STRUCTURE ASSESSMENT
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Analyzes the expected necessary elements for carrying out the activities as compared to the resources actually mobilized/implemented during the intervention
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Examples of potential indicators for a program to “Foster pharmaceutical care activities in a Municipal Regional Health Trust”
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- Proportion of basic health units with an embedded pharmacist’s office within the regional network as compared to the proportion planned for full program operation. |
- Proportion of pharmacist’s offices in basic health units participating in the program which have received Internet connectivity equipment as compared to the original goal of 75%. |
- Number of working hours of pharmacy providers working on program activities as compared to the planned minimum. |
PROCESS ASSESSMENT |
Analyzes the planned care process as compared to that actually implemented, and planned actions as compared to those actually carried out |
Examples of potential indicators for a project to “Improve the quality of pharmacist consultations for hypertensive patients at a Basic Health Unit” |
- Proportion of patients with care plans entered in their medical records at first consultation by the end of the project, as compared to the planned goal of recording care plans in 80% of patients. |
- Proportions of the number and type of pharmaceutical interventions provided for in the program which were actually carried out. |
- Proportion of pharmacist consultations for elderly hypertensive patients with polypharmacy during which the Medication Organization pharmaceutical procedure (CFC, 2016), provided for in the program, was actually carried out. |
OUTCOME ASSESSMENT
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Measurement of the observed clinical, humanistic, and/or economic effects of the intervention and comparison with the expected outcomes (whether the intervention actually caused the effects is not assessed) |
Examples of potential indicators for an intervention to “Improve medication adherence in hypertensive patients”
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- Proportion of elderly patients participating in the program who, according to caregivers, took their antihypertensive drugs “as prescribed” in at least 80% of doses. |
- Percent variation in responses to the 1986 Morisky-Green-Levine Medication Adherence Scale (MGLS) in patients who took part in the project for 6 months. |
- Reduction in hospitalizations for primary care-sensitive conditions related to high blood pressure in patients who took part in the project for 12 months and who exhibited improved adherence to therapy. |
- Reduction in emergency department visits for hypertensive crisis in patients who took part in the program. |
- Change in degree of satisfaction with level of treatment adherence in patients who took part in the program and who reported dissatisfaction at the start of the project. |
Evaluative Research: Potential interventions and indicators |
STRATEGIC ANALYSIS
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Relationship between the problems to be addressed and the objectives of the intervention
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Example of a potential indicator for an intervention to “Improve adherence through behavioral changes in hypertensive patients” |
- Extent to which the goals of therapy adequately address the causes of low adherence (which could be attributable mainly to deficiencies in the distribution or access to medicines rather than to patient behaviors). |
LOGIC ANALYSIS
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Relationship between the objectives of the intervention and its theoretical framework or the means made available to achieve them
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Examples of potential indicators for a project of “Implementation of a pharmaceutical referral service for hypertensive patients within a municipal primary care network”
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- Degree of scientific evidence about the effectiveness of this type of service (are there published experiences demonstrating positive effects of such referral services for this patient population?). |
- Relationship between the objectives of the pharmaceutical care program and the resources earmarked for its implementation (e.g., Is the number of providers to be hired consistent with the planned number of consultations?). |
EFFECTS ANALYSIS
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Tests for a causal relationship between the intervention and the set of effects it can produce (predicted and unpredicted; positive, negative, or neutral). Evaluates the generalizability of the effects of a given program.
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Example of potential indicators for a project to “Improve adherence through behavioral changes in hypertensive patients”
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- Comparison of responses to the 1986 MGLS between patients who took part in the program and patients from a control group which did not take part. |
- Variability in improvement in treatment adherence when the same program is implemented by teams with different degrees of motivation. |
PRODUCTION ANALYSIS
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Assesses the relationship between the resources used and the quantity and/ or quality of the services produced by the intervention
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Examples of possible indicators for a program to “Improve the quality of pharmacist consultations for hypertensive patients at a Basic Health Unit”
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- Number of pharmaceutical care encounters needed to obtain one patient whose blood pressure is “controlled” according to international parameters. |
- Quality of the accessibility of pharmaceutical consultations (measured after 12 months of project implementation) for those hypertensive patients considered to be at greatest risk. |
EFFICIENCY ANALYSIS
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Includes different types of economic evaluations (e.g., cost-benefit, cost-effectiveness, or cost-utility analyzes) used to judge the relationship between the results obtained and the resources employed in the intervention, considering the latter as costs.
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Example of a potential indicator for a program to “Foster pharmaceutical care activities in a Municipal Regional Health Trust”
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- Comparison of out-of-pocket costs to patients and their families for hospitalization due to complications of uncontrolled hypertension in patients who take part in the program vs. a control group not taking part in the program. |
IMPLEMENTATION ANALYSIS
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Studies the relationship between the intervention and its context (organizational, social, political); can also analyze the influence of this relationship on the effects achieved by the program. Can be used to study an intervention in a given context or to compare the same intervention in different contexts.
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Examples of a potential indicator for an intervention to “Improve medication adherence in hypertensive patients”
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- Differences in the implementation of technical aspects of the program (implementation of pharmaceutical procedures, defined according to CFF (2016CFF. Conselho Federal de Farmácia. Serviços Farmacêuticos diretamente destinados ao paciente, à família e à comunidade: contextualização e arcabouço conceitual. Brasília: Conselho Federal de Farmácia, 2016.), expected to improve adherence) between municipalities with and without outsourced health facility management models (effect of different organizational contexts on the program). |