Resultados clínicos del servicio de gestión de la terapia farmacológica ofrecido a personas con artritis reumatoide
DOI:
https://doi.org/10.15343/0104-7809.202650e19522026PPalabras clave:
Artritis Reumatoide, Gestión de la Terapia Farmacológica, Atención Farmacéutica, Evaluación de Resultados de la Atención al PacienteResumen
El tratamiento de la artritis reumatoide (AR) requiere una farmacoterapia compleja y de alto costo, ante la cual las personas presentan bajas tasas de persistencia. En este contexto, ofrecer el servicio de gestión de la terapia farmacológica (GTF) a personas con AR constituye una iniciativa importante para atender sus necesidades farmacoterapéuticas y, de este modo, optimizar sus resultados en salud. En este contexto, el presente estudio tuvo como objetivo evaluar los resultados clínicos del servicio de GTF ofrecido a personas con AR en un servicio ambulatorio de reumatología. Para ello, se llevó a cabo un estudio cuasiexperimental con un único grupo de pacientes con AR incluidos en un servicio de GTF. Se describieron los problemas relacionados con el uso de medicamentos (PRM) identificados y resueltos. Se utilizó la prueba de McNemar para comparar las proporciones de pacientes que se encontraban dentro y fuera de la meta terapéutica para el control de la AR antes y después de la intervención. Se evaluó un total de 50 pacientes con AR. Se observó un aumento en la proporción de personas que presentaron la AR controlada en la última consulta en comparación con la primera consulta (p = 0,0143). Por lo tanto, el presente estudio indica que el servicio de GTF ofrecido fue efectivo, demostrando el potencial de contribuir al logro del control de la AR.
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Este artículo es una traducción en Português (Brasil) del artículo:
Clinical outcomes of the comprehensive medication management services offered to patients with rheumatoid arthritis
Citas
Brasil. Portaria Conjunta nº 16, de 03 de setembro de 2021. Aprova o Protocolo Clínico e Diretrizes Terapêuticas da Artrite Reumatoide e da Artrite Idiopática Juvenil. Diário Oficial da União. 2021 set 10; Seção 1. p. 107. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/saes/2021/poc0016_10_09_2021.html
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Radu AF, Bungau SG. Management of Rheumatoid Arthritis: An Overview. Cells. 2021 Oct 23, 10(11), 2857. DOI: 10.3390/cells10112857.
GBD 2021 Rheumatoid Arthritis Collaborators. Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 Sep 25, 5(10), e594-e610. DOI: 10.1016/S2665 9913(23)00211-4.
Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, McInnes IB, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological dis-ease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020, 79(6), 685-99.
Acurcio FA, Machado MA, Moura CS, Ferre F, Guerra AAJ, Andrade EI, et al. Medication Persistence of Disease-Modifying Antirheumatic Drugs and Anti-Tumor Necrosis Factor Agents in a Cohort of Patients With Rheumatoid Arthritis in Brazil. Arthritis Care Res (Hoboken). 2016 Oct, 68(10), 1489-96. DOI: 10.1002/acr.22840
Vicente GNS, Pereira IA, Castro GRW, Mota LMH, Carnieletto AP, Souza DGS, et al. Cardiovascular risk comorbidities in rheumatoid arthritis patients and the use of anti-rheumatic drugs: a cross-sectional real-life study. Adv Rheumatol. 2021 Jun 25, 61(1), 38. DOI: 10.1186/s42358-021-00186-4
Norton S, Koduri G, Nikiphorou E, Dixey J, Williams P, Young A. A study of baseline prevalence and cumulative incidence of comorbidity and extra articular manifestations in RA and their impact on outcome. Rheumatology (Oxford). 2013 Jan, 52(1), 99-110. DOI: 10.1093/rheumatology/kes262
Gonçalves TS, Ramalho-de-Oliveira D, Silva HM, Oliveira IV, Neves CM, Nascimento MMG. Drug utilization and health profile of patients with rheumatoid arthritis attending in a rheumatology clinic. Revista de Ciências da Saúde Básica e Aplicada, 2019, 2, 57-67.
10. Ramalho-de-Oliveira D. Atenção Farmacêutica: da filosofia ao gerenciamento da terapia medicamentosa. São Paulo: RCN, 2011; 344p.
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the patient centered approach to medication management. 3 ed. New York: McGraw Hill, 2012; 697p.
CMM in Primary Care Research Team. The Patient Care Process for Delivering Comprehensive Medication Management (CMM): Optimizing Medication Use in Patient-Centered, Team-Based Care Settings. July 2018. Disponível em: http://www.accp.com/cmm_care_process
Rezende CP, et al. Clinical impact of comprehensive medication management services offered to geriatric and hypertensive patients. Journal of Pharmaceutical Health Services Research, 2023, 14(3), 285–90. DOI: 10.1093/jphsr/rmad028
Santos BD, et al. Clinical Impact of a Comprehensive Medication Management Service in Primary Health Care. J Pharm Pract. 2021 Apr, 34(2), 265 71. DOI: 10.1177/0897190019866309
Neves CM, Nascimento MMG, Silva DAM, Ramalho-de-Oliveira D. Clinical Results of Comprehensive Medication Management Services in Primary Care in Belo Horizonte. Pharmacy (Basel). 2019 Jun 12, 7(2), 58. DOI: 10.3390/pharmacy7020058
Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug-Related Morbidity and Mortality. Ann Pharmacother. 2018 Sep, 52(9), 829-837. DOI: 10.1177/1060028018765159
Obreli-Neto PR, et al. Economic evaluation of a pharmaceutical care program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized con-trolled clinical trial. J Manag Care Spec Pharm. 2015 Jan, 21(1), 66-75. DOI: 10.18553/jmcp.2015.21.1.66
Ramalho-de-Oliveira D, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm. 2010 Apr, 16(3), 185-95. DOI: 10.18553/jmcp.2010.16.3.185
Isetts BJ, et al. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. J Am Pharm Assoc (2003). 2008 Mar-Apr, 48(2), 203-14. DOI: 10.1331/JAPhA.2008.07108
Heidenreich PA, et al. Pharmacist management and quality of care for heart failure with reduced left ventricular ejection fraction. JACC: Heart Failure. 2025;13(9). DOI: 10.1016/j.jchf.205.102530.
Pastakia SD, et al. The impact of clinical pharmacist led comprehensive medication management on diabetes care at Federally Qualified Health Centers within the BD Helping Build Healthy Communities program. Journal of the American College Clinical Pharmacy. 2022;5:273-282. DOI: 10.1002/ jac5.1679.
Brajkovic A, et al. Healthcare utilization and clinical outcomes in older cardiovascular patients receiving comprehensive medication management services: A nonrandomized clinical study. International Journal of Environmental Research and Public Health. 2022;19:2781. DOI: 10.3390/ijerph19052781.
Wang Q, et al. Description and disposition of home patients with colorectal cancer assessing a practical, complications related medication therapy management service. Front Oncol 2025 Jul 17;15:1595010. DOI: 10.3389/fonc.2025.1595010
Cobb CD. Optimizing medication use with a pharmacist-provided comprehensive medication management service for patients with psychiatric disorders. Pharmacotherapy. 2014;34:1336-1340. doi.org/10.1002/phar.1503.
Rezende CP, Silva PVR, Oliveira DR, Silva HM, Nascimento MMG. Serviços clínicos farmacêuticos oferecidos a pessoas com artrite reumatoide: uma revisão da literatura. In: V Congresso Brasileiro de Saúde Online, 2024, Brasília. Anais do Evento: V Congresso Brasileiro de Saúde Online, 2024.
Peters DH, Tran NT, Adam T, et al. Implementation research in health: a practical guide. 2013. Disponível em: https://iris.who.int/bitstream/ handle/10665/91758/9789241506212_eng.pdf?sequence
Mendes EV. Desafios do SUS. Brasília: CONASS, 2019.
Mota LMHD, et al. 2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis. Advances in Rheumatology. 2018, 58:2. DOI: 10.1186/s42358-018-0005-0
Corbacho MI, Dapueto JJ. Avaliação da capacidade funcional e da qualidade de vida de pacientes com artrite reumatoide. Rev Bras Reumatol. 2010 Jan, 50(1), 31–43. DOI: 10.1590/S0482-50042010000100004
Santos ASA, Nascimento MMG, Paulino BLT, Plauska ALS, Soares DB, Ramalho-de-Oliveira D. Resultados além do gerenciamento da infecção em um serviço de Gerenciamento da Terapia Medicamentos para pessoas vivendo com HIV. Saúde E Pesquisa. 2023, 16(4), 1–22. DOI: 10.17765/2176 9206.2023v16n4.e11966
Souza IG, Nascimento MMG, Neves CM, Oliveira GC, Brum GA, Ramalho-Oliveira D. Resultados Clínicos do Serviço de Gerenciamento da Terapia medicamentosa em um Ambulatório de Diabetes. Rev. Bras. Farm. Hosp. Serv. Saúde 2017, 8(3), 19-24. DOI: 10.30968/rbfhss.2017.083.004
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017 Oct 10, 17(1), 230. DOI: 10.1186/s12877-017-0621-2
Jyrkka J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Polypharmacy status as an indicator of mortality in an elderly population. Drugs & aging. 2009, 26(12), 1039-48. DOI: 10.2165/11319530-000000000-00000
Cadogan C, et al. Dispensing appropriate polypharmacy to older people in primary care: a qualitative, theory-based study of community pharmacists’ perceptions an experiences. Int J Pharm Pract. 2015, 23(S2), 32.
Peiter CC, Santos JLG, Lanzoni GMM, Mello ALSF, Costa MFBNA, Andrade SR. Healthcare networks: trends of knowledge development in Brazil. Esc Anna Nery. 2019, 23(1), e20180214. DOI: 10.1590/2177-9465-EAN-2018-0214
Felipe MLS, Evangelista CP, Duarte SRMP. Motivos de procura de atendimentos não urgentes na atenção secundária ao invés da atenção primária. Rev Enferm Atenção Saúde. 2022,11(1), e202141. DOI: 10.18554/reas.v11i1.4510
Lacerda RST, Almeida PF. Coordenação do cuidado: uma análise por meio da experiência de médicos da Atenção Primária à Saúde. Interface (Botucatu). 2023, 27, e220665. DOI: 10.1590/interface.220665
Silva DAM, Mendonça SAM, Ramalho-de-Oliveira D, Chemello C. Clinical practice of pharmacists in family health support team. Trab Educ Saúde. 2018, 16, 659-82. DOI: 10.1590/1981-7746-sol00108
Moghadam-Kia S, Werth VP. Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol. 2010 Mar, 49(3), 239-48. DOI: 10.1111/j.1365-4632.2009.04322.x
Saif S, Kakalia S, Kitchlew R, Khan HA, Fida S, Siddique M. Role of Ondansetron in Reducing Methotrexate Intolerance in Patients with Inflammatory Arthritis. J Coll Physicians Surg Pak. 2022 Oct, 32(10), 1308-12. DOI: 10.29271/jcpsp.2022.10.1308
Conforti A, Cola I, Pavlych V, Ruscitti P, Berardicurti O, Ursini F, et al. Beyond the joints, the extra-articular manifes-tations in rheumatoid arthritis. Autoimmun Rev. 2021 Feb, 20(2), 102735. DOI: 10.1016/j.autrev.2020.102735.
Radu AF, Bungau SG. Management of Rheumatoid Arthritis: An Overview. Cells. 2021 Oct 23, 10(11), 2857. DOI: 10.3390/cells10112857.
GBD 2021 Rheumatoid Arthritis Collaborators. Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 Sep 25, 5(10), e594-e610. DOI: 10.1016/S2665 9913(23)00211-4.
Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, McInnes IB, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological dis-ease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020, 79(6), 685-99.
Acurcio FA, Machado MA, Moura CS, Ferre F, Guerra AAJ, Andrade EI, et al. Medication Persistence of Disease-Modifying Antirheumatic Drugs and Anti-Tumor Necrosis Factor Agents in a Cohort of Patients With Rheumatoid Arthritis in Brazil. Arthritis Care Res (Hoboken). 2016 Oct, 68(10), 1489-96. DOI: 10.1002/acr.22840
Vicente GNS, Pereira IA, Castro GRW, Mota LMH, Carnieletto AP, Souza DGS, et al. Cardiovascular risk comorbidities in rheumatoid arthritis patients and the use of anti-rheumatic drugs: a cross-sectional real-life study. Adv Rheumatol. 2021 Jun 25, 61(1), 38. DOI: 10.1186/s42358-021-00186-4
Norton S, Koduri G, Nikiphorou E, Dixey J, Williams P, Young A. A study of baseline prevalence and cumulative incidence of comorbidity and extra articular manifestations in RA and their impact on outcome. Rheumatology (Oxford). 2013 Jan, 52(1), 99-110. DOI: 10.1093/rheumatology/kes262
Gonçalves TS, Ramalho-de-Oliveira D, Silva HM, Oliveira IV, Neves CM, Nascimento MMG. Drug utilization and health profile of patients with rheumatoid arthritis attending in a rheumatology clinic. Revista de Ciências da Saúde Básica e Aplicada, 2019, 2, 57-67.
10. Ramalho-de-Oliveira D. Atenção Farmacêutica: da filosofia ao gerenciamento da terapia medicamentosa. São Paulo: RCN, 2011; 344p.
Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the patient centered approach to medication management. 3 ed. New York: McGraw Hill, 2012; 697p.
CMM in Primary Care Research Team. The Patient Care Process for Delivering Comprehensive Medication Management (CMM): Optimizing Medication Use in Patient-Centered, Team-Based Care Settings. July 2018. Disponível em: http://www.accp.com/cmm_care_process
Rezende CP, et al. Clinical impact of comprehensive medication management services offered to geriatric and hypertensive patients. Journal of Pharmaceutical Health Services Research, 2023, 14(3), 285–90. DOI: 10.1093/jphsr/rmad028
Santos BD, et al. Clinical Impact of a Comprehensive Medication Management Service in Primary Health Care. J Pharm Pract. 2021 Apr, 34(2), 265 71. DOI: 10.1177/0897190019866309
Neves CM, Nascimento MMG, Silva DAM, Ramalho-de-Oliveira D. Clinical Results of Comprehensive Medication Management Services in Primary Care in Belo Horizonte. Pharmacy (Basel). 2019 Jun 12, 7(2), 58. DOI: 10.3390/pharmacy7020058
Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug-Related Morbidity and Mortality. Ann Pharmacother. 2018 Sep, 52(9), 829-837. DOI: 10.1177/1060028018765159
Obreli-Neto PR, et al. Economic evaluation of a pharmaceutical care program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized con-trolled clinical trial. J Manag Care Spec Pharm. 2015 Jan, 21(1), 66-75. DOI: 10.18553/jmcp.2015.21.1.66
Ramalho-de-Oliveira D, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm. 2010 Apr, 16(3), 185-95. DOI: 10.18553/jmcp.2010.16.3.185
Isetts BJ, et al. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. J Am Pharm Assoc (2003). 2008 Mar-Apr, 48(2), 203-14. DOI: 10.1331/JAPhA.2008.07108
Heidenreich PA, et al. Pharmacist management and quality of care for heart failure with reduced left ventricular ejection fraction. JACC: Heart Failure. 2025;13(9). DOI: 10.1016/j.jchf.205.102530.
Pastakia SD, et al. The impact of clinical pharmacist led comprehensive medication management on diabetes care at Federally Qualified Health Centers within the BD Helping Build Healthy Communities program. Journal of the American College Clinical Pharmacy. 2022;5:273-282. DOI: 10.1002/ jac5.1679.
Brajkovic A, et al. Healthcare utilization and clinical outcomes in older cardiovascular patients receiving comprehensive medication management services: A nonrandomized clinical study. International Journal of Environmental Research and Public Health. 2022;19:2781. DOI: 10.3390/ijerph19052781.
Wang Q, et al. Description and disposition of home patients with colorectal cancer assessing a practical, complications related medication therapy management service. Front Oncol 2025 Jul 17;15:1595010. DOI: 10.3389/fonc.2025.1595010
Cobb CD. Optimizing medication use with a pharmacist-provided comprehensive medication management service for patients with psychiatric disorders. Pharmacotherapy. 2014;34:1336-1340. doi.org/10.1002/phar.1503.
Rezende CP, Silva PVR, Oliveira DR, Silva HM, Nascimento MMG. Serviços clínicos farmacêuticos oferecidos a pessoas com artrite reumatoide: uma revisão da literatura. In: V Congresso Brasileiro de Saúde Online, 2024, Brasília. Anais do Evento: V Congresso Brasileiro de Saúde Online, 2024.
Peters DH, Tran NT, Adam T, et al. Implementation research in health: a practical guide. 2013. Disponível em: https://iris.who.int/bitstream/ handle/10665/91758/9789241506212_eng.pdf?sequence
Mendes EV. Desafios do SUS. Brasília: CONASS, 2019.
Mota LMHD, et al. 2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis. Advances in Rheumatology. 2018, 58:2. DOI: 10.1186/s42358-018-0005-0
Corbacho MI, Dapueto JJ. Avaliação da capacidade funcional e da qualidade de vida de pacientes com artrite reumatoide. Rev Bras Reumatol. 2010 Jan, 50(1), 31–43. DOI: 10.1590/S0482-50042010000100004
Santos ASA, Nascimento MMG, Paulino BLT, Plauska ALS, Soares DB, Ramalho-de-Oliveira D. Resultados além do gerenciamento da infecção em um serviço de Gerenciamento da Terapia Medicamentos para pessoas vivendo com HIV. Saúde E Pesquisa. 2023, 16(4), 1–22. DOI: 10.17765/2176 9206.2023v16n4.e11966
Souza IG, Nascimento MMG, Neves CM, Oliveira GC, Brum GA, Ramalho-Oliveira D. Resultados Clínicos do Serviço de Gerenciamento da Terapia medicamentosa em um Ambulatório de Diabetes. Rev. Bras. Farm. Hosp. Serv. Saúde 2017, 8(3), 19-24. DOI: 10.30968/rbfhss.2017.083.004
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017 Oct 10, 17(1), 230. DOI: 10.1186/s12877-017-0621-2
Jyrkka J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Polypharmacy status as an indicator of mortality in an elderly population. Drugs & aging. 2009, 26(12), 1039-48. DOI: 10.2165/11319530-000000000-00000
Cadogan C, et al. Dispensing appropriate polypharmacy to older people in primary care: a qualitative, theory-based study of community pharmacists’ perceptions an experiences. Int J Pharm Pract. 2015, 23(S2), 32.
Peiter CC, Santos JLG, Lanzoni GMM, Mello ALSF, Costa MFBNA, Andrade SR. Healthcare networks: trends of knowledge development in Brazil. Esc Anna Nery. 2019, 23(1), e20180214. DOI: 10.1590/2177-9465-EAN-2018-0214
Felipe MLS, Evangelista CP, Duarte SRMP. Motivos de procura de atendimentos não urgentes na atenção secundária ao invés da atenção primária. Rev Enferm Atenção Saúde. 2022,11(1), e202141. DOI: 10.18554/reas.v11i1.4510
Lacerda RST, Almeida PF. Coordenação do cuidado: uma análise por meio da experiência de médicos da Atenção Primária à Saúde. Interface (Botucatu). 2023, 27, e220665. DOI: 10.1590/interface.220665
Silva DAM, Mendonça SAM, Ramalho-de-Oliveira D, Chemello C. Clinical practice of pharmacists in family health support team. Trab Educ Saúde. 2018, 16, 659-82. DOI: 10.1590/1981-7746-sol00108
Moghadam-Kia S, Werth VP. Prevention and treatment of systemic glucocorticoid side effects. Int J Dermatol. 2010 Mar, 49(3), 239-48. DOI: 10.1111/j.1365-4632.2009.04322.x
Saif S, Kakalia S, Kitchlew R, Khan HA, Fida S, Siddique M. Role of Ondansetron in Reducing Methotrexate Intolerance in Patients with Inflammatory Arthritis. J Coll Physicians Surg Pak. 2022 Oct, 32(10), 1308-12. DOI: 10.29271/jcpsp.2022.10.1308
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2026-09-04
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Rezende, C. de P., Oliveira, I. V., César, A. L. M., Silva, P. V. R. da, Silva, H. M., Ramalho-de-Oliveira, D., & Nascimento, M. M. G. do. (2026). Resultados clínicos del servicio de gestión de la terapia farmacológica ofrecido a personas con artritis reumatoide. O Mundo Da Saúde, 50. https://doi.org/10.15343/0104-7809.202650e19522026P
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