A implantação de serviços de cuidado farmacêutico em ambulatório multidisciplinar de hospital de referência em AVC reduz a reinternação de pacientes pós AVC em decorrência de fibrilação atrial não valvar em uso de anticoagulante oral direito

Abstract

Stroke is considered an event with a high impact on human life and is a global economic burden. New technologies such as the use of direct oral anticoagulants (DOACs) represent an advance in the secondary prevention of stroke of cardioembolic etiology in patients with Atrial Fibrillation (AF), which is a form of cardiac arrhythmia that is associated with a high risk of death, affecting more than 30 million people in the world representing a growing cost increase, putting pressure on healthcare systems in several countries. As stroke recurrence rates can be influenced by non-adherence to treatment, pharmaceutical care with its various services such as health education, pharmacotherapeutic monitoring, dispensing, health condition management, medication reconciliation, review of pharmacotherapy and therapeutic monitoring of Medications may improve outcomes in post-stroke patients.The objective was To evaluate the impact of the pharmaceutical care service on post-stroke patients on the readmission rate of patients using DOACs in a public reference hospital. This is a retrospective cohort study with a quantitative approach, in which two groups were identified, one group being exposed to pharmaceutical care (CF) and the unexposed group (without CF). Both were followed from March 2015 to December 2022 to determine the readmission rate for stroke. Patients who had a diagnosis of stroke with an indication for the use of DOAC were included, patients with a previous stroke who were already using DOAC and all patients using DOACs followed in the hospital outpatient clinic and patients who died before hospital discharge were excluded, in addition to patients who were readmitted to the stroke unit, but recurrent stroke was ruled out. 680 electronic medical records of patients who had a stroke due to AF were accessed. The majority of patients were male over 75 years of age. 70 patients (10%) were readmitted with a new stroke and it was shown that the CF group had greater adherence to treatment and a lower readmission rate than the group without CF. Of the 70 readmitted patients, 24 stated that they were compliant with the treatment and of these, only 6 were at risk of a drug interaction that could justify a new stroke. In relation to the cost of readmission of patients, ultrasounds of the circulatory system, tomography of the head, neck, spine, chest, upper limbs, lower limbs, abdomen and pelvis, consultations with doctors and other health professionals, nutritional therapy, daily hospital fees, orthoses and prosthetics in neurosurgeries when necessary and laboratory tests. The average cost of readmission per patient was $2,857.87. Stroke readmissions of study patients occurred in greater numbers in the group without CF, thus, pharmaceutical care proved to be an effective alternative to remedy this problem.