Abstract
Introduction: Sickle cell disease poses a significant public health concern, affecting approximately 50% of patients with this condition in the Federal District (DF), who are enrolled in the Specialized Component of Pharmaceutical Assistance (CEAF) pharmacies for the use of hydroxyurea, a proven effective treatment. Proper use of this medication can substantially reduce the risk of severe complications associated with the disease, such as death, acute painful crises, need for blood transfusions, and acute chest syndrome. In this context, a well-structured pharmaceutical clinical service is crucial not only to promote treatment adherence but also to improve therapeutic outcomes and reduce costs associated with hospital emergencies and admissions. Objective: This study aims to present the implementation process and initial results of a pharmaceutical clinical service focused on patients with sickle cell disease in CEAF pharmacies within the Health Department of the Federal District. Materials and Methods: The implementation plan was developed, and a specialized team was assigned to lead it. The service was structured to provide personalized care to patients. For new patients, a specific appointment for medication dispensing with the pharmacist was established. During the consultation, the pharmacist conducts a detailed assessment, welcomes the patient, provides educational guidance, answers questions, establishes a care plan, and records the interactions. Tools used include service scripts, educational materials (for adults and children), pharmaceutical records, referral letter templates for toxicity cases, and performance indicator spreadsheets. Regular meetings are held to monitor actions and discuss cases. Results: From August 2022 to January 2023, 50 patients were served. Approximately 40 medication-related issues were identified, primarily concerning treatment adherence. Common situations included patients forgetting medication use, misunderstanding usage instructions, having difficulty swallowing/administering the medication, or opting not to use it for various reasons. Other issues pertained to treatment safety, necessity, and effectiveness. A total of 357 interventions were made, including providing medication use reminders, recommending self-monitoring strategies, addressing adherence barriers, advising on product handling, referring patients to physicians and nutritionists, and educating patients/caregivers on non-pharmacological measures and overall treatment. Discussion and Conclusions: The study highlighted patient needs that could potentially be addressed through collaborative pharmaceutical services integrated with SUS health teams. Going forward, there are plans to institutionalize the service, expand inter-institutional partnerships with prescribers and other sectors, train more pharmacists for clinical practice, increase service provision, and enhance care management to monitor and evaluate clinical, humanistic, and economic outcomes through short-, medium-, and long-term indicators.
