Mapping community pharmacy services in Brazil: a scoping review

Garabeli, Aline Ansbach; Benetoli, Arcelio; Halila, Gerusa Clazer; Machinski, Isadora; Tonin, Fernanda Stumpf; Fernandez-Llimos, Fernando; Pontarolo, Roberto

doi:10.1590/s2175-97902022e20851

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Brazilian Journal of Pharmaceutical Sciences

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Article • Braz. J. Pharm. Sci. 58 • 2022 • https://doi.org/10.1590/s2175-97902022e20851 copy

Mapping community pharmacy services in Brazil: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The delivery of clinical pharmacy services has been growing in Brazilian community pharmacies, and it is necessary to have a comprehensive understanding of the topic. This scoping review aimed to provide an overview of Brazilian studies about clinical pharmacy services in community pharmacies. Original research articles, with no restriction of time, study design, or patient’s health condition, were included. Searches were conducted in PubMed, Scopus, Web of Science, Scielo, and Lilacs. Two reviewers conducted the screening, full-text reading, and data extraction independently. ROB and ROBINS-I were used for the assessment of quality. Charts and tables were built to summarise the data. Seventy-two articles were included. A diversity of study designs, number of participants, terms used, and outcomes was found. São Paulo and Sergipe States had the highest number of studies (n=10). Pharmacists’ interventions were not fully reported in 65% of studies, and most studies presented an unclear risk of bias. Studies were very diverse, impairing the comparisons between the results and hindering their reproducibility. This review suggests using guidelines and checklists for better structuration of pharmacists’ interventions as well as reporting results and measuring fidelity in future research.

Keywords:
Community pharmacy services; Pharmacists; Pharmacy research; Terminology; Public Reporting of Healthcare Data

Authors/year of publication	City/state	Nature of CP^a	Study design	PS^b evaluated	Participants (n intervention group / n control group)	Health condition	Outcomes (ECHO model)	Other elements evaluated
*Firmino et al., 2015*Firmino PYM, Vasconcelos TO, Ferreira CC, Moreira LM, Romero NR, Dias LA, et al. Cardiovascular risk rate in hypertensive patients attended in primary health care units: The influence of pharmaceutical care. Braz J Pharm Sci . 2015;51(3):617-28.	Fortaleza, CE	Public	RCT^c	Medication therapy management	Patients (26/30)	Hyp^d/CAD^e	Clinical	DRP^f
*Mourão et al., 2013*Mourão AOM, Ferreira WR, Martins MAP, Reis AMM, Carrillo MRG, Guimarães AG, et al. Pharmaceutical care program for type 2 diabetes patients in Brazil: A randomised controlled trial. Int J Clin Pharm . 2013;35(1):79-86.	Ouro Preto, MG	Public	RCT	Medication therapy management	Patients (50/50)	DM2^g	Clinical	Medication used profile
*Obreli-Neto et al., 2011aObreli-Neto PR, Guidoni CM, Baldoni A de O, Pilger D, Cruciol-Souza JM, Gaeti-Franco WP, et al. Effect of a 36-Month Pharmaceutical Care Program on Coronary Heart Disease Risk in Elderly Diabetic and Hypertensive Patients. J Pharm Pharm Sci. 2011a;14(2):249-63., 2011bObreli-Neto PR, Guidoni CM, Baldoni A de O, Pilger D, Cruciol-Souza J, Gaeti-Franco WP, et al. Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients. Int J Clin Pharm . 2011b;33(4):642-9., 2015*Obreli-Neto PR, Marusic S, Guidoni CM, Baldoni A de O, Renovato RD, Pilger D, et al. Economic evaluation of a Pharmaceutical Care Program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized controlled clinical trial. J Manag Care Spec Pharm. 2015;21(1):66-75.	Salto Grande, SP	Public	RCT	Medication therapy management	Patients (97/97)	Elderly - DM2, hyp	Clinical, economic	Adherence
*Plaster et al., 2012*Plaster CP, Melo DT, Boldt V, Cassaro KO dos S, Lessa FCR, Boëchat GAP, et al. Reduction of cardiovascular risk in patients with metabolic syndrome in a community health center after a pharmaceutical care program of pharmacotherapy follow-up. Braz J Pharm Sci . 2012;48(3):435-46.	Vila Velha, ES	Public	RCT	Medication therapy management	Patients (38/36)	Metabolic syndrome	Clinical	Adherence
*Aguiar et al., 2012*Aguiar PM, Balisa-Rocha BJ, Brito GC, Lyra DP. Pharmaceutical care program for elderly patients with uncontrolled hypertension. J Am Pharm Assoc. 2012;52(4):515-8.	Aracaju, SE	Public	Quasi-experimental	Medication therapy management	Patients (35) (pilot study)	Elderly, hyp	Clinical	DRP, adherence
Aguiar, Balisa-Rocha, Lyra Junior, 2013Aguiar PM, Balisa-Rocha BJ, Lyra-Júnior DP. Avaliação de indicadores de estrutura e processo de um serviço de Atenção Farmacêutica na Farmácia Popular do Brasil: um estudo piloto. Rev Ciências Farm Básica Apl. 2013;34(3):401-10.	Aracaju, SE	Public	Descriptive-evaluative	Medication therapy management	Pharmacists (2) and patients (69) (pilot study)	No restriction	Humanistic (satisfaction, patients)	Infra-structure, follow-up process, counselling, use of EBP^h, communication skills (pharmacists)
*Andrade et al., 2009*Andrade TU, Burini DM, Mello M de O, Bersácula N dos S, Saliba RAD, Bravim FT, et al. Evaluation of the satisfaction level of patients attended by a Pharmaceutical Care Program in a Private Communitarian Pharmacy in Vitória (ES, Brazil). Brazilian J Pharm Sci. 2009;45(2):349-55.	Vitória, ES	Private	Cross-sectional	Medication therapy management	Patients (50/41)	No restriction	Humanistic (satisfaction)	NA*
*Balisa-Rocha et al., 2012*Aguiar PM, Balisa-Rocha BJ, Brito GC, Lyra DP. Pharmaceutical care program for elderly patients with uncontrolled hypertension. J Am Pharm Assoc. 2012;52(4):515-8.	Aracaju, SE	Public	Quasi-experimental	Medication therapy management	Patients (34) (pilot study)	Elderly, DM2	Clinical, humanistic (QoL ⁱ)	Medication use profile, DRP
Brito et al., 2009	Aracaju, SE	Public	Quasi-experimental	Medication therapy management	Patients (30)	Elderly	NA	Medication use profile
Brune, Ferreira, Ferrari, 2014	Pontal do Araguaia, MT	Public	Quasi-experimental	Medication therapy management	Patients (25)	Hyp	Clinical	DRP
*Cazarim et al., 2016Cazarim M, Freitas O, Penaforte T, Achcar A, Pereira L. Impact assessment of pharmaceutical care in the management of hypertension and coronary risk factors after discharge. PLoS One. 2016;11(6):2006-8., 2017Cazarim M, Nunes AA, Pereira LRL. Cost-consequence analysis of Pharmaceutical Care program for systemic arterial hypertension in the public health system in Brazil. Braz J Pharm Sci. 2017;53(3):1-10., 2018*Cazarim M, Pereira L. Cost-effectiveness analysis of pharmaceutical care for hypertensive patients from the perspective of the public health system in Brazil. PLoS One . 2018;13(3):1-16.	Ribeirão Preto, SP	Public	Quasi-experimental	Medication therapy management	Patients (104)	Hyp/CAD	Clinical, humanistic (QoL), economic	Adherence
Correr et al., 2009a, 2009b, 2011	Curitiba, Paranaguá, Colombo, Campo Largo, PR	Private	Quasi-experimental	Medication therapy management	Patients (50/46)	DM2	Clinical, economic, humanistic (satisfaction, QoL)	Medication use profile
Foppa et al., 2016	Florianópolis, SC	Public	Quasi-experimental	Medication therapy management	Patients (51)	Parkinson’s	Clinical, humanistic (QoL)	Adherence, DRP
*Garabeli et al., 2016*Garabeli AA, Daher JB, Wiens A, Lenzi L, Pontarolo R. Quality of life perception of type 1 diabetic patients treated with insulin analogs and receiving medication review with follow-up in a public health care service from ponta Grossa-PR, Brazil. Braz J Pharm Sci . 2016;52(4):669-78.	Ponta Grossa, PR	Public	Cross-sectional	Medication therapy management	Patients (110)	DM1	Clinical, humanistic (QoL)	NA
Loureiro et al., 2012	Fortaleza, CE	Public	Quasi-experimental	Medication therapy management	Patients (45)	HIV/AIDS	Clinical, humanistic (QoL)	DRP, medication use profile
*Lyra Junior et al., 2007*Lyra Jr DP, Kheir N, Abriata JP, da Rocha CE, dos Santos CB, Pelá IR. Impact of Pharmaceutical Care interventions in the identification and resolution of drug-related problems and on quality of life in a group of elderly outpatients in Ribeirão Preto (SP), Brazil. Ther Clin Risk Manag. 2007;3(6):989-98.	Ribeirão Preto, SP	Public	Quasi-experimental	Medication therapy management	Patients (30)	Elderly	Humanistic (QoL)	DRP
Marques et al., 2009	Alfenas, MG	Public	Quasi-experimental	Medication therapy management	Patients (74)	No restriction	NA	Medication use profile, DRP
*Melo et al., 2017Melo DO, Molino CGC, Ribeiro E, Romano-Lieber NS. Capacitação e intervenções de técnicos de farmácia na dispensaçãvo de medicamentos em atenção primária à saúde. Cienc Saude Coletiva . 2017b;22(1):261-8.; Melo, Castro, 2017*Melo DO, Castro LLC. Pharmacist’s contribution to the promotion of access and rational use of essential medicines in SUS. Cienc Saude Coletiva. 2017a;22(1):235-44.	São Paulo, SP	Public	Cross-sectional	Medication therapy management, dispensing	Pharmacist (1) and assistants (4)	No restriction	NA	Counselling, follow-up process, components of dispensing
*Mendonça et al., 2016*Mendonça SM, Melo AC, Pereira GC, dos Santos D, Grossi EB, Sousa M, et al. Clinical outcomes of medication therapy management services in primary health care. Braz J Pharm Sci . 2016;52(3):365-73.	Divinópolis, MG	Public	Descriptive (retrospective)	Medication therapy management	Patients (92)	No restriction	Clinical	DRP, medication use profile
Silva, Bazotte, 2011Silva G, Bazotte RB. Development and evaluation of a Pharmaceutical Care Program to reduce modifiable risk of chronic complications in Brazilian type 2 diabetic patients. Lat Am J Pharm . 2011;30(1):154-60.	Maringá, PR	Private	Quasi-experimental	Medication therapy management	Patients (51)	DM2	Clinical	NA
Silva et al., 2013	Recife, PE	Public	Quasi-experimental	Medication therapy management	Patients (14) (pilot study)	Elderly - dys^j	Clinical	Medication use profile, DRP, adherence
Souza et al., 2009	Recife, PE	Public	Quasi-experimental	Medication therapy management	Patients (10) (pilot study)	Hyp	Clinical	Medication use profile; DRP
*Detoni et al., 2017*Detoni KB, Oliveira I V, Nascimento MMG, Caux TR, Alves MR, Ramalho-De-Oliveira D. Impact of a medication therapy management service on the clinical status of patients with chronic obstructive pulmonary disease. Int J Clin Pharm . 2017;39(1):95-103.	1 city, MG	Public	Cohort	Medication therapy management	Patients (83)	COPD^k	Clinical	NA
Santos et al., 2019	Lagoa Santa, MG	Public	Cross-sectional (phase I), quasi-experimental (phase II)	Medication therapy management	Patients (1,057)	No restriction	Clinical	DRP, medication use profile
*Scarabelin et al., 2019*Scarabelin A, Santana Dosea A, Aguiar PM, Storpirtis S. Pharmacist-patient communication in prostate cancer as a strategy to humanize health care: a qualitative study. J Patient Exp. 2019;6(2):150-6.	São Paulo, SP	Public	Qualitative	Medication therapy management	Patients (10)	Prostate cancer	NA	Communication with the pharmacist, medication use profile
*Gomes et al., 2020*Gomes LO, Teixeira MR, Rosa JA da, Foppa AA, Rover MRM, Farias MR. The benefits of a public pharmacist service in chronic hepattis C treatment: the real-life results of sofosbuvir-based therapy. Res Soc Adm Pharm. 2020;16(1):48-53.	Florianópolis, SC	Public	Cohort	Medication therapy management	Patients (240)	Chronic hepatitis C (treatment with sofosbuvir)	Clinical, humanistic (satisfaction)	Medication use profile (with identification of adverse reactions and cure rate)
Afonso et al., 2017	Igaratinga, MG	Public	Descriptive	Dispensing	Patients (198)	No restriction	Humanistic (satisfaction)	NA
Baldon et al., 2006	Curitiba, PR	Private	Cross-sectional	Dispensing	Pharmacists (101)	Pregnancy	NA	Knowledge, therapeutic choice, use of EBP
Bastos, Caetano, 2010	4 cities, RJ	Private	Qualitative	Dispensing	Pharmacists (15)	No restriction	Humanistic (perception, satisfaction)	NA
Bonadiman et al., 2018	8 cities, ES	Public	Descriptive (quantitative)	Dispensing	Pharmacists (11) and patients (294)	No restriction	Humanistic (satisfaction, patients)	Knowledge (pharmacists)
Cassaro et al., 2016	9 cities, ES	Public	Cross-sectional	Dispensing	Patients (408)	No restriction	Humanistic (satisfaction)	NA
Ferreira et al., 2016, 2018	Goiânia, GO	Public	Quasi-experimental	Dispensing	Patients (104) and pharmacists (2)	No restriction	Humanistic (satisfaction)	Knowledge about treatment and adherence (patients), use of EPB, dispensing process, human resources (pharmacists)
*Lima et al., 2017Lima MG, Álvares J, Guerra Junior AA, Costa EA, Guibu IA, Soeiro OM, et al. Indicators related to the rational use of medicines and its associated factors. Rev Saude Publica . 2017;51(suppl 2):23S.; Soeiro et al., 2017Soeiro OM, Tavares NUL, Nascimento JM do, Guerra AA, Costa EA, Acurcio F de A, et al. Patient satisfaction with pharmaceutical services in Brazilian primary health care. Rev Saude Publica . 2017;51( suppl 2):21s.; Araújo et al., 2017*Araújo P, Costa E, Guerra Junior A, Acurcio F, Guibu I, Álvares J, et al. Pharmaceutical care in Brazil’s primary health care. Rev Saude Publica. 2017;51:1s-11s.	PNAUM^l (all Brazilian regions)	Public	Cross-sectional	Clinical pharmacy services (dispensing, health education, drug therapy follow-up)	Pharmacists (285) and patients (8,803)	No restriction	Humanistic (satisfaction)	Infrastructure,. human resources, counselling, knowledge
Luz et al., 2017	Divinópolis, MG	Public	Mixed (qualitative/ quantitative)	Dispensing	Pharmacists (4) and patients (69)	No restriction	Humanistic (satisfaction)	Dispensing process, counselling, knowledge
Obreli-Neto et al., 2013	Ourinhos, Assis, SP	Private	Cross-sectional	Dispensing	Pharmacists (41)	OC^m	NA	Counselling, communication skills, dispensing process
Oliveira et al., 2016	São Paulo, SP	Public	Cross-sectional	Dispensing	Pharmacists (4)	No restriction	NA	Dispensing process, counselling
Piccoli, Brito, Castilho, 2017	Niterói, RJ	Public	Cross-sectional	Dispensing	Pharmacists (6) and patients (154)	HIV/AIDS	NA	Knowledge, dispensing process, counselling
Volpato et al., 2005	Joinville, SC	Private	Cross-sectional	Dispensing	Pharmacists (70) and assistants (37)	Sinusitis	NA	Counselling, dispensing process, therapeutic choice
Zanella, Aguiar, Storpirtis, 2015	São Paulo, SP	Public	Cross-sectional	Dispensing	Pharmacists (7) and assistant (1)	Mental disorders	NA	Dispensing process, counselling
Ajalla, Castro, 2003Ajalla M, Castro L. Contribuição para melhoria da prática farmacêutica no atendimento de pacientes com queixas referentes a doenças sexualmente transmissíveis, em Campo Grande-MS. Rev Ciências Farm. 2003;24(2):121-30.	Campo Grande, MS	Private	Quasi-experimental	Minor ailment management	Pharmacists and assistants (185)	STDⁿ	NA	Counselling, therapeutic choice
*Cadore et al., 1999*Cadore L, Marc C, Berti C, Peukert C, Machado A. Pharmacy distribution of advice, symptomatic treatment and antimicrobial drugs to patients with cough. Braz J Infect Dis. 1999;3(5):180-3.	Porto Alegre, RS	Private	Cross-sectional	Minor ailment management	Pharmacists (20) and assistants (94)	Cough	NA	Counselling, therapeutic choice
Coulibaly et al., 2017	Alto Solimões, AM	Private	Qualitative	Minor ailment management	Pharmacists and assistants (11)	Urethritis	NA	Counselling, therapeutic choice
*Galato et al., 2011*Galato D, Alano GM, Trauthman SC, França TF. Pharmacy practice simulations: performance of senior pharmacy students at a University in southern Brazil. Pharm Pract. 2011;9(3):136-40.	SC	Private	Cross-sectional	Minor ailment management	Pharmacists (291)	No restriction	NA	Counselling, therapeutic choice, knowledge
*Halila et al., 2015Halila GC, Junior EH, Otuki MF, Correr CJ. The practice of OTC counseling by community pharmacists in Parana, Brazil. Pharm Pract . 2015;13(4):1-8.; Hipólito Júnior et al., 2017*Hipólito Júnior E, Halila GC, Christini W, Reis T, Guimarães MM, Guanaes LD, et al. Quality indicators of pharmacists’ services in community pharmacies in Paraná State, Brazil. Braz J Pharm Sci . 2017;53(1):1-9.	PR	Private	Cross-sectional	Minor ailment management, pharmacy procedures#	Pharmacists (533)	No restriction	NA	Counselling, knowledge, infrastructure, use of EBP, identification of pharmacy procedures#, payment for PS
Lima et al., 1989	Porto Alegre, RS	Private	Cross-sectional	Minor ailment management	Pharmacists (20) and assistants (20)	Diarrhoea	NA	Knowledge, counselling, therapeutic choice
*Mesquita et al., 2013*Mesquita AR, Sá DAB de O, Santos APAL, Neto A de A, Lyra-Júnior DP. Assessment of pharmacist’s recommendation of non-prescription medicines in Brazil: a simulated patient study. Int J Clin Pharm . 2013;35(4):647-55.	Aracaju, SE	Private	Cross-sectional	Minor ailment management	Pharmacists (25)	Headache; diarrhoea	NA	Counselling, therapeutic choice, use of EBP, communication skills
Naves et al., 2008	Brasília-DF, Taguatinga, GO	Private	Quasi-experimental	Minor ailment management	Pharmacists and assistants (78)	STD	NA	Counselling, therapeutic choice, knowledge
Neto, Galato, 2011Galato D, Alano GM, Trauthman SC, França TF. Pharmacy practice simulations: performance of senior pharmacy students at a University in southern Brazil. Pharm Pract. 2011;9(3):136-40.	Tubarão, SC	Private	Qualitative	Minor ailment management	Pharmacists and assistants (20)	STD	NA	Knowledge, counselling, therapeutic choice
*Rocha et al., 2014*Rocha C, Bispo M, Alcantara T, Brito G, Vieira M, Lyra D. What do Brazilian community pharmacists know about self-medication for minor illnesses? A pilot study in the northeast of Brazil. J Appl Pharm Sci. 2014;4(5):12-20.	Aracaju, SE	Private	Mixed (qualitative/ quantitative)	Minor ailment management	Pharmacists (35) (pilot study)	No restriction	NA	Knowledge, use of EBP, counselling
*Rocha et al., 2015*Rocha C, Bispo M, dos Santos A, Mesquita A, Brito G, Lyra D. Assessment of community pharmacists’ counseling practices with simulated patients who have minor illness. Simul Healthc J Soc Simul Healthc. 2015;10(4):227-38.	Aracaju, SE	Private	Cross-sectional	Minor ailment management	Pharmacists (40)	Sinusitis; pregnancy	NA	Counselling, therapeutic choice, use of EPB, communication skills
*Santos et al., 2013*Santos A, Mesquita A, Oliveira K, Lyra D. Assessment of community pharmacists´ counselling skills on headache management by using the simulated patient approach: a pilot study. Pharm Pract . 2013;11(1):3-7.	Aracaju, SE	Private	Cross-sectional	Minor ailment management	Pharmacists (24)	Headache	NA	Counselling, therapeutic choice
Gerenutti, Martinez, Bergamaschi, 2017Gerenutti M, Martinez AMV, Bergamaschi CC. The effectiveness of a pharmaceutical care model on adherence to antiretroviral therapy: A same-based cohort study in Brazil. Adv Pharm Bull. 2017;7(3):469-72.	Socoraba, SP	Public	Cohort	Medication review	Patients (130/229)	HIV/AIDS	Clinical	Adherence
Rigoni et al., 2015	Tubarão, SC	Public	Quasi-experimental	Medication review	Patients (40)	Hyp	Clinical, humanistic (satisfaction)	Adherence, medication use profile
Zatta, Perassolo, 2017	Novo Hamburgo, RS	Private	Quasi-experimental	Medication review	Patients (18)	DM2	Clinical	Adherence
*Dosea et al., 2017*Dosea AS, Brito GC, Santos LM, Marques TC, Balisa-Rocha B, Pimentel D, et al. Establishment, implementation, and consolidation of clinical pharmacy services in community pharmacies: perceptions of a group of pharmacists. Qual Health Res. 2017;27(3):363-73.	3 cities, SE	Public	Qualitative	Clinical pharmacy services (medication dispensing, medication review, medication therapy management, pharmacy procedures#)	Pharmacists (11)	No restriction	NA	Barriers and facilitators for implementation of the services
Franceschet, Farias, 2005Franceschet I, Farias MR. Investigação do perfil dos farmacêuticos e das atividades desenvolvidas em farmácias do setor privado no município de Florianópolis, Santa Catarina, Brasil. Acta Farm Bonaer. 2005;24(4):590-7.	Florianópolis, SC	Private	Cross-sectional	Clinical pharmacy services (dispensing, counselling)	Pharmacists (90)	No restriction	NA	Infra-structure, human resources use of EBP, counselling, dispensing process
*França Filho et al., 2008*França Filho JB, Correr CJ, Rossignoli P, Melchiors AC, Fernández-Llimós F, Pontarolo R. Perfil dos farmacêuticos e farmácias em Santa Catarina: indicadores de estrutura e processo. Rev Bras Ciências Farm. 2008;44(1):105-13.	SC	Private	Cross-sectional	Clinical pharmacy services, pharmacy procedures#	Pharmacists (228)	No restriction	Humanistic (satisfaction)	Infrastructure, human resources, knowledge of EBP
*Reis et al., 2015*Reis TM, Rocha KSS, Barros IMC, Santos LMC, Paixão FP, Almeida FHO, et al. Pharmacists’ Skills in Conducting Clinical Services in Community Pharmacies in Urban Areas of Northeast Brazil. Lat Am J Pharm. 2015;34(4):725-31.	Aracaju, SE	Private	Cross-sectional	Clinical pharmacy services (counselling, dispensing, medication therapy management)	Pharmacists (39)	No restriction	NA	Use of EBP, counselling, therapeutic choice, knowledge
*Santos Júnior et al., 2020*Santos Júnior GA, Silva ROS, Onozato T, Silvestre CC, Rocha KSS, Araújo EM, et al. Implementation of clinical pharmacy services using problematization with Maguerez Arc: a quasi-experimental before-after study. J Eval Clin Pract . 2020;27(2):391-403.	Recife, PE	Public	Quasi-experimental	Clinical pharmacy services (health education, dispensing, medication review, medication therapy management)	Pharmacists (23) and patients (842 - medication therapy management)	No restriction	Clinical (patients)	Physical structure and resources, knowledge (pharmacists), work process (i.e., systematisation, counselling, number and type of interventions, collaboration with healthcare team), DRP, medication use profile
Aquino et al., 2019	Divinópolis, MG	Public	Quasi-experimental	Clinical pharmacy services (intervention to pharmacotherapeutic empowerment)	Patients (47)	DM2	Clinical	Adherence, self-care, self-efficacy, DRP
Santos, Silva, Tavares, 2018	Itaim Paulista, SP	Public	Descriptive (retrospective)	Clinical pharmacy services (consultation, health education)	Patients (1,080)	No restriction	Clinical	DRP, number of interventions

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E-mail: bjps@usp.br

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[1] *Correspondence: R. Pontarolo. Departamento de Farmácia. Universidade Federal do Paraná. Av. Pref. Lothário Meissner, 632, Curitiba, Paraná, Brasil. Phone: +55 41 3360-4076. E-mail: pontarolo@ufpr.br.