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- Seguimento farmacoterapêuticoPublication . Duarte, NunoNa farmácia comunitária dos dias de hoje enfrentam-se muitos desafios, relacionados com a sustentabilidade do modelo implementado e com a prática profissional. No paradigma atual, as farmácias são “reféns” dos preços dos medicamentos sujeitos a receita médica, uma vez que estes representam a grande maioria do retorno financeiro das mesmas. Apesar de sucessivas alterações legislativas ao regime jurídico das farmácias, a grande maioria não implementou novos serviços capazes de suprir necessidades relacionadas com os cuidados farmacêuticos. Neste contexto, o serviço de Seguimento Farmacoterapêutico é da maior relevância pois permite ganhos em saúde bem como a afirmação plena do profissional da farmácia na equipa interdisciplinar que acompanha o doente. Esta palestra dá a conhecer os cuidados farmacêuticos, nomeadamente o Seguimento Farmacoterapêutico, os métodos e recursos necessários para a implementação deste serviço nas Farmácias bem como os ganhos em saúde para os utentes. Pretende-se ainda demonstrar qual o novo papel dos profissionais de farmácia que realizam esta atividade cognitiva e consequentes responsabilidades que daí advém.
- Analgesic treatment in non-cancer chronic painPublication . Duarte, Nuno; Pedraza, José; Santos, MarleneThis book has been developed to support the curricular units of the Bachelor and Master study cycles of the School of Health of the Polytechnic Institute of Porto, which address the analgesic pharmacotherapy of chronic non-cancer pain. The aim of this book is to provide an overview of the pharmacological agents used in the treatment of chronic pain, focusing on the mechanism of action, indications, and adverse effects. This book analyzed the information available in articles on conventional drugs used in the treatment of chronic pain, including randomized controlled trials, open trials, and systematic reviews with or without meta-analysis. Newer drugs with potential off-label use were also included. Information on outcomes related to pain relief, safety/tolerability profile, or both was also included.
- Ten-year analgesic utilization patterns and economic implications in PortugalPublication . Duarte, Nuno; Martins, João Paulo; García-Pedraza, Jose-Ángel; Santos, MarleneThis study evaluated the 10-year consumption and economic patterns of classical analgesics, adjuvants and opioids in Portugal (2012-2022), and conducted a comparative analysis between Portugal, Spain and Denmark to explore the consumption patterns among these countries for 2022. Data on sales and national health service (NHS) costs were obtained from the Portuguese National Authority of Medicines and Health Products. Sales data were converted to defined daily dose (DDD) per 1000 inhabitants per day according to the Anatomical Therapeutic Chemical (ATC) classification/DDD methodology, while comparisons between Spain and Denmark were evaluated with the chi-square test, when appropriate. The findings reveal that classical analgesics use in Portugal remained stable during the period 2012-2022, with ibuprofen being the most consumed. Adjuvants, specifically gabapentinoids, experienced an 84% increase in use, primarily attributed to pregabalin. Weak opioids, led by tramadol, witnessed a 117% rise in use, while strong opioid use, led by tapentadol, increased by 618%. Portugal presented the lowest overall opioid consumption when compared to Denmark and Spain in 2022. Economic trends indicated a heightened NHS expenditure on analgesics, primarily driven by increased opioid use. Notwithstanding, there was no significant burden on relative expenditure over the 10-year period. Portugal presented a major increase in both weak and strong opioid prescriptions, aligning with the trends for Spain and Denmark. The development and approval of generic medicines and vigilant market monitoring are imperative strategies for managing the escalated costs resulting from heightened consumption, particularly concerning opioids.
- Pain intensity (PI) and quality of life (QoL) in patients with chronic non-cancer pain (CNCP) receiving medication review –A protocolPublication . Duarte, Nuno; Santos, Marlene; Pedraza, JoséChronic pain is defined by the International Association for the Study of Pain (IASP) as “pain that lasts or occurs for longer than 3 months”.A recent prevalence study conducted in primary care units in Portugal found a 33,6% prevalence of chronic pain. The study highlights a high prevalence of chronic pain patients while also identifying some characteristics and associated risk factors. In medication review with follow-up (MRF), care plans are developed with the patient’s agreement and recommendations regarding pharmacotherapy changes are discussed with physicians to optimize clinical outcomes. Implementation of MRF in chronic non-cancer pain (CNCP) patients in primary care setting, and compare this intervention with standard care by assessing, its influence on pain intensity (PI), quality of life (QoL) and patient global impression (PGI). A randomized parallel study, with blinding to patients relative to interventions and blinding to assessment, consisting of two arms, the intervention where MRF will be conducted, and the “active placebo” which will comprise standard care. Outcomes are assessed by self-report using a numerical rating scale (NRS) for PI, the brief pain inventory for QoL and patient global impression of change scale for PGI (secondary outcome). A PI improvement of 1,5 points in the NRS between-groups on average PI score from baseline until the end of the study, is defined as the minimal clinically relevant difference (MCRD). Standard deviation (SD) estimate was obtained based on interquartile range of a prevalence study on chronic pain in Portugal which gives an SD of 1,48. To detect the MCRD and considering the SD estimate, a confidence interval of 95% and a power size to detect effect of 80%, the sample size must be approximately 15 subjects for each arm (n=30) for a two-sided test. We hypothesized that these main outcomes will be different between groups, favoring the group receiving MRF.