Browsing by Author "Costa, Filipa Alves da"
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- Access to high price medicines in PortugalPublication . Costa, Filipa Alves da; Martins, Ana PaulaThis chapter provides an overview of the functioning of the Portuguese National Health Service (PNHS), focusing on access to high-cost medicines. The pharmacotherapeutic groups representing higher costs to the PNHS are described, highlighting aspects of costs, financing and access.
- Accessing the potential impact of education about cancer screening programs: a pilot before and after studyPublication . Teodoro, Maria Inês; Torres, Hugo; Venâncio, Nuno; Costa, Filipa Alves da
- Análise do perfil de utilização da terapêutica empírica antibiótica instituída em Infeções do Trato Urinário Adquiridas na Comunidade (ITU-AC)Publication . Aguiar, João Pedro; Silva, Patrícia Cavaco; Costa, Filipa Alves da"Objetivo: Caracterizar o perfil de utilização da terapêutica antibiótica instituída nas infeções do trato urinário adquiridas na comunidade (ITU-AC). Tipo de Estudo: Estudo observacional longitudinal prospetivo. Local: Farmácias comunitárias dos concelhos de Almada, Amadora, Cascais, Lisboa, Oeiras e Sintra. População: Doentes com ITU-AC que recorreram às farmácias participantes. Métodos: Os participantes, numa fase inicial, responderam a um questionário para caracterização sociodemográfica da amostra e recolha de informação sobre a terapêutica e recorrência das ITU. Após conclusão da terapêutica, responderam a uma entrevista telefónica para caracterização do perfil de utilização (de acordo com a escala adaptada de quatro itens MMAS). Os resultados obtidos foram tratados com recurso ao programa IBM SPSS, versão 20,0. Resultados: Obteve-se uma amostra de 33 doentes, mas apenas foi possível caracterizar o perfil de utilização de 21 doentes. Face à terapêutica indicada, a maior parte dos doentes utilizou fosfomicina (47,6%, n=10), seguido da nitrofurantoína (23,8%, n=5), ambos antibióticos de primeira linha. Relativamente ao perfil de utilização, verificou-se que 81 por cento (n=17) dos doentes foram classificados como aderentes. Entre os não aderentes, metade foi classificada como não intencionais e a outra metade como intencionais. Conclusão: Neste estudo verificou-se que a maioria dos doentes era aderente à terapêutica antibiótica instituída, e apenas uma pequena parte foi classificada como não aderentes. Assim, pode-se concluir que o valor encontrado para a não adesão (19 por cento) vai ao encontro do valor descrito na literatura (22 por cento)."
- Barriers and facilitators for the implementation of advanced pharmaceutical servicesPublication . Pedro, Maria Leonor; Miranda, Inês; Costa, Filipa Alves da
- Benefits of active involvement of community pharmacists in know your pulse awareness campaignPublication . Antoniou, Sotiris; Papastergiou, John; Rango, Fabio De; Griffiths, Dale; Hamedi, Nadya; Williams, Helen; Murillo, Maria Dolores; Tous, Salvador; Lobban, Trudie; Costa, Filipa Alves da; International Pharmacists for Anticoagulation Care Taskforce
- Creating an Interprofessional guideline to support patients receiving oral anticoagulation therapy: a Delphi exercisePublication . Damen, Nikki L.; Van den Bemt, Bart J. F.; Hersberger, Kurt E.; Papastergiou, John; Costa, Filipa Alves da; Rydant, Silas; Wartenberg, Naomi S.; Lobban, Trudy; Arnet, Isabelle; Antoniou, Sotiris; International Pharmacists for Anticoagulation Care Taskforce (iPACT)Background: Oral anticoagulation therapy has proven beneficial impact on the prevention of thromboembolic events. However, the use of antocoagulatns also increases the risk of bleeds. To maximize the benefits and minimize the risks of the treatment, guidance on appropriate use of oral anticoagulants is essential. An international guideline describing relevant components and requirements for pharmaceutical care for patients receiving a therapy woth oral antocoagulants would increase the quality of care. However, recommendations on pharmaceutical care for patients on anticoagulation is lacking. Objective: This study aims to develop an interprofessional guideline to support patients in their use of oral anticoagulation therapy. Method: Two systematic literature searches were performed on existing guidelines on the management and interventions to improve-oral anticoagulant use, to generate possible recommendations. Subsequently, an international expert panel with 26 pharmacists with extensive experience in clinical and/or scientific work on anticoagulation from a total of 22 European and 4 non-European countries was constituted. With this (geographically well distributed) expert panel, a four-round internet-based Delphi technique was conducted to reach consensus on their relevance. Items were ranked on a 1-10 scale of agreement. A median agreement score of ≥ 7.5 was considered the threshold for consensus. Levels of importance were rated on a 1-3 scale. Setting A global network of 26 pharmacists specialized in oral antocoagulation therapy. Main outcome measure Development of inter-professional guideline. Results: After the four Delphi rounds 18 guideline recommendations were formulated. Consensus of opinion was achieved for all recommendations (median agreement: 8.5-10.0), whereas mean levels of importance were between 1.1 and 2.0 (SD: 0.2-0.7). The following domains were rated as most important targets for improving the care around oral anticoagulation: 'INR-monitoring', 'Transfer of care between health care settings', 'Adherence to medication', 'Patient communication and engagement', and 'Medication reconciliation and medication review'. Conclusion: The 18 recommendations included in this guideline provide the base for optimization of anticoagulation care across different countries/healthcare systems. Future work involves translating the guideline recommendations into clinical practice. Once implemented, the recommendations of the guideline will support health care providers with the pharmaceutical care for patients on, oral anticoagulation which will improve the effective and safe use of these medicines.
- Development of a platform to align education and practice: bridging academia and the profession in PortugalPublication . Costa, Filipa Alves da; Martins, Ana Paula; Veiga, Francisco; Ramalhinho, Isabel; Lobo, José Manuel Sousa; Rodrigues, Luís; Granadeiro, Luiza; Castro, Matilde; Barata, Pedro; Gomes, Perpétua; Seabra, Vítor; Caramona, Maria MargaridaLimited fitness for practice may result from a mismatch between education and practice. Aiming to meet the common interests of academics and practitioners, the Portuguese Pharmaceutical Society (PPS) developed the Education and Practice Platform (EPP). The EPP includes one representative from each pharmacy faculty, and all Councils of Speciality Boards of Practice. Brainstorming with involved parties enabled sharing of interests, concerns and identifying a common path. Aims, mission, vision and values were set. The EPP’s mission is to: act as an enabler to foster the quality and adequacy of education through sharing best practices, ultimately leading to facilitate professional integration, and to foster quality development in teaching practices with recognition for autonomy in freedom to teach and to learn. Its vision is an alignment of education and practice with the PPS’ statutes to ensure validation of the competences defined for each practice area, and compliance with international guidance. Key performance indicators (KPIs) were set. Activities developed include the creation of a national forum to discuss education and practice, development of workshops on teaching methods and pharmacy internships, enhanced representation in international events and response to global and national requests. Ongoing work focuses on the creation of a common training framework in hospital and community pharmacy practice adapted to Portugal. The EPP is a worldwide case study, encouraging the development of discussion contributing to an open climate of sharing best practices, indirectly leading to foster a better alignment between education and practice. Many of these results are so far intangible in scientific terms but worth describing.
- Drug-related problems identified in a sample of Portuguese institutionalised elderly patients and pharmacists’ interventions to improve safety and effectiveness of medicinesPublication . Costa, Filipa Alves da; Silvestre, Luísa; Periquito, Catarina; Carneiro, Clara; Oliveira, Pedro; Fernandes, Ana Isabel; Cavaco-Silva, Patrícia"Background Currently, people live longer but often with poor quality of life. The decrease in healthy life-years is partly attributable to the institution of polypharmacy to treat various comorbidities. Objectives The objectives of the study were to determine the prevalence and nature of drug-related problems (DRPs) in polypharmacy elderly patients residing in nursing homes and to test the acceptability of a pharmacist’s intervention. Methods An exposure cohort was constituted in three Portuguese nursing homes, where all polypharmacy (five or more medicines) elderly patients (≥65 years of age) were analysed and then a random stratified sample was extracted to be subject to an intervention. Clinical and therapeutic data were collected and analysed for DRPs and classified according to the II Granada Consensus, by a pharmacist-led team. The intervention was the formulation of a pharmacist’s recommendations to prescribers addressing clinically relevant DRPs, along with suggestions for therapy changes. Results The initial sample included 126 elderly patients taking 1332 medicines, where 2109 DRPs were identified. The exposure cohort included 63 patients, with comparable baseline data (p > 0.005). Manifest DRPs occurred in 31.7 % of the intervention group (mainly quantitative ineffectiveness–DRP 4), whereas potential DRPs were identified in 100 % of patients (mainly non-quantitative unsafe–DRP 5). Amongst the DRPs identified, 584 (56.7 %) were reported to prescribers (all types of DRPs) and 113 (11 %) to nurses (only non-quantitative ineffectiveness–DRP 3). A total of 539 pharmacist recommendations were presented to physicians, corresponding to 62 letters sent by mail, each including an average of 8.7 recommendations to solve DRPs present in intervention group (IG) patients. There was a high non-response rate (n = 34 letters; 54.8 %; containing 367 pharmacist recommendations; 68.1 %) and amongst recommendations receiving feedback, only 8.7 % of pharmacist recommendations made were accepted (n = 15). Positive responses were significantly associated with a lower number of recommendations made, whereas a higher number of recommendations increased the odds of no response (p < 0.001). Conclusion A pharmacist-led medication review proved useful in identifying DRPs in elderly polypharmacy nursing home residents. Stronger bonds must be developed between healthcare professionals to increase patient safety in the vulnerable institutionalised elderly population."
- Effects of economic recession on elderly patients’ perceptions of access to health care and medicines in PortugalPublication . Costa, Filipa Alves da; Teixeira, Inês; Duarte-Ramos, Filipa; Proença, Luís; Pedro, Ana Rita; Furtado, Cristina; Silva, José Aranda da; Cabrita, José"Background: In view of the current financial and demographic situation in Portugal, accessibility to health care may be affected, including the ability to adhere to medication. Objective: To evaluate the perceived effects of the crisis on elderly patient’s access to medicines and medical care, and its implications on medicine-taking behaviour. Setting Community pharmacy. Method: A cross-sectional study was undertaken during April 2013, where elderly patients answered a self-administered questionnaire based on their health-related experiences in the current and previous year. Binary logistic regression was used to ascertain the effects of potential predictors on the likelihood of adherence. Main outcome measures self-reported adherence. Results: A total of 1231 questionnaires were collected. 27.3% of patients had stopped using treatments or health services in the previous year for financial motives; mostly private medical appointments, followed by dentist appointments. Almost 30% of patients stopped purchasing prescribed medicines. Over 20% of patients reduced their use of public services. Out-of-pocket expenses with medicines were considered higher in the current year by 40.1% of patients. The most common strategy developed to cope with increasing costs of medicines was generic substitution, but around 15% of patients also stopped taking their medication or started saving by increasing the interdose interval. Conclusion: Reports of decreasing costs with medicines was associated with a decreased likelihood of adherence (OR 0.42; 95% CI 0.27–0.65). Lower perceived health status and having 3 or more co-morbidities were associated with lower odds of adhering, whilst less frequent medical appointments was associated with a higher likelihood of exhibiting adherence."
- Evaluation of antibiotic prescription for upper respiratory tract infections in the community pharmacy settingPublication . Mangerico, Telma; Costa, Filipa Alves da; Silva, Patrícia Cavaco"Objectives: To empirically classify the etiology of URTI; to study the prescription pattern for antibiotics in URTI; and to analyze the necessity and adequacy of prescribed therapy. Study design: Observational non analytical cross-sectional study. Study sites: Two community pharmacies located in Almada and in Elvas. Study population: Patients with an antibiotic prescription for a URTI (self use) and age greater than or equal to 18 years. Methods: Clinical and therapeutic data were collected during patient observation performed by a training pharmacist, and complemented with information collected through a questionnaire administered face-to-face to patients meeting the inclusion criteria and agreeing to participate. Empirical classifications were developed, one to ascertain the probability of URTI, based on Centor criteria, and another, to judge the need for antibiotic therapy, based on additional criteria considering subpopulations known to be at higher risk. Data was analyzed using the software SPSS, version 20.0. Results: The sample included 22 patients (27.3% recruited in Almada and 72.7% in Elvas). The most frequently prescribed antibiotic class was macrolides (54.5%), followed by penicillins (36.4%). In the first group, clarithromycin prevailed (66.7%) and in the second group, the more common was the association amoxicillin/clavulanic acid (75%). Considering the empirical classification developed, it was estimated that only one patient (4.5%) presented signs and symptoms suggestive of URTI with probable bacterial aetiology, and only three patients (13.6%) had an indication for antimicrobial therapy. Conclusion: The majority of patients observed were classified as having infections with apparently non-bacterial aetiology, for which the prescription of antibiotic would have been probably needless. This alerts to the overuse of antibiotics in the community setting, particularly for URTI, and its contribution to resistance."