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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.
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Prescrição Inadequada , Aplicativos Móveis , Humanos , Idoso , Brasil/epidemiologia , Prescrição Inadequada/prevenção & controle , Tomada de Decisão Clínica , Atenção Primária à SaúdeRESUMO
OBJECTIVES: To evaluate the use of point-of-care testing to detect new cases of diabetes mellitus at a Brazilian public community pharmacy. METHODS: This cross-sectional study included individuals without a previous diagnosis of diabetes mellitus who met the criteria for screening according to the Brazilian Diabetes Society, which were identified during their presence at a Brazilian public community pharmacy. The measurements of HbA1c were performed using a Cobas b101 device (Roche Diagnostics) and were categorized according to the following classification established by the Brazilian Society of Diabetes: HbA1c <5.7%, normal; HbA1c between 5.7% and 6.4%, pre-diabetes; and HbA1c >6.4%, new diagnosis of T2DM. KEY FINDINGS: One hundred and eight users met the inclusion criteria. The patients' mean age was 54.4 (± 15.4) years old, ranging from 22 to 80 years old. Eighty (74.1%) participants presented with glycated haemoglobin levels over the standard threshold, of which 58 (72.5%) were in the pre-diabetes range (glycated haemoglobin levels between 5.7% and 6.4%), and 22 (27.5%) had glycated haemoglobin levels >6.4%, which corresponds to a new diagnosis of type 2 diabetes mellitus. CONCLUSIONS: The use of point-of-care glycated haemoglobin testing allowed community pharmacists at a Brazilian public community pharmacy to identify health system users with glycated haemoglobin alterations that corresponded to the pre-diabetes state or a new diagnosis of type 2 diabetes mellitus. This presented a good opportunity to refer these users to diabetes diagnosis and treatment services.
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Diabetes Mellitus Tipo 2 , Farmácias , Estado Pré-Diabético , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemoglobinas Glicadas , Diabetes Mellitus Tipo 2/diagnóstico , Estado Pré-Diabético/diagnóstico , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Transversais , Testes Imediatos , Preparações FarmacêuticasRESUMO
Resumo Este estudo tem como objetivo analisar os atributos da Atenção Primária à Saúde (APS) abrangente a partir da atuação das equipes de Saúde da Família com foco nas doenças crônicas não transmissíveis. Pesquisa qualitativa realizada entre agosto de 2018 a julho de 2019, na APS de Vitória da Conquista, Bahia, com 40 profissionais de saúde, por meio de grupos focais e entrevistas. A partir da análise temática, os temas centrais corresponderam aos sete atributos da APS abrangente. Como resultados, as potencialidades do trabalho das equipes relacionaram-se com a priorização do acesso, ao amplo leque de serviços oferecidos e o reconhecimento da realidade comunitária/familiar. Destacaram-se obstáculos relacionados a oferta, acessibilidade e cobertura dos serviços, fragmentação na coordenação assistencial e informacional, dificuldades de desenvolvimento de práticas inclusivas com a família e etnicamente situadas, bem como na continuidade da assistência, notadamente para o contexto rural. Espera-se que os resultados apresentados possam confirmar a necessidade de investimentos e a instituição de processos sistemáticos de avaliação do trabalho das equipes de saúde da família, a fim de acompanhar a trajetória de consolidação da APS no contexto do Sistema Único de Saúde brasileiro.
Abstract This study aims to analyze the attributes of comprehensive Primary Health Care (PHC) based on the work of the family health teams focused on non-communicable chronic diseases. Qualitative research conducted from August 2018 to July 2019, in primary health care in Vitória da Conquista, Bahia, Brazil, with 40 health professionals, through interviews and focus groups. From the thematic analysis, the central themes were defined, corresponding to the seven attributes of comprehensive PHC. As a result, the potentials work of the family health teams was related to prioritizing access, the wide range of services offered and the recognition of the community and family reality. The study highlighted obstacles related to service provision, accessibility, coverage, care fragmentation and in information coordination, challenges in developing practices with the family, in practices ethnically situated, and continuity of care, notably for the rural context. It is expected that the results presented may confirm the need for investments and the institution of systematic evaluation processes regarding the work of family health teams, in order to follow the trajectory of PHC consolidation in the context of the Brazilian Unified Health System.Resumo: Este estudo tem como objetivo analisar os atributos da Atenção Primária à Saúde (APS) abrangente a partir da atuação das equipes de Saúde da Família com foco nas doenças crônicas não transmissíveis. Pesquisa qualitativa realizada entre agosto de 2018 a julho de 2019, na APS de Vitória da Conquista, Bahia, com 40 profissionais de saúde, por meio de grupos focais e entrevistas. A partir da análise temática, os temas centrais corresponderam aos sete atributos da APS abrangente. Como resultados, as potencialidades do trabalho das equipes relacionaram-se com a priorização do acesso, ao amplo leque de serviços oferecidos e o reconhecimento da realidade comunitária/familiar. Destacaram-se obstáculos relacionados a oferta, acessibilidade e cobertura dos serviços, fragmentação na coordenação assistencial e informacional, dificuldades de desenvolvimento de práticas inclusivas com a família e etnicamente situadas, bem como na continuidade da assistência, notadamente para o contexto rural. Espera-se que os resultados apresentados possam confirmar a necessidade de investimentos e a instituição de processos sistemáticos de avaliação do trabalho das equipes de saúde da família, a fim de acompanhar a trajetória de consolidação da APS no contexto do Sistema Único de Saúde brasileiro.
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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).
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Automedicação , Odontalgia , Odontologia em Saúde Pública , Uso de MedicamentosRESUMO
PURPOSE: Incorporating technology such as home blood pressure monitoring (HBPM) into the clinical routine generates opportunities to improve BP monitoring and control in primary health care. It is also important to prevent overtreatment. However, the combination of HBPM with collaborative drug therapy management (CDTM) has not yet been studied. This study aimed to assess the efficacy of combining HBPM with CDTM to optimize hypertension treatment for older patients. METHODS: This open-label, parallel-group, randomized clinical trial was conducted between June 2021 and August 2022 in a Brazilian community pharmacy and included older patients (aged ≥60 years) with hypertension. Those who were classified as poorly adherent or nonadherent to the prescribed drug treatment or who were unable to perform HBPM were excluded. In the control group, participants received a BP monitor and instructions on how to perform HBPM. A general practitioner, who was provided a report with the obtained BP values, determined any changes to the treatment protocol. In the intervention group, a pharmacist enrolled participants in a drug therapy management protocol and provided the general practitioner with suggestions to optimize the antihypertensive drug therapy, in addition to the report with the BP values. The following outcomes were considered: the proportion of participants receiving deprescriptions of antihypertensive drugs, other treatment adjustments, and the difference in mean BP between the groups 45 days after performing HBPM. The study used a t test combined with Levene's test to calculate mean intergroup differences in BP, the paired t test to calculate mean intragroup differences in BP, and Pearson's χ2 test to determine intergroup differences in changes in drug therapy. FINDINGS: In each group, 161 participants completed the trial. Antihypertensive agents were deprescribed for 31 (19.3%) participants in the intervention group versus 11 (6.8%) in the control group (P = 0.01). In addition, 14 (8.7%) participants were prescribed antihypertensive drugs in the intervention group versus 11 (6.8%) in the control group (P = 0.52). The mean office systolic BP and HBPM values were lower in the intervention group (P = 0.22 and P = 0.29, respectively). IMPLICATIONS: Combining HBPM with a CDTM protocol effectively optimized antihypertensive treatment for older patients in a primary health care setting. CLINICALTRIALS: gov identifier: NCT04861727.
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Anti-Hipertensivos , Hipertensão , Humanos , Idoso , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial/métodos , Farmacêuticos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Pressão Sanguínea , Atenção Primária à SaúdeRESUMO
Purpose: This study aims to assess self-care in patients with non-optimal diabetes management (HbA1c >7.0% for adults and >8.0 for those aged 60 or over) and the positive and negative experiences associated with it in the rural communities of a Brazilian municipality. Patient and Methods: This is a cross-sectional mixed-methods study. The data were collected from participants with high HbA1c through focus group discussions, subsequently performing thematic analysis, and through structured questionnaires (socioeconomic characteristics and the Summary of Diabetes Self-Care Activities (SDSCA)). Results: The mean HbA1c of the 156 study participants was 9.94% (95% confidence interval: 9.70-10.19%) and most participants (86.54%) had negative self-care behaviors, with an overall SDSCA mean score of 3.55. This mean was not positive for any of the socioeconomic characteristics. The self-care activities with the most satisfactory performance concerned non-smoking and the use of prescribed medications, and the poorest results were observed for the practice of specific physical activities. The qualitative data indicated that the study participants face many difficulties regarding self-care practices, especially those related to an adequate diet. Conclusion: The self-care assessment revealed unsatisfactory self-care behaviors as well as high HbA1c levels among the study participants and highlighted the various difficulties they encounter. This indicates the need for more attentive health teams to monitor patients, especially regarding actions focused on the non-pharmacological elements of self-care, such as lifestyle changes, which were found to be the dimensions with the most unsatisfactory results.
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Background Inappropriate use of clonazepam by older adults is associated with cognitive impairment, delirium, and falls. Strategies to optimize its use are important to increase patient safety. Objective To evaluate the feasibility of a clonazepam deprescription protocol in the elderly. Methods This is a quasi-experimental study. Elderly people with chronic use of clonazepam and attended in primary care units in two Brazilian municipalities were selected. A deprescription protocol was used, which included five fortnightly meetings between the older adults and the research team, to reduce the dose by 25%. Patients received instructions on sleep hygiene behaviors and the advantages of clonazepam deprescription; family physicians followed a flowchart for gradual dose reduction. In the 1st and 5th meetings, there were medical appointments for anamnesis and discharge. The monitoring of patients and the application of tests were carried out by the research team. Results Of the 35 elderly people included in the study, 27 reached the end; 81.5% achieved deprescription: 22.2% stopped completely and 59.3% decreased the dose. At the last meeting, 20% of elderly patients reported an increase in blood pressure. Conclusion The high rate of deprescription and the little relevance of clonazepam withdrawal reactions, showed that the use of the protocol was effective. However, the increase in blood pressure and the worsening of sleep quality in the last meeting show the need for adjustment in the last stage of the deprescription process.
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Clonazepam , Desprescrições , Idoso , Brasil , Clonazepam/efeitos adversos , Estudos de Viabilidade , Humanos , Atenção Primária à Saúde/métodosRESUMO
Abstract To evaluate the prevalence of self-reported drug adherence and factors associated, as well as clinical health outcomes, for industry workers with hypertension (HTN) and diabetes mellitus (DM). This was a cross-sectional study of 137 Brazilian industry workers with HTN and/ or DM. Self-reported adherence was assessed, and the disease control was defined through blood pressure and capillary glycemia values. Data were descriptively analyzed and the factors associated with adherence were evaluated using the Poisson model with robust variance to calculate prevalence ratios. The prevalence of self-reported drug adherence was 79.6% and the prevalence of disease control was 53.8%. There was no statistically significant association between the two variables. In the controlled disease group, non-adherence was associated with being under 40 years of age, not having a partner, and having a risky alcohol consumption habit. In the uncontrolled disease group, adherence was highest for participants aged 40 years and older. The prevalence of self-reported drug adherence was high, but the prevalence of disease control was low and not associated with adherence, indicating that the self-reported adherence measure may be inaccurate. Our findings identify some factors that explain non-adherent behavior in the workforce.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Diabetes Mellitus/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Hipertensão/tratamento farmacológico , Indústrias , Brasil , Prevalência , Estudos Transversais , AutorrelatoRESUMO
Background: Living in a rural or remote area is frequently associated with impaired access to health services, which directly affects the possibility of early diagnosis and appropriate monitoring of diseases, mainly non-communicable ones, because of their asymptomatic onset and evolution. Point-of-care devices have emerged as useful technologies for improving access to several laboratory tests closely patients' beds or homes, which makes it possible to eliminate the distance barrier. Objective: To evaluate the application of point-of-care technology for glycated hemoglobin (HbA1c) estimation in the assessment of glycemic control and identification of new diagnoses of diabetes in primary care among rural communities in a Brazilian municipality. Materials and Methods: We included individuals aged 18 years or older among rural communities in a Brazilian municipality. From September 2019 to February 2020, participants were assessed for anthropometrics, blood pressure, and capillary glycemia during routine primary care team activities at health fairs and in patient groups. Participants previously diagnosed with diabetes but without recent HbA1c test results or those without a previous diagnosis but with random capillary glycemia higher than 140 mg/dL were considered positive and were tested for HbA1c by using a point-of-care device. Results: At the end of the study, 913 individuals were accessed. Of these, 600 (65.7%) had no previous diagnosis of diabetes, 58/600 (9.7%) refused capillary glycemia screening and 542/600 (90.7%) were tested. Among tested individuals, 73/542 (13.5%) cases without a previous diagnosis of diabetes, were positive for capillary glycemia. Among positives, 31/73 (42.5%) had HbA1c levels that were considered indicative of prediabetes and 16/73 (21.9%) were newly diagnosed with diabetes. Among the participants, 313/913 (34.3%) were previously diagnosed with diabetes. Recent HbA1c results were unavailable for 210/313 (67.1%). These individuals were tested using point-of-care devices. Among them, 143/210 (68.1%) had HbA1c levels higher than target levels (>7% and >8% for adults and elderly individuals, respectively. Conclusion: The application of point-of-care devices for HbA1c level measurement improved the access to this test for people living in rural or remote areas. Thus, it was possible to include this technology in the routine activities of primary health care teams, which increased the rates of new diagnoses and identification of patients with uncontrolled glycemia.
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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.
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Preparações Farmacêuticas , Polimedicação , Idoso , Brasil , Estudos Transversais , Humanos , Atenção Primária à SaúdeRESUMO
The study aimed to estimate the prevalence of arterial hypertension as the principal marker of chronic noncommunicable diseases (NCDs) and to identify associated modifiable factors in male workers. Baseline data were used from a longitudinal study with a sample of 1,024 male workers 18 years or older in a municipality in Northeast Brazil. The marker for NCDs was arterial hypertension, defined as systolic pressure ≥ 140mmHg and/or diastolic pressure ≥ 90mmHg and/or prior diagnosis of arterial hypertension and/or use of antihypertensive medication. Poisson regression with robust variance was used, adopting hierarchical entry of variables. Population attributable fractions (PAFs) were calculated for the lifestyle variables to measure the impact of modifiable factors on workers' health. Prevalence of hypertension was 28.6% (95%CI: 25.9-31.5). Distal factors associated with hypertension were age > 40 years, black skin color, and family income ≥ 3 times the monthly minimum wage. Intermediate factors were alcohol abuse, smoking, high self-rated salt intake, and physical inactivity. Proximal factors were overweight and obesity. Calculation of PAFs showed that a reduction or elimination of unhealthy lifestyle habits and behaviors in this population group would reduce the prevalence of the target NCD, hypertension, by 56.1%. The identification of modifiable factors and the ways they can negatively impact male workers' health allows planning interventions in the workplace itself to reach the largest number of individuals, aimed at reducing the harmful effects of NCDs.
Objetivou-se estimar a prevalência de hipertensão arterial, como principal marcador de doença crônica não transmissível (DCNT), e identificar os fatores modificáveis associados, em trabalhadores homens. Foram utilizados dados da linha de base de um estudo longitudinal com uma amostra de 1.024 trabalhadores homens com 18 anos ou mais de um município do Nordeste do Brasil. O marcador de DCNT foi a hipertensão arterial, definida por pressão arterial sistólica ≥ 140mmHg e/ou pressão arterial diastólica ≥ 90mmHg e/ou diagnóstico prévio de hipertensão arterial e/ou uso de medicamentos anti-hipertensivos. Empregou-se a regressão de Poisson com variância robusta, adotando a entrada hierárquica de variáveis. Foram calculadas frações atribuíveis populacionais (FAP) para as variáveis de estilo de vida, a fim de dimensionar o impacto dos fatores modificáveis na saúde dos trabalhadores. A prevalência da hipertensão arterial nesta população foi de 28,6% (IC95%: 25,9-31,5), os fatores distais: idade > 40 anos, cor da pele preta e renda familiar ≥ 3 salários mínimos; fatores intermediários: consumo abusivo de álcool, consumo de tabaco, percepção de um consumo elevado de sal e inatividade física e o fator proximal: sobrepeso e obesidade associaram-se positivamente com a hipertensão arterial. O cálculo da FAP permitiu observar que se ocorresse a redução ou eliminação de hábitos e comportamentos relacionados ao estilo de vida deste público, reduziria em 56,1% a prevalência da DCNT estudada. A identificação de fatores modificáveis e como estes podem interferir negativamente na saúde de trabalhadores homens possibilita o planejamento de intervenções no próprio local de trabalho, a fim de alcançar o maior número de indivíduos, visando reduzir os efeitos deletérios das DCNT.
El objetivo fue estimar la prevalencia de hipertensão arterial, como principal marcador de enfermedad crónica no transmisible (ECNT), así como identificar factores modificables asociados, en hombres trabajadores. Se utilizaron datos de la línea de base, procedentes de un estudio longitudinal, con una muestra de 1.024 hombres trabajadores con 18 años o más de un municipio del Nordeste de Brasil. El marcador de ECNT fue la hipertensão arterial, definida por presión arterial sistólica ≥ 140mmHg y/o presión arterial diastólica ≥ 90mmHg y/o diagnóstico previo de hipertensão arterial y/o uso de medicamentos antihipertensivos. Se empleó la regresión de Poisson con varianza robusta, adoptando la entrada jerárquica de variables. Se calcularon fracciones atribuibles poblacionales (FAP) en las variables de estilo de vida, a fin de dimensionar el impacto de los factores modificables en la salud de los trabajadores. La prevalencia de la hipertensão arterial en esta población fue de 28,6% (IC95%: 25,9-31,5), los factores distales: edad > 40 años, color de piel negra y renta familiar ≥ 3 salarios mínimos; factores intermedios: consumo abusivo de alcohol, consumo de tabaco, percepción de un consumo elevado de sal e inactividad física y el factor proximal: sobrepeso y obesidad se asociaron positivamente con la hipertensão arterial. El cálculo de la FAP permitió observar que, si se produjese una reducción o eliminación de hábitos y comportamientos relacionados con el estilo de vida de este público, se reduciría en un 56,1% la prevalencia de la ECNT estudiada. La identificación de factores modificables y cómo pueden interferir negativamente en la salud de hombres trabajadores posibilita la planificación de intervenciones en el propio lugar de trabajo, con el fin de alcanzar al mayor número de individuos para reducir los efectos mortíferos de las ECNT.
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Hipertensão , Doenças não Transmissíveis , Adulto , Brasil/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Estudos Longitudinais , Masculino , Doenças não Transmissíveis/epidemiologia , Sobrepeso , Prevalência , Fatores de RiscoRESUMO
Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Pressão Sanguínea , Ritmo Circadiano , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Gravidez , Atenção Primária à SaúdeRESUMO
OBJECTIVE: Cardiovascular risk stratification is an important clinical practice to estimate the severity of cardiovascular disease in patients with type 2 diabetes. This study aimed to compare the stratification of global cardiovascular risk with the specific risk stratification for patients with type 2 diabetes, seen at specialized outpatient clinics, and to evaluate possible differences in diagnoses and treatments. METHODS: A total of 122 patients with type 2 diabetes treated at two specialized outpatient clinics, from 2017 to 2019, were studied. The cardiovascular risk stratification calculators, global risk score, Cardiovascular Risk Stratification Calculator, and United Kingdom Prospective Diabetes Study-Risk Engine, were used to calculate the risk of death from cardiovascular disease. The agreement between these calculators was analyzed using the kappa index. The indications for the use of statins and acetylsalicylic acid for the group studied were evaluated according to the Brazilian Diabetes Society Guideline. RESULTS: There was a low degree of agreement among the three risk calculators. The global risk score calculator showed insignificant agreement with the Cardiovascular Risk Stratification Calculator (kappa=0.0816; p=0.0671). There was no agreement between the global risk score calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.099), or between the Cardiovascular Risk Stratification Calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.0095). CONCLUSION: The substantial disagreements among the cardiovascular risk calculators may lead to different diagnoses and may consequently influence therapeutic strategies. The findings herein highlight the need for specific validated cardiovascular risk calculators for patients with DM2 that can reliably estimate risk in these individuals.
Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/complicações , Fatores de Risco de Doenças Cardíacas , Humanos , Estudos Prospectivos , Medição de Risco , Fatores de RiscoRESUMO
Abstract Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.
Resumo A medição da pressão arterial no consultório está sujeita a erros; assim, a monitorização residencial da pressão arterial é utilizada para o monitoramento e diagnóstico da hipertensão. Descrever a viabilidade da monitorização residencial para avaliar a pressão arterial na atenção primária e comparar os valores da pressão arterial através da monitorização residencial e medida de consultório. Estudo transversal realizado com pacientes que utilizaram a monitorização residencial pela manhã e pela noite, em triplicata por sete dias consecutivos em domicílio. Foram incluídos pacientes maiores de 18 anos, com suspeita de hipertensão do avental branco, utilizando anti-hipertensivos ou intolerantes a monitorização ambulatorial. Foram excluídos pacientes que não seguiram o protocolo, aqueles que apresentavam ritmo cardíaco irregular ou mulheres grávidas. 134 pacientes participaram do estudo, 63,3% apresentaram pressão arterial alteradas em consultório e 48% pela monitorização residencial. A diferença média dos métodos foi de 10,1 mmHg para sistólica e 4,3 mmHg para diastólica. A prevalência de hipertensão do avental branco foi 19,4%. A monitorização residencial da pressão arterial no sistema de saúde brasileiro provou ser uma estratégia viável.
Assuntos
Humanos , Feminino , Gravidez , Monitorização Ambulatorial da Pressão Arterial , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Atenção Primária à Saúde , Pressão Sanguínea , Estudos de Viabilidade , Estudos Transversais , Ritmo CircadianoRESUMO
Background: Hypertension and diabetes mellitus are the second and third highest leading causes of disability-adjusted life-years (DALY), respectively, in Brazil. The clinical outcomes of chronic diseases are influenced by various factors. Therefore, there is a need for multifaceted interventions to achieve a decrease in the rate of DALY, with a better control of these diseases. Objective: To verify whether sustainable long-term interventions, such as health worker training and provision of health education to the patients, contribute to health improvements in patients with hypertension and diabetes from rural communities. Methods: Over a 6 month period, educational and medical interventions were provided to optimize the treatment of hypertension and diabetes. Furthermore, blood pressure and glycated hemoglobin (HbA1c) measurements were taken at baseline and after the interventions. Results: The monitored hypertensive patients (n = 276) had a reduction of 13.4 mmHg (p = 0.021) and 5.8 mmHg (p < 0.001) in mean systolic and diastolic blood pressure, respectively. Diabetic patients who were followed-up (n = 71) achieved a 0.55% (p = 0.185) reduction in HbA1c level. The desired blood pressure level (<140/90 mmHg) was achieved in 38.8% of patients with hypertension, whereas the desired level of HbA1c (<7.0% for adults and <8.0% for the elderly) was achieved in 16.9% of patients with diabetes; in addition, 38.0% had a reduction of HbA1c of at least 1%. Conclusion: The results showed that the interventions improved the blood pressure and HbA1c levels in patients with hypertension and diabetes from rural communities in a municipality in Northeast Brazil.
RESUMO
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.
Assuntos
Prescrição Inadequada , Médicos , Idoso , Brasil , Estudos Transversais , Humanos , Polimedicação , Atenção Primária à SaúdeRESUMO
BACKGROUND: This study aimed to identify the factors associated with the quality of life of young workers of a Social Work of Industry Unit. METHODS: This was a cross-sectional study conducted on 1270 workers. Data were collected using a digital questionnaire built on the KoBoToolbox platform that included the EUROHIS-QOL eight-item index to assess quality of life. Demographic, socioeconomic, behavioral, and clinical variables were considered explanatory. The associations were analyzed using the ordinal logistic regression model at a 5% significance level. RESULTS: Men and women had a mean quality of life of 31.1 and 29.4, respectively. Workers that rated their health as "very good" had an odds ratio of 7.4 (95% confidence interval (CI) = 5.17-10.81), and those who rated it as "good" had an odds ratio of 2.9 (95% CI = 2.31-3.77). Both these groups of workers were more likely to have higher levels of quality of life as compared to workers with "regular", "poor", or "very poor" self-rated health. Physically active individuals were 30% more likely to have higher levels of quality of life (odds ratio = 1.3; 95% CI = 1.08-1.65). After adjusting the model by gender, age group, marital status, socioeconomic class, self-rated health, nutritional status, and risky alcohol consumption, the odds ratio of active individuals remained stable (odds ratio = 1.3; 95% CI = 1.05-1.66). CONCLUSIONS: In the present study, self-rated health, physical activity, and gender were associated with young workers' quality of life.
Assuntos
Exercício Físico , Qualidade de Vida , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Razão de Chances , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
SUMMARY OBJECTIVE: Cardiovascular risk stratification is an important clinical practice to estimate the severity of cardiovascular disease in patients with type 2 diabetes. This study aimed to compare the stratification of global cardiovascular risk with the specific risk stratification for patients with type 2 diabetes, seen at specialized outpatient clinics, and to evaluate possible differences in diagnoses and treatments. METHODS: A total of 122 patients with type 2 diabetes treated at two specialized outpatient clinics, from 2017 to 2019, were studied. The cardiovascular risk stratification calculators, global risk score, Cardiovascular Risk Stratification Calculator, and United Kingdom Prospective Diabetes Study-Risk Engine, were used to calculate the risk of death from cardiovascular disease. The agreement between these calculators was analyzed using the kappa index. The indications for the use of statins and acetylsalicylic acid for the group studied were evaluated according to the Brazilian Diabetes Society Guideline. RESULTS: There was a low degree of agreement among the three risk calculators. The global risk score calculator showed insignificant agreement with the Cardiovascular Risk Stratification Calculator (kappa=0.0816; p=0.0671). There was no agreement between the global risk score calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.099), or between the Cardiovascular Risk Stratification Calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.0095). CONCLUSION: The substantial disagreements among the cardiovascular risk calculators may lead to different diagnoses and may consequently influence therapeutic strategies. The findings herein highlight the need for specific validated cardiovascular risk calculators for patients with DM2 that can reliably estimate risk in these individuals.
Assuntos
Humanos , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/complicações , Estudos Prospectivos , Fatores de Risco , Medição de Risco , Fatores de Risco de Doenças CardíacasRESUMO
OBJECTIVE: To analyze the frequency, profile, and additional variables associated with the prescription of potentially inappropriate medications (PIM) to older adults in primary care, and evaluate physicians' knowledge about these medications. METHODS: A cross-sectional study was conducted based on data from patient records for the period of January 2014 to December 2017 in a city located in the state of Minas Gerais. The frequency of PIM use was evaluated based on the 2019 Beers-Fick criteria. Physician knowledge was evaluated using a validated questionnaire as a primary data source. RESULTS: In a sample of 423 older adults, 75.89% (n = 321) used at least one PIM, the most common of which were medications used to treat central nervous system disorders (48.00%; n = 203). Most participants were female (62.41%; n = 264) and 70 years or older (69.50%; n = 294). When presented with clinical cases illustrating common situations in the management of older patients, 53.33% of physicians (n = 8) answered four or five questions correctly out of a possible seven; 13.33% (n = 2) answered six questions correctly; and 33.33% (n = 5) obtained three correct answers or fewer. CONCLUSIONS: These findings showed a high frequency of PIM use among older adults treated in Primary Health Care settings, with medications used in the treatment of central nervous system disorders. Our results highlight the importance of continuing education for health professionals and improved assessments of the medication available in the Unified Health System (Sistema Único de Saúde; SUS) for use in older adults, especially those taking multiple medications.
OBJETIVOS: Analisar a frequência, o perfil e os fatores associados à prescrição de medicamentos potencialmente inapropriados (MPI) aos idosos na Atenção Primária à Saúde, além de avaliar o conhecimento dos médicos sobre esses medicamentos. METODOLOGIA: Trata-se de um estudo transversal, cujas informações foram coletadas de prontuários dos pacientes, referentes ao período de janeiro de 2014 a dezembro de 2017, em um município localizado no estado de Minas Gerais. Para análise da frequência de uso de MPI, utilizou-se o critério Beers-Fick de 2019. Para avaliação do conhecimento médico, utilizou-se uma fonte primária de informação, um questionário validado. RESULTADOS: Dos 423 idosos, 75,89% (n=321) utilizavam pelo menos um MPI e a classe mais utilizada foi do sistema nervoso central (48,00%; n=203). Houve maior prevalência no sexo feminino (62,41%; n=264) e em idosos com idade ≥70 anos (69,50%; n=294). Em relação aos casos clínicos apresentados para avaliar o conhecimento dos médicos referentes às situações comuns no cuidado à saúde do idoso, 53,33% (n=8) acertaram quatro ou cinco questões das sete existentes, enquanto 13,33% (n=2) responderam corretamente a seis perguntas e 33,33% (n=5) obtiveram três ou menos acertos. CONCLUSÕES: Os resultados evidenciaram alta taxa de prescrição de MPI entre os idosos da Atenção Primária à Saúde, destacando-se os medicamentos que são destinados ao tratamento de doenças do sistema nervoso central. Ressalta-se a importância da educação continuada desses profissionais de saúde e a melhor avaliação de medicamentos incorporados ao Sistema Único de Saúde (SUS) e destinados à população geriátrica, sobretudo o idoso polimedicado.