacy & Pharmaceutical Care

Dreischulte T, Fernandez-Llimos F. Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy. Int J Clin Pharm. 2016 Dec;38(6):1445-1456.

Clinical Pharmacy & Pharmaceutical Care

Dreischulte T, Fernandez-Llimos F. Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy. Int J Clin Pharm. 2016 Dec;38(6):1445-1456.

Clinical Pharmacy & Pharmaceutical Care

Dreischulte T, Fernandez-Llimos F. Current perceptions of the term Clinical Pharmacy and its relationship to Pharmaceutical Care: a survey of members of the European Society of Clinical Pharmacy. Int J Clin Pharm. 2016 Dec;38(6):1445-1456.

Cuidados Farmacêuticos –Caminhos para o futuro

Fernando Fernandez-Llimos

Universidade de Lisboa

Barreiras? Quais?

Brazinha I, Fernandez-Llimos F. Barriers to the implementation of advanced clinical pharmacy services at Portuguese hospitals. Int J Clin Pharm. 2014 Oct;36(5):1031-8.

Barreiras? Quais?

ConclusionSeveral barriers to the implementation of advanced clinical services in hospital pharmacies in Portugal were identified. These barriers comprised hospital pharmacists’ mind-set, environmental factors, access to information and technology, and particularities regarding the structure and organisationof the pharmacy service within the hospital.Of these barriers, the pharmacists’ mind-set appears to be a major barrier that limits the implementation of advanced clinical pharmacy services in Portuguese hospitals and influences the perception of all the other barriers.

Brazinha I, Fernandez-Llimos F. Barriers to the implementation of advanced clinical pharmacy services at Portuguese hospitals. Int J Clin Pharm. 2014 Oct;36(5):1031-8.

Management by objectives

eu:

Fernando Fernandez-Llimos

Universidade de Lisboa

Rotta I, Souza TT, Salgado TM, Correr CJ, Fernandez-Llimos F. Characterization of published randomized controlled trials assessing clinical pharmacy services around the world. Res Social Adm Pharm. 2017 Jan - Feb;13(1):201-208.

Sabater-Hernández D, Sabater-Galindo M, Fernandez-Llimos F, Rotta I, Hossain LN, Durks D, Franco-Trigo L, Lopes LA, Correr CJ, Benrimoj SI. A Systematic Review of Evidence-Based Community Pharmacy Services Aimed at the Prevention of Cardiovascular Disease. J Manag Care Spec Pharm. 2016 Jun;22(6):699-713.

Carga horária de ciencias básicas

Nunes-da-Cunha I, Arguello B, Martinez F, Fernandez-Llimos F. A comparison of patient-centered care in pharmacy curricula in the United States and Europe. Am J Pharm Educ. 2016;80(5):83.

Carga horária de matérias clínicas

Nunes-da-Cunha I, Arguello B, Martinez F, Fernandez-Llimos F. A comparison of patient-centered care in pharmacy curricula in the United States and Europe. Am J Pharm Educ. 2016;80(5):83.

2011

Autonomia

Alterar uma dose 15,8%

Alterar um intervalo de administração 15,8%

Alterar a duração de uma terapêutica 26,3%

Introduzir um novo medicamento 5,3%

Suspender um medicamento 10,5%

Substituir por uma alternativa terapêutica 15,8%

Alterar a forma farmacêutica 36,8%

Alterar a via/método de administração 100,0%

Como mudar?

Kotter JP. Leading Change. Boston, MA: Harvard Business School Press; 1996. ISBN 9780875847474.

http://www.kotterinternational.com/8-steps-process-for-leading-change/

Teremos futuro, se mudarmos o presente