Questionnaire-based Survey on Subjective Understanding of Drug Effectiveness and Side Effects and Intention to Reduce Medication in Patients on Polypharmacy / 日本プライマリ・ケア連合学会誌

Introduction: This study aimed to survey patients on polypharmacy regarding their own intention and inclination to reduce medication use, and their subjective understanding of drug effectiveness and side effects. We aimed to contribute to the establishment of an information base to address polypharmacy.Methods: We enrolled 100 adult patients who had been admitted and administered ≥ 5 oral medications. A questionnaire was utilized to assess their willingness and inclination to reduce their medications, as well as their subjective understanding of drug effectiveness and side effects.Results: Sixty-two patients expressed an intention to reduce their medication use, citing reasons including medication management, drug combinations, and side effects. The proportion of patients with this intention increased as the number of prescribed medications increased. Of the 38 individuals who responded that they had no intention of reducing their medication, 21 (55.3%) cited the reason as being that they received the prescription from a physician. The level of understanding about the effectiveness of their own medications was significantly lower among those aged ≥ 75 years. However, the level of understanding of side effects did not vary based on age or number of prescriptions.Conclusion: To promote the optimization of prescriptions, it is necessary to ascertain patients' intentions, and the relationship between patients and prescribing physicians.

Multimorbidade e utilização de serviços de saúde no município de São Paulo, Brasil: prevalência e fatores associados / Multimorbidity and utilization of health services in the city of São Paulo, Brazil: prevalence and associated factors

Resumo O objetivo foi estimar a prevalência de multimorbidade no município de São Paulo e verificar os fatores associados à utilização de serviços de saúde. Estudo transversal de base populacional a partir do Inquérito de Saúde do Município de São Paulo (ISA-Capital 2015), em que foi realizada análise descritiva e foram elaborados modelos de regressão logística utilizando como desfecho a multimorbidade e variáveis independentes sociodemográficas, de condições de vida e utilização de serviços de saúde. Participaram 3.184 indivíduos com 20 anos ou mais, idade média de 43,8 anos. A prevalência de multimorbidade foi de 50,7% entre as mulheres, 62,5% entre os que relataram algum problema de saúde e 55,1% entre os que utilizaram serviços de saúde nas duas últimas semanas. Foi identificada maior prevalência nos indivíduos que usaram serviço de saúde por problema de saúde mental (66,1%) e que informaram maiores despesas com saúde no último mês (55,4%). A multimorbidade foi mais frequente com o envelhecimento, na população com nível econômico mais elevado, com pior autoavaliação de saúde, que utilizou serviços de saúde há seis meses ou menos, que relatou problema de saúde, que tinha plano de saúde e fazia uso da polifarmácia.

Abstract The scope of this paper was to estimate the prevalence of multimorbidity in the city of São Paulo and to verify the factors associated with the utilization of the health services. It involved a population based cross-sectional study based on data from the Health Survey in the city of São Paulo, in which descriptive analysis was conducted, and logistic regression models were developed using multimorbidity and sociodemographic independent variables, living conditions and use of health services as the outcome. A total of 3,184 individuals aged 20 years or older participated, with a mean age of 43.8 years. The prevalence of multimorbidity was 50.7% among women, 62.5% among those who reported some health problem and 55.1% among those who had recourse to health services in the last 2 weeks. A higher prevalence was identified among those who used the health service due to a mental health problem (66.1%), and in those who reported higher health expenditures in the preceding month (55.4%). Multimorbidity was more frequently associated with aging, in the population with a higher economic status, with worse self-rated health, who frequented health services for 6 months or less, who reported a health problem, or who had a health plan and opted for polypharmacy.

Pluripatología en internación: características de pacientes internados en clínica médica / Pluripathology among inpatients: characteristics of hos pitalized patients in medical clinic wards

Resumen Introducción: El objetivo del trabajo fue determinar prevalencia de pluripatología y polifarmacia entre in ternados en salas de clínica médica de un hospital de agudos, sus características sociodemográficas y clínicas. Métodos: estudio observacional, prospectivo, longitu dinal, descriptivo y analítico. Se incluyeron los pacientes internados en clínica médica del Hospital Tornú entre mayo y septiembre, 2019 mediante muestreo consecuti vo. Se relevaron datos de las historias clínicas. Se evaluó dependencia funcional y pronóstico mediante índices Barthel, Charlson y score PROFUND. Resultados: Se registraron 170 pacientes (58% mascu linos). La edad de mujeres fue significativamente mayor (mediana 79 años; p= 0.002). Prevalencia de pluripatolo gía 32%; polifarmacia 38%; hipertensión 48%; diabetes 27%; deterioro cognitivo 15%; insuficiencia cardíaca 14%; accidente cerebrovascular 12%; anemia 24%; enfermedad renal crónica 10%. Reingresos 10% (94% con reinterna ción precoz; 94% con motivo de reingreso relacionado con internación previa). Mortalidad general: 12%. Los pacientes pluripatológicos presentaron edad elevada (78% > 65 años), mayor frecuencia de polifarmacia (p < 0.0001) y de dependencia (p = 0.001). La mortalidad en pluripatológicos (22%) fue mayor que en el resto (p = 0.0095) y presentaron valores más elevados índice de Charlson y score PROFUND (p < 0.0001). No hubo diferencias significativas en estadía hospitalaria ni en reinternaciones. Conclusiones: La presencia de pacientes con pluri patología se presenta como una realidad cotidiana en nuestros servicios de internación. Este estudio revela la importancia de la consideración de este tipo de pa cientes en el ámbito público debido a su frecuencia y características, demandas sanitarias y costes.

Abstract Introduction: The purpose of this study was to de termine the prevalence of pluripathology and polyphar macy among hospitalized patients in internal medicine wards at an acute care hospital, including their socio-demographic and clinical characteristics. Methods: Observational, prospective, longitudinal, descriptive and analytical study. All patients hospital ized in the internal medicine ward at Hospital Tornú from May to September 2019 were included through consecutive sampling. Data from medical records were collected. Functional dependency and prognosis were assessed using the Barthel, Charlson and PROFUND Indexes. Results: 170 patients (58% male) were registered. Wom en were significantly older. Pluripathology prevalence: 32%; polypharmacy 38%; high BP: 48%; diabetes: 27%; cognitive impairment 15%; heart failure: 14%; stroke: 12%; anemia: 24%; CKD 10%. Total readmissions 10% (94% with early readmissions; 94% with readmissions related to a previous hospitalization). Global Mortality: 12%. Patients with pluripathology were elderly (78% > 65 years old) with a higher polypharmacy frequency (p < 0.0001) and functional dependence (p = 0.001). Mortality in patients with pluripathology (22%) was higher than in others (p = 0.0095) with higher Charlson and PROFUND scores (p < 0.0001). There were no significant differences in terms of hospital stay or readmissions. Conclusions: Pluripathological patients are common in our inpatient hospital department. This study reveals the importance of considering this type of patients in public hospitals due to its frequency, characteristics and healthcare utilization and costs.

Impacto da polifarmácia e o uso de medicamentos associados ao risco de quedas de idosos / Impact of polypharmacy and the use of medicines associated with the risk of falls in the elderly / Impacto de la polifarmacia y el uso de medicamentos asociados al riesgo de caídas en los adultos mayores

Objetivo: associar a polifarmácia e as classes medicamentosas com o risco de quedas de idosos. Método: estudo transversal e quantitativo, realizado em um ambulatório na cidade de São Paulo ­ SP, com 117 idosos, no período de março a novembro de 2019. A coleta dos dados foi realizada pela transcrição integral dos receituários e pela Escala de Risco de Quedas de Downton. Os testes estatísticos utilizados foram o Mann-Whitney e o Qui-Quadrado, sendo considerado um nível de significância de 5% e intervalo de confiança de 95%. Resultados: o risco de quedas apresentou correlação significativa com o número de medicamentos, média de seis ao dia (p<0,0001) e as classes medicamentosas, os anti-hipertensivos (p<0,0001), os antidiabéticos orais (p=0,027), os diuréticos (p<0,0001) e os antidepressivos (p=0,042). Conclusão: portanto, ressalta-se a importância da avaliação dos fatores relacionados ao aumento do risco de quedas, para planejar e implementar estratégias no cuidado da saúde do idoso

Objective: to associate polypharmacy and medication classes with the risk of falls in the elderly. Method: cross-sectional and quantitative study, carried out in an outpatient clinic in the city of São Paulo ­ SP, with 117 elderly people, from March to November 2019. Data collection was carried out by full transcription of prescriptions and the Falls Risk Scale from Downton. The statistical tests used were the Mann-Whitney and Chi-Square, considering a significance level of 5% and a confidence interval of 95%. Results:the risk of falls presented significantly with the number of medications, an average of 5.8 per day (p<0.0001) and the medication classes, antihypertensives (p<0.0001), oral antidiabetics (p =0.027), diuretics (p<0.0001) and antidepressants (p=0.042). Conclusion:therefore, the importance of evaluating factors related to the increased risk of falls is highlighted, to plan and implement strategies in the health care of the elderly

Adesão de pacientes idosos polimedicados: como eles se comportam frente à tomada de medicamentos? / Adherence of polymedicated older adults: how do they behave regarding medication intake?

Resumo Objetivo Analisar a associação entre a adesão à terapia medicamentosa com nível de entendimento e complexidade da prescrição, bem como avaliar a concordância entre dois questionários de adesão aplicados a pessoas idosas polimedicadas. Método Trata-se de estudo transversal, com pessoas idosas atendidas no ambulatório de geriatria de um hospital universitário do Rio de Janeiro, Brasil. Nesses pacientes foi avaliado a adesão à terapia medicamentosa (Brief Medication Questionarie - BMQ e Instrumento de Avaliação da Atitude frente à tomada de remédios - IAAFTR), o conhecimento sobre os medicamentos prescritos e a complexidade da farmacoterapia. Para análise estatística foram utilizados testes qui-quadrado e exato de Fisher sendo considerado o nível de significância de p-valor ≤0,05. A concordância entre os dois métodos de adesão foi avaliada pelo índice Kappa. Resultados Dos 49 idosos entrevistados, 75,5% eram mulheres, hipertensão arterial (82%) e diabetes (37%) as doenças mais prevalentes. Observou-se pelos testes BMQ e IAAFTR que 35% e 45% dos pacientes, respectivamente, eram aderentes a terapia medicamentosa. Não houve concordância de resultado entre os métodos de adesão. Grande parte dos pacientes apresentou bom nível de informação sobre seus medicamentos, porém, a maioria deles foi considerada não aderente. Não foi observado associação estatisticamente significativa entre a complexidade da prescrição frente a adesão e ao nível de informação sobre medicamentos. Conclusão A adesão a terapia medicamentosa é um processo multifatorial e as ferramentas de avaliação de adesão e de outros fatores que a influência deve ser criteriosamente escolhida de acordo com a população de estudo, pois em nosso trabalho elas apresentaram respostas diferenciadas.

Abstract Objective To analyze the association between medication therapy adherence and level of understanding and complexity of the prescription, as well as to assess the agreement between two adherence questionnaires administered to polymedicated older adults. Method This is a cross-sectional study involving older adults attending the geriatrics outpatient clinic at a university hospital in Rio de Janeiro, Brazil. In these patients, medication therapy adherence (assessed using the Brief Medication Questionnaire - BMQ and the Instrument for Assessing Attitudes Toward Medication Taking - IAAFTR), knowledge about prescribed medications, and pharmacotherapy complexity were evaluated. Statistical analysis was conducted using Chi-square tests and Fisher's Exact test, with a significance level set at p-value ≤ 0.05. The agreement between the two adherence methods was assessed using the Kappa index. Results Of the 49 interviewed older adults, 75.5% were women, with arterial hypertension (82%) and diabetes (37%) being the most prevalent conditions. According to the BMQ and IAAFTR tests, 35% and 45% of patients, respectively, were adherent to medication therapy. There was no agreement in the results between the adherence methods. A large proportion of patients exhibited a good level of information about their medications; however, the majority of them were considered non-adherent. No statistically significant association was observed between prescription complexity and adherence, nor between the level of medication information and adherence. Conclusion Medication therapy adherence is a multifactorial process, and the assessment tools for adherence and other influencing factors should be carefully chosen according to the study population, as they exhibited different responses in our work.

Quais condições se associam à polifarmácia em uma população geriátrica? / Which diseases are associated with polypharmacy in a geriatric population?

Resumo Objetivo Investigar a prevalência de polifarmácia e os seus fatores associados no espaço da Atenção Primária à Saúde em Caicó (RN, Brasil). Método Trata-se de um estudo de prevalência de abordagem quantitativa com amostra final de 295 pessoas idosas. Resultados A prevalência de polifarmácia foi de 22%. A maioria dos participantes tinha entre 60 e 79 anos (76%), cor parda (50,5%), era casada (43,1%), ensino fundamental incompleto (60,3%) e renda entre um e três salários-mínimos (74,2%). Os fármacos mais utilizados foram os bloqueadores dos receptores de angiotensina (26,1%), as estatinas (20,3%) e os diuréticos tiazídicos (19,3%). O modelo de regressão logística multivariada mostrou que a polifarmácia se associa com diabetes mellitus, hipertensão arterial sistêmica, transtorno de ansiedade generalizada, gastrite, insuficiência cardíaca, doença arterial coronariana e idade acima de 80 anos. Conclusão A polifarmácia é uma condição de alta prevalência, fortemente associada ao aumento da idade, do tipo e do número de comorbidades. A problemática aponta para a necessidade de fortalecer ações e políticas de promoção da saúde, educação profissional permanente, fortalecimento do trabalho em equipe e prestação de cuidado longitudinal e em rede, em vista do risco iatrogênico do uso de muitos medicamentos por parte dos idosos.

Abstract Objective To investigate the prevalence of polypharmacy and its associated factors in the Primary Care setting of Caicó city (Rio Grande do Norte state, Brazil). Method A quantitative prevalence study of 295 older adults was conducted. Results The prevalence of polypharmacy was 22%. Participants were predominantly aged 60-79 years (76%), brown (50.5%), married (43.1%), educated to primary (incomplete) level (60.3%) and had an income of 1-3 minimum wages (74.2%). The most used medications were angiotensin-receptor blockers (26.1%), statins (20.3%) and thiazide diuretics (19.3%). The multivariate logistic regression model showed that polypharmacy was associated with diabetes mellitus, systemic arterial hypertension, generalized anxiety disorder, gastritis, heart failure, coronary artery disease and age >80 years. Conclusion Polypharmacy prevalence was high and strongly associated with advanced age and number and type of comorbidity. These results highlight the need for greater health promotion actions and policies, continuous professional education, enhanced team work and longitudinal systemic care provision to address the iatrogenic risk of use of multiple medications by older adults.

Polifarmácia, medicamentos potencialmente inapropriados e a vulnerabilidade de pessoas idosas / Polypharmacy, potentially inappropriate medications, and the vulnerability of older adults

Resumo Objetivo Analisar a frequência de polifarmácia e prescrição de medicamentos potencialmente inapropriados (MPI) segundo os Critérios de Beers e CBMPI em pessoas idosas com vulnerabilidade clínico-funcional. Método Trata-se de um estudo transversal onde analisou-se os prontuários de 496 participantes com 60 anos ou mais, atendidos em primeira consulta em uma Policlínica Gerontológica. Os dados sociodemográficos, medicamentos, e o Índice de Vulnerabilidade Clínico Funcional 20 (IVCF-20) e quedas foram extraídos dos prontuários. A polifarmácia foi definida como o uso simultâneo de cinco ou mais medicamentos. Os participantes foram classificados em três grupos: robusto, em risco e vulnerável. Resultados A análise demonstrou que 69 (13,91%) dos participantes faziam uso de polifarmácia. Entre os usuários de polifarmácia, 40 (57,97%) faziam uso de pelo menos um MPI. Os MPIs mais encontrados foram a glibenclamida e o omeprazol, respectivamente. Pessoas idosas com vulnerabilidade apresentaram um risco três vezes maior de apresentar polifarmácia (RP 3,59; IC95% 2,109-6,092). Conclusão O uso de polifarmácia e MPI neste estudo estavam associados à vulnerabilidade da pessoa idosa, reforçando a necessidade de avaliação criteriosa de prescrições medicamentosas para essa população.

Abstract Objective To analyze the frequency of polypharmacy and the prescription of Potentially Inappropriate Medications (PIM) according to the Beers Criteria and CBMPI in older adults with clinical-functional vulnerability. Method This is a cross-sectional study where the medical records of 496 participants aged 60 and older, seen in their first appointment at a Gerontological Polyclinic, were analyzed. Sociodemographic data, medications, the Clinical-Functional Vulnerability Index-20 (IVCF-20), and falls were extracted from the medical records. Polypharmacy was defined as the simultaneous use of five or more medications. Participants were classified into three groups: robust, at risk, and vulnerable. Results The analysis revealed that 69 (13.91%) participants were using polypharmacy. Among polypharmacy users, 40 (57.97%) were using at least one PIM. The most commonly found PIM were glibenclamide and omeprazole, respectively. Older adults with vulnerability were three times more likely to have polypharmacy (OR 3.59; 95% CI 2.109-6.092). Conclusion The use of polypharmacy and PIM in this study was associated with the vulnerability of older adults, emphasizing the need for a thorough evaluation of medication prescriptions for this population.

Aspectos farmacológicos y adherencia al tratamiento antirretroviral en pacientes VIH

Introducción: La adherencia al tratamiento farmacológico favorece la supresión viral y reduce la resistencia a la terapia antirretroviral de gran actividad a largo plazo. Objetivo: Determinar la relación entre los aspectos farmacológicos y la adherencia al tratamiento antirretroviral de una IPS colombiana. Metodología: Estudio analítico transversal en pacientes con diagnóstico de VIH en tratamiento antirretroviral entre los años 2012 a 2020. Se utilizó un modelo de regresión logística binaria múltiple con fines explicativos. Resultados: Se analizaron 9835 pacientes donde la proporción de adherencia fue de 90 % y en el modelo ajustado se evaluó su relación con los antecedentes de no adherencia (ORa:0,52 IC95 °/o:0,40-0,66), grupo farmacológico (2 ITIAN + 1 IP u otro) (ORa:1,22 IC95 %:0,99-1,76), dos tomas al día (ORa:1,02 IC95 %:0,74-1,40), unidades al día (≥ 3) (ORa:0,69 IC95 %:0,47-1,02), reacciones adversas a medicamentos (ORa:0,56 IC95 °%:0,40-0,78), polimedicación (ORa:1,36 IC95 %:1,00-1,85), tiempo TAR (1 a 2 años) (ORa:1,63 IC95 %:1,27-2,09),tiempo TAR (6 a 12 meses) (ORa:1,66 IC95 %:1,27-2,18), tiempo TAR (<6 meses) (ORa:1,36 IC95 %:1,03-1,78), tasa de reclamación de los medicamentos (ORa:0,42 IC95 %:0,32-0,55) y antecedentes PRUM (ORa:0,11 IC95 %:0,09-0,14). Discusión: La proporción de adherencia obtenida es superior a lo descrito para otros países (entre 60-77 %); sin embargo se encuentra que los hallazgos correspondientes al efecto de las variables farmacológicas analizadas son acordes a lo descrito en estudios previos en el tema Conclusión: Los antecedentes de no adherencia, reacciones adversas, tasa de reclamación de los medicamentos y antecedentes de problemas relacionados con el uso de medicamentos son aspectos que reducen la probabilidad de adherencia; mientras que el mayor tiempo de uso del tratamiento aumenta la misma.

Introduction: Adherence to drug treatment promotes viral suppression and reduces long-term resistance to highly active antiretroviral therapy (HAART). Objective: To determine the relationship between the pharmacological aspects and adherence to antiretroviral treatment in a Colombian IPS. Methodology: Cross-sectional analytical study in patients with HIV on antiretroviral treatment between 2012 and 2020. A multiple binary logistic regression model was used for explanatory purposes. Results: A total of 9,835 patients were analyzed where the proportion of adherence was 90 % and in the adjusted model its relationship with history of non-adherence was assessed (ORa: 0,52 95 % CI: 0,40-0,66), pharmacological group (2 NRTI + 1 PI or other) (ORa: 1,22 95 % CI: 0,99-1,76), two doses per day (ORa: 1,02 95 % CI: 0,74-1,40), units per day (≥ 3 ) (ORa: 0,69 95 % CI: 0,47-1,02), adverse drug reactions (ORa: 0,56 95 % CI: 0,40-0,78), polypharmacy (ORa: 1,36 95 % CI : 1,00-1,85), ART time (1 to 2 years) (ORa: 1,63 95 % CI: 1,27-2,09), ART time (6 to 12 months) (ORa: 1,66 95 % CI: 1,27-2,18), ART time (<6 months) (ORa: 1,36 95 % CI: 1,03-1,78), inconsistency in the claim (ORa: 0,42 95 % CI: 0,32-0,55) and PRUM history (ORa: 0,11 95 % CI: 0,09-0,14). Discussion: The proportion of adherence obtained is higher than that described for other countries (between 60-77 %); however, the findings corresponding to the effect of the pharmacological variables analysed are in line with those described in previous studies on the subject. Conclusion: The history of non-adherence, adverse reactions, inconsistencies in the claim fill history and problems related to the use of medications are aspects that reduce the probability of adherence. While the longer time of use of the treatment increases adherence.

Síndromes geriátricos y abandono

Fundamento: el abandono en la vejez es un condicionante de muchos trastornos de salud y constituye en mayor medida una condición de gran incidencia a nivel mundial. Objetivo: comparar los síndromes geriátricos y el abandono en pacientes adultos mayores. Métodos: se realizó un estudio transversal, descriptivo, analítico y correlacional, en la Unidad de Medicina Familiar No. 33 del Instituto Mexicano del Seguro Social de Tabasco. La muestra se conformó con 203 pacientes de 60 años y más, que acudieron a consulta de Medicina Familiar y Atención Médica Continua. Se aplicaron 3 instrumentos: la escala de Pfeiffer, el International Consultation on Incontinence Questionnaire Short-Form, la Escala de Percepción de Abandono del Adulto Mayor y se interrogó sobre el consumo de medicamentos prescritos y automedicados. Resultados: existió relación entre los síndromes geriátricos y el abandono, como se comprobó en la correlación entre las variables analizadas. El deterioro cognitivo leve, moderado y severo, se encontró en bajas proporciones. El 40,7 % de los pacientes aceptó tener incontinencia urinaria. La presencia de polifarmacia se encontró en altas proporciones. Conclusiones: los síndromes geriátricos presentes en el estudio fueron: deterioro cognitivo, polifarmacia e incontinencia urinaria, más la presencia de ser soltero, viudo o divorciado muestran una relación significativa para sufrir abandono.

Foundation: abandonment in old age is a condition of many health disorders and is, to a greater extent, a condition of high incidence worldwide. Objective: to compare geriatric syndromes and abandonment in older adult patients. Methods: a cross-sectional, descriptive, analytical and correlational study was carried out in the Family Medicine Unit No. 33 of the Mexican Social Security Institute of Tabasco. The sample was made up of 203 patients aged 60 and over, who attended Family Medicine and Continuing Medical Care consultations. Three instruments were applied: the Pfeiffer scale, the International Consultation on Incontinence Questionnaire Short-Form, the Perception of Abandonment Scale for the Elderly, and questions were asked about the consumption of prescribed and self-medicated medications. Results: there is a relationship between geriatric syndromes and abandonment, as verified in the correlation between the variables analyzed. Mild, moderate and severe cognitive impairment was found in low proportions. 40.7 % of the patients accepted having urinary incontinence. The presence of polypharmacy was found in high proportions. Conclusions: the geriatric syndromes present in the study such as: cognitive impairment, polypharmacy and urinary incontinence, plus the presence of being single, widowed or divorced show a significant relationship to suffering abandonment.

Perfil medicamentoso e frequência de polifarmácia em idosos de uma Unidade Básica de Saúde / Drug profile and frequency of polypharmacy in elderly people in a Primary Care Unit / Perfil farmacológico y frecuencia de polifarmacia en ancianos en una Unidad Básica de Salud

Objetivo: identificar o perfil medicamentoso e a frequência de polifarmácia em idosos cadastrados e que fazem acompanhamento em uma unidade básica de saúde. Método: estudo observacional e retrospectivo, realizado em uma unidade básica de saúde de um município do Triângulo Mineiro, Minas Gerais. Foi realizada amostragem aleatória e estratificada para coleta de dados de prontuários físicos e eletrônicos de idosos atendidos nos anos de 2019 e 2020, analisados por meio de estatística descritiva. Resultados: entre 448 prontuários foram analisados, porém somente 208 (46,4%) foram válidos. Os medicamentos mais prescritos foram losartana (n=72; 34,6%), sinvastatina (n=60; 28,8%) e metformina (n=51; 24,5%). Observou-se 24,0% de frequência de polifarmácia (n=51), maior frequência de mulheres (n=42; 30,2%) e com significativa associação com diabetes mellitus (p=0,034). Conclusão: a polifarmárcia foi detectada, mais presente nas mulheres, sendo que medicamentos mais utilizados foram relacionados à hipertensão arterial, dislipidemias e diabetes mellitus. Destaca-se a incompletude de informações nos prontuários analisados(AU)

Objective: to identify the medication profile and frequency of polypharmacy in registered elderly people who are followed up at a primary care unit. Method: observational and retrospective study, carried out in a primary care unit in a municipality in Triângulo Mineiro, Minas Gerais. Random and stratified sampling was carried out to collect data from the physical and electronic medical records of the elderly assisted in the years 2019 and 2020, analyzed using descriptive statistics. Results: among 448 medical records analyzed, 208 (46.4%) were considered valid for inclusion in the study. The most prescribed drugs were losartan (n=72; 34.6%), simvastatin (n=60; 28.8%) and metformin (n=51; 24.5%). There was a 24.0% frequency of polypharmacy (n=51), a higher frequency of wome (n=42; 30.2%) and with a significant association with diabetes mellitus (p=0.034). Conclusion: polypharmacy was detected, more present in women, and the most used drugs were related to arterial hypertension, dyslipidemia and diabetes mellitus. The incompleteness of information in the analyzed medical records stands out. Descriptors: Health of the Elderly; Aged; Primary Health Care; Polypharmacy(AU)

Objetivo: identificar el perfil farmacológico y frecuencia de polifarmacia en ancianos registrados en seguimiento en una unidad básica de salud. Método: estudio observacional y retrospectivo, realizado en una unidad básica de salud de un municipio del Triângulo Mineiro, Minas Gerais. Se realizó un muestreo aleatorio y estratificado para recolectar datos de las historias clínicas físicas y electrónicas de los ancianos atendidos en los años 2019 y 2020, analizados mediante estadística descriptiva. Resultados: de 448 historias clínicas analizadas, 208 (46,4%) fueron consideradas válidas para su inclusión en el estudio. Los fármacos más prescritos fueron Losartán (n=72; 34,6%), Simvastatina (n=60; 28,8%) y Metformina (n=51; 24,5%). La frecuencia de polifarmacia estuvo en el 24,0% (n=51), mayor frecuencia de mujeres (n=42; 30,2%) y con asociación significativa con diabetes mellitus (p=0,034). Conclusión: se detectó la polifarmacia, más presente en las mujeres; los fármacos más utilizados estuvieron relacionados con hipertensión arterial, dislipidemia y diabetes mellitus. Se destaca la incompletitud de la información en las historias clínicas analizadas(AU)

A questionnaire-based study evaluating medication storage habits of patients attending outpatient department of a tertiary care teaching hospital

Background: Due to easy availability and high prevalence of chronic diseases, an increased number of drugs are being prescribed per family. It is important to ensure patients are aware of appropriate storage requirements to prevent negative health and economic consequences. Aim and Objectives: (1) To identify drug storage habits of patients (2) To evaluate the awareness of patients regarding appropriate storage conditions. (3) To identify potential harmful usage patterns of stored drugs in the household. Materials and Methods: This is a survey-based study among 100 patients attending the medicine outpatient department (OPD). A pre-validated questionnaire was given to the participants and response was collected and analyzed. Results: All participants reported storage of medications at home. An average of 3.42 ± 1.8 drugs were stored at home. Future use (50%) was the most common reason for storing medications. Analgesics (35%), cardiovascular medications (35%), and antibiotics were the most common drug groups to be stored. Bedroom cabinets and drawers were the most common storage location. Only 25% of participants were aware that drugs had specific storage requirements. Most participants (85%) could not read or understand the label present on drug formulations. Conclusion: Awareness of appropriate home storage conditions for medications remains low. This presents an opportunity for health-care providers and workers to better communicate storage instructions. Understanding patient behavior in this regard may lead to better health outcomes

La medicalización de los servicios de salud y la publicidad masiva de medicamentos en la automedicación y la polifarmacia / Medicalization of Health Services and Massive Advertising of Drugs in Self-Medication and Polypharmacy

La medicalización de los servicios de salud y la publicidad masiva de medicamentos en la automedicación y la polifarmacia son temas relevantes de interés mundial. Se encuentran vinculados a la calidad de vida, el deterioro de la salud, la funcionalidad, la autonomía y los actuales modelos económicos y de salud pública. Estos mal manejados perpetúan un círculo perjudicial que trasciende las políticas públicas, las naciones y la sociedad en su conjunto. Ambos modifican el pronóstico de las enfermedades de base (transmisibles o no transmisibles), las comorbilidades, y los procesos farmacocinéticos y farmacodinámicos, cambian su índice terapéutico, y su relación entre las concentraciones para producir efectos terapéuticos o tóxicos. Ejemplos como la insuficiencia renal atribuida al consumo frecuente de antiinflamatorios no esteroideos y la suspensión de metformina en personas adultas mayores con un filtrado glomerular < 30 ml/min o la presencia de comorbilidades(AU)

The medicalization of health services and the massive advertising of drugs in self-medication and polypharmacy are relevant issues of global interest. They are linked to the quality of life, deterioration of health and current autonomy of the economic and public health models. The medicalization of poorly managed services perpetuates a harmful circle that transcends public policies, modifying the prognosis of underlying communicable and non-communicable diseases, comorbidities, and pharmacokinetic and pharmacodynamic processes. As a result of these problems, alterations appear in the therapeutic index and its relationship between concentrations to produce therapeutic or toxic effects. This global problem of polypharmacy in public health mainly affects the elderly(A)

Heart Smart Diabetes Care

The world is growing smarter day by day, and so is health care. In spite of innumerable inventions and tech-tools, however, we struggle to contain chronic illnesses like diabetes and heart disease. We need to work together and design a rational, scientific and socially sustainable Heart Smart diabetes care ecosystem, with Heart Smart management strategies, to ensure happiness and harmony in persons who live with diabetes.

Clinical value of Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales to predict hospital-associated functional decline in an acute geriatric unit in Colombia

Background: Older adults admitted to a hospital for acute illness are at higher risk of hospital-associated functional decline during stays and after discharge. Objective: This study aimed to assess the calibration and discriminative abilities of the Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales as predictors of hospital-associated functional decline at discharge in a cohort of patients older than age 65 receiving management in an acute geriatric care unit in Colombia. Methods: This study is an external validation of ISAR and HARP prediction models in a cohort of patients over 65 years managed in an acute geriatric care unit. The study included patients with Barthel index measured at admission and discharge. The evaluation discriminate ability and calibration, two fundamental aspects of the scales. Results: Of 833 patients evaluated, 363 (43.6%) presented hospital-associated functional decline at discharge. The HARP underestimated the risk of hospital-associated functional decline for patients in low- and intermediate-risk categories (relation between observed/expected events (ROE) 1.82 and 1.51, respectively). The HARP overestimated the risk of hospital-associated functional decline for patients in the high-risk category (ROE 0.91). The ISAR underestimated the risk of hospital-associated functional decline for patients in low- and high-risk categories (ROE 1.59 and 1.11). Both scales showed poor discriminative ability, with an area under the curve (AUC) between 0.55 and 0.60. Conclusions: This study found that HARP and ISAR scales have limited discriminative ability to predict HAFD at discharge. The HARP and ISAR scales should be used cautiously in the Colombian population since they underestimate the risk of hospital-associated functional decline and have low discriminative ability.

Antecedentes: los adultos mayores ingresados en un hospital por una enfermedad aguda tienen un mayor riesgo de deterioro functional hospitalario durante su estancia y después del alta. Objetivo: este estudio tuvo como objetivo evaluar las capacidades de calibración y discriminación de las escalas Hospital Admission Risk Profile (HARP) e Identification of Seniors at Risk (ISAR) como predictores de deterioro funcional hospitalario al alta en una cohorte de pacientes mayores de 65 años que recibieron manejo en una unidad geriátrica de agudos en Colombia. Métodos: este estudio es una validación externa de los modelos de predicción ISAR y HARP en una cohorte de pacientes mayores de 65 años atendidos en una unidad geriátrica de agudos. El estudio incluyó pacientes con índice de Barthel medido al ingreso y al alta y la evaluación de la capacidad de discriminación y calibración, dos aspectos fundamentales para esta medición. Resultados: de 833 pacientes evaluados, 363 (43.6%) presentaron deterioro funcional hospitalario al momento del alta. La escala HARP subestimó el riesgo de deterioro funcional hospitalario para los pacientes en las categorías de riesgo bajo e intermedio (relación entre eventos observados /esperados (ROE) 1.82 y 1.51, respectivamente). El HARP sobrestimó el riesgo de deterioro funcional hospitalario para pacientes en la categoría de alto riesgo (ROE 0.91). El ISAR subestimó el riesgo de deterioro hospitalario para pacientes en categorías de bajo y alto riesgo (ROE 1.59 y 1.11). Ambas escalas mostraron una pobre capacidad de discriminación, con un área bajo la curva (AUC) entre 0.55 y 0.60. Conclusiones: este estudio encontró que las escalas HARP e ISAR tienen una capacidad de discriminación limitada para predecir deterioro funcional hospitalario al alta. Las escalas HARP e ISAR deben usarse con cautela en la población colombiana ya que subestiman el riesgo de deterioro funcional hospitalario y tienen baja capacidad de discriminación.

Polifarmacia en pacientes mayores de 60 años en la Atención Primaria / Polypharmacy in patients over 60 years of age in primary health care

Los pacientes de la tercera edad conforman el grupo etario más medicado de la sociedad, principalmente por el incremento de la prevalencia de enfermedades crónicas, y por presentar tres características principales que lo diferencian de otros grupos de edad: polienfermedad, polifarmacia y cambios fisiológicos relacionados con el envejecimiento. El objetivo de esta investigación fue caracterizar la presencia de polifarmacia y las asociaciones de fármacos sugerentes de posibles interacciones medicamentosas potenciales, en el adulto mayor en un Consultorio Médico vinculado a la Farmacia Principal Municipal de Santa Clara.

Elderly patients make up the most medicated age group in society, mainly due to the increase in the prevalence of chronic diseases and because they have three main characteristics that differentiate them from other age groups: polypathology, polypharmacy and physiological changes related to aging. The objective of this research was to characterize the presence of polypharmacy and the associations of drugs suggestive of possible potential drug interactions in the elderly from a doctor's office linked to the Main Municipal Pharmacy of Santa Clara.

Polypharmacy and potential drug-drug interactions in adult outpatients receiving cardiovascular drugs

Background: The prevalence of polypharmacy is rising and is particularly relevant to cardiovascular diseases. Assessing the extent of polypharmacy and potential drug-drug interactions (pDDIs) is an essential first step in improving safe and rational use of drugs. Aims and Objective: This study aims to study the frequency of polypharmacy and pDDI in adult outpatients receiving cardiovascular drugs. Materials and Methods: Prescriptions of all adult outpatients receiving at least one cardiovascular drug were considered for the study. A total of 2027 prescriptions were analyzed for estimating rate of polypharmacy. Out of these, 335 randomly selected prescriptions were analyzed with the help of an online drug interaction checker software for estimating rate of pDDIs, commonly involved drug pairs and severity of pDDI. Results: The rate of polypharmacy in cardiac outpatients was 56.93% and that of pDDI was 78.81%. The commonly involved drugs in interactions were amlodipine, atenolol, calcium carbonate, atorvastatin, metformin, furosemide, and aspirin. One-third of pDDIs were categorized to be of minor severity while half of the pDDIs belonged to monitor closely category. Conclusion: Polypharmacy and pDDI are common in cardiac outpatients.

Heart Smart Diabetes Care

The world is growing smarter day by day, and so is health care. In spite of innumerable inventions and tech-tools, however, we struggle to contain chronic illnesses like diabetes and heart disease. We need to work together and design a rational, scientific and socially sustainable Heart Smart diabetes care ecosystem, with Heart Smart management strategies, to ensure happiness and harmony in persons who live with diabetes.

RELATIONSHIP BETWEEN POLYPHARMACY, LENGTH OF HOSPITALIZATION, AND DELIRIUM AMONG HOSPITALIZED ELDERLY PATIENTS

Background: Decreased organ function in the elderly is associated with the aging process, which initiates various chronic diseases and increases the risk of polypharmacy. Meanwhile, polypharmacy tends to provoke adverse drug reactions that prolong the treatment period and increases the risk of delirium in elderly patients. Aim: To determine the relationship between polypharmacy, length of hospitalization, and delirium in geriatrics admitted to the Universitas Sumatera Utara Hospital. An observational analytical study with a cross-sectional design was carried out Method: at the Universitas Sumatera Utara Hospital. Patients aged 60 years or older who had 2 or more drugs during hospitalization were enrolled, while those with incomplete medical records were excluded. The demographic and clinical data were gathered, processed, and analyzed using the Statistical Package for Social Sciences (SPSS) version 25 software and the P-value of <0.05 was considered signi?cant. A total of 116 subjects participated in this study and were dominated by males in the 60-69 Result: years age group. A signi?cant correlation was discovered between polypharmacy and the length of hospitalization (p=0.012). Polypharmacy was detected in 67.2% of subjects, 58.6% had an increased risk of drug interactions, 44% had a prolonged length of hospitalization, and 29.3% experienced altered mental status. This showed that several delirium-related drugs were still prescribed to geriatric patients, namely ranitidine (38.7%) and ketorolac (20.2%). There is a signi?cant Conclusion: relationship between polypharmacy, length of hospitalization, and delirium in geriatric patients.

Polifarmácia e adesão medicamentosa em idosos no âmbito da atenção básica de saúde: estudo transversal / Polypharmacy and drug adherence in the elderly in the context of primary health care: cross-sectional study

OBJETIVO: Avaliar a adesão medicamentosa em idosos que fazem o uso de polifarmácia no âmbito da Atenção Básica. MÉTODO: Estudo transversal de caráter quantitativo. A amostra foi constituída por 231 idosos. RESULTADOS: Dos 231 idosos que participaram do estudo 36,4% eram do sexo masculino e 63,6% do sexo feminino. A média de idade observada foi de 73,4 (± 8,7) anos. Houve uma diferença estatisticamente significativa entre as variáveis "sexo", "quantidade de medicamentos" e "possui cuidador". Ademais, observou-se a correlação estatística positiva entre a idade e a quantidade de medicamentos utilizada pelo idoso. A prevalência de polifarmácia identificada foi de 16,0%. A maior parte dos usuários de múltiplos fármacos apresentaram adesão ao tratamento (86,5%). CONCLUSÃO: Presume-se a necessidade de uma maior investigação da relação entre o cuidador e a quantidade medicamentos utilizados pelos idosos, além da capacitação profissional para o manejo da polifarmácia.

OBJECTIVE: To evaluate drug adherence in elderly people who use polypharmacy in the context of primary care. METHOD: Cross-sectional study of quantitative character. The sample consisted of 231 elderly. RESULTS: Of the 231 elderly who participated in the study, 36.4% were male and 63.6% were female. The mean age observed was 73.4 (± 8.7) years. There was a statistically significant difference among the variables "sex", "quantity of drugs" and "has caregiver". In addition, a positive statistical correlation was observed between age and the amount of drugs used by the elderly. The prevalence of polypharmacy identified was 16.0%. Most users of multiple drugs showed adherence to treatment (86.5%). CONCLUSION: It is assumed the need for a greater investigation of the relationship between the caregiver and the amount of medicines used by the elderly, in addition to professional training for the management of polypharmacy.

Research progress on coping strategies of unreasonable drug use in the elderly / 中华老年医学杂志

Irrational drug use is common and inevitable in the elderly population, which leads to the occurrence of adverse drug reactions, the increase of hospital readmission rate and related mortality rate, and the increase of medical economic burden.Therefore, it is imperative to reduce irrational drug use, and the standardized drug prescription has become a new challenge for clinicians and pharmacists.Accurate detection method of irrational drug use, practical and effective drug use scheme, and intervention measures are the key to guide rational drug use in clinical practice.Mainly in terms of risk factors of irrational drug use, the status quo and its coping strategies, this paper reviews the research status at home and abroad in order to reduce irrational drug use in the elderly, reduce drug risk, and improve medication environment for the elderly.