Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey.

BACKGROUND: With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs). OBJECTIVE: This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families. METHODS: US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance. RESULTS: Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families. CONCLUSIONS: Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary.

Healthcare Providers' Attitudes and Experiences of the Quality Use of Medications Among Culturally and Linguistically Diverse Patients in Australia: A Systematic Review of Qualitative Studies.

This review aims to identify healthcare providers' (HCPs) experiences with issues related to the quality use of medicines among culturally and linguistically diverse (CALD) patients, the underlying factors, and the enablers of and barriers to providing culturally safe care to promote quality use of medicines. The searched databases were Scopus, Web of Science, Academic search complete, CINHAL-Plus, Google Scholar and PubMed/Medline. The initial search returned 643 articles, of which 14 papers were included. HCPs reported that CALD patients were more likely to face challenges in accessing treatment and sufficient information about treatment. According to the theoretical domains framework, determinants such as social influences due to cultural and religious factors, lack of appropriate resources about health information and cultural needs, lack of physical and psychological capabilities such as lack of knowledge and skills, and lack of motivation could impede HCPs' abilities to provide culturally safe care. Future interventions should deploy multilevel interventions, such as education, training, and organisation structural reforms.

Actividades de superación profesional de médicos generales integrales sobre el uso racional de medicamentos / Professional training activities of comprehensive general doctors on the rational use of medications i: en

Introducción: El uso irracional de medicamentos se debe, entre otros elementos, a la falta de superación profesional; situación con mayor repercusión en la atención primaria de salud, donde generalmente laboran los médicos generales integrales. Objetivo: Caracterizar las actividades de superación profesional de médicos generales integrales sobre el uso racional de medicamentos. Métodos: Se realizó un estudio descriptivo y transversal de 269 médicos generales integrales que laboraban en los consultorios del médico de la familia o en los servicios de urgencia de las 17 áreas de salud del municipio de Santiago de Cuba en el período comprendido desde enero hasta julio de 2022, quienes fueron seleccionados mediante muestreo probabilístico por conglomerado bietápico. Se consideró como variable las actividades de superación profesional relacionadas con el uso racional de medicamentos, las cuales fueron valoradas a través de 5 indicadores. Resultados: La triangulación metodológica de los resultados evidenció que el nivel alcanzado en cuanto a la frecuencia de realización de dichas actividades fue bajo (índice de 1,18), al igual que lo obtenido en los indicadores analizados, excepto en el referido a la autopreparación que mostró un nivel medio. Conclusiones: Las actividades de superación profesional de los médicos generales integrales relacionadas con el uso racional de medicamentos en el municipio de Santiago de Cuba se caracterizaron por un nivel bajo de frecuencia de realización.

Introduction: Irrational use of medications is, among other elements, due to the lack of professional training; situation with more repercussion in primary health care, where comprehensive general doctors generally work. Objective: To characterize the professional training activities of comprehensive general doctors on the rational use of medications. Methods: A descriptive and cross-sectional study of 269 comprehensive general doctors who worked in the family doctor offices or in the emergency services of the 17 health areas of Santiago de Cuba municipality was carried out from January to July, 2022, who were selected by means of a probabilistic sampling by biphase conglomerate. The activities of professional training related to the rational use of medications were considered as variable, which were valued through 5 indicators. Results: The methodological triangulation of the results evidenced that the level reached as for the frequency of realization of this activities was low (index of 1.18), as well as what was obtained in the analyzed indicators, except the one referred to the self-preparation which showed a mean level. Conclusions: Professional training activities of comprehensive general doctors related to the rational use of medications in Santiago de Cuba municipality were characterized by a low level of realization frequency.

Medication Fall Risk Score e Evaluation Tools: Adaptação Transcultural para o uso no Brasil / Medication Fall Risk Score and Evaluation Tools: Cross-Cultural daptation for Use in Brazil

A queda é um problema potencial para todos os pacientes já que o risco aumenta no ambiente hospitalar, independente da instituição. Muitos fatores podem estar associados a queda, dentre eles o equilíbrio, que pode ser influenciado pelo uso de medicamentos. A aplicação de escala de avaliação para risco de quedas é uma das ferramentas mais empregadas no Brasil e no mundo, porém se faz necessário avaliar também os medicamentos em uso do paciente. Com o objetivo de realizar a adaptação transcultural e validação do Medication Falls Risk Score e da Evaluation Tools para a língua portuguesa do Brasil. Método: Estudo metodológico para a adaptação transcultural e validação das ferramentas Medication Falls Risk Score e Evaluation Tools, utilizando-se o protocolo de Beaton et al. e realizando a validação da praticabilidade de ambas as escalas. Os instrumentos obtiveram Índice de Validade de Conteúdo (IVC) médio de 0,99, sendo considerados válidos. A validação da praticabilidade de ambos os instrumentos teve resultados favoráveis, 65,2% dos participantes acharam a ferramenta de fácil aplicação, e o tempo médio gasto para a aplicação foi de 13 minutos e 30 segundos. Dentre as dificuldades encontradas, destaca-se a de reconhecer os medicamentos perante sua classe terapêutica, o que justifica a diferença entre o tempo de aplicação e acerto do teste aplicado. As ferramentas foram adaptadas transculturalmente para o português brasileiro, e apontaram uma excelente concordância e viabilidade de uso na prática nos cenários de atenção em saúde. A escala e as ferramentas aprovadas poderão servir como apoio para identificação, classificação e cuidado multiprofissional perante o risco de quedas de pacientes internados, sendo uma avaliação adicional a Morse Fall Scale - versão brasileira.

Falls are a potential problem for all patients, especially as the risk increases in the hospital environment, regardless of the institution. Many factors may be associated with falls, including balance, which may be influenced by the use of medication. The application of an assessment scale for the risk of falls is one of the most used tools in Brazil and in the world, but it is also necessary to evaluate the medications the patient is using. The objective of this study is to carry out the cross-cultural adaptation and validation of the Medication Falls Risk Score and the Evaluation Tools for the Brazilian Portuguese language. Method: Methodological study for the cross-cultural adaptation and validation of the Medication Falls Risk Score and Evaluation Tools, using the protocol by Beaton et al. and performing the validation of the feasibility of both scales. The instruments obtained an average Content Validity Index (CVI) of 0.99, being considered valid. The validation of the feasibility of both instruments had favorable results, 65.2% of the participants found the tool easy to apply, and the average time taken to apply it was 13 minutes and 30 seconds. Among the difficulties encountered, the difficulty of recognizing the drugs in terms of their therapeutic class stands out, which justifies the difference between the time of application and the accuracy of the applied test. The tools were cross-culturally adapted to Brazilian Portuguese and demonstrated excellent agreement and practicality in healthcare settings. The approved scale and tools may serve as support for the identification, classification, and multidisciplinary care regarding the risk of falls in hospitalized patients, with the Morse Fall Scale - Brazilian version being an additional assessment.

Análise da automedicação pediátrica em pacientes atendidos em hospital de alta complexidade / Analysis of pediatric self-medication in patients treated at a highcomplexity hospital

A automedicação pediátrica ocorre quando pais ou responsáveis usam medicamentos sem prescrição para tratar doenças ou sintomas reconhecidos nas crianças. Analisar o perfil da automedicação pediátrica em um hospital de alta complexidade no interior do Ceará. Trata-se de um estudo transversal baseado na técnica de entrevista, realizado com 135 pais/responsáveis de crianças com idade entre 0 a 12 anos que procuraram atendimento hospitalar entre novembro de 2020 e março de 2021. Observou-se uma prevalência de automedicação de 60%. Quanto à frequência, 43,2% dos entrevistados relataram realizar às vezes. Destes, a maioria era: mãe (94,3%; p<0,0001), com 17 a 27 anos (48,6%; p<0,0001) e renda familiar de menos de 1 salário mínimo (57,1%; p=0,020); 59,3% apontaram como motivo considerar o problema de saúde simples. A principal causa da automedicação foi a febre e os medicamentos mais utilizados foram analgésicos e antipiréticos. A predominância da automedicação pediátrica pelas mães deve-se à experiência com seus outros filhos. Além disso, as condições socioeconômicas influenciaram as práticas errôneas da automedicação, pois as famílias que não possuem recursos para a consulta e compra dos fármacos acabam optando pela autoadministração. O uso indiscriminado de medicações deve ser reprimido, pois, a depender da dose, consequências graves podem ocorrer às crianças. Destaca-se a importância da equipe multiprofissional de saúde durante uma consulta pediátrica, com médicos, enfermeiros e farmacêuticos repassando aos pais informações a respeito dos medicamentos, seus benefícios e riscos, desestimulando a prática nesta faixa populacional e reduzindo os erros de medicação.

Pediatric self-medication occurs when parents or guardians use over-the-counter medications to treat recognized illnesses or symptoms in children. To analyze the profile of pediatric self-medication in a high-complexity hospital in the interior of Ceará. This is a cross-sectional study based on the interview technique, carried out with 135 parents/guardians of children aged 0 to 12 years old who sought hospital care between November 2020 and March 2021. There was a prevalence of self-medication of 60%. As for frequency, 43.2% of respondents reported doing it sometimes. Of these, the majority were: mothers (94.3%; p<0.0001); aged 17 to 27 years old (48.6%; p<0.0001); family income of less than 1 minimum wage (57.1 %; p=0.020); and 59.3% indicated that their reason for medicating was that they considered the health problem as simple. The main cause of self-medication was fever, and the most used drugs were analgesics and antipyretics. The predominance of pediatric self-medication by mothers is due to their experience with their other children. In addition, socioeconomic conditions influenced the erroneous practices of self-medication, as families that do not have the resources to consult and purchase drugs end up opting for self-administration. The indiscriminate use of medications must be repressed, because, depending on the dose, serious consequences can occur to children. The importance of a multidisciplinary health team during a pediatric consultation is highlighted, with doctors, nurses, and pharmacists providing parents with information about medication, their benefits and risks, discouraging the practice in this population group and reducing medication errors.

Factores asociados al consumo de alcohol en adolescentes residentes en Lima, Perú / Factors associated with alcohol consumption in adolescents living in Lima, Peru

Introducción: El consumo de alcohol es particularmente alto en América Latina y el Caribe. Los estudios en Perú sobre prevención y consumo de drogas en estudiantes de educación secundaria lo reportan como problema de salud. Objetivo: Determinar las variables del factor personal, familiar y social que están asociadas con el consumo de alcohol en adolescentes de un colegio particular del distrito de Villa María del Triunfo, Lima, en 2016. Material y Métodos: Estudio transversal, con una muestra de 194 adolescentes, se aplicó muestreo aleatorio estratificado, donde los estratos fueron los grados de estudio del primero al quinto grados de secundaria. Se recolectó la información mediante la aplicación de un cuestionario estructurado. Resultados: 47,4 por ciento de los escolares consumió alcohol en el último año; con respecto al factor personal a los estudiantes que les ofrecieron bebida alcohólica tuvieron 11,84 (OR = 11,84; 95 por ciento CI 5,31:26,4; p** <0,001) veces más de probabilidad de consumirla respecto a los estudiantes que no les ofrecieron. Con respecto al factor familiar, los estudiantes que no tienen ningún familiar enfermo en casa tienen 2,21 (OR = 2,21; IC 95 por ciento 1,11:4,36; p** <0,001) veces más de uso de medicamentos. Las variables del factor social no fueron factores de riesgo. Conclusiones: Casi la mitad de los adolescentes consumieron bebidas alcohólicas en el último año y según los factores favorecedores del consumo destaca en primer lugar el factor personal, seguido de familiares; el factor social no estuvo asociado con el consumo de alcohol(AU)

Introduction: Alcohol consumption is particularly high in Latin America and the Caribbean. Studies conducted on drug prevention and use in high school students in Peru report it as a health problem. Objective: To determine the variables related to personal, family and social factors associated with alcohol consumption in adolescents from a private school in the district of Villa María del Triunfo, Lima, in 2016. Material and Methods: Cross-sectional study with a sample of 194 adolescents, using a stratified random sampling where the strata were the study grades from the first to the fifth grades of secondary school. The information was collected by applying a structured questionnaire. Results: Our results show that 47,4 percent of schoolchildren consumed alcohol in the last year; with respect to the personal factor, the students who were offered alcoholic drinks were 11,84 (OR = 11,84; 95 percent CI 5,31:26,4; p** <0,001) times more likely to consume an alcoholic beverage compared to the students who were not offered them. Regarding family factor, the students who did not have a sick family member at home were 2,21 (OR = 2,21; IC 95 percent 1,11:4,36; p** <0,001) times more likely to consume alcoholic beverages compared to students who had a sick family member at home. The variables related to social factor were not risk factors. Conclusions: Almost half of the adolescents consumed alcoholic beverages in the last year and according to the factors favoring consumption, the personal factor stands out in the first place, followed by relatives; the social factor was not associated with alcohol consumption(AU)

La actualización sobre el uso racional de medicamentos en el proceso de superación del médico general integral en Cuba: aspectos históricos / Upgrading on the rational use of medications in the training process of the comprehensive general doctor in Cuba: historical aspects

La relevancia y el alcance del uso racional de medicamentos y su contribución al mejoramiento de la salud poblacional constituyen suficientes argumentos para que el médico general integral en Cuba lo adopte como modalidad de superación que cualifica su desempeño profesional. Al respecto, se han desarrollado varios estudios históricos sobre la superación de este especialista; sin embargo, se requiere profundizar en determinados temas que pueden aportarle un sentido renovador como prescriptor de medicamentos. A tal efecto, en este artículo se exponen los antecedentes del proceso de educación de posgrado de este galeno, con énfasis en la actualización sobre el uso racional de medicamentos. Pudo concluirse que existen vacíos importantes en el diseño de superación profesional en cuanto al uso racional de medicamentos en la atención primaria de salud; no obstante, se reconoce la trascendencia social de esa problemática por parte de los niveles directivos correspondientes.

The relevance and reach of the rational use of medications and their contribution to the improvement of the populational health constitute enough arguments so that the comprehensive general doctor in Cuba adopts it as training modality that qualifies his professional performance. In this respect, several historical studies have been developed on the training of these specialists; however, it is required to deepen in certain topics that can contribute a renovating sense to them as drugs prescribers. To such an effect, the history of the postdegree educational process of this doctor is exposed in this work, with emphasis in upgrading on the rational use of medications. It could be concluded that there are important gaps in the training design as for the rational use of medications in the primary health care; nevertheless, the social transcendency of that problem is recognized on the part of the corresponding directive levels.

Criterios de medicación potencialmente inapropiada para el anciano: una propuesta cubana / Medication approaches potentially inappropriate for the elderly: a Cuban proposal

Introducción: El impacto de la prescripción inapropiada de fármacos en el anciano ha llevado al desarrollo de métodos para su reducción en varias partes del mundo. Objetivo: Diseñar y validar los criterios de medicación potencialmente inapropiada en el anciano, adaptados al entorno sociosanitario de Cuba. Métodos: Se realizó una investigación cualitativa, en la cual los criterios fueron validados por medio de la metodología Delphi, por un comité de expertos (especialistas en medicina geriátrica y clínica de diferentes zonas geográficas del país), y se les calculó la consistencia interna mediante el coeficiente alfa de Cronbach. Resultados: Los criterios quedaron estructurados en tres listas: 1) medicación potencialmente inapropiada, medicamento indicado no prescripto, cuando no existe contraindicación para su uso; 2) medicación potencialmente inapropiada independiente del diagnóstico o la condición clínica; 3) medicación potencialmente inapropiada dependiente del diagnóstico o la condición clínica. Conclusiones: Se demostró la validez del contenido y la adecuada consistencia interna de los criterios diseñados para la identificación de medicación potencialmente inapropiada en el anciano.

Introduction: The impact of inappropriate prescription of medication in the elderly has led to the development of methods for its reduction in several parts of the world. Objective: To design and validate the medication approaches potentially inappropriate in the elderly, adapted to the socio-sanitary environment of Cuba. Methods: A qualitative investigation was carried out, in which the approaches were validated by means of the Delphi methodology, by an experts committee (specialists in geriatrics medicine and clinic from different geographical areas of the country), and the internal consistency was calculated by means of the alpha coefficient of Cronbach. Results: The approaches were structured in three lists: 1) potentially inappropriate medication, advised medication non prescribed, when contraindication doesn't exist for its use; 2) medication potentially inappropriate, independent from the diagnosis or clinical condition; 3) potentially inappropriate medication, depending on the diagnosis or clinical condition. Conclusions: The validity of the content and the appropriate internal consistency of the designed approaches for the medication identification potentially inappropriate in the elderly were demonstrated.

Assistência farmacêutica no cuidado à saúde na Atenção Primária: tão perto, tão longe / Pharmaceutical care in Primary Health care: so close, so far

Resumo A expansão da Atenção Primária à Saúde (APS) exigiu mudanças na Assistência Farmacêutica, de maneira a aumentar a cobertura da distribuição gratuita de medicamentos e reforçando a necessidade do uso racional de medicamentos. O objetivo deste trabalho foi estudar a Assistência Farmacêutica na produção do cuidado na APS, contribuindo para o entendimento do uso racional de medicamentos. Método: Optou-se por analisar o material de uma investigação de natureza etnográfica, realizada no ano de 2014 em sete Unidades Básicas de Saúde. Além disso, realizou-se um seminário com atores institucionais das Unidades estudadas, de forma a aumentar a lateralidade dos resultados. Resultados: Foi possível identificar cenas e falas, que se conectavam e davam visibilidades a elementos micropolíticos relacionados ao uso de medicamentos, a autonomia profissional − o papel do médico na prescrição dos medicamentos e o usuário prescritor do seu cuidado. Conclusão: O que acontece depois que o usuário deixa a Unidade com seus medicamentos retirados na farmácia parece ainda ficar oculto aos olhos dos profissionais de saúde. O estudo produz indicações de algumas falhas na atuação da Assistência Farmacêutica e mostra o quanto estamos distantes de uma gestão do cuidado que inclua o uso racional de medicamentos em suas múltiplas racionalidades.

Abstract The expansion of Primary Health Care required changes in Pharmaceutical Care, in order to increase the coverage of the free distribution of medicines and reinforcing the need for the rational use of medicines. This work aimed to study Pharmaceutical Care in the production of care in Primary Health Care, contributing to the understanding of rational use of medicines. Method: We chose to analyze the material of an ethnographic investigation, carried out in 2014 in seven Basic Health Units. In addition, a seminar was held with institutional actors from the Units studied, in order to increase the laterality of the results. Results: It was possible to identify scenes and speeches, which connected and gave visibility to micropolitical elements related to the use of medicines, professional autonomy - the role of the physician in the prescription of medicines and the user who prescribes their care. Conclusion: What happens after the user leaves the UBS with his medicines taken at the pharmacy still seems to be hidden from the eyes of health professionals. The study produces indications of some flaws in the performance of Pharmaceutical Care and shows how far we are from a care management that includes the rational use of medicines in its multiple rationalities.

Medication Use and Sexual Function: A Population-Based Study in Middle Aged Women.

INTRODUCTION: Medications used to treat chronic diseases have contributed to increasing longevity and improving quality of life. These medications are considered an indispensable resource in the management of most treatable diseases. However, they can affect sexual function through their effects on the central or the peripheral nervous system or due to hormonal effects. AIM: To evaluate the association between the use of medication for chronic diseases and sexual dysfunction in Brazilian women 45-60 years of age. METHODS: A secondary analysis of household survey data from a previous cross-sectional, population-based study conducted with a sample of 749 women of a population of 257,434 female urban residents in the age bracket of interest. Sexual function was evaluated using the Short Personal Experiences Questionnaire (SPEQ). Associations between the use of medication and sexual function were evaluated, as were correlations with other variables. MAIN OUTCOME MEASURE: We found associations of the individual SPEQ domains with the use of some medications. RESULTS: Mean age of participants was 52.5 ± 4.4 years. Mean age at menopause was 46.5 ± 5.8 years. The overall prevalence of medication use was 68.8%, with the drugs predominantly consisting of those used for cardiovascular diseases. In the Poisson regression analysis, sexual dysfunction, as based on the overall SPEQ score, was associated with sexual inactivity (prevalence ratio [PR] = 4.05; 95% CI 3.16-5.20; P < .001), a sedentary lifestyle (PR = 1.49; 95% CI 1.06-2.09; P = .021), and untreated anxiety (PR = 1.44; 95% CI 1.08-1.92; P = .014). Analysis of the individual SPEQ domains revealed that women who scored low in the desire domain were more likely to use antihypertensive agents (P = .019), whereas a lower score for the arousal domain was associated with the use of antidepressants, with treatment for osteoarticular diseases and with polypharmacy (P = .003). Women with lower scores in the satisfaction domain were more likely to use antidepressants, drugs for osteoarticular diseases, diabetes medication, and polypharmacy (P = .019). A lower score in the orgasm domain was associated with the use of antidepressants, the treatment of osteoarticular diseases, and diabetes (P < .001). Hormone therapy proved protective against loss of libido (P = .036). CLINICAL IMPLICATIONS: Some medications can interfere with sexual function negatively and, clinicians have to be aware of it to choose the treatment with fewer collateral effects. STRENGTH & LIMITATIONS: The strength of our study is the large, population-based sample of middle-aged women evaluated for sexual dysfunction with the SPEQ. However, it was a self-reported cross sectional study. CONCLUSION: This study found no association between the use of medication for chronic diseases and the overall SPEQ score, whereas untreated anxiety was 1 of the main factors associated with female sexual dysfunction. On the other hand, medical treatments were found to contribute to lower scores in the different sexual function domains. Common drug culprits included antihypertensives, antidepressants, treatment for osteoarticular disease, diabetes medications, and polypharmacy. Hormone therapy protected against loss of libido. Gueldini de Moraes AV, Ribeiro Valadares AL, Lui Filho JF, et al. Medication Use and Sexual Function: A Population-Based Study in Middle Aged Women. J Sex Med 2019;16:1371-1380.

Polypharmacy and potentially inappropriate medications for elder people in gerontological nursing / Polifarmacia y medicamentos potencialmente inapropiados para ancianos en la enfermería gerontológica / Polifarmácia e medicamentos potencialmente inapropriados para idosos na enfermagem gerontológica

ABSTRACT Objective: To identify polypharmacy and potentially inappropriate medications (PIM) for elder people with chronic health situations and its implications for gerontological nursing. Method: Descriptive and transversal study, conducted from March to September 2016 by pharmaceutical residents in the clinic of Endocrinology of a hospital in Mid-West region of Brazil. Results: 44 elder people with an average age of 69.5 (± 6.79) years old had their assessed prescriptions. We identified 65 medications prescribed 253 times, in which 10 PIM (15.4%) were prescribed 51 times. 33 seniors (72.7%) had at least one PIM, of those, 66.7% were polymedicated. Of the total, 22 elder people (50%) were subjected to polypharmacy and made use of at least one PIM. Conclusion: The results showed high incidence of PIM and polypharmacy, as well as their physiological impacts to the elder population. The study provokes discussions about that the trained nurse in human aging has skills and competencies able to enhance interventions related to pharmacotherapy.

RESUMEN Objetivo: Identificar polifarmacia y medicamentos potencialmente inapropiados (MPI) para ancianos con situaciones crónicas de salud y sus implicaciones para enfermería gerontológica. Método: Estudio descriptivo, transversal, realizado de marzo a septiembre de 2016 por residentes farmacéuticos, en el ambulatorio de endocrinología de un hospital en el Centro-Oeste de Brasil. Resultados: Cuarenta y cuatro ancianos con edad media de 69,5 (± 6,79) años tuvieron sus prescripciones evaluadas. Se identificaron 65 medicamentos prescritos 253 veces, siendo que 10 MPI (15,4%) fueron prescritos 51 veces. Treinta y tres ancianos (72,7%) presentaron al menos un MPI, de los que el 66,7% eran polimedicados. Del total, 22 ancianos (50%) estaban sometidos a la polifarmacia y utilizaban al menos un MPI. Conclusión: Los resultados evidenciaron alta incidencia de MPI y polifarmacia, así como sus impactos fisiológicos a la población anciana. El estudio provoca discusiones acerca de que el enfermero capacitado sobre el envejecimiento humano tiene habilidades y competencias que potencializan intervenciones relacionadas a la farmacoterapia.

RESUMO Objetivo: Identificar polifarmácia e medicamentos potencialmente inapropriados (MPI) para idosos com situações crônicas de saúde e suas implicações para enfermagem gerontológica. Método: Estudo descritivo, transversal, realizado de março a setembro de 2016 por residentes farmacêuticos, no ambulatório de endocrinologia de um hospital no Centro-Oeste do Brasil. Resultados: Quarenta e quatro idosos com idade média de 69,5 (± 6,79) anos tiveram suas prescrições avaliadas. Identificaram-se 65 medicamentos prescritos 253 vezes, sendo que 10 MPI (15,4%) foram prescritos 51 vezes. Trinta e três idosos (72,7%) apresentaram pelo menos um MPI, desses, 66,7% eram polimedicados. Do total, 22 idosos (50%) estavam submetidos à polifarmácia e faziam uso de pelo menos um MPI. Conclusão: Os resultados evidenciaram alta incidência de MPI e polifarmácia, bem como seus impactos fisiológicos à população idosa. O estudo provoca discussões acerca de que enfermeiro capacitado sobre o envelhecimento humano possui habilidades e competências capazes de potencializar intervenções relacionadas à farmacoterapia.

Pharmacotherapeutic problems and pharmaceutical interventions in critical hospitalized patients / Problemas farmacoterapêuticos e intervenções farmacêuticasa em pacientes críticos hospitalizados

A critical patient is one who is seriously ill and needs a multi-professional team dedicated to their intensive care. Because ample prescription medication is involved, such patients are more susceptible to pharmacotherapeutic problems. The purpose of the study was to evaluate the profile of pharmacotherapeutic problems (PP) and pharmaceutical interventions (PI) performed by residents of a Multi-professional Residency Program in Critical Patient Care. This was a descriptive and quantitative study carried out by evaluating pharmaceutical care records completed by residents caring for critical patients who were hospitalized at a teaching hospital in Campo Grande, MS, from March to August 2016. The study was approved by the Ethics Committee of the Federal University of Mato Grosso do Sul, opinion No. 1,371,325. The drug prescriptions of 60 patients with an average age of 60.2 (± 16.6) years were evaluated. A total of 218 PP were identified, with an average of 3.6 (± 1.4) PP per participant. Twenty-six patients (43.3%) had 4 or more PP. The most frequent were: medication not available due to lack of stock (n=48; 22%), existence of a more adequate/available therapeutic alternative (n=37; 17%), and need for laboratory monitoring (n=22; 10.1%). A total of 154 PI, 2.56 (± 0.7) per participant, were performed. The most frequent were: indication of a more adequate/available therapeutic alternative (n=37; 24%), orientation on drug-drug incompatibility (n=16, 10.4%), and orientation on drugdrug interaction (n=12; 7.8%). Most PI (n=133; 86.4%) were directed to physicians and were accepted without change (n=96; 62%). The results showed a high incidence of PP and PI in critical patients

Paciente crítico é aquele que se encontra gravemente doente e necessita de equipe multiprofissional dedicada ao seu cuidado intensivo. Por apresentar ampla prescrição medicamentosa, é mais susceptível a problemas farmacoterapêuticos (PF). O estudo teve como propósito avaliar o perfil dos PF e das intervenções farmacêuticas (IF) realizadas pelos residentes de um Programa de Residência Multiprofissional em Atenção ao Paciente Crítico. Tratou-se de um estudo descritivo e quantitativo, realizado através da avaliação das fichas de cuidado farmacêutico preenchidas pelos residentes durante o cuidado a pacientes críticos internados em um hospital de ensino de Campo Grande/MS, de março a agosto de 2016. O estudo foi aprovado pelo Comitê de Ética da Universidade Federal de Mato Grosso do Sul, sob o parecer nº 1.371.325. As prescrições medicamentosas de 60 pacientes com idade média de 60,2 (±16,6) anos foram avaliadas. Identificou-se um total de 218 PF, sendo a média por participante igual a 3,6 (±1,4). Vinte e seis pacientes (43,3%) apresentaram 4 ou mais PF. Os mais frequentes foram: medicamento não dispensado por falta de estoque (n=48; 22%), alternativa terapêutica mais adequada/disponível (n=37; 17%) e necessidade de monitoramento laboratorial (n=22; 10,1%). Foram realizadas 154 IF, 2,56 (±0,7) por participante. As mais frequentes foram: indicação de alternativa terapêutica mais adequada/ disponível (n=37; 24%), orientação sobre incompatibilidade fármaco-fármaco (n=16; 10,4%) e orientação sobre interação fármaco-fármaco (n=12; 7,8%). A maioria das IF (n=133; 86,4%) foram direcionadas aos médicos e foram aceitas sem alteração (n=96; 62%). Os resultados evidenciaram alta incidência de PF e IF em pacientes críticos

Environmental variables and errors in the preparation and administration of medicines / Variables ambientales y errores en la preparación y administración de medicamentos / Variáveis ambientais e erros no preparo e administração de medicamentos

ABSTRACT Objective: to identify the relationship between environmental factors and errors in the preparation and administration of antibacterial. Method: an observational, cross-sectional study conducted between August and December, 2014 in two clinical units. The sample consisted of 265 doses of medication, observed in different shifts that through a form had the environmental conditions of noise, illumination, humidity, temperature and physical space measured in the preparation and administration stages. Results: the physical dimension for the preparation was inadequate in one unit (3.8m2), and the items illumination, temperature and noise were extremely oscillating in the three shifts and in the two clinics, with averages generally higher than the recommended for the hospital environment, however, variations in illumination and noise were not statistically significant to cause dose errors or erroneous medicine choice (p> 0.05). Conclusion: the environmental variables analyzed may favor medication errors in both the preparation and administration stages.

RESUMEN Objetivo: identificar la relación entre los factores ambientales y los errores de preparación y administración de antibacterianos. Método: estudio observacional, transversal, realizado entre agosto y diciembre de 2014 en dos unidades clínicas. La muestra fue compuesta de 256 dosis de medicamentos, observadas en diferentes turnos, que por medio de un formulario tuvieron las condiciones ambientales de ruido, iluminación, humedad, temperatura y espacio físico medidos en las etapas de preparación y administración. Resultados: la dimensión física para la preparación fue inadecuada en una unidad (3,8m2), y los elementos iluminación, temperatura y ruido fueron extremadamente oscilantes en los tres turnos y en las dos clínicas, con medias generalmente por encima de lo recomendado para el ambiente hospitalario. Sin embargo, las variaciones de iluminación y ruido no fueron estadísticamente significativas para provocar errores de dosis o de elección errónea del medicamento (p>0,05). Conclusión: las variables ambientales analizadas pueden favorecer errores de medicación tanto en la etapa de preparación como en la de administración.

RESUMO Objetivo: identificar a relação entre os fatores ambientais e os erros de preparo e administração de antibacterianos. Método: estudo observacional, transversal, realizado entre agosto a dezembro de 2014 em duas unidades clínicas. A amostra foi composta de 265 doses de medicamentos, observadas em diferentes turnos, que por meio de um formulário tiveram as condições ambientais de ruído, iluminação, umidade, temperatura e espaço físico mensuradas nas etapas de preparo e administração. Resultados: a dimensão física para o preparo foi inadequada em uma unidade (3,8m2), e os itens iluminação, temperatura e ruído foram extremamente oscilantes nos três turnos e nas duas clínicas, com médias geralmente acima do recomendado para o ambiente hospitalar, porém, as variações de iluminação e ruído não foram estatisticamente significativas para provocar erros de dose ou de escolha errada do medicamento (p>0,05). Conclusão: as variáveis ambientais analisadas podem favorecer erros de medicação tanto na etapa de preparo quanto na administração.

How do Swiss general practitioners agree with and report adhering to a top-five list of unnecessary tests and treatments? Results of a cross-sectional survey.

BACKGROUND: In 2014, the 'Smarter Medicine' campaign released a top five list of unnecessary tests and treatments in Swiss primary care, such as imaging for acute low-back pain and long-term prescribing of proton pump inhibitors. OBJECTIVES: Measure general practitioners' (GPs) agreement with the recommendations and self-reported adherence. METHODS: Cross-sectional, online survey of GPs in the 'Swiss primary care active monitoring' (SPAM) network, which assessed awareness of 'Smarter Medicine' and views on each recommendation. Questions included whether the clinical situation is common, whether the recommendation is followed, whether GPs agree with the recommendation and reasons why the recommendation would not be followed. RESULTS: One-hundred-and-sixty-seven of 277 GPs from the SPAM network participated (60%), of which 104 (62%) knew of 'Smarter Medicine', including 79% in German areas, 49% in French areas and 38% in Italian areas (P < 0.001). Agreement with the five recommendations was high, with scores around nine out of 10. The proportion saying they typically follow each recommendation was 68 to 74%, except not continuing long-term PPI prescriptions without attempting dose reduction, with only 34%. Common reasons for not following the recommendations were patient or other provider requests and situations that might suggest the need for more aggressive care. CONCLUSION: Two years after the launch of the campaign, awareness and acceptance of 'Smarter Medicine' appear to be high among Swiss GPs. By self-report, the recommendations are adhered to by most of the respondents but there may be room for improvement, especially for long-term PPI prescriptions.

Elderly people with mental disorders: experiencing the use of psychotropic medicines / Ancianos con trastornos mentales: vivenciando el uso de psicofármacos / Idosos com transtornos mentais: vivenciando o uso de psicofármacos

ABSTRACT Objective: To interpret the experience of the elderly with mental disorder in the use of psychotropic medicines. Method: Qualitative study in the interpretative modality, supported by the Grounded Theory. It was carried out from interviews with 16 elderly people with mental disorder and six relatives, totaling 22 participants. Results: In the experience of the use of psychotropic medicines, the elderly with mental disorders become aware of their condition, attribute meaning and establish strategies for the correct use. On the other hand, they express their dissatisfaction with being dependent on psychotropic medicines to live without symptoms, face their side effects and do not always use them correctly. Conclusion: The use of psychotropic medicines is a priority in the life of the elderly and, in view of the fragilities found, it is necessary a continuous monitoring of health professionals.

RESUMEN Objetivo: Interpretar la vivencia de ancianos con trastorno mental en la utilización de psicofármacos. Método: Estudio cualitativo en la modalidad interpretativa, apoyado por la Teoría Fundamentada en los Datos. Se realizó a partir de entrevistas con 16 ancianos con trastorno mental y seis familiares, totalizando 22 participantes. Resultados: En la vivencia del uso de psicofármacos, los ancianos con trastornos mentales toman conciencia de su condición, atribuyen significado y establecen estrategias para el uso correcto. En cambio, ellos expresan su descontento por depender de los psicofármacos para vivir sin síntomas, enfrentan sus efectos colaterales y ni siempre los utilizan de forma correcta. Conclusión: El uso de psicofármacos se constituye en prioridad en la vida de los ancianos y, frente a las fragilidades encontradas, es necesario un acompañamiento continuo de los profesionales de la salud.

RESUMO Objetivo: Interpretar a vivência de idosos com transtorno mental na utilização de psicofármacos. Método: Estudo qualitativo na modalidade interpretativa, apoiado pela Teoria Fundamentada nos Dados. Foi realizado a partir de entrevistas com 16 idosos com transtorno mental e seis familiares, totalizando 22 participantes. Resultados: Na vivência do uso de psicofármacos, os idosos com transtornos mentais tomam consciência da sua condição, atribuem significado e estabelecem estratégias para o uso correto. Em contrapartida, eles expressam o descontentamento por depender dos psicofármacos para viver sem sintomas, enfrentam seus efeitos colaterais e nem sempre os utilizam de forma correta. Conclusão: O uso de psicofármacos se constitui em prioridade na vida dos idosos e, frente às fragilidades encontradas, é necessário um acompanhamento contínuo dos profissionais de saúde.

Ação educativa na perspectiva do uso racional de medicamentos em idosos: um relato de experiência / Educational action in the perspective of the rational use of medicines in elderly: a report of experience abstract

Trata-se de um relato de experiência de ação educativa com idosos sobre o uso racional de medicamentos, realizado na casa de apoio Remanso da Paz-Quixadá-CE em maio de 2017. Foi desenvolvida por discentes do curso de farmácia por meio de dúvidas pelos participantes. A atividade "Quiz Medicamento" foi composta por dez perguntas sobre os medicamentos em placas com afirmativas direcionadas aos idosos que respondiam verdadeiro ou falso. Observou-se interação das informações e ainda contribuição para um melhor entendimento dos idosos acerca da saúde e do uso racional de medicamentos, efetivando a terapia medicamentosa e por consequência a qualidade de vida.

This is an account of experience of educational action with seniors on the rational use of medicines, carried out at the Remanso da Paz-Quixadá-CE support house in May 2017. It was developed by students of the pharmacy course through doubts participants. The "Medication Quiz" activity consisted of ten questions about prescription drugs with statements directed to the elderly who answered true or false. It was observed interaction of the information and also contribution to a better understanding of the elderly about the health and the rational use of medicines, effecting the drug therapy and consequently the quality of life.

Prescripción de antimicrobianos y su relación con la resistencia bacteriana en un hospital general municipal / Antimicrobians prpescription and their relationship with the bacterial resistance in a municipal general hospital

Se realizó un estudio descriptivo y transversal, de utilización de medicamentos de tipo prescripción-indicación, de los 303 adultos que recibieron tratamiento antimicrobiano, ingresados en los servicios de Cuidados Intensivos, Medicina Interna y Cirugía del Hospital General Orlando Pantoja Tamayo del municipio de Contramaestre, desde enero hasta junio de 2015, con vistas a evaluar la prescripción de estos medicamentos y su relación con la resistencia bacteriana. En la serie, de un total de 568 prescripciones evaluadas predominaron las inadecuadas (82,3 por ciento); asimismo, los antimicrobianos más prescriptos resultaron ser la cefuroxima y la ceftriaxona, que también presentaron el mayor número de cepas resistentes y el Staphylococcus aureus resultó ser el germen con mayor resistencia

A descriptive and cross-sectional study on the use of prescription-indication medications of the 303 adults that received antimicrobian treatment was carried out. They were admitted to the Intensive Care, Internal Medicine and Surgery services of Orlando Pantoja Tamayo General Hospital in Contramaestre, from January to June, 2015, aimed at evaluating the prescription of these medications and their relationship with the bacterial resistance. In the series, there was a prevalence of inadequate prescriptions (82.3 percent) from a total of 568 that were evaluated; also, the most prescribed antimicrobians were the cefuroxime and the ceftriaxone that also presented the highest number of resistant stumps and the Staphylococcus aureus was the germ with higher resistance

Estratégia saúde da família e uso racional de medicamentos: o trabalho dos agentes comunitários em palmas (to) / Family health strategy and the rational use of medications: work of the community agents of the municipality of palmas (to) / Estrategia slud de la familia y el uso racional de medicamentos: el trabajo de los agentes comunitarios del municipio de palmas (to)

Resumo Procurou-se analisar as ações dos agentes comunitários de saúde referentes à orientação da comunidade sobre o uso racional de medicamentos na Estratégia Saúde da Família em Palmas, capital do estado do Tocantins. Tratou-se de estudo descritivo-exploratório, de abordagem quantitativa, realizado com 246 agentes entre janeiro e abril de 2014. A coleta de dados foi por questionário, objetivando verificar a formação e a informação específica sobre medicamentos e os riscos da farmacoterapia no trabalho dos participantes da pesquisa. Observou-se que 88% dos agentes não realizaram curso de capacitação sobre medicamentos; 75,5% consideraram não ter conhecimento suficiente para dar orientações sobre medicamentos; 80,41% informaram que em nenhuma vez foram discutidos pela equipe temas sobre medicamentos; e 90,20% sentiam necessidade dessa formação. O estudo revelou que esses profissionais buscavam informações em várias fontes - as bulas de medicamentos constituíam a principal (71,14%). Dos agentes comunitários de saúde, respectivamente 52,46% e 50% referenciaram o enfermeiro para solucionar problemas e sanar dúvidas sobre farmacoterapia. Dentre eles, 68,03% consideraram importante orientar as famílias, mas afirmaram precisar de educação permanente. Evidenciou-se a necessidade de qualificação e formação do agente comunitário na promoção do uso racional de medicamentos, considerando o seu papel como promotor de saúde na comunidade.

Abstract An analysis was made of actions carried out by community health agents regarding community guidance on the rational use of medications in the Family Health Strategy in the municipality of Palmas, state of Tocantins, Brazil. This was a descriptive and exploratory study with a quantitative approach, done with 246 agents between January and April 2014. Data were collected via a questionnaire to verify the training and specific information on medications and on the risks of pharmacotherapy in their work. It was noted that 88%of the agents had no training on medications; 75.5% believed they did not have enough knowledge to provide guidance on medications; 80.41% said that the team never discussed topics on medications, and 90.20%felt they needed such training. The study revealed that these professionals sought information from various sources - medication insert leaflets were their main source (71.14%). Among the community health agents, respectively 52.46% and 50% asked for help from the nurse to solve issues and answer questions about pharmacotherapy. Among them, 68.03% considered it important to provide guidance to the families, but they said they need permanent education. There was a clear need for community agent qualification and training in promoting the rational use of medications, considering their role as health promoters in the community.

Resumen Por medio del estudio presentado en este artículo se buscó analizar las acciones de los agentes comunitarios de salud, referentes a la orientación de la comunidad sobre el uso racional de medicamentos en la Estrategia Salud de la Familia en Palmas, en el estado de Tocantins, Brasil. Se trató de un estudio descriptivo y exploratorio, de enfoque cuantitativo, realizado con 246 agentes entre enero y abril de 2014. La recolección de datos fue mediante cuestionario, apuntando a verificar la formación y la información específicas sobre medicamentos y los riesgos de la farmacoterapia en su trabajo. Se observó que el 88% de los agentes no realizaron curso de capacitación sobre medicamentos; el 75,5% consideraron no tener conocimiento suficiente para dar orientaciones sobre medicamentos; el 80,41% informaron que en ningún momento se discutieron en el equipo temas sobre medicamentos; y el 90,20% sentía la necesidad de esa formación. El estudio reveló que estos profesionales buscaban información en varias fuentes —los prospectos de los medicamentos constituían la principal (71,14%). De los agentes comunitarios de salud, respectivamente el 52,46% y el 50% tomaban como referencia el enfermero para solucionar problemas y evacuar dudas sobre farmacoterapia. Entre ellos, el 68,03% consideraban importante orientar a las familias, pero afirmaron precisar educación permanente. Se puso de manifiesto la necesidad de calificación y formación del agente comunitario en el fomento del uso racional de medicamentos, considerando su papel como promotor de la salud en la comunidad.

Relationship of polypharmacy and polypathology with falls among institutionalized elderly / Relación de la polifarmacia y polipatología con la caída de adultos mayores institucionalizados / Relação da polifarmácia e polipatologia com a queda de idosos institucionalizados

ABSTRACT Objective: identify relationships of association between the risk of falls in institutionalized elderly people with polypharmacy and polypathy, as well as to outline the epidemiological profile of its casuistry. Method: a prospective obseracional study with 271 elderly residents in long-stay institutions in the Federal District (Brazil). The date were a actualized by inferencial statistics. Results: a monitoring of elderly confirmed the association between polypathology and falls (p: 0.0028), however, it did not follow the trend of other studies in identifying polypharmacy as a risk factor for falls (p: 0.141). Among the most prevalent comorbidities, changes in blood pressure levels (77.4%), followed by Diabetes Mellitus (27.37%), depression (17.7%) and dementia (46.8%) may be highlighted. The most identified drugs were antihypertensives (73.8%), sleep inducers (61.2%), diuretics (50.1%) and antidepressants (34.3%). Conclusion: multiple disabilities associated with chronic-degenerative diseases and the chronic use of medications may interfere with the incidence of falls, ratifying factors related to the diagnosis of risk for falls presented in the NANDA-I Taxonomy I. This contribution to the nurses' diagnostic rationale ensures better evaluation of the elderly, ensuring a care plan focused on prevention and detection of risk conditions.

RESUMEN Objetivo: identificar relaciones de asociación entre riesgo de caída en adultos mayores institucionalizados con la polifarmacia y la polipatología, asi como trazar un perfil epidemiológico de esta casuística. Método: estudio prospectivo, observacional realizado con 271 ancianos residentes de instituciones a largo plazo del Distrito Federal. Los datos han sido actualizados por inferencial. Resultados: el acompañamiento de adultos mayores confirmó la asociación entre la polipatología y la caída (p: 0,0028), sin embargo no siguió la tendencia de otros estudios en identificar la polifarmacia como factor de riesgo de caída (p: 0,141). Entre las comorbidades más prevalentes se destacaron la alteración de los niveles tensionales (77,4%), seguida de la Diabetes Mellitus (23, 37%), depresión (17,7%) y demencia (46,8%). Los medicamentos más identificados fueron los anti-hipertensivos (73,8%), inductores del sueño (61,2%), diuréticos (50,1%) y antidepresivos (34,3%). Conclusión: que multiples incapacidades asociado a enfermedades crónico degenerativas y el uso crónico de medicamentos pueden interferir en la incidencia de caída, ratificando los factores relacionados al diagnóstico de Riesgo de Caída presente en la Taxonomia I de la NANDA-I. Esta contribución al raciocinio diagnostico del enfermero garantiza mejor evaluación del adulto mayor, garantizando un plano de cuidados vinculado a la prevención y detección de condiciones de riesgo.

RESUMO Objetivo: identificar relações de associação entre o risco de queda em idosos intitucionalizados com a polifarmácia e a polipatologia, bem como traçar o perfil epidemiológico desta casuística. Método: estudo prospectivo, observacional realizado com 271 idosos moradores de instituições de longa permanência do Distrito Federal. Os dados foram atualizados por estatística inferencial. Resultados: o acompanhamento dos idosos confirmou a associação entre a polipatologia e a queda (p: 0,0028), porém não seguiu a tendência de outros estudos em identificar a polifarmácia como fator de risco de queda (p: 0,141). Entre as comorbidades mais prevalentes destacou-se alteração dos níveis tensionais (77,4%), seguida de Diabetes Mellitus (27,37%), depressão (17,7%) e demência (46,8%). Já os medicamentos mais identificados foram os anti-hipertensivos (73,8%), indutores do sono (61,2%), diuréticos (50,1%) e antidepressivos (34,3%). Conclusão: que múltiplas incapacidades associado a doenças crônico-degenerativas e o uso crônico de medicamentos, podem interferir na incidência de queda, ratificando os fatores relacionados ao diagnóstico risco de queda presente na Taxonomia I da NANDA-I. Essa contribuição ao raciocínio diagnóstico do enfermeiro garante melhor avaliação do idoso, garantindo um plano de cuidados voltado a prevenção e detecção de condições de risco.

Uso y gasto en medicamentos antihipertensivos en el subsector público de salud de la provincia del Neuquén en 2012-2014 / Use of and spending on antihypertensive drugs in the public health subsector of Neuquén province in 2012-2014

INTRODUCCIÓN: la hipertensión arterial es un factorde riesgo con alto impacto en la morbi-mortalidad cardiovascular. Laprescripción de antihipertensivos no siempre sigue las recomendacionesvigentes, lo que representa un uso ineficiente de los recursos.OBJETIVOS: Evaluar el uso de medicamentos antihipertensivos, costosasociados y grado de adecuación a las recomendaciones provinciales.MÉTODOS: Se analizaron las compras de medicamentosantihipertensivos de la Subsecretaría de Salud provincial y entregasdel Plan Remediar para 2012-2014. Los consumos se expresaron endosis diaria definida (DDD)/1000 habitantes. RESULTADOS: El gastoen medicamentos antihipertensivos representó un 1,14% del total delgasto anual en medicamentos. Las DDD/1000 habitantes provistasen los años sucesivos fueron 75,5; 86,7 y 73,8. El sistema público deSalud provincial financió dos terceras partes, y el Plan Remediar elresto. El costo de adquisición por compra directa fue, en promedio,un 79% mayor que el de licitación pública. Más de dos tercios de lasDDD correspondieron a enalapril e hidroclorotiazida. CONCLUSIONES:La erogación en antihipertensivos representa una mínima partedel gasto provincial en medicamentos. El patrón de prescripción nose adecua completamente a la Guía de Práctica Clínica provincial, conuna relación hidroclorotiacida-enalapril inversa a la recomendada.Pese a esto, el 80% de las DDD dispensadas corresponden a estosdos medicamentos, lo que se considera una forma de uso racional.

INTRODUCTION: hypertension is a risk factor withhigh impact on cardiovascular morbidity and mortality. The prescriptionof antihypertensive drugs does not always follow currentrecommendations, which represents an inefficient use of resources.OBJECTIVES: To assess the use of antihypertensive medications,costs and adequacy to provincial recommendations. METHODS:Information on antihypertensive medications purchase was obtainedfrom provincial Health Undersecretariat, and deliveries ofPlan Remediar for 2012-2014. Drug use was expressed as defineddaily doses (DDD) per 1000 inhabitants. RESULTS: Spending onantihypertensive medications accounted for 1.14% of total annualdrug spending. The DDD/1000 inhabitants provided were 75.5 in2012, 86.7 in 2013 and 73.8 in 2014. The provincial public healthsystem funded two thirds, and Plan Remediar the remaining third.The average cost of direct purchase was 79% higher than with publicauction purchase. More than two thirds of DDD corresponded toenalapril (EN) and hydrochlorothiazide (HCT). CONCLUSIONS:Spending on antihypertensive drugs represents a minimum fractionof total provincial drug spending. The prescription pattern doesnot fully adhere to the clinical practice guidelines, with a HCT-ENrelationship that is inverse compared to the recommended one.In spite of this, 80% of the dispensed DDD correspond to thesetwo drugs, which is considered a rational use.