Healthcare Utilisation and Clinical Outcomes in Older Cardiovascular Patients Receiving Comprehensive Medication Management Services: A Nonrandomised Clinical Study.

The objective of this study was to evaluate the impact of comprehensive medication management (CMM) services on healthcare utilisation and cardiovascular risk factors among older patients with established cardiovascular diseases (CVDs). This quasi-experimental study that was performed at the Croatian primary care ambulatory clinic included patients aged 65 to 80 years. Patients were divided into intervention (65 patients) and control groups (68 patients) and were followed-up for one year. Pharmacists provided face-to-face consultations to patients from the intervention group. Groups were compared with regards to the clinical parameters (blood pressure, HbA1c, LDL, TC) and healthcare utilisation (hospital admission, emergency visits, unplanned GP visits). The CMM intervention significantly improved systolic blood pressure (p = 0.038), diastolic blood pressure (p = 0.001), total cholesterol (p = 0.014), low-density lipoprotein cholesterol (p = 0.005), and glycosylated haemoglobin (p = 0.045) in comparison with the control group. Patients included in CMM services had statistically and clinically lower systolic (−9.02 mmHg, p < 0.001) and diastolic blood pressure (−4.99 mmHg, p < 0.001) at the end of the study. The number of hospital admissions and unplanned GPs visits were 3.35 (95% CI 1.16−10.00) and 2.34 (95% CI 1.52−3.57) times higher in the control group compared to the intervention group, respectively. This study demonstrated that pharmacists providing CMM services can significantly contribute to better clinical outcomes and lower healthcare utilisation, thus potentially contributing to total healthcare savings.

Instruments to Measure Patient Satisfaction with Comprehensive Medication Management Services: A Scoping Review Protocol.

Comprehensive medication management (CMM) is the service offered within the clinical practice of pharmaceutical care, which has the objective to optimize pharmacotherapeutic outcomes. Patient satisfaction is a multidimensional construct that points to the quality of the health services offered and the degree to which the patients' expectations and needs are met. The evaluation of the level of patient satisfaction is a key indicator to support decisions and to improve the quality of the service provided. This study aims to describe the protocol for a scoping review to map the instruments to measure patient satisfaction with CMM services and compare them according to their development characteristics and the applicability of patient-reported outcome measures. The literature search will be conducted using the scoping review methodology, proposed by the Joanna Briggs Institute and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) method. The results will be presented in two sessions: (1) description of the search strategy; and (2) the characteristics of the satisfaction instruments, number of items and questions related to the conceptual model, content validity, construct validity, reliability, score/interpretation, and respondent burden. This review will shed light on the available satisfaction measurement instruments, allowing existing gaps to be identified for future research.

Use of psychotropic drugs by population in an area affected by the tailings dam rupture: Brumadinho Health Project.

OBJECTIVE: To describe the consumption of psychotropic drugs in the adult population residing in Brumadinho, Minas Gerais, after the Vale dam collapse, which occurred in 2019. METHODS: This is a cross-sectional study, part of the Brumadinho Health Project, developed in 2021, with a representative population-based sample of adults (18 years and over) residing in Brumadinho. A total of 2,805 adults with information on self-reported use of psychotropic drugs (antidepressants and anxiolytics-hypnotics/sedatives) in the last 15 days were included in the analysis. The prevalence of psychotropic drug use was estimated, and the most used psychotropic drugs were identified. Pearson's chi-square test (with Rao-Scott correction) was used to test associations between exposures and use of psychotropic drugs, considering a significance level of p<0.05. RESULTS: The use of antidepressants (14.2%) was more common than the use of anxiolytics or hypnotics/sedatives (5.2%), with sertraline and fluoxetine being the most used antidepressants. The use of anxiolytics and hypnotics/sedatives was higher among residents who lived in the area directly affected by the dam's mud, and the use of any psychotropic drug was higher among those who lost a relative/friend in the disaster and assessed that their health worsened after the disaster, and among women. CONCLUSION: The results of the study corroborate what was observed in other populations exposed to similar tragedies, regarding the pattern of associations and the of use of psychotropic drugs.

Implementation and Effectiveness of a Pharmacotherapeutic Follow-Up Service for People with Tuberculosis in Primary Healthcare.

Tuberculosis (TB) is a disease of great relevance, responsible for 1.5 million deaths worldwide. Therefore, actions to control TB are necessary, and pharmacists may play an important role, especially in primary healthcare (PHC), where the diagnosis and management of this infection occurs. In a large Brazilian city, pharmacotherapeutic follow-up in PHC has been offered by pharmacists to people with TB since 2018. The objective of this study was to evaluate the implementation and effectiveness of this service though a longitudinal type 1 effectiveness-implementation hybrid study. Data were collected from January 2018 to February 2020 in the pharmaceutical services system. The service indicators were described and effectiveness was evaluated using Poisson regression analysis to compare the incidence of cure among patients using and not using the service. The service was performed in 148 PHC units by 82 pharmacists. Of the total of 1076 treatments, 721 were followed up by pharmacists, and TB was cured more frequently in these cases (90.4% attended vs. 73.5% unattended). The adjusted hazard ratio of cure among patients enrolled in the pharmacotherapeutic follow-up service was 2.71 (2.04-3.61; p < 0.001). Pharmacotherapeutic follow-up for people with TB significantly increased the incidence of cure and should be encouraged.

Caring for elderly people during the COVID-19 pandemic: the experience of family caregivers.

OBJECTIVE: To build a theoretical model that represents the experience of family caregivers of elderly people during the COVID-19 pandemic. METHOD: Qualitative study that used the Grounded Theory as a methodology, carried out in Minas Gerais State in August 2020. 16 caregivers were interviewed. RESULTS: Uncomfortable emotions emerged and drove the caregivers' actions to: adopt preventive measures to protect the elderly from contracting the coronavirus; guarantee their healthcare; and make them aware of the pandemic. However, when these emotions manifested in an exacerbated manner, they needed to be alleviated so that they could adopt such initiatives. CONCLUSION: The emotions felt by caregivers can compromise their health and quality of life. Therefore, health professionals need to create strategies to ensure that they are well assisted, enabling care through telehealth. Guidance on the pandemic for caregivers could reflect better care for the elderly people.

Factors associated with the identification of drug therapy problems among older patients in Primary Health Care.

OBJECTIVE: To determine the frequency of drug therapy problems among older adults in Primary Health Care, and to analyze the factors associated with their identification in the initial patient assessment, carried out by pharmacists offering medication therapy management services. METHODS: A cross-sectional study conducted with data from 758 older adults followed up in medication therapy management services in Primary Health Care in the cities of Belo Horizonte, Betim, and Lagoa Santa (MG, Brazil). Univariate and multivariate analyses were performed to evaluate the factors associated with identification of four or more drug therapy problems in the initial clinical assessment. RESULTS: A total of 1,683 drug therapy problems were identified, 73.6% of older patients had at least one problem. The most frequent problems were nonadherence (23.0%) and the need for additional drug therapy (18.0%). Polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and aged 75 years or older remained positively and statistically associated with identification of four or more drug therapy problems (p<0.05). CONCLUSION: There is a high frequency of problems related to medication use among older users of Primary Health Care, and the medication therapy management services should be prioritized to the older patients, who present with polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and age ≥ 75 years, since they are more likely to have more drug therapy problems.

Assessment of Pharmaceutical Services for Smoking Cessation: An Effectiveness-Implementation Hybrid Study.

Smoking is the main preventable cause of illness and early death worldwide. Thus, it is better to promote smoking cessation than to treat tobacco-related diseases. The objective of this study was to assess the implementation and effectiveness of smoking cessation pharmaceutical services offered in primary health care (PHC) in a large Brazilian city through a type 1 effectiveness-implementation hybrid study. The services were offered through individual or group approaches (Jan/2018-Dec/2019). The service indicators were described and the incidence of cessation in the services was evaluated. Factors associated with cessation were assessed by Poisson regression analysis. The services were offered in most PHC centers (61.2%) and by most pharmacists (81.3%). In total, 170 individual (9.7%) and 1591 group (90.3%) approaches occurred, leading to cessation in 39.4% (n = 67) and 44.8% (n = 712) of these, respectively. The use of nicotine plus antidepressants (RR = 1.30; 95%CI = 1.08-1.57; p = 0.006) and the number of sessions with pharmacists (RR = 1.21; 95%CI = 1.19-1.23; p < 0.001) were positively associated with cessation; a very high level of dependence was negatively associated (RR = 0.77; 95%CI = 0.67-0.89; p = 0.001). The smoking cessation services were effective and should be encouraged.

Clinical Impact of a Comprehensive Medication Management Service in Primary Health Care.

OBJECTIVE: To evaluate the clinical impact of a comprehensive medication management (CMM) service in a Brazilian primary health-care setting. METHODS: A quasi-experimental study has been carried out between July 2014 and November 2016 with patients who received the service in the primary care setting of a Brazilian city (n = 1057). Factors associated with drug therapy problems (DTP) detection in the initial assessment were evaluated by performing univariate and multivariate analyzes. To evaluate the impact of the CMM service, a linear regression model was constructed from the difference between the initial and final values of the clinical and laboratory parameters adjusted by multiple variables. RESULTS: A total of 1642 DTPs was identified, the most prevalent one being "nonadherence" (31.9%) and the "need for additional drug therapy" (22.9%). The use of 5 or more medications and the presence of 3 or more diseases were positively associated with the identification of 3 or more DTPs during the initial assessment. Even after multiple adjustments, a statistically significant reduction has been observed in the values of glycated hemoglobin, systolic blood pressure, low-density cholesterol, and total cholesterol. CONCLUSION: The CMM service contributed to the resolution of DTP and showed positive clinical impact in primary health care in the studied setting.

Increased use of benzodiazepines among older adults: Bambuí Project. / Aumento da utilização de benzodiazepínicos entre idosos mais velhos: Projeto Bambuí.

BACKGROUND: Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults. OBJECTIVE: To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years. METHODS: The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance. RESULTS: The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62). CONCLUSION: This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.

Clinical Results of Comprehensive Medication Management Services in Primary Care in Belo Horizonte.

The high prevalence of chronic diseases and use of multiple medications identified in Primary Health Care (PHC) suggest the need for the implementation of Comprehensive Medication Management (CMM) services. This study aimed to evaluate the clinical results of CMM services in a Brazilian PHC setting. A quasi-experimental study was performed with patients followed-up for two years (n = 90). Factors associated with the detection of four drug therapy problems (DTP) or more in the initial assessment were evaluated (univariate and multivariate analyses), as well as the clinical impact observed in laboratory parameters (HbA1c, Blood Pressure, LDL- and HDL-covariance analysis). A predominance of women (61.1%), a mean age of 65.5 years, and a prevalence of polypharmacy (87.8%)-use of five or more drugs-were observed. A total of 441 DTP was identified, 252 required interventions with the prescriber, 67.9% of which were accepted and 59.6% were solved. The main DTP were 'non-adherence' (28.1%), 'need for additional drug therapy' (21.8%), and 'low dose' (19.5%). Hypertension was positively associated with the identification of four DTP or more. A statistically significant reduction was detected in all assessed laboratory parameters (p < 0.05). CMM services contributed to the resolution of DTP and improved clinical outcomes.

Electronic prescription: frequency and severity of medication errors.

OBJECTIVE: To assess the frequency and severity of prescriptions errors with potentially dangerous drugs (heparin and potassium chloride for injection concentrate) before and after the introduction of a computerized provider order entry (CPOE) system. METHODS: This is a retrospective study that compared errors in manual/pre-typed prescriptions in 2007 (Stage 1) with CPOE prescriptions in 2014 (Stage 2) (Total = 1,028 prescriptions), in two high-complexity hospitals of Belo Horizonte, Brasil. RESULTS: An increase of 25% in the frequency of errors in Hospital 1 was observed after the intervention (p<0.001). In contrast, a decreased error frequency of 85% was observed in Hospital 2 (p<0.001). Regarding potassium chloride, the error rate remained unchanged in Hospital 1 (p>0.05). In Hospital 2, a significant decrease was recorded in Stage 2 (p<0.001). A reduced error severity with heparin (p<0.001) was noted, while potassium chloride-related prescription severity remain unchanged (p> 0.05). CONCLUSIONS: The frequency and severity of medication errors after the introduction of CPOE was affected differently in the two hospitals, which shows a need for thorough observation when the prescription system is modified. Control of new potential errors introduced and their causes for the adoption of measures to prevent these events must be in place during and after the implementation of this technology.

Drug interactions among older adults followed up in a comprehensive medication management service at Primary Care.

OBJECTIVE: To estimate the prevalence of drug interactions and associated factors among older adults followed up in a Comprehensive Medication Management Service at Primary Care. METHODS: Firstly, the Beers criteria 2015 was used to define drug interactions; later, drug interactions proposed by Dumbreck for patients with diabetes, depression, and heart failure were evaluated. The associated factors were assessed by univariate (Pearson's χ2) and multivariate analyses (logistic regression). The significance level of 5% was set for all analyses. RESULTS: The mean age of the studied population was 70.2±7.8 years; 52.2% were between 60 and 69 years, and 61.3% were female. Among the older adults, 94.5% used two or more drugs (condition for the occurrence of drug-drug interaction). The prevalence of drug interaction according to the Beers criteria was 4.9%. After multivariate analysis, diseases of the central nervous system, arrhythmia, number of medications, and female sex were positively associated with drug interaction. The prevalence of drug interaction according to Dumbreck was 27.2%. After multivariate analysis, the number of medications, the presence of heart failure, and Charlson comorbidity index greater than 1 were conditions positively associated with drug interactions. CONCLUSION: The holistic and individualized approach used in comprehensive medication management services for older patients is important, considering the prevalence of drug interactions and the need to minimize adverse events.

Factors associated with drug interactions in elderly hospitalized in high complexity hospital. / Fatores associados às interações medicamentosas em idosos internados em hospital de alta complexidade.

This study aims to determine the frequency of potential drug-drug interactions (PDI) in hospitalized elderly and associated factors. This is a cross-sectional study in a teaching hospital. The dependent variable was the occurrence of potential drug interactions identified using DrugReax software. Patients with adverse drug reactions (ADR) related to clinical manifestations of PDIs were also identified. Multivariate logistic regressions was performed to analyze the association between the occurrence of PDIs and independent variables. In total, 237 older adults were included in the study. The prevalence of PDIs and interaction-related ADRs was 87.8% and 6.8%, respectively. The multivariate analysis showed a positive association between the detection of PDIs (OR 8.6; 95% CI, 2.5-30.0), and hospitalization due to a diagnosed circulatory system disease and number of medications > 14 (OR 9.8; 95% CI, 2.8-34.3%). The study showed a high prevalence of PDIs in the drug treatment of the elderly, but a lower prevalence of ADRs, as well as a positive association between PDIs and hospitalization due to a diagnosed circulatory system disease and number of medications > 14. The identification of factors associated with PDIs guides prevention measures for people that are more exposed to adverse events.

O estudo tem por objetivo determinar a frequência de interações medicamentosas potenciais (IMP) entre idosos hospitalizados e os fatores associados. Estudo transversal realizado em um hospital de ensino. A variável dependente do estudo foi a ocorrência de IMP identificadas utilizando o software DrugReax. Também foram identificados os pacientes que desenvolveram reações adversas a medicamentos (RAM) relacionadas à manifestação clínica de IMP. Realizou-se regressão logística para analisar a associação da ocorrência de IMP e variáveis independentes. No estudo foram incluídos 237 idosos, a prevalência de IMP foi de 87,8 %, e de RAM relacionadas às interações foi de 6,8%. Identificou-se associação positiva entre a detecção de IMP (OR 8,6; IC95% 2,5-30,0), internação por diagnóstico de doença do aparelho circulatório e número de medicamentos superior que 14 (OR 9,8; IC95% 2,8-34,3). O estudo evidenciou uma elevada prevalência de IMP na farmacoterapia dos idosos, mas reduzida prevalência de RAM. Além disso, detectou associação positiva entre IMP e internação por diagnóstico de doença do aparelho circulatório e número de medicamentos superior a 14. A identificação de fatores associados às IMP permite direcionar medidas de prevenção para populações mais expostas à ocorrência de eventos adversos.

Erros de medicação na mídia brasileira / Medication errors in the brazilian media

Objetivos: identificar e descrever as notícias sobre erros de medicação ocorridos no Brasil e divulgados na mídia digital brasileira. Metodológia: pesquisa de caráter exploratório, com dados coletados em notícias de mídias digitais do Brasil entre 2015 e 2019. A busca das notícias sobre erros de medicação foi realizada no Google®. Os casos divulgados na mídia foram descritos conforme o tipo e a classificação do erro, medicamento e profissional envolvido na ocorrência do erro, características do paciente que sofreu o erro e local onde o erro ocorreu. Resultados: dos 20 erros noticiados identificados na busca, foram encontrados 11 casos de erros com morte (55,0%), seis casos de erros com dano (30,0%) e três casos de erros sem danos (15,0%). Dos 23 pacientes envolvidos nos erros, 14 pertenciam a grupos de extremos etários, sendo nove pacientes pediátricos (39,1%) e cinco pacientes geriátricos (21,8%). Quanto ao tipo de erro, quatro casos noticiados envolvendo erros de prescrição (20,0%), cinco reportando erros de dispensação (25,0%), 10 erros de administração (50,0%), e um envolvendo erro de dispensação e administração concomitantemente (5,0%). Dentre os 11 casos de erros com morte do paciente, oito traziam a informação sobre qual medicamento estava envolvido no erro, sendo seis deles considerados medicamentos potencialmente perigosos (MPP). Conclusão: os resultados do presente estudo apontam para a necessidade de implementação de melhorias nos estabelecimentos de saúde em geral ­ farmácias, drogarias, hospitais, centros de saúde ­ no que tange a prevenção de erros de medicação. Para isso, devem ser priorizadas iniciativas envolvendo os sistemas de medicação com elevada efetividade, sobretudo em contextos de situações de alto risco como uso de MPP e cuidado a pacientes em extremos etários

Aims: to identify and describe the news about medication errors that occurred in Brazil and were published in the Brazilian digital media. Methods: exploratory research, with data collected in news from digital media in Brazil, between 2015 and 2019. The search for news about medication errors was carried out on Google®. The cases published in the media were described according to the type and classification of the error, medication and professional involved in the occurrence of the error, characteristics of the patient who suffered the error and place where the error occurred. Results: of the 20 reported errors identified in the search, 11 cases of errors with death (55.0%), six cases of errors with harm (30.0%) and three cases of errors without harm (15.0%) were found. Of the 23 patients involved in the errors, 14 belonged to extreme age groups, nine pediatric patients (39.1%) and five geriatric patients (21.8%). As for the type of error, four reported cases involving prescription errors (20.0%), five reporting dispensing errors (25.0%), 10, administration errors (50.0%) and one involving concurrent dispensing and administration error (5.0%). Among the 11 cases of errors resulting in patient death, eight contained information about which medication was involved in the error, six of which were considered high alert medications. Conclusions: the results of this study point to the need to implement improvements in health institutions in general - pharmacies, drugstores, hospitals, health centers - with regard to the prevention of medication errors. For this, initiatives involving medication systems with high effectiveness should be prioritized, especially in contexts of high-risk situations such as the use of high alert medications and care for patients at extremes of age

Factors Associated with Inadequate Management of Antiplatelet Agents in Perioperative Period of Non-Cardiac Surgeries.

BACKGROUND: The current guidelines dispose recommendations to manage antiplatelet agents in the perioperative period; however, the daily medical practices lack standardization. OBJECTIVES: To asses factors associated with inadequate management of antiplatelet agents in the perioperative period of non-cardiac surgeries. METHODS: Cross-sectional Study conducted in hospital from October 2014 to October 2016. The study dependent variable was a therapy that did not comply with the recommendations in the Brazilian Association of Cardiology (SBC) guidelines. The independent variables included some characteristics, the people in charge of the management and causes of lack of adherence to those guidelines. Variables were included in the multivariate model. Analysis was based on the odds ratio (OR) value and its respective 95% confidence interval (CI) estimated by means of logistic regression with 5% significance level. RESULTS: The sample was composed of adult patients submitted to non-cardiac surgeries and who would use acetylsalicylic acid (aspirin) or clopidogrel (n = 161). The management failed to comply with the recommendations in the guidelines in 80.75% of the sample. Surgeons had the highest number of noncomplying orientations (n = 63). After multivariate analysis it was observed that patients with a higher level of schooling (OR = 0.24; CI95% 0.07-0.78) and those with a previous episode of acute myocardial infarction (AMI) (OR = 0.18; CI95% 0.04-0.95) had a higher probability of using a therapy complying with the guidelines. CONCLUSION: Positive association between patients' schooling level, or those with a history of previous AMI, with management of the use of aspirin and clopidogrel in the perioperative period of non-cardiac surgeries. However, diverging conducts stress the need of having internal protocol defined.

Telemonitoramento de idosos usuários de anticoagulante durante a pandemia da COVID-19 / Telemonitoring of older anticoagulant users during the COVID-19 pandemic

A pandemia da COVID-19 trouxe desafios para o monitoramento de usuários de anticoagulantes, sobretudo idosos, sendo o telemonitoramento uma alternativa para dar continuidade aos cuidados para esses pacientes. O presente estudo teve como objetivo descrever a experiência do telemonitoramento de idosos usuários de anticoagulantes na pandemia da COVID-19. Trata-se de estudo referente ao serviço farmacêutico de telemonitoramento de idosos (≥60 anos) em uso de anticoagulantes orais em ambulatório de geriatria privado (Belo Horizonte). Idosos tiveram parâmetros de efetividade e segurança dos anticoagulantes monitorados mensalmente por telefone (abr-dez/2021). Problemas identificados geraram intervenções ao paciente ou equipe multiprofissional. Ao total 425 idosos foram incluídos no serviço. A maioria usava apixabana (189;41,9%), rivaroxabana (146;34,4%) e varfarina (47;11,1%). Observou-se média de idade de 82,1 anos, maioria feminina (65,2%), maioria com alto risco de vulnerabilidade (69%), e incidência de 9,9% de COVID-19. Realizou-se 219 intervenções relativas à varfarina (média de 4,6 intervenções/paciente); referiram-se à solicitação de exame de RNI (57,5%), orientações em saúde (19,6%), alteração da dose (redução - 10,5%; aumento - 5,9%; suspensão - 0,6%), ou encaminhamento (5,9%). Usuários de outros anticoagulantes não apresentaram alterações nos parâmetros acompanhados. Onze idosos sofreram quedas e 10 demandaram internação por eventos tromboembólicos ou hemorrágicos. Não houve diferença estatisticamente significativa nas proporções de internação entre usuários de varfarina ou outros anticoagulantes (p=0,314). Acompanhar idosos usuários de anticoagulantes é importante, sobretudo considerando-se o alto nível de fragilidade identificado e os riscos tromboembólicos e não-tromboembólicos que a COVID-19 traz. O telemonitoramento foi importante, permitindo realização de múltiplas intervenções.

The COVID-19 pandemic brought challenges to the monitoring of anticoagulant users, especially older adults, making telemonitoring an alternative to provide continuity of care for these patients. The present study aimed to describe the experience of telemonitoring of older anticoagulant users during the COVID-19 pandemic. This is a descriptive study concerning the telemonitoring pharmaceutical service for older adults (≥60 years old) using oral anticoagulants in a private geriatric outpatient clinic (Belo Horizonte). Older people had parameters of effectiveness and safety of anticoagulants monitored monthly by telephone (Apr-Dec/2021). Identified problems generated interventions for the patient or the multidisciplinary team. A total of 425 older adults were included in the service. Most used apixaban (189;41.9%), rivaroxaban (146;34.4%) and warfarin (47;11.1%). There was a mean age of 82.1 years, mostly female (65.2%), most at high risk of vulnerability (69%), and an incidence of 9.9% of COVID-19. There were 219 interventions related to warfarin (average of 4.6 interventions/patient); including requests for an INR test (57.5%), health guidelines (19.6%), dosage change (reduction - 10.5%; increase - 5.9%; suspension - 0.6%), or referral (5.9%). Users of other anticoagulants did not show alterations in the monitored parameters. Eleven older adults suffered falls and 10 required hospitalizations due to thromboembolic or hemorrhagic events. There was no statistically significant difference in hospitalization rates between users of warfarin or other anticoagulants (p=0.314). Monitoring older anticoagulant users is important, especially considering the high level of frailty identified and the thromboembolic and non-thromboembolic risks that COVID-19 brings. Telemonitoring was important, allowing for multiple interventions to be performed.

As múltiplas violências vivenciadas por farmacêuticas no ambiente laboral / The multiple violences experienced by pharmacist women in the workplace / Las múltiples violencias experimentadas por las farmacéuticas en el entorno laboral

Resumo A divisão sexual do trabalho ocasiona iniquidade entre gêneros, bem como situações de violência direcionadas às mulheres no ambiente laboral. Na área farmacêutica, a maioria feminina e a inserção em múltiplos cenários, que envolvem contato com público e parcerias profissionais diferenciadas, potencializam a exposição à violência. Assim, o objetivo deste estudo foi analisar situações de violência vivenciadas por farmacêuticas no ambiente laboral. Para tal, utilizou-se método qualitativo, com análise de conteúdo, realizada no software NVivo®, de uma survey on line, respondida por farmacêuticas (n=381) registradas no Conselho Regional de Farmácia de Minas Gerais, Brasil. Como resultado, identificou-se quatro categorias: 'Convivendo com o desrespeito, ameaças e vulnerabilidade', 'O sexismo e o machismo estrutural que cala, diminui e atordoa', 'A discriminação contra a mulher como obstáculo à equidade' e 'Assédio sexual e objetificação da mulher'. Emergiram diversas expressões de violências no ambiente laboral provenientes de múltiplos agressores. Farmacêuticas reconheceram prejuízo profissional e pouco reconhecimento pela capacidade técnica. Conclui-se que os relatos expuseram a falta de proteção da integridade farmacêutica no ambiente de trabalho. Espera-se que esses resultados tragam à luz a desigualdade de gênero no trabalho farmacêutico, com destaque para situações de violência, ampliando a discussão e proporcionando evolução dessa profissão majoritariamente feminina.

Abstract The sexual division of labor causes inequality between genders, as well as situations of violence directed to women in the workplace. In the pharmaceutical area, the majority of women and insertion in multiple scenarios, involving contact with public and differentiated professional partnerships, enhance exposure to violence. Thus, the objective of this study was to analyze situations of violence experienced by pharmacists in the workplace. For this, a qualitative method was used, with content analysis, performed in the NVivo® software, of an online survey, answered by pharmacists (n=381) registered in the Regional Pharmacy Council of Minas Gerais, Brazil. As a result, four categories were identified: 'Living with disrespect, threats and vulnerability,' 'Sexism and structural chauvinism that shuts down, diminishes and torments,' 'Discrimination against women as an obstacle to equity' and 'Sexual harassment and objectification of women.' Several expressions of violence in the labor environment emerged from multiple aggressors. Pharmacists recognized professional impairment and little recognition for technical capacity. We concluded that the reports exposed the lack of protection of pharmaceutical integrity in the workplace. It is expected that these results bring to light the gender inequality in pharmaceutical work, with emphasis on situations of violence, expanding the discussion and providing evolution of this mostly female profession.

Resumen La división sexual del trabajo ocasiona iniquidad entre los géneros, así como situaciones de violencia dirigidas a las mujeres en el entorno laboral. En el ámbito farmacéutico, la mayoría de las mujeres y la inserción en múltiples escenarios, que implican contacto con el público y asociaciones profesionales diferenciadas, potencian la exposición a la violencia. Por lo tanto, el objetivo de este estudio fue analizar las situaciones de violencia experimentadas por las farmacéuticas en el entorno laboral. Para esto, se utilizó un método cualitativo, con análisis de contenido, realizado en el software NVivo®, de una encuesta en línea, respondida por farmacéuticas (n=381) registradas en el Consejo Regional de Farmacia de Minas Gerais, Brasil. A consecuencia, se identificaron cuatro categorías: 'Conviviendo con falta de respeto, amenazas y vulnerabilidad', 'el sexismo y el machismo estructural que cala, disminuye y atormentó', 'la discriminación contra la mujer como obstáculo a la equidad' y 'el acoso sexual y la objeción de la mujer'. Han surgido varias expresiones de violencia en el entorno laboral procedentes de múltiples agresores. Los productos farmacéuticos han reconocido el daño profesional y el escaso reconocimiento de la capacidad técnica. Se concluye que los informes haciendo hincapié de manifiesto la falta de protección de la integridad farmacéutica en el entorno laboral. Se espera que estos resultados traigan a la luz la desigualdad de género en el trabajo farmacéutico, haciendo hincapié en las situaciones de violencia, ampliando el debate y dando lugar a la evolución de esa profesión principalmente femenina.

Resultados além do gerenciamento da infecção em um serviço de Gerenciamento da Terapia Medicamentos para pessoas vivendo com HIV

Avaliar os resultados clínicos de serviços de gerenciamento da terapia medicamentosa (GTM) oferecidos a pessoas vivendo com HIV (PVHIV) em uma unidade de dispensação de medicamentos brasileira. O estudo foi dividido em uma etapa transversal (etapa I), que avaliou o fator associado à identificação de dois ou mais problemas relacionados ao uso de medicamentos (PRM) na avaliação inicial; e uma etapa quasi- experimental (etapa II), realizada com um único grupo de pacientes para avaliar desfechos clínicosForam acompanhadas 52 PVHIV. A média de idade foi de 60±11,3 anos (min. = 29; máx. =78). A presença de dislipidemia (OR=5,38; IC 95%=1,61-17,97; p=0,006) e o uso de sete ou mais medicamentos (OR=4,28; IC 95%=1,32-13,88; p=0,015) foram fatores associados a identificação de dois ou mais PRM. Foi demonstrada uma diferença significativa entre os valores iniciais e finais de pressão arterial sistólica, carga viral do HIV, contagem de células T CD4+ e triglicerídeos (p<0,05). O serviço de GTM favoreceu os desfechos clínicos positivos.

To assess the clinical outcomes of comprehensive medication management (CMM) services offered to people living with HIV (PLHIV) at a Brazilian Antiretroviral Medication Dispensing Unit. The study was divided into a cross-sectional stage (stage I), to evaluate associated factor with the identification of two or more drug therapy problems (DTP) in the initial assessment; and a quasi-experimental stage (stage II), conducted with a single group of PLHIV to evaluate clinical outcomes. A total of 52 PLHIV, with 60±11.3 years of age were followed up. In stage I, the presence of dyslipidemia (OR=5.38; 95%CI=1.61-17.97) and the use of seven or more medications (OR=4.28; 95% CI=1.32-13.88) were factors associated with the identification of DTP. In stage II, a significant difference was demonstrated between the initial and final values of systolic blood pressure, triglycerides, HIV viral load and CD4+T-cells count (p<0,05). The CMM service favored positive clinical outcomes.

Sedative use and incidence of falls and hip fractures among older adults in an outpatient geriatric clinic / Perfil de uso de sedativos e ocorrência de quedas e fratura de fêmur entre idosos em um ambulatório de geriatria

OBJECTIVE: To investigate the use of sedatives by older adults attending a private outpatient geriatric clinic in Belo Horizonte (MG), Brazil, and its association with falls and hip fractures. METHODS: Using a longitudinal design, the prevalence of benzodiazepine and nonbenzodiazepine ("z-drugs") intake by older adults was described and their association with the incidence of falls and fractures (30 days after the initial visit) was evaluated through logistic regression. RESULTS: A total of 7821 older adults were included in the study, most of them women (72.50%), with a mean age of 77.5 years and a mean Clinical-Functional Vulnerability Index (IVCF-20) score of 16.5. The overall prevalence of sedative use (any sedative) was 6.19%, with 4.48% benzodiazepines and 1.98% z-drugs. The most widely used sedatives were clonazepam (29.04%), zolpidem (28.65%), and alprazolam (23.44%). Falls were reported for 182 patients (2.33%), with a higher incidence among users of any sedatives (4.34; p = 0.002; OR = 1.94, adjusted for sex, age, and IVCF-20) and benzodiazepines (5.14%; p < 0.001; OR = 2.28) than among non-users (2.19%). Hip fractures occurred in 33 patients (0.42%), and again were more frequent among users of sedatives (1.03%; p = 0.032; OR = 2.57) and benzodiazepines (1.43%; p = 0.003; OR = 3.45) than among non-users (0.38%). CONCLUSIONS: The use of sedatives, especially benzodiazepines, is associated with an increased incidence of falls and hip fractures in older adults

OBJETIVO: Investigar a utilização de sedativos entre idosos atendidos em ambulatório privado de geriatria em Belo Horizonte (MG), bem como sua associação com quedas e fraturas de fêmur. METODOLOGIA: Trata-se de estudo longitudinal, no qual foi descrita a prevalência de uso de benzodiazepínicos e drogas Z entre idosos (60 anos ou mais) e avaliada sua associação com a incidência de queda e fratura (30 dias após consulta inicial) por meio de regressão logística. RESULTADOS: Foram incluídos no estudo 7821 idosos, com maioria feminina (72,50%), idade média de 77,5 anos e Índice de Vulnerabilidade Clínico Funcional (IVCF-20) médio de 16,5 pontos. A prevalência de uso de sedativos em geral foi de 6,19%, sendo 4,48% de benzodiazepínicos e 1,98% de drogas Z. Os medicamentos sedativos mais utilizados foram clonazepam (29,04%), zolpidem (28,65%) e alprazolam (23,44%). Relatou-se queda para 182 idosos (2,33%), com incidência maior entre usuários de sedativos (4,34; p = 0,002; OR = 1,94 ajustada por sexo, idade e IVCF-20) e de benzodiazepínicos (5,14%; p < 0,001; OR = 2,28) do que entre não usuários (2,19%). Identificou-se fratura de fêmur em 33 idosos (0,42%), sendo mais frequente entre usuários de sedativos (1,03%; p = 0,032; OR = 2,57) e de benzodiazepínicos (1,43%; p = 0,003; OR = 3,45) do que entre não usuários (0,38%). CONCLUSÃO: Concluiu-se que a incidência de quedas e fraturas de fêmur em idosos possui associação com o uso de medicamentos sedativos, em especial os benzodiazepínicos

Omissões de prescrição e inclusão de novos medicamentos na farmacoterapia de pacientes idosos na atenção primária à saúde / Prescribing omissions and inclusion of new medications in the pharmacotherapy of older adults in primary care

A falta de uso de um medicamento necessário envolve riscos consideráveis para o idoso. Por meio da prestação de serviços de gerenciamento da terapia medicamentosa (GTM), os farmacêuticos podem contribuir na identificação de condições de saúde não tratadas que precisam de tratamento farmacológico. O objetivo deste estudo é descrever potenciais omissões de prescrição identificadas por farmacêuticos que cuidam de idosos na atenção primária brasileira e se elas estão incluídas na ferramenta START - Screening Tool to Alert to Right Treatment. Os dados foram coletados dos prontuários de 585 idosos acompanhados em serviços de GTM na atenção básica em Minas Gerais, Brasil, de 2014 a 2017. Os farmacêuticos identificaram a necessidade de adicionar pelo menos um medicamento para 28,4% dos pacientes idosos, totalizando 233 medicamentos relacionados a 31 diferentes problemas de saúde não tratados. Um terço (n = 79) dos medicamentos sugeridos pelos farmacêuticos correspondeu a algum critério proposto pela ferramenta START. Estes resultados enfatizam a importância do atendimento holístico ao paciente nos serviços de GTM.

The lack of use of a necessary medication involves considerable risks to the older person. Through the provision of comprehensive medication management (CMM) services, pharmacists may identify untreated health conditions that need pharmacological treatment. The purpose of this study is to describe potential prescribing omissions identified by pharmacists taking care of older adults in Brazilian primary care and whether they are included in the Screening Tool to Alert to Right Treatment (START). Data were collected directly from the records of 585 older adults followed up in CMM services in primary care in Minas Gerais, Brazil, from 2014-2017. Pharmacists identified the need to add at least one medication for 28.4 % of the older patients, totaling 233 drugs related to 31 different untreated health problems. One third (n=79) of the drugs suggested corresponded to some criterion proposed by START. These results emphasize the importance of holistic patient care in CMM services.