Impact Assessment of Pharmaceutical Care in the Management of Hypertension and Coronary Risk Factors after Discharge.
BACKGROUND
Almost 50% of the 17.5 million deaths worldwide from cardiovascular disease have been associated with systemic arterial hypertension (SAH). Into this scenario, Pharmaceutical Care (PC) has been inserted in order to improve the management of SAH and reduce its risks.


OBJECTIVE
To evaluate the outcomes and healthcare assistance achieved after discharge of hypertension patients from the PC program.


METHODS
This is a quasi-experimental study with historical controls. Retrospective data collection from 2006 to 2012 was begun in 2013 and included a PC program performed over one year. PC was performed in two basic units of the public health system in Ribeirão Preto-SP, Brazil, where the pharmacist followed up 104 hypertensive patients. The clinical indicators of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, total-cholesterol, high and low density lipoprotein cholesterol were collected, as well as care indicators related to the number of consultations (basic, specialized and emergency care) and antihypertensive drugs used. The coronary risk of patients by the Framingham risk score was also calculated. For the analysis, the data were divided into three periods, 2006-2008 as pre-PC, 2009 as PC and 2010-2012 as post-PC.


RESULTS
In the pre-PC period, 54.4%, 79.0% and 27.3% of patients presented satisfactory levels of SBP, DBP and total-cholesterol, respectively. In the post-PC period, the percentages were 93.0% for SBP and DBP [p <0.001] and 60.6% for total-cholesterol [p <0.001]. The average number of consultations per patient/year in primary care was 1.66 ± 1.43 and 2.36 ± 1.73, [p = 0.012]; and for emergency care was 1.70 ± 1.43 and 1.06 ± 0.81, [p = 0.002] in the pre-PC and post-PC periods, respectively. The pre-PC Framingham risk in the last year was 14.3% ± 10.6 and the average post-PC was 10.9% ± 7.9.


CONCLUSIONS
PC was effective in the control of blood pressure and total-cholesterolafter discharge of the hypertensive patients from PC program.
Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, state of São Paulo, Brazil.
Maurílio de Souza
http://orcid.org/0000-0002-2826-5903
Mde S
Cazarim
Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, state of São Paulo, Brazil.
Osvaldo
O
de Freitas
Department Medicine, Pharmacy School, Federal University of Bahia, Salvador, state of Bahia, Brazil.
Thais Rodrigues
TR
Penaforte
Department of Social Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, state of São Paulo, Brazil.
Angela
A
Achcar
Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, state of São Paulo, Brazil.
Leonardo Régis Leira
LR
Pereira
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001938:Brazil; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010593:Pharmaceutical Services / Q000592:standards / Q000706:statistics & numerical data*; D015397:Program Evaluation / Q000379:methods / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides; D002784:Cholesterol