Predictors of drug-drug interactions of medications prescribed to patients admitted due to suicidal behavior.

INTRODUCTION: Drug-drug interactions among people with suicidal behavior is a challenging topic, considering the harm it poses for patients already vulnerable and the lack of literature on the thematic. This aspect must not be neglected in research and clinical practice, and thus requires thorough investigation. OBJECTIVE: to investigate predictors of drug-drug interaction of prescribed drugs and the prescription of two or more drugs for people admitted due to suicidal behavior in a psychiatric emergency department (short-stay hospital ward). METHOD: A cross-sectional study with retrospective approach, carried out in a Brazilian psychiatric emergency unit in 2015. Data about first and last medical prescriptions were collected from 127 patients' files. Descriptive statistics and the Zero Adjusted Logarithmic Distribution (ZALG) model were adopted, with the significance level α = 0.05. RESULTS: Potential drug-drug interactions were found in most of the first and last prescriptions. The sample majority were female, with previous suicide attempts, being discharged from the hospital with three drugs (or more) prescribed, and without referral to any health service. Age and comorbidities were predictors of more drug prescriptions and the amount of prescribed drugs was the most important predictor of drug-drug interactions (quantity and severity). CONCLUSIONS: the variables associated with drug-drug interactions and prescription of two or more drugs among people with suicidal behavior needs to be investigated in different contexts and addressed in interventions with the aim to promote patient safety.

Theoretical domains framework como ferramenta para pesquisas de implementação no Brasil: uma adaptação cultural / Theoretical domains framework as a tool for implementation research in Brazil: a cultural adaptation

Introdução: O Theoretical Domains Framework é uma estrutura integrativa que investiga os determinantes do comportamento e ainda não foi difundida para uso no Brasil. Considerado que a implementação de práticas baseadas em evidências depende basicamente de comportamentos relacionados à adesão ou não a uma prática há muitas barreiras e facilitadores a serem superados. O comportamento e sua mudança são complexos e influenciados por diversos fatores - cognitivos, afetivos, sociais e ambientais. Compreender tais fatores é crucial para a modificação de comportamentos que atuam como barreira para a implementação de práticas mais éticas e fundamentadas cientificamente. Sendo assim, o presente estudo metodológico de adaptação cultural possui o objetivo de adaptar culturalmente o Theoretical Domains Framework para o português brasileiro. Método: A adaptação consistiu na tradução, análise por comitê de especialistas, retrotradução, análise por especialista em estudos utilizando a estrutura e análise final por comitê de especialistas. Análise de concordância dos especialistas utilizou o teste estatístico first-order agreement coefficient (AC1) com nível de significância α= 0.05. Para confiabilidade de avaliação entre observadores, foi adotado para o presente estudo, o alcance do valor AC1 ≥ 0,8 ou a concordância percentual ≥ 80%. Resultados: Foi obtida concordância final entre observadores ≤0,005 e a estrutura foi considerada adaptada para o português do Brasil. Considerações Finais: Trata-se de estudo pioneira da adaptação do TDF para língua diferente da de origem. Com a disponibilização da estrutura para profissionais e pesquisadores do Brasil, espera-se contribuir para a investigação dos fatores que atuam como barreiras e/ou facilitadores na implementação das práticas baseadas em evidências, em diversas áreas e, principalmente, para a melhora do cuidado em saúde no país

Background: The Theoretical Domains Framework is an integrative framework that investigates the behavioural determinants and it's not well diffused in Brazil. Considering that the evidence-based practice implementation depends basically on behaviours related to adherence and to adhere or not to a practice, there are several barriers and enablers that needs to be overcome. The behaviour and its change are complex and influenced by several factors - cognitive, affective, social, and environmental. Understanding these factors and how they act as barriers and/or facilitators to quality and ethical practices its crucial to change behaviours considered barriers to an implementation intervention. Therefore, the present methodological study aims to culturally adapt the Theoretical Domains Framework to the Brazilian Portuguese. Method: The adaptation was developed following six stages: translation, expert committee analysis, backtranslation, analysis by the original authors, translation, and expert committee analysis. To analyse the expert agreement was used the first-order agreement coefficient (AC1) with a significance level of α= 0.05. To address the reliability of the expert agreement, the AC1 ≥ 0,8 or the percentual agreement of ≥ 80% was adopted. Results: The final agreement between experts was achieved (≤0,005) and the framework was adapted to the Brazilian Portuguese. Conclusions: With the availability of the framework to Brazilian researchers and professionals, we aim contribute to the investigation of factors that act as barriers and enablers on the evidence-based practice implementation in several areas, improving the quality of the healthcare in Brazil