RESUMO
Introduction: Given the number of patients with mental conditions who receive treatment within the primary care (PC) context, and the high prevalence of multimorbidity (especially in older people), there is a need to study mental-physical multimorbidity (MPM) in this population and context. This study sought to identify the impact on health-related quality of life (QoL) of MPM in adults aged 60 years and older. Material and methods: Secondary analysis of data derived from 251 primary health individuals. Data were collected via a sociodemographic and clinical questionnaire. Health-related QoL was assessed using the SF-12 instrument. Multiple linear regressions were performed for physical and mental health in MPM patients and in patients with physical-only multimorbidity. Results: Mean age of participants was 70.6 years; 57.8% were female. Quality of life was lower in MPM patients than in those with physical-only multimorbidity. Regarding MPM patients, female sex, 75 years and over, and low income were associated with worse physical health. Female sex was also associated with worse mental health. Conclusions: This study contributes to the global knowledge of MPM in older people, illuminates health-related QoL differences among MPM and physical-only multimorbidity patients, and highlights the importance of non-modifiable characteristics associated with deterioration of health-related QoL. Team collaboration between primary care physicians, psychiatrists (and other mental health providers), and social workers may be necessary to assess psychiatric and physical symptoms and provide for the care needs of older people with MPM.
RESUMO
BACKGROUND: Non steroidal anti-inflammatory drugs computer-assisted prescription in General Practice/Family Medicine (GP/FM) ambience can give information about the prescription profile during a period of time and understand its trend. Such prescription profile could vary according to the urban (city) vs non urban (village) setting of the GP/FM practice. OBJECTIVES: To characterize the prescription trends of non steroidal inflammatory drugs (NSAIDs) in General Practice, from 2007 to 2009, by public sales price per inscript, daily defined doses (DDD) per inscript and price of DDD. To verify differences of the three fractions according to the urban vs non urban health centre. MATERIAL AND METHODS: Retrospective observational study conducted in February 2010, by the analysis of prescription informatic files automatically generated when the prescription was made. Population calculated at the middle point of each period of study. The differences in volume prescription in Daily Defined Dose (DDD) per registered patient in the middle of 2006 and 2007 two semesters, as well as the value of prescription measured by the price per registered patient were calculated and medicines were studied by the third level of the Portuguese medicines classification very similar to the ATC. The price per DDD was calculated as well. RESULTS: The studied population was of 315.377 subjects in 2007, 321.784 in 2008 and 331.106 in 2009. In price per inscript urban health centres showed a growth from 2007 to 2009 in "Indol and Inden" derivatives (+51.6%), in "Propionic acid derivatives" (+39.4%) and in "Selective cox-2 inhibitors" (+33.6%). For "Sulfanilamidic derivatives, a reduction of 3.8% was verified. For non urban Health Centres prescription a generalised reduction in price per inscript was observed. For DDD/per inscript from 2007 to 2009 we found a generalised increase for urban health centres, except for "Oxicans". For non urban Health Centres there is a generalised decrease of DDD/per inscript from 2007 to 2009, with a special decrease for non-acidic compounds. As for Price of DDD from 2007 to 2009 there is a generalised reduction of such ratio with the only exception of "non acidic compounds" (+9,1%) for urban Health Centres. In view of the calculated ratios, the differences by urban vs non urban Health Centre in each of the studied years there is a significant higher value in non urban health centre, with the exception of Price of DDD for 2008 and 2009 where such ratio is non significantly higher in urban heath centre. CONCLUSIONS: During the study period, demographic growth was higher than the prescription growth in volume and in value. Prescription was more frequent and expensive in non-urban Health Centres. Price of DDD decreases from 2007 to 2009 signifying a much cheaper NSAIDs therapeutics.
