Journal of Hospital Pharmacy and Health Services

Effectiveness and safety of Basiliximab as induction therapy in liver transplantation: A Retrospective Cohort Study in a Tertiary Hospital in southern Brazil

Chaiane Lemos CASTILHOS, Camila Schafer ROJAS, Carine Raquel BLATT — Tue, 18 Mar 2025 00:00:00 -0300

Objective: to evaluate the effectiveness and safety of basiliximab as induction therapy in adult patients undergoing liver transplantation at a tertiary hospital in southern Brazil. Methods: a retrospective cohort study was conducted with adult patients who underwent liver transplantation at a tertiary hospital in southern Brazil from January to December 2023. Patients were divided into two groups: standard immunosuppression regimen (Group 1) and basiliximab induction (Group 2). Sociodemographic variables (sex, age, ethnicity) were evaluated, along with the influence of potential determinants, such as reason for transplantation, pre- and post-transplant comorbidities, presence and type of adverse drug event (ADE), incidence of acute rejection, infections, length of hospital stay, graft loss, and death. Results: in 2023, 546 solid organ transplants were performed, of which 109 were liver transplants. Pediatric patients (32), retransplants (4), and patients undergoing multiple organ transplants (3) were excluded, totaling 70 patients. Of these, 51 received a standard immunosuppression regimen (Group 1), and 19 received basiliximab (Group 2). Regarding the sociodemographic profile, most patients were male (Group 1, 78.4%; Group 2, 68.4%) with a mean age of 58.5 and 54.8 years, respectively. Pretransplant renal dysfunction was slightly more frequent in Group 2 (p=0.05). Regarding post-transplant clinical outcomes, there were no significant differences in survival, infection rate or type, length of hospital stay, graft loss, or death between groups. The acute rejection rate was observed in 17.6% of patients in Group 1, while no cases were recorded in Group 2 (p=0.1). The occurrence of ADEs also did not differ significantly, with 17 cases in Group 1 and 5 cases in Group 2 (p=0.785). Conclusions: the use of basiliximab showed no significant differences in survival, acute rejection rate, or other important clinical outcomes, such as infections and mortality, compared to the standard immunosuppression regimen. Additional studies are needed to more precisely assess the role of basiliximab and identify subgroups of patients who may benefit from this intervention.

Clinical practice of pharmacists in the public hospital facilities of a city in Rio de Janeiro’s countryside

Mon, 31 Mar 2025 00:00:00 -0300

Objective: To analyze the clinical practice of hospital pharmacists in the public health system of a municipality in the Rio de Janeiro Metropolitan Region. Method: A descriptive cross-sectional study was conducted through interviews with pharmacists from public hospitals belonging to the municipal network. For this purpose, a semi-structured questionnaire was used, composed of sociodemographic questions and questions about clinical activities. Additionally, an open question about the challenges for carrying out these activities was included, with the answers recorded and transcribed. The analyses included simple descriptive statistics, using absolute frequency and content analysis. Categories were created based on the responses, which included: lack of team integration, infrastructure and human resources (HR), and training. Results: All hospitals in the municipality were included in the study. Of the six pharmacists interviewed, half performed clinical activities, while the others pointed out limitations such as lack of HR, private physical space, and training. The results also indicated that clinical activities are often limited by fragmented organizational structures, lack of recognition of the pharmacist's role, and that academic training still focuses on operational functions. Moreover, among those who carry out clinical activities, the absence of a standardized record and the lack of patient screening strategies, such as prioritizing more critical cases, were identified. Conclusions: This study highlighted the need to implement strategies to promote the clinical role of pharmacists in the investigated hospitals, ensuring their contributions to patient care and safety, rational use of medications, and effective participation in the healthcare team.

Survey of minimum hospital pharmacy standards in countries within the COSUDEFH

Wed, 26 Feb 2025 00:00:00 -0300

Objectives: The main objective of this study is to establish a reading of the current situation of hospital pharmacy services in the countries that make up the COSUDEFH, and to identify strengths and weaknesses in each country. These findings will serve as input for the formulation of strategies aimed at strengthening hospital pharmacy in South America. Methods: For this purpose, a closed multiple-choice survey was designed, based on the regulations of several countries and with specific thematic axes such as: infrastructure, human talent, management processes, technical processes, and quality systems. The survey was distributed among the hospital pharmacy services in the COSUDEFH member countries. Results: The results were grouped, tabulated, and quantified on a percentage scale. Significant differences were observed between the different countries across all thematic axes. These differences reflect the varied economic, political, educational, technological, and sociocultural realities of each country. Conclusion: The progress of hospital pharmacy services in South America is unequal and multifactorial. Identifying the specific strengths and weaknesses of each country provides a solid foundation for developing strategies aimed at strengthening hospital pharmacy in the region.

Capacity of ChatGPT, Deepseek, and Gemini in predicting major potential drug interactions in adults within the Intensive Care Unit

Tácio Mendonça LIMA — Mon, 31 Mar 2025 00:00:00 -0300

Objective: evaluate the ability of the ChatGPT v.3.5, DeepSeek v-3, and Gemini 2.0 flash to accurately predict major potential drug interactions (DIs) in critically ill patients. Methods: A list of 20 DIs was compiled from previously published literature. The Micromedex and Drugs.com databases were used as references. A specific prompt was designed to interact with the tools. The generated responses were stored for subsequent analysis by a pharmacist. Specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), accuracy, and agreement were calculated for each tool based on the responses regarding DDI severity, which were categorized into five levels: contraindicated, major, moderate, minor, and no interaction. Additionally, the responses related to the mechanism of action and recommended management for each DDI were categorized as “adequate and accurate,” “adequate but inaccurate”, and “inadequate.” Results: When the Micromedex was used as a reference, ChatGPT performed better, achieving an accuracy rate of 75%, while DeepSeek and Gemini scored 70% and 65%, respectively. Overall, there was an improvement in the performance of all tools when Drugs.com was used as the reference, with accuracy rates of 80% for DeepSeek and 75% for both ChatGPT and Gemini. However, the agreement on the severity of DDIs between the tools and references was 0.354 (weak) for Drugs.com and 0.410 (moderate) for Micromedex. In general, two “inadequate” responses and 10 “adequate but inaccurate” responses regarding the mechanism of action and recommended management were observed when compared with Micromedex (14 DDIs analyzed), while eight “inadequate” responses and 21 “adequate but inaccurate” responses were found when compared with Drugs.com (17 DDIs analyzed). Conclusion: The tools analyzed show promise to assist healthcare professionals in predicting DDI in adults hospitalized in the intensive care unit (ICU). However, their use should be approached with caution, as they may generate incorrect/inaccurate information. Additional advancements are required to ensure their reliable application in clinical practice.

Strategies to Overcome Barriers in Pharmaceutical Care in Primary Health Care

Thu, 20 Mar 2025 00:00:00 -0300

Pharmaceutical Care (PC) has a positive impact on primary care, improving health indicators and patient pharmacotherapy management. However, its implementation in the Unified Health System (SUS) faces administrative, technical, attitudinal, and political challenges. This report aims to present strategies to overcome barriers to the implementation of PC in the SUS. A workshop was conducted using a transversal approach, involving six pharmacists participating in a larger project, where participants discussed previously identified challenges. The overcoming strategies were collaboratively developed based on experience and group consensus. The results indicated that administrative strategies include the reorganization of the workflow, awareness of managers, and adoption of electronic health records. On a technical level, the need for continuous training and active integration of pharmacists into multidisciplinary teams was highlighted. Attitudes such as assertive communication, use of scientific evidence, and personalized care were effective in overcoming resistance from patients and professionals. Politically, intersectoral articulation and the demonstration of economic and clinical benefits strengthened managerial support. The discussed strategies reinforce the importance of integrated and participatory actions to promote a sustainable implementation of PC in the SUS, positively impacting the effectiveness of health services.

Patient prioritisation in current practice of Brazilian hospital clinical pharmacist: a cross-sectional survey

Stephanie Ferreira BOTELHO, Lais Lessa NEIVA-PANTUZZA, Adriano Max REIS — Mon, 31 Mar 2025 00:00:00 -0300

Objectives: To survey the insertion of patient prioritisation in the current practice of clinical pharmacists at Brazilian hospitals and describe the applicability of patient prioritisation criteria for clinical pharmacy developed in a Delphi study with clinical pharmacists. Methods: This was a cross-sectional, online survey. The authors developed the survey questionnaire based on studies published in the literature. Hospital pharmacists from all over Brazil were invited to participate in the survey. The authors adopted the snowball sampling strategy to replicate the questionnaire on social networks. Results: A total of 149 pharmacists agreed to participate in the survey. In clinical practice, 94 (63.1%) participants used prioritisation criteria to select patients for clinical pharmacy care, and 55 (36.9%) employed prioritisation using an interface with a computerised hospital system. Eighty-nine (74.2%) of the 120 evaluations of criteria/sub criteria assessed regarding their applicability in clinical practice obtained agreement above 70%. Conclusions: Patient prioritisation for clinical pharmacy services is frequently used in the clinical practice of pharmacists participating in the survey. Prioritization of patients for clinical pharmacy services integrated with the hospital’s computerized system is a facilitator for incorporating prioritization into care practice. Information availability and accessible data collection are relevance for criterion be used for patient prioritisation for clinical pharmacy.

Self-report instruments for assessing medication adherence validated in Brazil: a scoping review

Tue, 18 Mar 2025 00:00:00 -0300

Objective: To identify validated self-report instruments measuring medication adherence in Brazil. Methodology: A systematic search was conducted in the databases PubMed/Medline, Scopus, Web of Science, EMBASE, and LILACS to identify validation studies of self-report adherence instruments conducted in Brazil until September 2023. The following health descriptors were used for study identification: “medication adherence,” “self-report,” “patient-reported outcome measures,” “validation study,” and “psychometrics.” Article selection was performed by two independent reviewers based on established eligibility criteria. The quality of the studies was assessed using the COSMIN checklist. Results: The initial search identified 329 studies, of which 9 were included in this review. Nine instruments were identified: BAASIS, CEAT-VIH, MAT, MMAS-8, ITAS, QAM-Q, PEDIA, SEA-ART, and WebAd-Q, which were validated for patients with chronic hypertension, transplant patients on immunosuppressants, patients with HIV undergoing antiretroviral treatment, and patients in general outpatient care. The PEDIA and SEA-ART scales showed the highest internal consistencies, while BAASIS and MMAS-8 demonstrated greater test-retest stability. Regarding construct validity, the SEA-ART and QAM-Q scales exhibited the highest combined sensitivity and specificity values. Conclusion: Although they offer advantages, few self-report instruments for measuring medication adherence have been validated in Brazilian patient samples. The heterogeneity of results regarding psychometric properties and validation tests focused on specific clinical conditions does not allow for broad recommendations for any instrument at this time; it is necessary to consider the type of patient and the advantages of each instrument for the chosen population. Additionally, several chronic health conditions still lack adequately validated instruments, such as diabetes mellitus, cardiovascular diseases like angina and heart failure, among others.

Administration of fluids and antibiotics via hypodermoclysis in adult patients in palliative care: a scoping review

Mon, 31 Mar 2025 00:00:00 -0300

Objective: To map studies in the literature on the administration of fluids and antibiotics via hypodermoclysis in adult patients in palliative care. Methods: A scoping review was conducted, with a systematic search performed in July 2024 in the PubMed, Scopus, Web of Science and CINAHL databases. Primary studies evaluating the administration of fluids and antibiotics via hypodermoclysis in adult patients receiving palliative care were included. Two reviewers independently screened the titles and abstracts, followed by the full texts of the articles. Data from the selected studies were extracted and presented descriptively. Results: The database search resulted in 1,782 articles, of which 19 were included in this review. Observational studies stood out (n = 16). The majority exclusively included patients with advanced cancer (n = 11), with a mean age over 60 years (n = 17), and hospitalized (n = 12). Fluids were evaluated in 18 studies. The most commonly used fluids were 0.9% sodium chloride, either administered alone (n = 11) or in combination with 5% dextrose (n = 11). In most studies, the administered volumes ranged from 500 to 1,000 mL of fluids, delivered slowly and steadily, for average periods of up to 7 days. Mild adverse effects at the infusion site were commonly reported. The main benefits of fluid infusion via hypodermoclysis mentioned in the studies include effectiveness in hydration and symptom management, a lower risk of severe systemic complications, and comfort for the patient and their family. However, limitations were highlighted regarding the volume, infusion rate, and type of solution used, along with the frequent occurrence of local adverse effects. Three studies evaluated the use of antibiotics. None of them reported information about dosage, infusion rate, or treatment duration. Mild adverse effects observed included edema, hyperemia, and pain, with no data on effectiveness. Conclusion: The review highlighted the effectiveness and safety of hypodermoclysis for fluid administration but noted the lack of studies on the use of antibiotics with this technique in palliative care, emphasizing the need for further research in this area.

Cover page

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The International Collaboration of Pharmacy Journal Editors (ICPJE) formally constituted to foster quality around clinical and social pharmacy practice research publications

Wed, 26 Feb 2025 00:00:00 -0300

Journal of Hospital Pharmacy and Health Services: Expanding Horizons, Strengthening Global Networks

Elisangela Costa LIMA, Fernando FERNANDEZ-LLIMOS, Maely Peçanha FÁVERO-RETTO — Tue, 25 Mar 2025 00:00:00 -0300

Application of trigger tools for the detection of adverse drug events in pharmaceutical care management

Geovana SCHIAVO, Marcela FORGERINI, Patrícia Carvalho MASTROIANNI — Mon, 31 Mar 2025 00:00:00 -0300

Given the increasing global concern about medication without harm, one method for detecting, managing, and preventing adverse drug events (ADEs) is to apply screening tools. These tools consist of triggers (signals) that, when identified in medical records, indicate a potential ADE. To facilitate the implementation of these tools, management strategies for their use are presented, and a protocol for promoting drug safety is proposed. It is recommended to implement triggers that are flexible, understandable and do not generate additional costs for the health service. The professionals involved in screening the triggers and conducting the causality analysis must be qualified. Indicators of structure, performance, processes and results from the application of triggers can support the development and updating of protocols to identify, manage, monitor, and minimize ADEs. Finally, evaluating and controlling indicators allows for the adoption of preventive and corrective actions, providing feedback to the pharmaceutical care cycle and promoting continuous improvement in addressing drug safety issues.