Learning demands of diabetes self-management: a qualitative study with people who use insulin.

OBJECTIVE: to understand the experiences with diabetes mellitus management of people who use insulin, in order to identify possible factors that may influence adherence to self-care and thus define their learning demands for diabetes self-management. METHOD: this is a qualitative study carried out using individual semi-structured interviews online. The interviews were recorded, transcribed and evaluated using Atlas.ti® software by means of Thematic Content Analysis, using the Health Beliefs Model as a theoretical framework. RESULTS: 11 people living with diabetes and using insulin took part in the study. Four categories were identified: understanding diabetes, how to deal with diabetes, difficulties related to insulin use and emotional adaptation. CONCLUSION: the perception of the severity of the disease, its complications and the benefits of adhering to treatment positively influences adherence to self-care behaviors. Although the study participants have lived with diabetes for many years, they are not exempt from difficulties related to insulin use and disease management, reinforcing the importance of continuing health education. In this sense, the findings of this study guide important educational themes to be worked on by health professionals to promote autonomy in diabetes self-management. BACKGROUND: (1) Perceived severity of diabetes positively influences self-care. (2) Continued health education for people who use insulin is essential. (3) The importance of recognizing the benefits of insulin in adherence to treatment. (4) Emotional aspects in diabetes management should be considered in health education.

Learning demands of diabetes self-management: a qualitative study with people who use insulin / Demandas de aprendizaje para la autogestión de la diabetes: estudio cualitativo con personas que utilizan insulina / Demandas de aprendizado da autogestão do diabetes: estudo qualitativo com pessoas que utilizam a insulina

Objective: to understand the experiences with diabetes mellitus management of people who use insulin, in order to identify possible factors that may influence adherence to self-care and thus define their learning demands for diabetes self-management. Method: this is a qualitative study carried out using individual semi-structured interviews online. The interviews were recorded, transcribed and evaluated using Atlas.ti® software by means of Thematic Content Analysis, using the Health Beliefs Model as a theoretical framework. Results: 11 people living with diabetes and using insulin took part in the study. Four categories were identified: understanding diabetes, how to deal with diabetes, difficulties related to insulin use and emotional adaptation. Conclusion: the perception of the severity of the disease, its complications and the benefits of adhering to treatment positively influences adherence to self-care behaviors. Although the study participants have lived with diabetes for many years, they are not exempt from difficulties related to insulin use and disease management, reinforcing the importance of continuing health education. In this sense, the findings of this study guide important educational themes to be worked on by health professionals to promote autonomy in diabetes self-management.

Objetivo: comprender las experiencias en el manejo de la diabetes mellitus de personas que utilizan insulina, para identificar posibles factores que pueden influir en la adhesión al autocuidado y, así, definir sus demandas de aprendizaje para la autogestión de la diabetes. Método: se trata de una investigación cualitativa realizada mediante entrevistas semi-estructuradas individuales en la modalidad online . Las entrevistas fueron grabadas, transcritas y evaluadas en el software Atlas.ti ® mediante el Análisis de Contenido Temático, utilizando como marco teórico el Modelo de Creencias en Salud. Resultados: participaron 11 personas que conviven con diabetes, usuarias de insulina. Se identificaron cuatro categorías: entendimiento sobre la diabetes, cómo lidiar con la diabetes, dificultades relacionadas con el uso de la insulina y adaptación emocional. Conclusión: la percepción sobre la severidad de la enfermedad, sus complicaciones, y de los beneficios de adherirse al tratamiento influye positivamente en la adhesión a los comportamientos de autocuidado. A pesar de que los participantes del estudio han convivido muchos años con la diabetes, no están exentos de dificultades relacionadas con el uso de la insulina y el manejo de la enfermedad, reforzando la importancia de la educación en salud continuada. En este sentido, los hallazgos de este estudio orientan temas educativos importantes a ser trabajados por los profesionales de la salud para la promoción de la autonomía en la autogestión de la diabetes.

Objetivo: compreender as experiências com o manejo do diabetes mellitus de pessoas que utilizam a insulina, para identificar possíveis fatores que podem influenciar na adesão ao autocuidado e, assim, definir suas demandas de aprendizado para a autogestão do diabetes. Método: trata-se de pesquisa qualitativa realizada por meio de entrevistas semiestruturadas individuais na modalidade online . As entrevistas foram gravadas, transcritas e avaliadas no software Atlas.ti ® por meio da Análise de Conteúdo Temática, utilizando-se como referencial teórico o Modelo de Crenças em Saúde. Resultados: participaram 11 pessoas que convivem com diabetes, usuárias de insulina. Foram identificadas quatro categorias: entendimento sobre o diabetes, como lidar com o diabetes, dificuldades relacionadas ao uso da insulina e adaptação emocional. Conclusão: a percepção sobre a severidade da doença, suas complicações, e os benefícios de aderir ao tratamento influencia positivamente na adesão aos comportamentos de autocuidado. Apesar dos participantes do estudo conviverem há muitos anos com o diabetes, eles não são isentos de dificuldades relacionadas ao uso da insulina e ao manejo da doença, reforçando a importância da educação em saúde continuada. Nesse sentido, os achados deste estudo norteiam temas educacionais importantes a serem trabalhados pelos profissionais da saúde para promoção da autonomia na autogestão do diabetes.

Barriers and enablers to deprescribing benzodiazepines in older adults: elaborating an instrument and validating its content / Facilitadores e dificultadores do processo de desprescrição de benzodiazepínicos em idosos: elaboração de um instrumento e validação de seu conteúdo

OBJECTIVE: To elaborate and validate an instrument on barriers and enablers to deprescribing benzodiazepines in the patient's perspective. METHODS: This study was conducted in 3 stages: (1) a methodological stage, (2) a semi-structured pilot interview with 25 older adults undergoing clonazepam deprescribing, and (3) content validation with the Delphi technique. Content validation was performed by 50 specialists with degrees and/or experience with primary health care and/or health care of older adults, such as physicians, pharmacists, and nurses. For evaluating the obtained results, we analyzed the concordance of evaluations with the coefficient of content validity (CCV). We considered values equal to or higher than 0.8 as acceptable levels of concordance. RESULTS: The instrument was considered validated in the first round of evaluation, where all items obtained a CCV of more than 0.8 in the specialists' assessment. Nevertheless, they proposed improvements that were incorporated to the final version of the questionnaire. CONCLUSION: The instrument represents an important tool to be used by health care professionals for optimizing benzodiazepine deprescribing, with suitable levels of clarity and validity.

OBJETIVO: Elaborar e validar um instrumento sobre facilitadores e dificultadores do processo de desprescrição de benzodiazepínicos na perspectiva do paciente. METODOLOGIA: Estudo desenvolvido em três etapas, quais sejam: (1) metodológica, (2) entrevista piloto semiestruturada com 25 idosos em desprescrição de clonazepam e (3) validação de conteúdo por meio da técnica de Delphi. A validação deu-se por 50 especialistas com formação e/ou experiência na área da Atenção Primária à Saúde e/ou Saúde do Idoso, entre eles médicos, farmacêuticos e enfermeiros. Como medidas para avaliar os resultados obtidos, foi analisada a concordância da avaliação por meio do coeficiente de validade de conteúdo (CVC). Considerou-se como nível aceitável de concordância o valor maior ou igual a 0,8. RESULTADOS: O instrumento foi considerado validado na primeira rodada de avaliação, em que todos os itens avaliados obtiveram CVC superior a 0,8 na avaliação dos especialistas. Entretanto, estes propuseram sugestões de melhorias que foram incorporadas na versão final do questionário. CONCLUSÃO: O instrumento apresenta-se como uma importante ferramenta a ser utilizada pelos profissionais de saúde para a otimização do processo de desprescrição de benzodiazepínicos, possuindo índice de clareza e de validade adequados.

Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines.

Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval - 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.

INSAF-HAS: a tool to select patients with hypertension for pharmaceutical care.

OBJECTIVE: To develop and validate the content of a tool aimed to select patients with hypertension for pharmaceutical care, based on identification of individuals in greater need of attention. METHODS: The tool was developed and assessed for face and content validity, which was carried out in three stages. Phase I consisted of comprehensive literature review, which prompted the development of the first version of the tool. Phase II consisted of validation by an expert panel. Phase III consisted of a pilot study with hypertensive patients and preparation of the final version of the instrument. RESULTS: Literature review yielded 30 studies, out of which 13 factors associated with hypertension and cardiovascular disease control and complications were selected. Once the initial version of the tool named INSAF-HAS was obtained, four expert meetings were held, each leading to instrument improvement until a final consensus was reached. In the pilot study, INSAF-HAS was applied to 30 patients with a diagnosis of hypertension for applicability pretest; adjustments were made and the final version of INSAF-HAS obtained. CONCLUSION: The INSAF-HAS tool developed in this study has face and content validity, and may contribute to the selection of patients with hypertension in greater need of pharmaceutical care services.

Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines / Utilização de medicamentos para distúrbios gastrintestinais: evidências da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos

ABSTRACT Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval − 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.

RESUMO Objetivo Estimar a prevalência de utilização de medicamentos para o tratamento de distúrbios gastrintestinais, segundo características demográficas, socioeconômicas e de saúde da população brasileira. Métodos Trata-se de inquérito de base populacional, que entrevistou indivíduos residentes em municípios das cinco regiões do Brasil. A amostra deste estudo foi composta por 32.348 indivíduos de 20 anos ou mais de idade. Foi avaliado o perfil de utilização de medicamentos para distúrbios gastrintestinais entre as variáveis sexo, idade, plano de saúde, região e número de doenças crônicas. Analisou-se a frequência de indivíduos que declararam utilizar outros medicamentos, além daqueles já utilizados para tratamento de distúrbios gastrintestinais. Além disso, foram estimadas as frequências das classes medicamentosas utilizadas. Resultados A prevalência de utilização de medicamentos para distúrbios gastrintestinais no Brasil foi de 6,9% (intervalo de confiança de 95% − 6,4-7,6), sendo maior no sexo feminino, entre pessoas acima de 60 anos de idade, naqueles que possuíam plano privado de saúde e tinham duas ou mais doenças crônicas. Observou-se que 42,9% dos idosos que utilizaram medicamentos para distúrbios gastrintestinais também eram polimedicados. Em relação às classes medicamentosas, 82% correspondiam a medicamentos para o trato alimentar e metabolismo, destacando os inibidores da bomba de prótons. Conclusão A utilização de medicamentos para tratamento de distúrbios gastrintestinais foi significativa entre mulheres e idosos. Nesta faixa etária, o consumo pode estar vinculado à proteção gástrica causada por polimedicação. Este estudo representa oportunidade inédita para observar o perfil de consumo autorreferido desses medicamentos no Brasil e pode, portanto, subsidiar estratégias para promoção de seu uso racional.

INSAF-HAS: a tool to select patients with hypertension for pharmaceutical care / INSAF-HAS: ferramenta para seleção de pacientes com hipertensão arterial sistêmica e inserção em serviços de cuidado farmacêutico

ABSTRACT Objective To develop and validate the content of a tool aimed to select patients with hypertension for pharmaceutical care, based on identification of individuals in greater need of attention. Methods The tool was developed and assessed for face and content validity, which was carried out in three stages. Phase I consisted of comprehensive literature review, which prompted the development of the first version of the tool. Phase II consisted of validation by an expert panel. Phase III consisted of a pilot study with hypertensive patients and preparation of the final version of the instrument. Results Literature review yielded 30 studies, out of which 13 factors associated with hypertension and cardiovascular disease control and complications were selected. Once the initial version of the tool named INSAF-HAS was obtained, four expert meetings were held, each leading to instrument improvement until a final consensus was reached. In the pilot study, INSAF-HAS was applied to 30 patients with a diagnosis of hypertension for applicability pretest; adjustments were made and the final version of INSAF-HAS obtained. Conclusion The INSAF-HAS tool developed in this study has face and content validity, and may contribute to the selection of patients with hypertension in greater need of pharmaceutical care services.

RESUMO Objetivo Desenvolver e realizar a validação de conteúdo de uma ferramenta para seleção de pacientes com hipertensão arterial sistêmica a serem atendidos em serviços de cuidado farmacêutico, com base na identificação daqueles com maior necessidade dessa assistência. Métodos O instrumento foi desenvolvido e avaliado por validação de face e conteúdo, subdividida em três fases. A fase I abordou ampla revisão bibliográfica, que originou a versão inicial da ferramenta. Na fase II, realizou-se a validação com a análise de um painel de experts . A fase III foi composta por estudo piloto realizado com pacientes com hipertensão, tendo sido definida a versão final do instrumento. Resultados A partir da revisão bibliográfica, 30 estudos foram consultados, e foram selecionados 13 fatores associados ao controle e à ocorrência de complicações, relacionados à hipertensão arterial sistêmica e a doenças cardiovasculares. Por conseguinte, mediante a versão inicial da ferramenta intitulada INSAF-HAS, realizaram-se quatro reuniões com especialistas, para obtenção de consenso final. A cada encontro, o instrumento foi aprimorado. No estudo piloto, 30 pacientes com diagnóstico de hipertensão arterial sistêmica foram abordados para o pré-teste de avaliação da aplicabilidade e, após as adequações, obteve-se a versão final do INSAF-HAS. Conclusão A ferramenta elaborada INSAF-HAS apresenta validade de face e conteúdo. Ela deve contribuir para a seleção de pacientes portadores de hipertensão arterial sistêmica e com maior necessidade de participação em serviços de cuidado farmacêutico.

Analysis of clinical pharmacist interventions in the neurology unit of a Brazilian tertiary teaching hospital.

It is estimated that around five to 10.0% of hospital admissions occur due to clinical conditions resulting from pharmacotherapy. Clinical pharmacist's activity can enhance drug therapy's effectiveness and safety through pharmacotherapy interventions (PIs), thus minimizing drug-related problems (DRPs) and optimizing the allocation of financial resources associated with health care. This study aimed to estimate the DRPs prevalence, evaluate PI which were performed by clinical pharmacists in the Neurology Unit of a Brazilian tertiary teaching hospital and to identify factors associated with the occurrence of PI-related DRP. A single-arm trial included adults admitted in the referred Unit from 2012 July to 2015 June. Patients were evaluated during their hospitalization period and PIs were performed based on trigger DRPs that were detected in medication reconciliation (admission or discharge) or during inpatient follow-up. Student's t-test, Chi-square test, Pearson and Multiple logistic regression models to analise the association among age, number of drugs, hospitalization period, and number of diagnoses with occurrence of DRPs. Analyses level of significance was 5%. In total 409 inpatients were followed up [51.1% male, mean age of 49.1 (SD 16.5)]. Patients received, on average, 11.9 (SD 5.8) drugs, ranging from two to 38 drugs per patient, and 54.3% of the sample presented at least one DRP whose most frequent description was "untreated condition". From all 516 performed PIs that resulted from DRPs, 82.8% were accepted and the majority referred to "drug introduction" (27.5%). Multiple logistic regression showed that age, length of hospital stay, number of drugs used, diagnosis of epilepsy, multiple sclerosis and myasthenia gravis would be clinical variables associated with DRP (p < 0,05). Monitoring the use of drugs allowed the clinical pharmacist to detect DRPs and to suggest interventions that promote rational pharmacotherapy.