Intervenções farmacêuticas em cuidados paliativos - análise do cenário em um centro pediátrico de hospital universitário em Salvador - Ba.

Abstract

Palliative Care refers to a holistic approach of assistance for individuals who have life-limiting conditions, moves away from a curative ideal and inspires constant technical training of the team that performs them. Applied to pharmaceutical follow-up, the idea that their insertion in the working group is restricted to pharmacotherapeutic review has been increasingly disconnected, even though this is one of the main instruments of action. In the pediatric field, pharmaceutical interventions encounter multiple challenges in the bio-psycho-social particularities of these individuals. Considering that the theme has been discussed since the 20th century, institutional recognition is required for the perception of the advances achieved and the gaps that still exist, justifying the relevance of this analysis. Even so, the scarcity of regional studies from the perspective of the pharmaceutical professional in this specialized care is reiterated. In this way, this production brings the results of a descriptive cross-sectional study, carried out from the information present in medical records, whose population of interest was composed of patients hospitalized at the Pediatric Center Professor Hosannah de Oliveira (CPPHO/COMHUPES) during the period of June 2018 to June 2020. Being a diagnostic study, as long as they were followed up by the Clinical Pharmacy Service, patients eligible for Palliative Care were characterized in terms of age, biological sex and main disease. The captured pharmaceutical behaviors were categorized, and, if interventions, were associated with the respective Drug-Related Problem and its outcome. The drugs used by the patients were classified according to the Anatomic Therapeutic Chemical (ATC) index, indicating whether they were used off-label or unlicensed. Thus, of the 370 patients selected for diagnosis, 31 were included in the study, as they had clinical follow-up from the pharmacist. Of these, 54.83% were biologically male (n=17), with a mean age of 6.19 years, ranging from 10 days to 18 years. The most frequent diagnoses were endocrine, nutritional and metabolic diseases (25.8%). Of the adopted pharmaceutical approaches, 12 (19.04%) were detection of adverse events, 2 (3.17%) additional monitoring, 13 (20.63%) guidance to the family or team and 36 (57.14%) interventions. The most numerous interventions were related to the need for security (36.11%). Of the regularly prescribed drugs, 20.03% were systematized in the alimentary tract and metabolism in the ATC, followed by nervous system (21.57%) and antimicrobials for systemic use (15.48%). Even so, 30 items prescribed off-label were identified, 3 of which were associated with suspected adverse reactions. Given the small number of patients included in the study, it is considered that the levels of clinical pharmaceutical assistance adopted may not be guaranteeing adequate coverage for the needs of pediatric patients with poor prognosis. The biases of the analysis, the technical support to the professionals involved and the need to foster institutional improvements aimed at changing this scenario should also be taken into account. It is expected that pharmaceutical professionals may be increasingly inserted in the principles of Palliative Care, uniting voices so that this science ceases to be, in addition to being underused, a synonym for the end of life.