Realização de interação mediada por telefone com idosos após a alta hospitalar: experiência de um programa de residência multiprofissional / Interaction of conduct mediated phone with elderly after hospital discharge: a multiprofessional program experience

Introdução: a transição do cuidado, principalmente no momento da alta hospitalar, é considerada um momento crítico e de muita ansiedade para o paciente. Destacam-se os problemas relacionados ao uso de medicamentos, principalmente quando ocorrem mudanças nas prescrições de fármacos no momento da alta, quando comparado aos medicamentos prescritos na pré-internação. A continuidade do uso de novos medicamentos após a alta pode gerar comprometimentos, principalmente quando nos referimos aos pacientes idosos, que apresentam especificidades fisiológicas e cognitivas que influenciam o uso dos medicamentos. Com o intuito de melhor identificar possíveis barreiras e propiciar segurança durante a continuidade do cuidado, um grupo composto por farmacêuticos propôs a realização de Interação Mediada por Telefone (IMT) com pacientes idosos que receberam alta hospitalar e que encontravam-se no ambiente domiciliar. Objetivo: identificar as ações realizadas e resultados alcançados por meio da IMT. Metodologia: realizou-se um estudo transversal de caráter exploratório, onde os registros em prontuários eletrônicos e planilha do serviço de IMT foram analisados, com descrição do perfil dos pacientes e realização de regressão logística a partir das características dos pacientes e equipe de referência a qual pertenciam na internação (Acidente Vascular Cerebral; Equipe Idoso Frágil; Cuidados Paliativos; Equipe de oferecimento de cuidados aos pacientes com Comprometimento do Pé Diabético e Equipe de Atendimento a Pacientes com Fratura de Fêmur). Resultados: 87 pacientes idosos participaram do IMT sendo 44 (50,6%) do sexo feminino e 43 (49,4%) do sexo masculino. A média da idade dos pacientes foi de 73,7 anos, comdesvio padrão de 8,3. Um percentual de 52,9% dos pacientes relataram procurar atendimento na Atenção Primária após a alta hospitalar, 20% relataram dificuldade no acesso, 13% relataram uso de medicamentos diferentes dos prescritos na alta, conforme orientação médica na Atenção Primária, e 13% automedicação. No modelo final da regressão logística, identificou-se que idade igual ou superior a 75 anos foi associada positivamente ao pertencimento do paciente na equipe Idoso Frágil/Cuidados Paliativos. Ainda no modelo final, a ocorrência de automedicação também esteve positivamente associada à equipe Idoso Frágil (OR=6,8; p<0,05).Conclusão: entende-se que o serviço de IMT apresentou-se como interessante ferramenta para identificação de problemas farmacoterapêuticos após a alta hospitalar. Automedicação após a alta hospitalar esteve associada positivamente aos pacientes das equipes cuidados paliativos/idoso frágil quando comparado à Unidade AVC e idade inferior a 75 anos esteve positivamente associada à Equipe complicações do pé diabético.

Introduction: the transition from hospital to home care is considered a critical moment and brings a lot of anxiety for the patient, especially due to changes in the pharmacotherapy. Aim: to identify the actions taken and results achieved through Phone-Mediated Iinteraction (PMI). Methodology: an exploratory cross-sectional study was carried out, where the data in the electronic records and PMI service worksheet were analyzed, with a description of the patients' profile and logistic regression based on the characteristics of the patients and the reference team (Cerebral Vascular Accident, Fragile Elderly Person, Palliative Care, Team to offer care to patients with Diabetic Foot Impairment, Team of Patients with Fracture of the Femur). Results: a total of 87 elderly participated in the PMI, 44 (50.6%) were female and 43 (49.4%) were male. The mean age of the patients was 73.7 years, with a standard deviation of 8.3. A percentage of 52.9% of the patients reported seeking care in Primary Care after hospital discharge, 20% reported difficulty accessing, 13% reported using medications other than those prescribed at discharge, according to medical guidance in Primary Care, and 13% self-medication. In the final logistic regression model, it was identified that age equal to or greater than 75 years was positively associated with the patient's membership in the Fragile Elderly/Palliative Care team. In the final model, the occurrence of self-medication was also positively associated with the Fragile Aged (OR = 6.8, p <0.05). Conclusion: it is understood that the PMI service was an interesting tool for identifying pharmacotherapeutic problems after hospital discharge. Self-medication after hospital discharge was positively associated with patients in the palliative care / fragile elderly when compared to the Cerebral Vascular Accident Unit and age below 75 years was positively associated with Team for diabetic foot complications

Identificação de eventos hemorrágicos em idosos participantes de ação educativa em um Ambulatório de Anticoagulação / Identifying hemorragics events in eldery participants in education intervention at a anticoagulation clinic

OBJETIVO: Caracterizar pacientes participantes de uma oficina educacional, assim como identificar os medicamentos em uso, interações com a varfarina, e ocorrência de eventos hemorrágicos. MÉTODOS: Trata-se de um estudo observacional descritivo, realizado no período entre junho a setembro de 2014 em um hospital público geral, referência na Rede de urgência e emergência (RUE) do Sistema Único de Saúde (SUS) em Minas Gerais. Na primeira etapa realizou-se oferecimento de oficinas educativas, e na segunda realizou-se consulta a prontuários com o intuito de identificar características sócio-demográficas, clínicas, e farmacoterápicas, destacando-se o registro de ocorrência de eventos hemorrágicos. Os dados foram registrados em planilha do programa Microsoft Excel para análise estatística descritiva. RESULTADOS: Um total de 64 pacientes com idade média de 64,8 anos participaram das oficinas, sendo 33 (51%) do sexo masculino. As indicações de anticoagulação mais frequentes foram fibrilação atrial (26;40,6%) e eventos tromboembólicos (24;37,5%). Dentre as interações, a varfarina foi o medicamento com maior frequência de uso, seguido da sinvastatina, atenolol e omeprazol. Do total de pacientes, 4 (6,25%) apresentaram registros de eventos hemorrágicos em prontuários. CONCLUSÕES: Ao caracterizar os pacientes e identificar a possibilidade de aumento do risco de sangramento associado ás interações medicamentosas, os achados reforçam a necessidade do acompanhamento contínuo de pacientes em uso do anticoagulante varfarina, assim como a importância do investimento em estratégias educacionais. (AU)

Aim: To characterize patients participants in an educational workshop, and identify the medications in use, interactions with warfarin, and he occurrence of hemorrhagic events. Methods: This is a descriptive study conducted between june and september 2014 in a general public hospital in Minas Gerais, Brazil. In the first stage, educational workshops were offered, and in the second, a medical consultation was carried out with the purpose of identify socio-demographic, clinical, and pharmacotherapeutic characteristics, highlighting the occurrence of hemorrhagic events. The data were recorded in a microsoft excel spreadsheet for descriptive statistical analysis. Results: A total of 64 patients with a mean age of 64.8 years participated in the workshops, of which 33 (51%) were male. The most frequent anticoagulation indications were atrial fibrillation (26; 40.6%) and thromboembolic events (24; 37.5%). Among the interactions, warfarin was the drug with the highest frequency of use, followed by simvastatin, atenolol and omeprazole. Of the total number of patients, 4 (6.25%) had records of hemorrhagic events in medical records. Conclusions: In characterizing patients and identifying the possibility of increased risk of bleeding associated with drug interactions, the findings reinforce the need for continuous monitoring of patients using warfarin anticoagulant, as well as the importance of investing in educational strategies. (AU)

Evaluation of late presentation for HIV treatment in a reference center in Belo Horizonte, Southeastern Brazil, from 2008 to 2010

Introduction: Since 1996 Brazil has provided universal access to free antiretroviral therapy, and as a consequence, HIV/AIDS patients' survival rate has improved dramatically. However, according to scientific reports, a significant number of patients are still late presenting for HIV treatment, which leads to consequences both for the individual and society. Clinical and immunological characteristics of HIV patients newly diagnosed were accessed and factors associated with late presentation for treatment were evaluated. Methods: A cross-sectional study was carried out in an HIV/AIDS reference center in Belo Horizonte, Minas Gerais, in Southeastern Brazil from 2008 to 2010. Operationally, patients with late presentation (LP) for treatment were those whose first CD4 cell count was less than 350 cells/mm3 or presented an AIDS defining opportunistic infection. Patients with late presentation with advanced disease (LPAD) were those whose first CD4 cell count was less than 200 cells/mm3 or presented an AIDS defining opportunistic infection. LP and LPAD associated risk factors were evaluated using logistic regression methods. Results: Five hundred and twenty patients were included in the analysis. The median CD4 cell count was 336 cells/mm3 (IQR: 130-531). Two hundred and seventy-nine patients (53.7%) were classified as LP and 193 (37.1%) as LPAD. On average, 75% of the patients presented with a viral load (VL) >10,000 copies/ml. In multivariate logistic regression analysis the factors associated with LP and LPAD were age, being symptomatic at first visit and VL. Race was a factor associated with LP but not with LPAD. Conclusion: The proportion of patients who were late attending a clinic for HIV treatment is still high, and effective strategies to improve early HIV detection with a special focus on the vulnerable population are urgently needed. .