Health Literacy, Patient Knowledge and Adherence to Oral Anticoagulation in Primary Care

Abstract Background Warfarin is the only oral anticoagulant available in the Brazilian public health system. Health knowledge and treatment are essential to achieving the desirable therapeutic effect. However, data on these aspects among primary care patients are still lacking. Objective To assess health literacy, patient knowledge, and adherence to oral anticoagulation with warfarin, as well as the medication regimen complexity in primary health units in the municipality of Divinópolis, Minas Gerais, Brazil. Methods This cross-sectional study included patients using warfarin from primary care settings. Sociodemographic and clinical data were collected from medical records. Short Assessment of Health Literacy for Portuguese-Speaking Adults (SAHLPA-18), Oral Anticoagulation Knowledge (OAK), adaptation of the Measure of Adherence to Treatment (MAT-adapted) to oral anticoagulation, and Medication Regimen Complexity Index (MRCI) were applied, and the time in therapeutic range (TTR) was calculated. Patients were stratified in two groups (TTR < 60% and TTR ≥ 60%) and compared using Fisher's exact test at a significance level of p < 0.050. Results Analysis included 162 patients (64.8 ± 12.7 years old, 55.6% women). Nonvalvular atrial fibrillation (26.5%) and venous thromboembolism (24.1%) were the main indications for warfarin, and 67.9%, 88.3%, and 16.7% of the patients had inadequate health literacy, insufficient knowledge regarding anticoagulant therapy, and non-adherence to warfarin therapy, respectively. There was no significant association of these parameters in relation to TTR. MRCI showed high pharmacotherapy complexity between the drug prescriptions. Conclusion This study showed alarming insufficient knowledge about warfarin therapy and low health literacy in primary care patients.

COVID-19 outcomes in people living with HIV: Peering through the waves

Abstract Objective To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.

Pharmacotherapy used for alcohol and cocaine use disorders in a CAPS-AD of Minas Gerais

Abstract Substance use disorder is one of the major social and public health problems in the world. The present study analyzed the pharmacoepidemiological profile of patients treated at the Psychosocial Treatment Center for Alcohol and Substance Use Disorders (CAPS-AD) for treatment of alcohol use disorders (AUD), cocaine use disorders (CUD) and concomitant alcohol and cocaine use disorders (A-CUD) in the city of Betim-MG. The study used quantitative and descriptive data and was based on the evaluation of medical records of patients attended from January to December 2016. After analyzing 295 medical records, the majority of study participants were male (83.7 %) with an average age of 46.26 for AUD, 28.88 for CUD and 34.29 for A-CUD. The most prescribed drugs for AUD were diazepam (54.1 %), thiamine (37 %), complex B vitamins (29.5 %), and disulfiram (2.7 %); for CUD, diazepam (26.9 %) and haloperidol (23.1 %). It should be noticed that although contraindicated by the guidelines, chlorpromazine (42.3 %, 25.3 %, 20.3 %) was prescribed for CUD, AUD, and A-CUD respectively. Knowing the pharmacoepidemiological profile of CAPS-AD patients is extremely important for making decisions regarding which medicines to make available to the population.

Factors associated with the occurrence of adverse events to antiretroviral therapy in adults and elderly living with HIV

Objectives: This study identifies the factors associated with the occurrence of adverse events in adults and elderly on antiretroviral therapy. Methods: This is a cross-sectional study carried out with adults and elderly patients, attended by the Specialized Assistance Service between September 2016 and August 2017. Adverse events were measured through self-reports collected in interviews, information collected in medical records, and changes identified in laboratory tests, with the degree of causality being assessed using the Naranjo Algorithm. Univariate analysis, with results expressed as odds ratio (OR) and their respective confidence intervals (CI 95%), was performed to estimate the association between sociodemographic, pharmacotherapeutic, and clinical characteristics (explanatory variables) with the occurrence of four or more adverse events to antiretroviral therapy (response variable). For multivariate analysis, multiple logistic regression was considered in order to verify the permanence or absence of associations previously found in the univariate analysis. Results: Prevalence of adverse events to antiretroviral therapy was 92.6%, with the median of adverse events being four (IQR 25%: 2 ; IQR 75%: 5) and two (IQR 25%: 2 ; IQR 75%: 4), respectively, among adults and elderly (p <0.05). Additionally, 340 adverse events were identified, among which nightmares (15.0%) and vertigo (13.5%) were the most frequent. Most of the adverse events identified were classified as possible (96.2% / n = 327). In the initial univariate analysis, factors such receipt of guidance on adverse events and age were associated with a higher occurrence of adverse events to antiretroviral therapy. Contrary to expectations, the elderly were considered less susceptible to have adverse events when compared to adults (OR = 0.363; CI 95% = 0.164-0.801). However, the final multivariate analysis model revealed "receipt of guidance on adverse events" as the only variable significantly associated with the presence of four or more adverse events to antiretroviral therapy (OR = 4.183 ; CI 95% = 1.775-9.855). Conclusions: Results suggest difference in perception of adverse events between patients who received and those who did not receive guidance in this regard, which indicates the importance of health professionals to provide specific information to their patients regarding adverse events to antiretroviral therapy. Thus the patient can understand the effects generated by the treatment and inform these professionals for the notification of adverse events, in order to improve pharmacovigilance actions and promote patient safety.

Potentially inappropriate medication use in older adults: prevalence and physician knowledge / Medicamentos potencialmente inapropriados para idosos: prevalência de uso e conhecimento médico

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.

Profile of intoxications served at the 24-hour emergency service unit

Intoxications represent a serious public health problem. According to the World Health Organization, 193,000 deaths per year are caused by unintended intoxications worldwide. This study aims to know the profile of intoxications at the 24-hour Emergency Service Unit in Divinópolis, in the state of Minas Gerais. This is a descriptive study in which the study population chosen were all patients treated for intoxications in the period from 2017 to 2018, registered in the health service; 421 cases of intoxications were recorded. The female gender was the most prevalent, and the age group with the most cases was 21 to 30 years. The main circumstance found was attempted suicide (83.1%), and the main causative agent was drugs (76.5%), with benzodiazepines being the main class responsible for intoxications. The most used treatment was gastric lavage and activated charcoal. This study demonstrates that knowledge about the city's intoxication profile is important for the development of treatment and patient management methods to better suit the demands of the municipality.

Alterações farmacocinéticas de antimicrobianos em situações especiais: uma revisão narrativa / Antimicrobial pharmacokinetic changes in special situations: A narrative review

Até o ano de 1940, as doenças infecciosas eram uma das principais causas de morte no Brasil. Atualmente, apesar de um grande declínio, a mortalidade ainda é elevada em relação a países desenvolvidos e a outros países da América Latina. Dessa maneira, o objetivo do presente trabalho foi relatar as alterações fisiológicas em condições específicas, as consequências na farmacocinética dos antimicrobianos e ainda o impacto do ajuste de dose em tais situações. Realizou-se uma revisão narrativa de artigos publicados sobre a utilização de antimicrobianos nas seguintes situações: doença crítica e sepse, alcoolismo, tabagismo, extremos de idade, obesidade, nutrientes, polimorfismo genético, gravidez e lactação, insuficiência cardíaca, insuficiência hepática e renal. Observou-se que as alterações fisiológicas em tais situações afetam a farmacocinética dos antimicrobianos, modificando os processos de absorção, distribuição, metabolismo e excreção, os quais dependem muitas vezes da natureza do fármaco, podendo requerer ajuste de dose. Pôde-se concluir que as alterações observadas reduzem a precisão de uma dose terapêutica eficaz, evidenciando, dessa maneira, a importância do ajuste de dose.

Until the year 1940, infectious diseases were one of the main causes of death in Brazil. Currently, despite a large decline, mortality is still high in comparison to developed countries and other Latin American countries. Thus, the objective of the present study was to report the physiological changes under specific conditions, the consequences on the pharmacokinetics of antimicrobials and also the impact of the dose adjustment in such situations. A review of published articles on the use of antimicrobials was conducted in the following situations: critical illness and sepsis, alcoholism, smoking, age extremes, obesity, nutrients, genetic polymorphism, pregnancy and lactation, heart failure, hepatic and renal failure. It has been observed that the physiological changes in such situations affect the pharmacokinetics of antimicrobials, modifying the absorption, distribution, metabolism and excretion processes, and which often depend on the nature of the drug, which may require dose adjustment. It could be concluded that the observed changes reduce the accuracy of an effective therapeutic dose, thus evidencing the importance of the dose adjustment.