Profile of pharmaceutical interventions of a pharmacotherapeutic follow-up model for diabetic patients in a community pharmacy

Abstract The insertion of Pharmaceutical Care in Primary Health Care (PHC) improves patients' clinical outcomes and quality of life. Pharmacotherapeutic follow-up can contribute to the management of chronic diseases such as diabetes, promoting better glycemic control and adherence to therapy. This study aimed to assess the Drug-therapy Problems (DTPs) and Pharmacist Interventions (PIs) on the pharmacotherapeutic management in patients with type 2 diabetes mellitus (T2DM) in a community pharmacy. A quantitative, retrospective, and cross-sectional study was conducted in a Pharmaceutical Care Program within the PHC in Juiz de Fora (Minas Gerais, Brazil). Inclusion criteria were patients with T2DM above 18, who attended at least three pharmaceutical consultations between July 2016 and October 2018 and presented two or more glycated hemoglobin tests. The study group (n = 17) was largely composed of women (65%), elderly (76%), sedentary (72%), and obese people (52%). The resolution was achieved in 79% of the DTPs identified (n = 115). Most of DTPs were related to administration and adherence to pharmacotherapy (46%). 60% of the 437 PIs involved the provision of information and counseling. In other words, accessible interventions lead to high resolvability. Therefore, clinical actuation of pharmacists could improve the prognosis in diabetes treatment

Fatores associados à não adesão à farmacoterapia em pessoas idosas na atenção primária à saúde no Brasil: uma revisão sistemática / Factors associated with non-adherence to pharmacotherapy in older people in primary health care in Brazil: a systematic review

Resumo Objetivos Identificar os fatores associados à não adesão à farmacoterapia em pessoas idosas brasileiras no âmbito da atenção primária à saúde (APS) através da realização de uma revisão sistemática da literatura. Método Trata-se de uma revisão sistemática da literatura nos idiomas inglês, espanhol e português, realizada na biblioteca eletrônica SciELO e nas bases de dados eletrônicas MEDLINE - via PubMed, LILACS, Embase e Web of Science no período de janeiro de 2010 a junho de 2020. A seleção dos estudos foi realizada de maneira independente por dois revisores, por meio do aplicativo de seleção Rayyan. Resultados Após a aplicação dos critérios de elegibilidade, foram incluídos nove estudos na revisão sistemática. O principal método utilizado para mensurar o desfecho foi a Escala de Morisky-Green (4-itens). Os resultados apontam as dificuldades de acesso aos medicamentos, as multimorbidades, a polifarmácia, o uso de medicamentos potencialmente inapropriados para idosos, o grau de confiança no profissional médico, as crenças, a autopercepção de saúde negativa e a incapacidade funcional como os principais fatores associados à não adesão à farmacoterapia na APS. Conclusões No âmbito da APS, a não adesão à farmacoterapia pela população idosa se apresenta como um problema muito frequente, sendo desencadeado por múltiplos fatores e com consequências negativas para o controle das condições de saúde, para o uso racional de medicamentos e para um envelhecimento saudável. Destaca-se ainda que parte dos fatores associados são passíveis de intervenção nesse nível de atenção à saúde.

Abstract Objectives To identify the factors associated with non-adherence to pharmacotherapy in elderly Brazilians assisted by Primary Health Care (PHC) through a systematic review of the literature. Method This is a systematic literature review in English, Spanish, and Portuguese, performed in the SciELO electronic library and in the electronic databases MEDLINE - via PubMed, LILACS, Embase, and Web of Science from January 2010 to June 2020. Study selection was performed independently by two reviewers using the Rayyan selection application. Results After applying the eligibility criteria, nine studies were included in the systematic review. The most frequent method used to measure the outcome was the Morisky-Green Scale (4-items). The results point that the main factors related to non-adherence to pharmacotherapy in PHC are difficulties in medication access, multimorbidities, polypharmacy, the use of potentially inappropriate medications for the elderly, the degree of trust in the medical professional, beliefs, negative self-perception of health and functional disability. Conclusions In the context of PHC, non-adherence to pharmacotherapy by the elderly population presents itself as a very frequent problem, being triggered by multiple factors and with negative consequences for the control of health conditions, the rational use of medications, and healthy aging. It is also noteworthy that part of the associated factors are subject to intervention at this level of health care.

Factors associated with adherence to pharmacological treatment among elderly persons using antihypertensive drugs / Fatores associados à adesão ao tratamento farmacológico em idosos que utilizam medicamento anti-hipertensivo

Abstract Objective: analyze adherence to pharmacotherapy and associated factors among elderly patients using at least one antihypertensive medication. Methods: A cross-sectional, population-based study was performed of elderly patients resident in Juiz de Fora, Minas Gerais, Brazil. Adherence to medication was assessed with the Morisky-Green Test. Socio-demographic variables and variables related to health status, the health service and drug therapy were collected. The Poisson regression model was used to assess crude and adjusted (95% confidence interval) prevalence ratios (PR). The level of significance was tested using the Wald test. Results: The prevalence of adherence to pharmacological therapy was 47% (95% CI: 41%-53%). The sample consisted of 279 elderly persons, the majority of whom were women (69%), described themselves as white (45.5%), and had up to four years of schooling (76.48%). Regarding pharmacological therapy, the subjects took 5.19 (±2.8) medications and 7.1 (±4.4) tablets per day. Conclusion: a significant association was observed between adherence to pharmacological therapy and the variables positive perception of vision, positive perception of hearing and absence of frailty.AU

Resumo Objetivo: Analisar adesão ao tratamento farmacológico e fatores associados em idosos que utilizam pelo menos um medicamento anti-hipertensivo. Método: Estudo transversal de base populacional, realizada com idosos residentes em Juiz de Fora, MG, Brasil. Para mensurar a adesão foi utilizado o Teste de Morisky e Green. Coletadas variáveis sociodemográficas relacionadas à condição de saúde, ao serviço de saúde e à terapia farmacológica. Para estimar razões de prevalência (RP) brutas e ajustadas (intervalo de confiança de 95%) utilizou-se modelo de regressão de Poisson. O teste de Wald foi utilizado para testar a significância de cada variável do modelo. Resultados: A prevalência de adesão à terapia farmacológica foi de 47% (IC95%: 41%-53%). A amostra foi composta por 279 idosos, sendo a maioria de mulheres (69%), autodeclarados brancos (45,5%), com até 4 anos de escolaridade (76,48%). No que concerne à terapia farmacológica, foi observada utilização de 5,19 (±2,8) medicamentos e 7,1 (±4,4) comprimidos tomados por dia. Conclusão: Foi observada associação significativa entre as variáveis: percepção positiva da visão, percepção positiva da audição e ausência de fragilidade com a adesão a terapia farmacológica.AU