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Abstract(s)
O presente relatório para a obtenção do grau de mestre é composto por três capítulos distintos, sendo o Capítulo I referente à vertente de investigação, seguindo-se a experiência profissionalizante em Farmácia Comunitária (Capítulo II) e em Farmácia Hospitalar (Capítulo III).
No Capítulo I consta a componente de investigação na qual foi abordada a doença pulmonar obstrutiva crónica (DPOC). A DPOC é uma patologia caraterizada por uma limitação persistente do débito aéreo que é geralmente progressiva. O COPD Assessment Test (CAT) é um instrumento rápido e fácil de utilizar para a medição da qualidade de vida em doentes com DPOC. O presente estudo teve como principal objetivo a avaliação do impacto da DPOC na qualidade de vida de doentes residentes na Cova da Beira. A amostra incluiu doentes com DPOC do serviço de Pneumologia do Hospital Pêro da Covilhã. A recolha de dados decorreu entre os meses de novembro de 2013 e abril de 2014 e incluiu o preenchimento de um questionário estruturado e a consulta de processos clínicos. A severidade da doença foi avaliada por espirometria e classificada segundo a Global Iniciative for Obstrutive Lung Disease (GOLD). O impacto da DPOC na qualidade de vida foi avaliado pelo CAT.
Foram recrutados 84 indivíduos com DPOC seguidos nas consultas de Pneumologia. 92.9% dos inquiridos pertenciam ao sexo masculino (média de idades de 69.3 anos). Nesta amostra, 63,1% eram ex-fumadores e 25% fumadores. Apenas 27.4% dos inquiridos apresentava antecedentes familiares da doença. A maior parte dos indivíduos da amostra encontrava-se no estadio II da doença (53.6%) seguindo-se os que estavam no estadio I (20.2%) e estadios III e IV (ambos com 13.1%). Cerca de 48.8% apresentava mais do que três comorbilidades sendo que apenas 4.8% da amostra em estudo não ostentava nenhuma doença concomitante. Relativamente a hospitalizações 77.4% não apresentou nenhuma no último ano devido à doença, 65.5% não apresentou nenhuma exacerbação e apenas 27.4% fazia oxigenoterapia. Quanto ao Volume Expirado Forçado no 1º Segundo (FEV1) este apresentava valores que variavam entre 21.8 e 116.0, com média de 63.4. As pontuações do CAT dos 84 inquiridos variavam entre 6 e 37. A categorização das pontuações mostrou que mais de metade tem um impacto clínico moderado (56.0%), seguindo-se os que têm um impacto severo (27.4%). Apenas 7.1% apresentou um impacto muito severo da DPOC na qualidade de vida.
O coeficiente de correlação de Pearson (p <0.01) mostrou a existência de uma correlação negativa forte entre a pontuação do CAT e o FEV1. Comparando a pontuação do CAT com o grau da doença, utilizando uma ANOVA, verifica-se um aumento na pontuação do CAT quando se avança do estadio I para o estadio IV da doença (p <0.001).
Relativamente ao sexo existem diferenças estatisticamente significativas nas pontuações do CAT (p =0.039) tendo as mulheres apresentado pontuações superiores às dos homens. Verificou-se uma correlação positiva com o número de exacerbações (p <0.001) e de hospitalizações (p <0.001). Existe também uma correlação positiva com a idade (p = 0.040) e com o número de comorbilidades (p = 0.014). De entre todas as comorbilidades, as doenças cardíacas, entre as quais a hipertensão arterial (p = 0.002), insuficiência cardíaca congestiva (p <0.001) e arritmia (p = 0.003) mostraram diferenças estatisticamente significativas relativamente aos indivíduos que não as possuíam. Também se verificou uma diferença estatística nos doentes que apresentavam osteoporose (p=0.018) e apneia do sono (p=0.017).
Em suma, este estudo mostrou que a qualidade de vida medida pelo CAT piora com a severidade da obstrução do fluxo. Além disso, os indivíduos do sexo feminino e aqueles com exacerbações e hospitalizações apresentaram pior qualidade de vida.
No Capítulo II é descrito o estágio curricular em Farmácia Comunitária realizada na Farmácia da Alameda, na Covilhã entre os dias 3 de fevereiro e 25 de abril de 2014. Sob a orientação do Dr. Jacinto Campos, especialista em Farmácia Comunitária, tive a oportunidade de contactar com o dia a dia de um farmacêutico comunitário. O facto de me ter sido dada muita autonomia na realização de todas as tarefas foi bastante importante para o desenvolvimento de competências essenciais ao meu futuro como farmacêutica. Pretende-se com este capítulo a descrição das atividades desenvolvidas no âmbito do estágio em Farmácia Comunitária.
O Capitulo III relata o estágio em Farmácia Hospitalar decorrido entre 28 de abril e 20 de junho no Centro Hospitalar Cova da Beira sob a orientação da Dra. Olímpia Fonseca. O contacto com a realidade hospitalar veio complementar a minha aprendizagem, tornando as minhas competências mais vastas visto ter podido contactar com outra realidade e terapêuticas que não se observam na vertente de Farmácia Comunitária. Com este relatório pretende-se a descrição de todas as atividades desenvolvidas durante o estágio nos Serviços Farmacêuticos do CHCB.
This report consists of three distinct chapters: Chapter I which concerns research, followed by professional internship in community pharmacy (Chapter II) and hospital pharmacy (Chapter III). Chapter I refers to the research component, related to chronic obstructive pulmonary disease (COPD). COPD is a disease characterized by chronic airflow limitation that is usually progressive. The COPD Assessment Test (CAT) is a fast and easy to use instrument for measuring the quality of life in patients with COPD. The present study was aimed at evaluating the impact of COPD on the quality of life of patients living in the Cova da Beira region. The sample included patients with COPD, followed in the Pneumology Department of the Hospital Pêro da Covilhã. Data collection took place between the months of November 2013 and April 2014 and included the completion of a structured questionnaire and consultation of clinical files. Disease severity was assessed by spirometry and classified according to the Global Initiative for Obstructive Lung Disease (GOLD). The impact of COPD on the quality of life was evaluated by the CAT instrument. 84 subjects with COPD followed in clinical pneumology consultations were recruited. 92.9% of the respondents were male (mean age 69.3 years). In this sample, 63.1% were former smokers and 25% present smokers. Only 27.4% of the respondents had a family history of the disease. The majority of the sample was at stage II (53.6%) followed by those who were in stage I (20.2%) and stages III and IV (both 13.1%). About 48.8% had more than three comorbidities and only 4.8% of the study sample did not bear any concomitant disease. 77.4% showed no hospitalizations in the last year due to illness, 65.5% showed no exacerbation and only 27.4% had oxygen therapy. The forced expiratory volume in 1 second (FEV1) yielded values ranging between 21.8 and 116.0, with a mean of 63.4. CAT scores of the 84 respondents ranged from 6 to 37. Categorization of scores showed that more than one half had a moderate clinical impact (56.0%) followed by those who had a severe impact (27.4%) of the disease. Only 7.1% had a very severe impact of COPD in the quality of life. There was a strong negative correlation between CAT score and FEV1 (coefficient of correlation p <0.01). Moreover there is an increase in the CAT score with disease severity ( ANOVA p <0.001). Regarding sex, women had higher CAT score than men (p = 0.039). There was a positive correlation with the number of exacerbations (p <0.001) and hospitalizations (p <0.001). There was also a positive correlation with age (p = 0.040) and the number of comorbidities (p = 0.014). Among all comorbidities, only heart disease, including high blood pressure (p = 0.002), CHF (p <0.001) and arrhythmia (p = 0.003) showed statistically significant diferences with regard to individuals who did not possess them. There was also a statistically significant difference in patients with osteoporosis (p=0.018) and sleep apnea (p=0.017). In summary, this study showed that the quality of life measured by CAT worsens with the severity of airflow obstruction. In addition, females and those with exacerbations and hospitalizations had a poorer quality of life. Chapter II describes the traineeship in Community Pharmacy held at the Alameda Pharmacy, in Covilhã between February 3rd and April 25th of 2014. Under the guidance of Dr. Jacinto Campos, specialist in community pharmacy, I had the opportunity to contact with the day-to-day life of a community pharmacist. The fact that I have been given a lot of autonomy in performing all tasks was very important for the development of all pharmaceutical skills essential to my future. The aim of this chapter is to describe the activities carried out during this training in community pharmacy. Chapter III reports the internship in Hospital Pharmacy that occurred between April 28th and June 20th at the Cova da Beira Hospital Centre (CHCB) under the guidance of Dra. Olímpia Fonseca, specialist in hospital pharmacy. The contact with the hospital reality complemented learning, enabling me to contact with another reality and therapies that were not observed or are unavailable in the community pharmacy. This report describes all of the activities undertaken during the internship in the Pharmaceutical Services CHCB.
This report consists of three distinct chapters: Chapter I which concerns research, followed by professional internship in community pharmacy (Chapter II) and hospital pharmacy (Chapter III). Chapter I refers to the research component, related to chronic obstructive pulmonary disease (COPD). COPD is a disease characterized by chronic airflow limitation that is usually progressive. The COPD Assessment Test (CAT) is a fast and easy to use instrument for measuring the quality of life in patients with COPD. The present study was aimed at evaluating the impact of COPD on the quality of life of patients living in the Cova da Beira region. The sample included patients with COPD, followed in the Pneumology Department of the Hospital Pêro da Covilhã. Data collection took place between the months of November 2013 and April 2014 and included the completion of a structured questionnaire and consultation of clinical files. Disease severity was assessed by spirometry and classified according to the Global Initiative for Obstructive Lung Disease (GOLD). The impact of COPD on the quality of life was evaluated by the CAT instrument. 84 subjects with COPD followed in clinical pneumology consultations were recruited. 92.9% of the respondents were male (mean age 69.3 years). In this sample, 63.1% were former smokers and 25% present smokers. Only 27.4% of the respondents had a family history of the disease. The majority of the sample was at stage II (53.6%) followed by those who were in stage I (20.2%) and stages III and IV (both 13.1%). About 48.8% had more than three comorbidities and only 4.8% of the study sample did not bear any concomitant disease. 77.4% showed no hospitalizations in the last year due to illness, 65.5% showed no exacerbation and only 27.4% had oxygen therapy. The forced expiratory volume in 1 second (FEV1) yielded values ranging between 21.8 and 116.0, with a mean of 63.4. CAT scores of the 84 respondents ranged from 6 to 37. Categorization of scores showed that more than one half had a moderate clinical impact (56.0%) followed by those who had a severe impact (27.4%) of the disease. Only 7.1% had a very severe impact of COPD in the quality of life. There was a strong negative correlation between CAT score and FEV1 (coefficient of correlation p <0.01). Moreover there is an increase in the CAT score with disease severity ( ANOVA p <0.001). Regarding sex, women had higher CAT score than men (p = 0.039). There was a positive correlation with the number of exacerbations (p <0.001) and hospitalizations (p <0.001). There was also a positive correlation with age (p = 0.040) and the number of comorbidities (p = 0.014). Among all comorbidities, only heart disease, including high blood pressure (p = 0.002), CHF (p <0.001) and arrhythmia (p = 0.003) showed statistically significant diferences with regard to individuals who did not possess them. There was also a statistically significant difference in patients with osteoporosis (p=0.018) and sleep apnea (p=0.017). In summary, this study showed that the quality of life measured by CAT worsens with the severity of airflow obstruction. In addition, females and those with exacerbations and hospitalizations had a poorer quality of life. Chapter II describes the traineeship in Community Pharmacy held at the Alameda Pharmacy, in Covilhã between February 3rd and April 25th of 2014. Under the guidance of Dr. Jacinto Campos, specialist in community pharmacy, I had the opportunity to contact with the day-to-day life of a community pharmacist. The fact that I have been given a lot of autonomy in performing all tasks was very important for the development of all pharmaceutical skills essential to my future. The aim of this chapter is to describe the activities carried out during this training in community pharmacy. Chapter III reports the internship in Hospital Pharmacy that occurred between April 28th and June 20th at the Cova da Beira Hospital Centre (CHCB) under the guidance of Dra. Olímpia Fonseca, specialist in hospital pharmacy. The contact with the hospital reality complemented learning, enabling me to contact with another reality and therapies that were not observed or are unavailable in the community pharmacy. This report describes all of the activities undertaken during the internship in the Pharmaceutical Services CHCB.
Description
Keywords
Cat Dpoc Farmácia Comunitária Farmácia Hospitalar Qualidade de Vida