Using a mobile application to reduce potentially inappropriate prescribing for older Brazilian adults in primary care: a triple-blind randomised clinical trial.

BACKGOUND: Potentially inappropriate prescribing (PIP) has been evaluated in several countries, and several strategies have been devised for deprescribing drugs in older adults. The aim of this study was to evaluate the efficacy of a mobile application in reducing PIP for older adults in primary care facilities in Brazil. METHODS: This randomised, triple-blind, parallel-group trial was conducted in 22 public primary care facilities in Brazil. During the intervention phase, the general practitioners (GPs) were randomly allocated to the intervention (MPI Brasil app provides information about PIP, therapeutic alternatives and deprescribing) or control (MedSUS app provides general information about medications) group. All GPs were trained on the Clinical Decision-Making Process and how to access an Evidence-Based Health website. The GPs received an Android tablet with an installed mobile application depending on their allocated group, which they used when caring for older patients over at least 3 months. At the end of this period, a sample of older patients aged ≥ 60 years who had been awaiting medical consultation by the participating GPs were interviewed and their prescriptions analysed. The primary outcome was the frequency of PIP in and between the groups. RESULTS: Among 53 GPs who were administered the baseline survey, 14 were included in the clinical trial. At baseline, 146 prescriptions were analysed: the PIP overall was 37.7% (55/146), in the intervention group was 40.6% (28/69), and in the control group was 35.1% (27/77). After the intervention, 284 prescriptions were analysed: the PIP overall was 31.7% (90/284), in the intervention group was 32.2% (46/143), and in the control group was 31.2% (44/141) (RR: 1.16; 95% CI, 0.76-1.76). In the within-group analysis, the PIP reduced from before to after the intervention in both groups-more significantly in the intervention than in the control group (p < 0.001). In the stratified analysis of PIP frequency by GPs, there was a relative risk reduction in 86% (6/7) of GPs in the intervention group compared to 71% (5/7) in the control group. CONCLUSION: We found that the MPI Brasil app effectively reduced PIP, suggesting that it may be useful to incorporate this tool into clinical practice. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT02918643). First registration on 22/09/2016.

Self-medication associated with toothache: a systematic literature review / Automedicação associada à dor de dente: uma revisão sistemática da literatura / Automedicación asociada al dolor de dientes: una revisión sistemática de la literatura

Introduction: Self-medication consists of selecting and using medication without a poprescription or guidance from a healthcare professional. This practice has been widely reported worldwide, which has contributed to a series of adverse health outcomes, such as delayed diagnosis, worsening of clinical conditions, drug interactions, intoxication, and adverse reactions, which tend to compromise patient safety. Objective:To analyze the prevalence of self-medication associated with toothache, the main factors associated with self-medication in dental patients, as well as outline the profile of medications used by these individuals, the preferred route of administration, and the main sources of medication.Methodology:Asystematic review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Relevant articles published in the last ten years, without limitations of language were searched using the following descriptors/MeSHterms and keywords: "self-medication" and (toothache or "dental pain") not Child. Results:The initial search returned 61 manuscripts. Fourteen papers, all cross-sectional studies, were eligible for inclusion in the systematic review.Conclusions:The prevalence of self-medication for toothache ranged from 6.5% to 100.0%. Cultural and economic factors, barriers to access, the high cost of dental treatments, lack of time and money, and the perception that dental problems are not a serious problem are among the main factors associated with the practice. Regarding the drugs used, the most used classes were paracetamol, especially anti-inflammatory drugs, particularly ibuprofen, and analgesics administered orally (AU).

Introdução:A automedicação consiste na escolha e uso de medicamentos sem prescrição ou orientação de um profissional de saúde. Essa prática tem sido amplamente divulgada em todo o mundo, o que tem contribuído para uma série de desfechos adversos à saúde, como atraso no diagnóstico, piora do quadro clínico, interações medicamentosas, intoxicações e reações adversas, que tendem a comprometer a segurança do paciente. Objetivo:Analisar a prevalência da automedicação associada à dor de dente, os principais fatores associados à automedicação em pacientes odontológicos, bem como traçar o perfil dos medicamentos utilizados por esses indivíduos, a via preferencial de administração e as principais fontes de medicação. Metodologia:Uma revisão sistemática foi desenvolvida de acordo com os itens de relatório preferidos para revisões sistemáticas e meta-análises (PRISMA). Foram pesquisados artigos relevantes publicados nos últimos dez anos, sem limitação de linguagem, utilizando os seguintes descritores/MeSHterms e palavras-chave: "self-medication" e (toothache or "dental pain") não Child. Resultados:A busca inicial encontrou61manuscritos. Quatorze artigos, de delineamento transversal,foram considerados elegíveis e incluídos para a revisão.Conclusões:A prevalência de automedicação para dor de dente variou de 6,5% a 100,0%. Fatores culturais e econômicos, barreiras de acesso, alto custo dos tratamentos odontológicos, falta de tempo e dinheiro e a percepção de que os problemas odontológicos não são um problema grave estão entre os principais fatores associados à prática. Em relação aos medicamentos utilizados, as classes mais utilizadas foram o paracetamol, principalmente os anti-inflamatórios, principalmente o ibuprofeno, e os analgésicos por via oral (AU).

Introducción: La automedicación consiste en seleccionar y utilizar medicamentos sin receta ni orientación de un profesional sanitario. Esta práctica ha sido ampliamente reportada a nivel mundial, lo que ha contribuido a una serie de resultados adversos para la salud, como retraso en el diagnóstico, empeoramiento de las condiciones clínicas, interacciones medicamentosas, intoxicaciones y reacciones adversas, que tienden a comprometer la seguridad del paciente.Objetivo: Analizar la prevalencia de automedicación asociada al dolor de muelas, los principales factores asociados a la automedicación en pacientes odontológicos, así como delinear el perfil de medicamentos utilizados por estos individuos, la vía de administración preferida y las principales fuentes de medicación. Metodología: Se desarrolló una revisión sistemática de acuerdo con los Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Se buscaron artículos relevantes publicados en los últimos diez años, sin limitaciones de idioma, utilizando los siguientes descriptores/MeSHterms y palabras clave: "self-medication" y (toothache or "dental pain") not Child. Resultados: La búsqueda inicial arrojó 61 manuscritos. Catorce artículos, todos estudios transversales, fueron elegibles para su inclusión en la revisión sistemática.Conclusiones: La prevalencia de automedicación para el dolor de muelas osciló entre 6,5% y 100,0%. Los factoresculturales y económicos, las barreras de acceso, el alto costo de los tratamientos dentales, la falta de tiempo y dinero, y la percepción de que los problemas dentales no son un problema grave se encuentran entre los principales factores asociados con la práctica. En cuanto a los fármacos utilizados, las clases más utilizadas fueron el paracetamol, especialmente los antiinflamatorios, especialmente el ibuprofeno, y los analgésicos por vía oral (AU).

Older people's knowledge of the purpose of drugs prescribed at primary care appointments.

OBJECTIVE: This study aimed to assess older people's knowledge of the purpose of drugs prescribed at medical appointments in primary care units and the possible factors related to their level of knowledge about their medications. METHODS: This was a cross-sectional study conducted in 22 basic health units in Brazil. Patients aged ≥60 years were included in this study (n=674). Knowledge of prescribed medications was assessed by comparing the responses to the questionnaire and the medication and prescription information. Multivariate analyses were conducted using the Poisson regression with robust variance. RESULTS: The mean age of the sample was 70.1 (standard deviation: ±7.1) years. Among 674 patients, 272 (40.4%) did not know the indication of at least 1 of their prescribed drugs; among them, 78 (11.6%) did not know the indication of any of their prescribed drugs. In the final multivariate analysis, polypharmacy, illiteracy, and cognitive impairment were found to be associated with misunderstanding the purpose of at least one prescribed drug. Moreover, illiteracy and cognitive impairment were associated with a greater misunderstanding of the purpose of all prescribed drugs. CONCLUSIONS: In the studied sample, patients demonstrated a high rate of misunderstanding of the purpose of prescribed drugs. Therefore, it is necessary for health services and professionals to implement strategies that increase the quality of the guidance and instructions given to older people in order to promote adherence to treatment.

Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil.

BACKGROUND: Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.

Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil

ABSTRACT BACKGROUND: Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.

Polypharmacy in older patients at primary care units in Brazil.

Background Despite extensive studies of polypharmacy in older patients, no consensus regarding the definition of this practice exists in the literature. Several studies have defined polypharmacy as problematic when considering only the numbers of medications used by patients. Objective This study aimed to assess the prevalence of polypharmacy prescribing by comparing two different definitions (quantitative and qualitative) and evaluating factors associated with this practice in older patients. Setting Twenty-three basic health units. Method A cross-sectional study involving 386 older adults who received a prescription after a medical consultation. Multivariate analyses were conducted using a Poisson regression with robust variance. Main outcome measure The main outcome measures included patients with a prescription of five or more medications (quantitative polypharmacy) and those with a prescription of five or more medications including at least one drug considered potentially inappropriate for older adults (qualitative polypharmacy). Results The frequency of quantitative polypharmacy was 20.5%. The results of an adjusted analysis showed that the frequency of quantitative polypharmacy was associated with a higher number of self-reported morbidities and the prescription of potentially inappropriate drugs. The prevalence of qualitative polypharmacy was 10.4%, and after adjustment, this outcome remained significantly associated with the presence of three or more self-reported morbidities. Conclusions The presence of multiple comorbidities was identified as the main factor associated with the prescription of both quantitative and qualitative polypharmacy.