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INT-008 Implementation of pharmaceutical consultation in primary health care – pharmacotherapy follow-up of poly-medicated elderly patients in ulscb health centre, epe
  1. Maria do Carmo Gonçalves


Background There is a high number of elderly poly-medicated patients with co-morbidities. Problems related to poly-medication are known due to discrepancies in dosages, posology, interactions, adverse effects, lack of adherence to treatment and inadequate duration of treatment. Moreover, the elderly present diverse physiological features that predispose themselves to drug iatrogeny. The intervention of the pharmacist with these patients, integrating a team of health professionals, aims to promote the rational use of medication, as well as optimise and reduce costs of health therapies.

Purpose The main aim is to identify discrepancies that diminish the effectiveness and safety of medication in elderly poly-medicated major patients. Implement the pharmaceutical medication review for patients referred by the GP. Integrate the professional pharmacist into the multidisciplinary team of the primary healthcare unit.

Material and methods Gathering of information on medication for chronic disease prescribed to the patient in the previous 6 months, by consulting the clinical file. Preparation of patient pharmacotherapeutical profile. Observation of the patient’s medication brown bag and pharmaceutically consult with the patient for further information gathering. Comparative analysis of both the prescribed medication as well as the medication contained in the patient’s brown bag so as to allow the identification of discrepancies.

Results Sample: 20; average medication: 8; pathologies: arterial hypertension (65%), cardiovascular diseases (60%), diabetes (50%) and rheumatic diseases (35%). Frequent therapeutic groups: antihypertensive agents (23%); anti-diabetic (9.3%); proton-pump inhibitors (9.3%); anxiolytics, sedatives and hypnotics (6.45%)

Discrepancies: non-adherence (21%); non-prescribed medication (39%); different dosage (7%); different posology (32%); therapeutic duplication (5%); moderate potential interactions (100%); potential serious interactions (40%); and inadequate treatment duration (20%).

Conclusion The pharmaceutical consultation allows the immediate intervention of the pharmacist in the correction of unintentional and non-documented mistakes, also in avoiding drug-related problems, improving adherence and therapeutic management, and providing information relevant to the GP. The role of the pharmacist in primary healthcare is relevant in promoting the rational and responsible use of medications and complementary therapies. The pharmacist also plays an important role in improving the quality of life of patients, thus contributing to the efficiency and sustainability of the national health service.


  1. . Sabater D, Fernandez-Llimos F, Parras M, Faus MJ. Tipos de intervenciones farmacêuticas en seguimento farmacoterapêutico. Seguimenteo Farmacoterapêutico2002;3(2):90–97.

  2. . Figueiredo IV, Caramona MM, Fernandez-Llimos, Castel-Branco MM. Results of pharmaceutical patient-centred services implemented in Portugal. Acta Farmacêutica Portuguesa2014;3(1):15–22.

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