Avaliação dos serviços farmacêuticos de apoio clínico à alta hospitalar na unidade de cardiologia de um hospital-escola

Abstract

Good practices in discharge care are essential to prevent patient complications and readmissions. However, the implementation and execution of clinical services aimed at the hospital-to-home transition involve complex issues, such as the availability of human resources, interprofessional collaboration, and workflow alignment. In this context, the present research aimed to generate relevant data to improve pharmaceutical services focused on hospital discharge through a randomized clinical trial. Participants were divided into three groups: Usual Care, Intervention I, and Intervention II. The first group did not receive pharmaceutical services for the hospitalto-home transition. The second group received discharge services, while the third group received both discharge and post-discharge services. The study included users of the Cardiology Unit at Cassiano Antonio Moraes University Hospital (HUCAM), located in Vitória-ES, Brazil. Data collection involved electronic medical records, questionnaires, interviews, and pharmacist interventions. The indicators used to evaluate study outcomes included levels of anxiety/depression, medication adherence, treatment discrepancies, adverse outcomes, user satisfaction, medical evaluation, and others. Descriptive analysis used sample standard deviations of the investigated groups, and data distribution patterns for each variable were verified using ShapiroWilk and Anderson-Darling normality tests. Most data sets did not exhibit a normal distribution pattern and were analyzed using non-parametric tests such as KruskalWallis and Mann-Whitney U tests. A total of 74 pharmaceutical interventions were recorded at hospital discharge and 35 during post-discharge consultations. Most interventions addressed discrepancies identified in medication reconciliation. Intervention groups showed lower rates of outpatient returns within six months and fewer adverse outcomes (hospital readmissions and unplanned emergency visits) within 30 days after discharge. Pairwise comparisons between groups achieved statistical significance when comparing Usual Care with Intervention I and Usual Care with Intervention II. However, regarding the number of discrepancies, results were statistically significantly better in the Intervention II group. The number of causes of (real or potential) pharmacotherapy-related problems was also lower (with statistical significance) in both intervention groups. The medical evaluation of patients' clinical progress was another variable that showed positive results in the intervention groups, with statistically significant differences between Usual Care and Intervention II. Additionally, reductions in anxiety and depression levels were more pronounced in the intervention groups, with statistical significance in some evaluated parameters. Based on these findings, it can be concluded that the clinical support pharmaceutical services for hospital discharge evaluated in this trial provided direct benefits to both patient clinical outcomes and the hospital institution hosting the research. However, the set of services applied to the Intervention II group-encompassing both discharge and postdischarge care-yielded more significant results overall.