[Interaction between prescribers, dispensers, and patients: shared information as a possible therapeutic benefit]

[This elusive unknown quantity: reflections on the prescription of psychotropic drugs in early childhood]

The scope of this article is to study aspects related to prescription habits and the use of psychoactive drugs in early childhood. It takes as a starting point the bibliographical survey carried out on the BVS and Scielo databases on epidemiological and clinical research in Brazil regarding the use of psychotropic drugs in children under six years of age. Based on international literature, it highlights the increase in the number of children diagnosed with mental and behavioral disorders, as well as the respective prescription of psychotropic drugs. It discusses the predominantly off-label character of psychoactive drugs for children under six years of age, the heterogeneous use of prescriptions and polypharmacology, pointing to an ethical paradox regarding clinical research in this age group. It concludes that the use of psychotropic drugs in early childhood is as yet not well known in Brazil, and epidemiological studies are urgently needed in this area.

[Use of medicines before and during pregnancy: prevalence and associated factors]

This cross-sectional prospective nested cohort study aimed to assess the prevalence of use of medication before and during pregnancy and associated factors in women in a municipality in the countryside of Bahia State, Brazil. Data were collected with a structured questionnaire applied to pregnant women at their prenatal visits at health units. Prevalence rates for use of medication before and during pregnancy were 52.1% and 84.7%, respectively. The following were associated with use of medication before pregnancy: age ≥ 30 years, non-white skin color, first prenatal visit after the 1st trimester, and economic classes C/D/E. There was an increase in medication during pregnancy among women with ≥ 11 years of schooling, women with more than three prenatal visits, and those with some health problem. Pregnant women are exposed to medication before and during pregnancy, notwithstanding the lack of secure information to back the use of medicines during this phase; such use is associated with factors pertaining to prenatal follow-up, suggesting the need for more active participation by pharmacists in orientation and support for rational use of medicines.

Promoção do uso racional de medicamentos: uma proposta de modelo avaliativo da gestão municipal

RESUMO O artigo propõe um modelo avaliativo da gestão municipal na promoção do uso racional de medicamentos. Análises documentais, revisão de literatura e reuniões com grupos de interessados orientaram a elaboração do modelo. Para a sua validação, utilizou-se a técnica de conferência de consenso. A matriz é composta por 28 indicadores agregados nas dimensões estruturais e operacionais. O estudo possibilitou a explicitação e o entendimento dos objetivos e metas da intervenção, indicando a possibilidade de o modelo expressar a atuação da gestão na promoção do uso racional de medicamentos. E concluiu, pela plausibilidade do modelo avaliativo, a sua pertinência em estudos dessa natureza.

[Rational use of medicines by individuals with diabetes mellitus and arterial hypertension in the municipality of Rio de Janeiro, Brazil]

This study focuses on the rational use of medicines (RUM) by hypertensive and/or diabetic patients treated in primary health care units in the city of Rio de Janeiro. It involves a cross-sectional study conducted between January and February 2010. Indicators were created considering the following aspects: adherence to prescribed medicine, self-medication and how patients store medicines within their households. Univariate and multivariate data analysis was performed. Of the 547 patients studied, 77.5% reported that they usually take the entire course of medicines and 80.3% reported that they tend not to forget to take them. Almost all respondents reported that they only take medications prescribed by authorized health professionals. Half of the patients had no expired medicines or damaged medicine packages in the home. Statistical tests revealed that RUM is higher among hypertensive individuals who are married and working, who mention receiving medical guidance about diet and physical exercise, and who have not missed any scheduled medical appointments at the primary health care unit within the 6 months before this research was conducted. The findings emphasize the importance of primary health care in promoting the rational use of medicines.

[The role of the pharmacist in dispensing medication in Adult Psychosocial Care Centers in the city of São Paulo, Capital of the State of São Paulo, Brazil]

The objective of this study was to evaluate the role of the pharmacist in dispensing medication by conducting cross-sectional exploratory-descriptive research in eight Adult Psychosocial Care Centers (CAPS) in São Paulo. The pharmacists responsible for each of the dispensing units studied filled out a semi-structured questionnaire about the service provided. Two Adult CAPS units were selected from each of the North, South, Eastand West regions of São Paulo. The central region has no Adult CAPS, and was therefore not included in the study. Most of the respondents were aged between 35 and 40 years and were predominantly female. It was found that half of the respondents performed only 25% of dispensations and few conducted an analysis of all prescriptions before dispensing medication. All respondents contacted the prescriber if any medication-related problems a rose. However, few pharmaceutical interventions were commonly performed. Furthermore, one respondent indicated that all his/her functions in the pharmacy could be delegated to another professional. These findings reveal the pressing need for actions that ensure the ongoing training of pharmacists to enable them to be clinically prepared to deal with patients with mental disorders.

Chronic functional constipation in children: adherence and factors associated with drug treatment

OBJECTIVE

The aim of the present study was to evaluate the treatment adherence of children with chronic functional constipation.

METHODS

The present study is a prospective and longitudinal study realized at a pediatric gastroenterology clinic of a Brazilian University Hospital, between August 2009 and October 2011. Rome III criteria and the Bristol Stool Scale were used to define constipation and to characterize feces, respectively. Drug treatment was prescribed for patients according to the protocols previously standardized in the clinic. Specific questionnaires, containing questions related to 1 dependent variable and independent variables were completed in the first and sixth months of the treatment. Independent variables related to the patients, their caregivers, the disease itself, and the therapeutic plan were analyzed and compared with the dependent variable (adherence to the treatment). Adherence was considered when the patient returned with >75% of the prescribed medicine containers empty.

RESULTS

Fifty children participated in both the first and sixth months of treatment. The mean age of the sample was 77.6 ± 43.8 months and the mean age of the onset of symptoms was 18.8 ± 27.9 months. The adherence rate was 38% in the first month and 30% in the sixth month. Patients who were treated with polyethylene glycol had greater adherence than patients who were prescribed other laxatives, with statistical significance in the second moment of the study (P = 0.19 and P = 0.04, respectively).

CONCLUSIONS

The study showed low adherence rates to drug treatment of constipation in children. It is necessary to seek new strategies to increase treatment adherence, while avoiding complications and reducing costs.

Prevalence and factors associated with incidents related to medication in surgical patients

The aim of this study was to estimate the prevalence and factors associated with the occurrence of incidents related to medication, registered in the medical records of patients admitted to a Surgical Clinic, in 2010. This is a cross-sectional study, conducted at a university hospital, with a sample of 735 hospitalizations. Was performed the categorization of types of incidents, multivariate analysis of regression logistic and calculated the prevalence. The prevalence of drug-related incidents was estimated at 48.0% and were identified, as factors related to the occurrence of these incidents: length of hospitalization more than four days, prescribed three or more medications per day and realization of surgery intervention. It is expected to have contributed for the professionals and area managers can identify risky situations and rethink their actions.

[Dispensing specialized component medicines in areas of the State of Rio de Janeiro]

The Specialized Pharmaceutical Services Component (CEAF) ensures the dispensing of high-cost medicines for the treatment of specific diseases. The fact that these medicines are mandatory though access is only through legal injunctions, suggests flaws in the management of pharmaceutical services. This paper analyzed adherence to Clinical Protocols and Therapeutic Guidelines (PCDT) in the dispensing of these CEAF medicines. Qualitative research was also conducted in facilities with different characteristics in the State of Rio de Janeiro. It was noted that the lack of adequate structure in the units studied, including trained personnel, compromises the dispensing CEAF medicines in all facilities. The CEAF dispensing procedure, heavily dependent on interaction between prescribers and dispensers, is not carried out as would be expected. It is possible that inadequate performance is also linked to flaws in the planning and organization of services. The results indicate barriers in adherence to PCDT by health professionals, prejudicing health system users and possibly leading them to access medicines by legal means. It is believed that characteristics of the investigated facilities are similar to others in Brazil, and the barriers identified may be the same, compromising healthcare.

Adesão à medicação em pacientes com doença de Parkinson atendidos em ambulatório especializado

A doença de Parkinson é universal, sendo a segunda doença neurodegenerativa mais comum em idosos e tem alta prevalência, afetando entre 0,5 e 1% da população com idade entre 65 e 69 anos. A adesão à terapia medicamentosa é considerada o principal determinante para a efetividade do tratamento, porém apenas recentemente vem sendo estudado em pacientes com doença de Parkinson. Trata-se de estudo transversal e descritivo que avaliou a adesão à terapia com levodopa em 112 pacientes com doença de Parkinson que frequentavam regularmente o ambulatório de distúrbios do movimento do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo utilizando o teste Morisky e Green e o instrumento que avalia atitudes frente à tomada dos remédios (IAAFTR). Dos pacientes entrevistados, 53% não apresentaram adesão ao tratamento e 52% não tomam a medicação no horário correto. Os pacientes devem ser orientados sobre a importância de ingerir sua medicação no horário correto, entendendo os benefícios que a adesão pode proporcionar estando cientes de que doses não tomadas, tomadas em excesso, ou em horários diferentes dos prescritos podem diminuir sua resposta ao tratamento, afetando negativamente sua evolução clínica e qualidade de vida, gerando maiores custos à saúde pública do país.

Logic models from an evaluability assessment of pharmaceutical services for people living with HIV/AIDS

Brazil was the first developing country to provide people living with HIV/AIDS (PLWA) with comprehensive, universal, free access to antiretroviral medicines (ARV). Pharmaceutical services are considered a strategic action that has the goal of providing access to rational use of quality medicines while also promoting user satisfaction. User satisfaction is a complex concept, and evaluation models for pharmaceutical services for PLWA were not found in the literature. Therefore, an evaluation approach to help assess this issue had to be developed. This article seeks to describe a theoretical evaluation model of user satisfaction with the dispensing of ARV, developed as part of an Evaluability Assessment (EA). It presents a brief review of the EA and user satisfaction and describes the development of models created during the EA. The lessons learned in the process are presented as a conclusion.

Acompanhamento farmacoterapêutico em idosos hipertensos residentes em um lar geriátrico, localizado na Região do Vale dos Sinos, Rio Grande do Sul, Brasil

INTRODUÇÃO: A hipertensão arterial sistêmica (HAS) é um dos problemas de saúde de maior prevalência, afetando cerca de 600 milhões de pessoas em todo mundo. No Brasil, aproximadamente 65% da população idosa é portadora desta doença. Objetivo: Avaliar a resposta farmacoterapêutica em idosos hipertensos, residentes em um lar geriátrico, após acompanhamento farmacoterapêutico e intervenções farmacêuticas. METODOLOGIA: Trata-se de estudo quantitativo, observacional com delineamento longitudinal retrospectivo. Participaram 31 (62%) idosos do total de 50 indivíduos (acima de 60 anos), de ambos os sexos e com HAS diagnosticada. Avaliaram-se as médias mensais das pressões sistólica, diastólica e pressão arterial média, no período de setembro/2008 a julho/2010. A análise dos resultados ocorreu por meio de estatística descritiva e teste t de Student para amostras pareadas. RESULTADOS: Quanto ao tratamento medicamentoso para HAS, predominou o uso de Inibidores da ECA (71%) e diuréticos tiazídicos (41,9%); 61,3% dos pacientes em estudo fazem tratamento farmacológico em associação de fármacos anti-hipertensivos. Não foram observadas interações medicamentosas clinicamente relevantes entre os fármacos anti-hipertensivos e as demais classes terapêuticas utilizadas pelos idosos. Houve queda nas médias pressóricas, assim como no número de pacientes com pressão arterial alterada. CONCLUSÃO: O decréscimo das médias pressóricas pode ser atribuído a diversos fatores e, após o acompanhamento farmacoterapêutico desses pacientes, os níveis de pressão arterial melhoraram.

[Patient awareness about drugs prescribed after medical appointment and prescription]

Information provided to patients about medication is important for the success of the treatment, since the lack of such information is one of the main reasons why patients fail to take medicines as prescribed. The aim of this study was to verify patients' awareness about prescribed drugs distributed at the Grão Pará (Santa Catarina) primary healthcare unit after a medical appointment. One hundred and eleven patients were interviewed, seventy after a medical appointment and forty-one after drugs were distributed. Patient awareness was tested by asking questions about the name, usage, dosage, length of treatment, side effects, and precautions. After a medical appointment 28.5% of patients were classified as having a good level of awareness, 17.1% fair and 64.4% insufficient. After drugs were distributed 4.9% of patients were classified as having a good level of awareness, 87.8% fair and 7.3% insufficient. The majority of those interviewed had a low level of awareness about the use of the prescribed drugs. Results after drugs were distributed were better in comparison to results after a medical appointment, suggesting the importance of the pharmacist in informing patients about the correct use of drugs.

Nível de entendimento de prescrições medicamentosas pediátricas em Unidades Básicas de Saúde

OBJETIVOS: avaliar o nível de entendimento das prescrições medicamentosas pediátricas, pelos responsáveis das crianças, em Unidades Básicas de Saúde (UBS), município de Campo Grande, Mato Grosso do Sul. MÉTODOS: estudo transversal e descritivo, realizado entre maio de 2007 e junho de 2008. Foram entrevistados 336 acompanhantes de crianças, atendidas em UBS municipais, que receberam prescrição de medicamentos dispensados pela farmácia. Foram avaliados mediante questionário o nível de escolaridade e fatores relacionados à compreensão da prescrição como legibilidade, nome, dose, freqüência de administração, tempo de uso de medicamentos, bem como a compreensão das informações verbais complementares. RESULTADOS: dos entrevistados, 80,4% (270) eram mães, 55%-(185) cursaram ensino fundamental e 90,2% (303) receberam informações verbais complementares à prescrição. Das prescrições apresentadas 87,5% (294) foram consideradas legíveis. Dos entrevistados, 47% (158) tiveram entendimento insuficiente da prescrição. O entendimento insuficiente da prescrição foi associado à baixa escolaridade, ao não recebimento de informação verbal complementar e ao maior número de medicamentos presentes na prescrição. CONCLUSÕES: é necessário que os responsáveis pela criança e profissionais envolvidos na prescrição e dispensação estejam conscientes da importância da informação sobre o medicamento, para a segurança das crianças.

[Uncomplicated malaria treatment in the Brazilian Amazon: knowledge, practices and perceptions of health workers in high-incidence municipalities]

Malaria control in Brazil is based on early diagnosis and adequate and timely treatment as strategies for a rapid and long-lasting cure. Clinical consequences and resistance to antimalarials may arise from problems in prescribing, dispensing and in acceptance of therapeutic regimens by healthcare workers. We studied knowledge and practices, perceptions and attitudes of health workers participating in pharmaceutical services for malaria, regarding the official protocol and the possible flaws in therapy. Health workers from six municipalities in the Brazilian Amazon were interviewed. Speech analysis was employed as a technique to determine analytical categories and to organize data. There was only 1 physician among the 63 interviewees, the others were health technicians carrying out diagnosis, therapy indication and dispensing of antimalarial treatment. Training time and period since course completion varied. Flaws in the adherence to the national protocol included therapy indication, dispensing and counseling. Health workers need knowledge to face disease and treatment specificities. Holding accountable health workers that are unprepared and unfit for the job may indicate the need for adequacy in policies regarding adequate training and hiring of human resources.

Prescrição médica: orientações adequadas para o uso de medicamentos?

O conhecimento insuficiente de informação dada ao paciente durante a consulta médica resulta em grandes dificuldades para a condução correta da terapêutica medicamentosa. Baseados nesse contexto, o estudo teve como objetivo avaliar o grau de conhecimento dos pacientes sobre os medicamentos prescritos na Atenção Básica no município de Esperança (PB). Para tal, foram entrevistadas 199 pessoas que, após consulta médica, receberam prescrição, tendo sido avaliado o nível de conhecimento desses pacientes em relação ao nome do medicamento, a dose, o horário, a finalidade, o tempo de uso e reações desagradáveis. Entre os entrevistados, 53,8% evidenciaram desconhecer o nome do medicamento, 20,3% a dosagem e 25,4% o horário de utilização. O item em que se observou maior frequência de acerto foi finalidade do medicamento, tendo 75,1% dos pacientes apresentado bom conhecimento. No que se refere ao tempo de uso e às reações desagradáveis, 57,4% e 94,4% dos pacientes, respectivamente, não possuíam nenhuma informação correta. Os resultados sugerem que a maioria dos pacientes não apresenta o conhecimento adequado e seguro para a utilização dos medicamentos prescritos.

Pharmacist professionals in the prevention of drug abuse: updating roles, and opportunities

The objective of this paper was to prepare and provide resources to pharmacists and other healthcare professionals, enabling them to carry out a critical analysis on drug abuse, acquiring knowledge in several areas that effectively contribute to their personal development in this professional field. Professionals play a crucial role in the reduction and prevention of substances abuse, since they are able to advise patient about illicit drugs, psychotropic medicines and alcohol abuse. There is an urgent need to specialize pharmacists to act in the national public health service and contribute to actions aimed at the surrounding community.

Analysis and detection of dental prescribing errors at primary health care units in Brazil

AIM OF STUDY

To analyze dental prescribing errors in Aracaju, Brazil, and to suggest feasible improvements for patient safety.

METHODS

A descriptive study was conducted at nine Primary Health Care Units (PHCUs) in the northeast region of Brazil. A convenience sample of 300 dental prescriptions was selected during the period February-May 2007. The World Health Organization (WHO) prescribing criteria were used to measure the quality of the prescriptions.

MAIN OUTCOME MEASURES

All medications were prescribed by generic name; 98.3% of prescription information contained abbreviations and 26% of them were classified as having low legibility or as being illegible. The most commonly prescribed medications were diclofenac (35%), both sodium and potassium, and amoxicillin (26%).

CONCLUSIONS

Dental prescribing errors should be considered as a potential area for improvement in the medication management process and patient safety. We suggest that a pharmacist should be available for medication dispensing at all units and that dentists are trained continuously so that medication orders may become more legible and complete. Improving the quality of dental prescriptions will reduce the risks for medication errors and will promote the rational use of pharmacotherapy, and patient safety.

Interação entre paciente com transtorno afetivo bipolar e equipe ambulatorial quanto à terapêutica medicamentosa

OBJETIVO: Identificar, na perspectiva da pessoa com transtorno afetivo bipolar (TAB) e de seu familiar, como ocorre a interação paciente-equipe de saúde relacionada à terapêutica medicamentosa. MÉTODOS: Foi utilizada a abordagem qualitativa, com referencial metodológico da Teoria Fundamentada nos Dados, à luz do Interacionismo Simbólico. Participaram do estudo 14 pessoas com TAB de um serviço ambulatorial e 14 familiares. Para obtenção dos dados utilizou-se a entrevista e observação. RESULTADOS: Os resultados revelaram três categorias que descrevem o referido processo de interação: identificando falhas nas orientações sobre medicamentos, sentindo necessidade de acolhimento pela equipe de saúde e julgando que o paciente deve ser avaliado na sua individualidade. CONCLUSÃO: Evidenciou-se a necessidade de implementação, nos serviços de saúde, de espaços de acolhimento como forma do paciente enfrentar seu processo saúde-doença.

[Compliance to drug therapy in inflammatory bowel diseases outpatients from a university hospital]

BACKGROUND

Compliance to drug therapy is important for a successful treatment. Although many studies have assessed compliance to treatment in patients with chronic diseases, few investigations have been carried out in inflammatory bowel diseases.

AIM

To assess compliance to drug therapy in patients with inflammatory bowel diseases, Crohn's disease and ulcerative colitis, followed at a university hospital, who had prescribed medication supplied by the Brazilian National Health System.

METHODS

In a cross sectional study, a structured interview was applied to assess the compliance of 26 Crohn's disease patients, 26 ulcerative colitis patients and 4 cases with undetermined colitis. Patients were characterized as presenting higher or lower degree of compliance, based on the comparison of the information provided by the patient in the interview and data in the medical records. The Morisky test was also used to assess the behavioral pattern of the patient regarding the daily use of the medication.

RESULTS

The interview showed that 15.4% of patients with Crohn's disease and 13.3% of those with ulcerative colitis could be regarded as less compliant. However, the Morisky test revealed lower compliance in 50% of patients with Crohn's disease and 63.3% of those with ulcerative colitis. Univariate analysis showed an association between low compliance and long disease duration, married status and colon involvement in Crohn's disease, and between low compliance and increased disease activity and greater number of medications in ulcerative colitis. However, multivariate analysis did not confirm any association between low compliance and any demographic or clinical factor.

CONCLUSIONS

A high degree of noncompliance to treatment, linked to habitual behavior and hard to predict from demographic or clinical factor, was detected in inflammatory bowel disease patients, which suggests the need for investment in patient education regarding medication use.

Estudos de utilização de medicamentos: uma síntese de artigos publicados no Brasil e América Latina

O medicamento tem se convertido em elemento importante na recuperação e garantia da qualidade de vida; no entanto, há riscos evitáveis associados a seu uso. Neste contexto, o objetivo deste trabalho foi analisar as publicações de estudos de utilização de medicamentos quanto aos tipos de resultados obtidos e suas contribuições para as intervenções terapêuticas. Foram analisados 27 artigos sobre estudos de utilização de medicamentos selecionados nas bases de dados Scielo e Lilacs em relação a objetivos, tipo de estudo, população e amostra selecionada, métodos de estudo e resultados mais relevantes. Os resultados dos artigos analisados foram discutidos a partir das categorias analíticas, criadas através da seleção dos temas emergentes da análise, prevalência do consumo de medicamentos, fatores relacionados ao uso de medicamentos, automedicação, organização dos serviços de saúde, percepção do medicamento e adesão à terapia. De forma geral, as sugestões dos autores restringiram-se à necessidade de prestar informação ao paciente. Conclui-se que as informações construídas pelos estudos de utilização de medicamentos podem ser o caminho inicial para a mudança tão almejada nas práticas profissionais.

[Knowledge and information concerning generic drugs in a public outpatient population in Recife, Pernambuco, Brazil]

Brazilian Federal Act 9,787/99, regulating generic medicines, includes rules for drug registration and provides for the population's access to safe, effective, high-quality, and low-cost medication. Four years after the introduction of generic drugs on the Brazilian market, we proposed to measure knowledge and information on generic drugs among the clientele at a public outpatient clinic in Recife, Pernambuco State, applying a questionnaire in 2000. 76.1% of the interviewees were women, 95.7% had heard of generic drugs, and 68.1% could define generic medication. Government action to publicize the properties of such medicines and their advantages for consumers has thus reached the vast majority of the population.

Determinantes nas intoxicações medicamentosas agudas na zona urbana de um município do Sul do Brasil

As intoxicações medicamentosas no Brasil resultam entre diversos fatores os relacionados a uma frágil política de medicamentos em nosso país. Assim, o objetivo deste estudo foi analisar variáveis sócio-econômicas, tipos de indicação, formas de aquisição e armazenamento de medicamentos das pessoas acometidas por intoxicações medicamentosas agudas não-intencionais. Os dados foram coletados durante visitas domiciliares aos pacientes com registro de intoxicação medicamentosa aguda não-intencional pelo Centro de Controle de Intoxicações de Maringá, Paraná, em 2004. Foram estudadas variáveis relacionadas ao intoxicado, à intoxicação, ao medicamento e armazenamento doméstico de medicamentos. Dentre as 97 intoxicações registradas no período, foram entrevistadas 72 famílias, sendo a maioria de menores de 10 anos (73,6%), sexo masculino (54,2%), estratos econômicos C e D (63,9%). Muitos entrevistados referiram não ter recebido informações sobre o medicamento (76,5%). Houve associação significativa entre pessoas dos estratos econômicos C e D e armazenamento inadequado de medicamentos (p < 0,05). Entrevistados dos estratos econômicos A e B apresentaram medicamentos vencidos com maior freqüência (p < 0,05). Concluiu-se que condições inadequadas de aquisição e armazenamento domiciliar de medicamentos podem ter favorecido a ocorrência das intoxicações.

[Drug prescription and dispensing from the patient's perspective: a community-based study in Fortaleza, Ceará State, Brazil]

The objective of this study was to analyze aspects of the physician-patient and pharmacist-patient relationship, based on patients' opinions. It consists of community-based research performed in Fortaleza, Ceará State, Brazil, where 957 persons were interviewed; 904 answered questions about the last visit to the physician and 831 about the last visit to the pharmacy. The data reflect several aspects of medical and pharmaceutical practice and patients' attitudes towards the questions posed and information provided to guide rational use of drugs. In the therapeutic choice, physicians failed to ask their patients about hypersensitivity to drugs (65%) and use of other medication (64.1%) and ignored recommendations concerning adverse drug reactions (73.3%) and drug interactions (58.2%). The situation was even worse in hospitals, where in most cases a pharmacist's assistant was responsible for dispensing to patients (57.1%). The study suggests poor quality in the medical and pharmaceutical roles and patient apathy towards proceedings involving the prescription and receipt of drugs in pharmacies, as well as in rational use.

[Pharmaceutical services for inpatients provided by hospital pharmacies in Brazil: a review of the literature]

This paper discusses the literature on hospital pharmacy services for in-patients in Brazil, seeking a broader view of its characteristics and priorities. Seventeen papers were located in the Medline and Lilacs databases that complied with the pre-defined inclusion/exclusion criteria. Most of them were related to teaching and research, logistics and compounding, based on observations in public hospitals in Southeast Brazil. Few studies focused on core activities such as management and selection. The academic syllabus through which pharmacy students are trained may underlie the perception that compounding is the preponderant aspect of hospital pharmacy services, although this is required in only a few institutions. Added to this is poor compliance by pharmacy activities with established norms and standards and the lack of an indexed Brazilian publication in this field. As there were far more studies of the public sector than its private counterpart, it seems as though there is either greater freedom of action in the former or less scientific output in the latter, quantified by published studies.

[A literature review on pharmacists' interventions in the use of medication by elderly patients]

The total proportional geriatric population in Brazil is projected to increase from 9.05% in 1999 to approximately 13% in 2020. Non-communicable diseases are common in this age group, and medication is used frequently. Inadequate prescription and improper use of drugs can produce undesirable outcomes, leading to avoidable hospitalization and increasing health care costs. The objective of this paper was to conduct a literature review of pharmacists' interventions and their influence on use of medication by elderly patients, based on five databases from 1970 to 1999. The sample consisted of 76 studies, of which 15 were analyzed and discussed. Research on this subject is scarce, and limited to developed countries. In general, the interventions presented favorable outcomes. Most actions were limited to counseling patients and their physicians, and there was a lack of interventions to adjust the medication to the user.