Atención integrada madre-niño. efectos sobre adherencia y conocimientos de métodos anticonceptivos / Integrated mother-child care. Effects on adherence and knowledge of contraceptive methods

Resumen Introducción : La evidencia científica sugiere que es trategias de atención conjunta madre-hijo facilitarían el conocimiento de métodos anticonceptivos (MAC) y su acceso. El objetivo fue evaluar el efecto del Modelo de atención integrada de la madre y el niño sobre la adherencia y conocimientos de MAC en mujeres durante el primer semestre postparto. Métodos : Se realizó un estudio de intervención, se conformaron 2 grupos, GI: grupo de intervención (3 con troles hasta los 6 meses postparto) y GC: grupo control (un control a los 6 meses postparto). La intervención consistió en asesoramiento presencial acerca de MAC combinada con folletería informativa y mensajes de WhatsApp®. Se recabaron datos sociodemográficos, an tecedentes gineco-obstétricos, uso y conocimientos de MAC. Se comparó la adherencia al uso y el conocimiento de MAC en ambos grupos a los 6 meses post parto. El análisis se realizó mediante el software R versión 4.0.3. Resultados : Se incorporaron 39 mujeres en cada grupo. Se halló una diferencia en el uso de MAC entre grupos a los 6 meses (92.3% vs. 64.1%), siendo más eleva do su uso en el GI. Se hallaron diferencias significativas en el conocimiento de algunos MAC a los 6 meses. Un mayor porcentaje de mujeres del GI conocía las pastillas anticonceptivas (p = 0.009), ligadura de trompas (p = 0.04) y la vasectomía (p = 0.010), en comparación con el GC. Discusión : La intervención en el postparto temprano con diversas estrategias de comunicación e información pueden ser útiles para elegir el MAC que se considere más adecuado para cada mujer y su utilización correcta.

Abstract Introduction : Scientific evidence suggests that moth er-child joint care strategies would facilitate knowledge of contraceptive methods (MAC) and their access. The objective was to evaluate the effect of the Integrated Mother and Child Care Model on adherence and knowl edge of CAM in women during the first postpartum semester. Methods : An intervention study was carried out, 2 groups were formed, GI: intervention group (3 controls up to 6 months postpartum) and GC: control group (one control at 6 months postpartum). The intervention con sisted of face-to-face counseling about MAC combined with informative brochures and WhatsApp® messages. Sociodemographic data, gynecological and obstetric history, use and knowledge of contraceptive methods were collected. Adherence to the use and knowledge of MAC were compared in both groups at 6 months post partum. The analysis was performed using R software version 4.0.3. Results : Thirty-nine women were incorporated into each group. A difference was found in the use of MAC between groups at 6 months (92.3% vs. 64.1%), its use being higher in GI. Significant differences were found in the knowledge of some MAC at 6 months. A higher percentage of women in GI knew about birth control pills (p = 0.009), tubal ligation (p = 0.04) and vasectomy (p = 0.010), compared to GC. Discussion : Early postpartum intervention with vari ous communication and information strategies can be useful to choose the MAC that is considered most ap propriate for each woman and its correct use.

Appropriate knowledge of the indications for medications in use among older individuals assisted in the Jornada Científica dos Acadêmicos de Farmácia-Bioquímica

This study aimed to identify variables associated with the appropriate recall of indications and the drug classes that represented the most unmatching medications (i.e., when the individual who used it had not reported any illness that matched its indications). Community-dwelling individuals aged ≥60 years using ≥1 medication, from Santa Cruz da Esperança-SP, Brazil, were home-interviewed. Logistic regression models were used to evaluate the association between the appropriate recall of the indications for all medications in use and the following: gender, age, education, individual income, living arrangement, self-perceived health, and medication number, administration, payment, and identification. Medications whose indications were inappropriately recalled were classified as matching or unmatching. One hundred seventeen individuals used an average of 5.1 (standard deviation, 3.3) medications. Sixty-one (52.1%) appropriately recalled all indications. The appropriate recall of all indications was negatively associated with the number of medications in use (e.g., individuals taking 5-6 medications were 25 times less likely to appropriately recall all indications than those taking 1-2). Antithrombotic, acid-related disorder and psychoanaleptic classes showed greater frequencies of unmatching than matching medications. Therefore, counseling the elderly about drug indications should focus on those using ≥3 medications and/or antithrombotic, acid-related disorder, and psychoanaleptic agents.

Grado de satisfacción y conocimiento de pacientes positivos para HIV ante el cambio de tenofovir a tenofovir-alafenamida en tratamientos con emtricitabina y rilpivirina / Satisfaction and knowledge among patients with HIV after switching from tenofovir to tenofovir alafenamide in regimens containing emtricitabine and rilpivirine

Introducción. La satisfacción y el conocimiento del cambio de tenofovir por tenofovir- alafenamida en pacientes con HIV no se han estudiado aún. Estos dos parámetros se relacionan con mejores resultados en salud y, por lo tanto, es importante medirlos durante la práctica clínica habitual. Objetivo. Evaluar el grado de conocimiento y satisfacción de los pacientes positivos para HIV ante el cambio de tratamiento antirretroviral con rilpivirina, emtricitabina y tenofovir (RPV-FTC-TDF) por rilpivirina, emtricitabina y tenofovir-alafenamida (RPV-FTC-TAF). Materiales y métodos. Se llevó a cabo un estudio prospectivo en un hospital de tercer nivel entre los meses de septiembre y noviembre de 2018. Se incluyeron pacientes previamente tratados con RPV-FTC-TDF que acudían por segunda vez a consulta para recibir el tratamiento con RPV-FTC-TAF. La satisfacción y el grado de conocimiento se analizaron mediante nueve preguntas, usando una escala de tipo Likert de 5 puntos para evaluar el grado de acuerdo. Resultados. Se incluyeron 116 pacientes en el estudio. El 75 % de ellos se mostró satisfecho con el cambio y se consideró que el 64 % conocía lo que implicaba. Los pacientes jóvenes se mostraron menos satisfechos con el modo en que se les explicó el cambio (p=0,0487). Los pacientes estaban mejor informados sobre las ventajas renales (85 % de conocimiento) y óseas (82 %) de la nueva medicación, que sobre sus inconvenientes para el perfil lipídico (40 %). Conclusiones. En general, los pacientes se mostraron satisfechos con el cambio de medicación y conocían la posología del medicamento y las ventajas de la tenofovir- alafenamida frente al tenofovir, pero no sus posibles efectos adversos.

Introduction: Satisfaction and knowledge among patients with HIV after switching from tenofovir to tenofovir/alafenamide remain unexplored. Given that both parameters are associated with better health outcomes it is relevant to measure them in patients during routine clinical practice. Objective: To evaluate the degree of knowledge and satisfaction in patients who had their antiretroviral regimen switched from rilpivirine (RPV)/emtricitabine (FTC)/TDF to RPV/FTC/TAF. Materials and methods: We conducted a prospective study in a third-level hospital between September, 2018, and November, 2018. We included patients who had previously been treated with RPV/FTC/TDF and collected their RPV/FTC/TAF treatment in the second visit. A 5-point Likert-type agreement/disagreement scale was used to assess satisfaction and knowledge regarding the medication switch. Results: We included 116 patients in the study of whom 75% were satisfied and 64% had a high-level of knowledge. Young patients were less satisfied with the way in which the change was explained (p=0.0487). Concerning the new medication, the patients were better informed about its renal (85% of them) and bone benefits (82%) than about its adverse effects on the lipid profile (40%). Conclusions: The patients were generally satisfied with the change in medication and well informed about the dosage and advantages of TAF over TDF, but less well informed about the possible adverse effects of TAF.

Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines / Utilização de medicamentos para distúrbios gastrintestinais: evidências da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos

ABSTRACT Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval − 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.

RESUMO Objetivo Estimar a prevalência de utilização de medicamentos para o tratamento de distúrbios gastrintestinais, segundo características demográficas, socioeconômicas e de saúde da população brasileira. Métodos Trata-se de inquérito de base populacional, que entrevistou indivíduos residentes em municípios das cinco regiões do Brasil. A amostra deste estudo foi composta por 32.348 indivíduos de 20 anos ou mais de idade. Foi avaliado o perfil de utilização de medicamentos para distúrbios gastrintestinais entre as variáveis sexo, idade, plano de saúde, região e número de doenças crônicas. Analisou-se a frequência de indivíduos que declararam utilizar outros medicamentos, além daqueles já utilizados para tratamento de distúrbios gastrintestinais. Além disso, foram estimadas as frequências das classes medicamentosas utilizadas. Resultados A prevalência de utilização de medicamentos para distúrbios gastrintestinais no Brasil foi de 6,9% (intervalo de confiança de 95% − 6,4-7,6), sendo maior no sexo feminino, entre pessoas acima de 60 anos de idade, naqueles que possuíam plano privado de saúde e tinham duas ou mais doenças crônicas. Observou-se que 42,9% dos idosos que utilizaram medicamentos para distúrbios gastrintestinais também eram polimedicados. Em relação às classes medicamentosas, 82% correspondiam a medicamentos para o trato alimentar e metabolismo, destacando os inibidores da bomba de prótons. Conclusão A utilização de medicamentos para tratamento de distúrbios gastrintestinais foi significativa entre mulheres e idosos. Nesta faixa etária, o consumo pode estar vinculado à proteção gástrica causada por polimedicação. Este estudo representa oportunidade inédita para observar o perfil de consumo autorreferido desses medicamentos no Brasil e pode, portanto, subsidiar estratégias para promoção de seu uso racional.

Conhecimento inadequado sobre medicamentos prescritos e seus preditores em pacientes muito idosos e seus cuidadores / Inadequate knowledge of prescription drugs and their predictors in very old patients and their caregivers

Resumo Objetivo Identificar preditores do conhecimento inadequado sobre medicamentos prescritos a pacientes ambulatoriais muito idosos e seus cuidadores. Método O conhecimento sobre os medicamentos prescritos para 80 pacientes com 80 anos ou mais de idade foi avaliado por meio de um questionário validado, em uma entrevista realizada com os pacientes ou seus cuidadores (quando os pacientes apresentavam dificuldades de comunicação, demência ou qualquer necessidade de assistência para ajudá-los a usar medicamentos). Dois modelos de regressão logística hierárquica avaliaram a associação entre conhecimento inadequado sobre medicamentos e variáveis ​​sociodemográficas e medicamentosas. Resultados Trinta e nove (48,8%) entrevistados eram cuidadores. Conhecimento inadequado foi encontrado em 81,5% (404/496) dos medicamentos prescritos. Forma de administração, Dose, Frequência e Duração do Tratamento foram os aspectos de maior conhecimento, enquanto Reações Adversas, Precauções, Interações e Contraindicações, os de menor. No primeiro modelo, o conhecimento inadequado foi associado à escolaridade do ensino fundamental completo ao médio incompleto (Razão de Chances (RC):0,12; p=0,018), do médio ao superior incompleto (RC:0,12; p<0,001), superior completo (RC:0,13; p<0,001), agentes que atuam no sistema renina-angiotensina (SRA) (RC:0,30; p=0,001), diuréticos (RC:0,31; p=0,013) e antitrombóticos (RC:12,59; p=0,027). No segundo modelo, os preditores foram cuidadores (RC:0,17; p<0,001), agentes que atuam no SRA (RC:0,33; p=0,002), diuréticos (RC:0,35; p=0,024) e antitrombóticos (RC:12,57; p=0,026). Conclusão A maioria dos medicamentos prescritos para pessoas muito idosas é pouco conhecida. Além disso, o aconselhamento acerca de informações sobre medicamentos deve ser mais intensivo para os pacientes do que para seus cuidadores, com foco em informações de segurança e ser direcionado a antitrombóticos.

Abstract Objective Identify predictors of inadequate knowledge about the medication prescribed to very old outpatients and their caregivers. Method The knowledge on the medication prescribed for 80 patients aged 80 years and over was assessed using a validated questionnaire to interview patients or their caregivers (when patients had communication difficulties, dementia, or any need for care to help them take the medication). Two hierarchical logistic regression models assessed the association between inadequate knowledge of the medication and sociodemographic and drug variables. Results Thirty-nine (48.8%) respondents were caregivers. Inadequate knowledge was found in 81.5% (404/496) of medication prescribed. Route of Administration, Dose, Frequency, and Duration of Treatment were the aspects of greatest knowledge, whereas Adverse Effects, Precautions, Interactions, and Contraindications were the least known ones. In the first model, inadequate knowledge was associated to the level of education from complete elementary school to incomplete high school (Odds Ratio (OR): 0.12; p=0.018), from high school to incomplete higher education (OR: 0.12; p<0.001), complete higher education (OR: 0.13; p<0.001), agents acting on the renin-angiotensin system (RAS) (OR: 0.30; p=0.001), diuretics (OR: 0.31; p=0.013) and antithrombotic (OR: 12.59; p=0.027). In the second model, the predictors were caregivers (OR: 0.17; p<0.001), agents working in the RAS (OR: 0.33; p=0.002), diuretics (OR: 0.35; p=0.024) and antithrombotic (OR: 12.57; p=0.026). Conclusion Most of the medication prescribed for very old people is not very well known. Also, advice on drug information should be more intensive to patients than to their caregivers, with a focus on safety information and targeted at antithrombotics.

Fatores relacionados à adesão ao tratamento farmacológico por idosos na Atenção Primária à Saúde / Factors related to adhesion to pharmacological treatment by seniors in Primary Health Care

Objective: To identify factors related to adherence to pharmacological treatment by the elderly people in Primary Health Care.Method: It is a descriptive study developed with a team of the Family Health Strategy, in a municipality in northwestern Paraná. Data were collected in June and July 2018, through a questionnaire applied at home visit. Subsequently, the data were recorded, organized in spreadsheets and submitted to descriptive statistics.Results: Among the 118 elderly participants, 61.1% were female, 78.8% were between 60 and 69 years old, 59.3% had up to eight years of schooling, 12.2% had some physical disability, 9, 7% needed help to use medication, 60.1% were taking medication as prescribed, 12.1% had already used medication changed, 39.8% used 1 to 3 medications prescribed by the doctor, 50% reported Self-medication, 84.7% reported knowledge of the indication of all medications, 5.1% indicated that the greatest difficulty in adhering to treatment is that the medication is not provided free of charge. Conclusion: Given the factors highlighted by the participants as influential in adherence to drug treatment, it is necessary that professionals and managers jointly establish strategies to facilitate access to the necessary drugs for seniors.

Objetivo: identificar os fatores relacionados à adesão ao tratamento farmacológico por idosos na Atenção Primária à Saúde. Método: Estudo descritivo desenvolvido junto a uma equipe da Estratégia Saúde da Família, em um município do noroeste do Paraná. Os dados foram coletados nos meses de junho e julho de 2018, por meio de questionário aplicado no momento da visita domiciliar. Posteriormente, os dados foram registrados, organizados em planilhas e submetidos à estatística descritiva. Resultados: Dentre os 118 idosos participantes, 61,1% eram do sexo feminino, 78,8% tinham entre 60 e 69 anos, 59,3% possuíam até oito anos de estudo, 12,2% apresentavam alguma deficiência física, 9,7% necessitavam de auxílio para utilizar medicamentos, 60,1% faziam uso da medicação conforme prescrição médica, 12,1% já fez uso de medicamento trocado, 39,8%, utilizavam de 1 a 3 medicamentos prescritos pelo médico, 50% relataram automedicação, 84,7% relataram conhecimento da indicação de todos os medicamentos, 5,1% indicaram que a maior dificuldade para aderir ao tratamento é o medicamento não ser fornecido gratuitamente. Conclusão: Diante dos fatores destacados pelos participantes como influentes na adesão ao tratamento medicamentoso, torna-se necessário que profissionais e gestores estabeleçam conjuntamente estratégias para facilitar o acesso aos medicamentos necessários para os idosos.

Validação do questionário "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) / Validation of the "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) questionnaire

Resumo Este trabalho adaptou transculturalmente o questionário espanhol "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) para uso no Brasil. Ele mede o grau de conhecimento sobre medicamentos por meio de 11 perguntas. Oitenta pacientes ≥ 80 anos foram investigados e com 39 também foi entrevistado o cuidador. A avaliação das equivalências conceitual e de item considerou o conceito de conhecimento e as perguntas que o medem como pertinentes. A equivalência semântica foi obtida pela correspondência de significado denotativo e conotativo dos itens. O estudo da equivalência de mensuração incluiu análise fatorial e o cálculo de estimativas de validade e confiabilidade. Semelhante ao questionário original, a análise de componentes principais identificou 4 componentes, porém, em 2 deles houve diferenças nos itens incluídos. Uma pergunta foi removida desta análise devido à sua inadequação amostral. O conhecimento sobre medicamentos esteve correlacionado à complexidade da prescrição r = -0,22, p = 0,046. O conhecimento sobre anti-hipertensivos esteve correlacionado à sua adesão r = 0,70, p < 0,001, e ao controle da pressão arterial rb = 0,46, p = 0,029. A versão adaptada apresentou equivalência funcional de modo que pode ser usada no contexto brasileiro.

Abstract This work cross-culturally adapted the Spanish questionnaire `Patients' knowledge about their medications ("Conocimiento del Paciente sobre sus Medicamentos" - CPM-ES-ES) for use in Brazil. It measures the level of medication knowledge by means of 11 questions. Eighty patients ≥ 80 years were investigated and in 39 cases the caregivers were interviewed. The evaluation of conceptual and item equivalences considered the concept of knowledge and the questions that assess it as pertinent. Semantic equivalence was obtained by the correspondence in the denotative and connotative meaning of items. The study of measurement equivalence included factorial analysis and the calculation of validity and reliability estimates. As with the original questionnaire, principal component analysis identified 4 components, however, in 2 of them there were differences regarding included items. One question was removed from this analysis due to its sample inadequacy. Medication knowledge was correlated with medication regimen complexity r = -.22, p = .046. Medication knowledge of antihypertensives was correlated with their adherence r = .70, p < .001, and blood pressure control rb = .46, p = .029. The adapted version revealed functional equivalence, therefore it can be used in the Brazilian context.

Compliance to treatment in diabetic pa tients from Bucaramanga, Colombia: a cross sectional study / Adherencia al tratamiento en pacientes diabéticos de Bucaramanga, Colombia: estudio de corte transversal

Objective: this study is aimed to evaluate knowledge about the disease, some behavioral habits and the level of compliance to pharmacological treatment, in a sample of diabetic patients, attending at hospital institution in the city of Bucaramanga (Colombia), during 2016. Diabetes mellitus is a chronic disease whose prevalence is increasing significantly in developing countries. Materials and Methods: cross sectional, descriptive study; a sample of 411 diabetic, aged over 35 years, who consulted at cardiovascular risk program, answered in the period between January and December 2016, a self-administered questionnaire that included the instruments IMEVID, Berbés and modified SMMS; Additionally, sociodemographic variables such as age, sex, stratum, education, were included. Results: 90% had a low socioeconomic status and 82.7% only reached primary studies or less. High Pharmacological adherence was observed in only 3.65%, medium adherence in 87.83% and low at 8.52%. Mean level of knowledge about diabetes was 13.32; Almost half (46.72%) scored below the average; Mean of glycosylated hemoglobin was 7.93%; 34.8% scored above this value. 18.7% have an inadequate lifestyle (IMEVID score <60). Low adherence found associated with: alcohol intake, IMEVID score <60, Ask more after eating, have a job and don't use insulin. Conclusion: it is necessary to esta-blish learning strategies and methodologies of motivation and training for diabetic patients, to improve quality of life and knowledge of the diabetes and, in this way,optimize the prognosis of the disease..(AU)

Objetivo: el estudio se propone evaluar el conocimiento sobre la enfermedad, algunos hábitos de comportamiento y el nivel de cumplimiento con el tratamiento farmacológico en una muestra de pacientes diabéticos que asistieron a una institución hospitalaria en la ciudad de Bucaramanga (Colombia) durante el 2016. La diabetes mellitus es una enfermedad crónica, su prevalencia está aumentando significativamente en los países en desarrollo. Materiales y Métodos: estudio de corte transversal, descriptivo; una muestra de 411 diabéticos, mayores de 35 años, que consultaron al programa de riesgo cardiovascular, respondieron en el período comprendido entre enero a diciembre de 2016, un cuestionario autoadministrado que incluía los instrumentos IMEVID, Berbés y SMMS modificado; Adicionalmente, se incluyeron variables sociodemográficas como edad, sexo, estrato, educación. Resultados: el 90% tenía un estatus socioeconómico bajo y el 82.7% solo alcanzó estudios primarios o menos. Se observó una alta adherencia farmacológica en solo el 3,65%, una adherencia media en el 87,83% y una baja en el 8,52%. El nivel medio de conocimiento sobre la diabetes fue de 13.32; Casi la mitad (46.72%) puntuó por debajo del promedio; La media de hemoglobina glicosilada fue de 7.93%; El 34.8% puntuó por encima de este valor. El 18.7% tiene un estilo de vida inadecuado (puntuación IMEVID <60). Se encontró que la baja adherencia estaba asociada con: consumo de alcohol, puntaje IMEVID <60, pedir más después de comer, tener un trabajo y no usar insulina. Conclusión: es necesario establecer estrategias de aprendizaje y metodologías de motivación y entrenamiento a los pacientes diabéticos, para mejorar la calidad de vida y el conocimiento de la diabetes, y de esta manera, optimizar el pronóstico de la enfermedad..(AU)

Interventions to reduce the prescription of inappropriate medicines in older patients / Intervenções para reduzir a prescrição de medicamentos inapropriados para idosos

ABSTRACT OBJECTIVE: Identify and critically evaluate systematic reviews addressing the effectiveness of interventions to reduce the number of prescriptions of potentially inappropriate medication to older patients. METHODS: This is an overview of systematic reviews. The studies were searched and selected from Medline, Cochrane Library, Embase, CINAHL, Virtual Health Library, and Web of Science databases, combining the terms aged, prescriptions, inappropriate prescribing and potentially inappropriate medication list with their entry terms and other related descriptors, published by June 2017. This study included systematic reviews with or without meta-analysis that addressed the effectiveness of any intervention or combined interventions to reduce the number of prescriptions of potentially inappropriate medications to older patients, without restriction in terms of design, language or date of publication of primary studies. AMSTAR - A MeaSurement Tool to Assess systematic Reviews - was used to evaluate the methodological quality of selected systematic reviews. Study selection and the methodological quality evaluation were performed by two independent evaluators, who resolved any divergence by consensus. The main findings were grouped into thematic categories, defined after a content analysis and discussed qualitatively as narrative synthesis. RESULTS: This study analyzed 24 systematic reviews. In terms of study design and methodological quality evaluation, most were systematic reviews of randomized controlled clinical trials and studies of moderate quality, respectively. The interventions were analyzed in five thematic categories: medication review services, pharmaceutical interventions, computerized systems, educational interventions, and others. The interventions analyzed showed good results and most of them helped reduce the number of prescriptions of potentially inappropriate medication to older patients. CONCLUSIONS: The systematic reviews included in this overview showed potential benefits of different interventions. However, it was not possible to determine the most effective intervention. Combined interventions are likely to provide better results than isolated interventions.

RESUMO OBJETIVO: Identificar e avaliar criticamente revisões sistemáticas sobre a efetividade de intervenções para reduzir a prescrição de medicamentos potencialmente inapropriados para pacientes idosos. MÉTODOS: Overview de revisões sistemáticas. A busca e a seleção dos estudos foram feitas nas bases de dados Medline, Biblioteca Cochrane, Embase, CINAHL, Biblioteca Virtual em Saúde e Web of Science, combinando os termos aged, prescriptions, inappropriate prescribing e potentially inappropriate medication list com seus sinônimos remissivos e outros descritores associados até junho de 2017. Foram incluídas revisões sistemáticas com ou sem metanálise, que tenham abordado a efetividade de qualquer intervenção ou a combinação de intervenções para reduzir a prescrição de medicamentos potencialmente inapropriados para pacientes idosos, sem restrição quanto ao desenho dos estudos primários, idioma ou data de publicação. Para avaliação da qualidade metodológica das revisões sistemáticas selecionadas, foi utilizado o instrumento A MeaSurement Tool to Assess systematic Reviews. A seleção e a avaliação da qualidade metodológica foram realizadas por dois avaliadores independentes. As divergências foram superadas por consenso. Os principais achados foram agrupados em categorias temáticas, definidas com base em análise de conteúdo e discutidas qualitativamente na forma de síntese narrativa. RESULTADOS: Vinte e quatro revisões sistemáticas foram incluídas no estudo. Quanto ao desenho do estudo e à avaliação da qualidade metodológica, prevaleceram revisões sistemáticas de ensaios clínicos controlados randomizados e estudos de qualidade moderada, respectivamente. As intervenções foram analisadas em cinco categorias temáticas: serviços de revisão de medicamentos, intervenções farmacêuticas, sistemas informatizados, intervenções educacionais e outras. As intervenções estudadas apresentaram bons resultados e a maioria contribuiu para reduzir a prescrição de medicamentos inapropriados para pacientes idosos. CONCLUSÕES: As revisões sistemáticas incluídas nesse overview apontaram benefícios potenciais de diferentes intervenções. No entanto, não foi possível determinar qual a mais efetiva. É provável que intervenções multifacetadas alcancem resultados melhores do que intervenções isoladas.

Alarming lack of knowledge about antithrombotic therapy among patients with atrial fibrillation / Terapia antitrombótica: alarmante falta de conhecimento em pacientes com fibrilação atrial

ABSTRACT Large population campaigns have been conducted in Brazil to improve knowledge about the signs and symptoms of stroke and the importance of time to care. Objective: Parallel to these important actions, we aimed to evaluate the lay knowledge of patients with atrial fibrillation, a well-recognized etiology of stroke, adequate treatment and management of which can prevent up to 30% of cerebrovascular events. Methods: We questioned 143 patients with atrial fibrillation about the risks associated with the disease. Results: Ninety-one percent were on anticoagulation treatment. Of the total, 63.6% reported having been informed about the risks and benefits of anticoagulants but only 46.9% were able to correctly mention one of these risks. Ischemic stroke was identified as a risk by only 25.9% and hemorrhagic stroke was not mentioned. A CHADS2 ≥ 2 was scored by 84.0% of the patients. Conclusions: Our study showed an alarming knowledge gap in patients with atrial fibrillation. Difficulty in adherence to treatment resulting from the failure of this communication is possibly one of the factors responsible for the high incidence and recurrence of stroke, and should not go unnoticed.

RESUMO Campanhas populacionais para melhorar o conhecimento sobre os sinais e sintomas do acidente vascular encefálico e a importância do tempo para o tratamento têm sido realizadas no nosso país, visando a melhoria da linha do atendimento. Objetivo: Paralelamente a estas relevantes ações, objetivamos avaliar o conhecimento leigo de pacientes portadores de fibrilação atrial, etiologia determinada e prevalente do acidente vascular encefálico, cujo tratamento e manejo adequado podem prevenir até 30% dos eventos cerebrovasculares. Métodos: Entrevistamos portadores de fibrilação atrial sobre os riscos associados à doença. Resultados: Noventa e um por cento estavam sob uso de anticoagulantes. Do total, 63,6% responderam terem sido informados sobre riscos e benefícios da terapia anticoagulante, mas apenas 46,9% souberam citar corretamente um desses riscos. Acidente vascular encefálico isquêmico foi associado ao risco por apenas 25,9% e acidente vascular encefálico hemorrágico não foi mencionado. CHADS2 ≥ 2 foi pontuado por 84,0% dos pacientes. Conclusões: Nosso estudo demonstra uma alarmante falha no conhecimento do risco de acidente vascular encefálico nos portadores de fibrilação atrial. Dificuldade na aderência ao tratamento resultante da falha dessa comunicação é fator relevante na incidência e recorrência do acidente vascular encefálico e não deve ser negligenciado.

Adesão farmacológica e conhecimento de pacientes anticoagulados / Pharmacological adherence and knowledge of anticoagulated patients

Resumo Objetivo: Investigar a adesao farmacológica e o conhecimento de pacientes sob terapia de anticoagulacao oral acompanhados ambulatorialmente. Método: Estudo transversal, com abordagem quantitativa. Resultados: 222 pacientes foram avaliados; destes, 60,8 % foram clasificados como nao aderentes, e 63,1 % possuiam conhecimento nao adequado em relacao ao anticoagulante oral. A nao adesao foi relacionada ao maior tempo de tratamento (p < 0,001) e aos pacientes com valores da Razao Normatizada Internacional (rni) fora da faixa terapeutica (p = 0,022). O conhecimento nao adequado foi asociado a baixa escolaridade (p < 0,001), ao sedentarismo (p = 0,027), ao menor tempo de acompanhamento ambulatorial (p < 0,001) e aos pacientes com valores da rni fora da faixa terapeutica (p = 0,012). Conclusões: Diante dos resultados, evidencia-se a necessidade de estrategias de educacao em saude que atendam a esse publico e que considerem a compreensao individual e a adesao farmacológica como algo crucial na terapia.

Resumen Objetivo: Investigar la adherencia farmacologica y el conocimiento de pacientes en tratamiento con anticoagulantes orales con acompañamiento en ambulatorio. Método: Estudio transversal con enfoque cuantitativo. Resultados: Se evaluaron 222 pacientes; de ellos el 60,8 % se clasificaron como no adherentes, y el 63,1 % poseian conocimiento inadecuado sobre la anticoagulacion oral. La no adhesion estaba relacionada con un tratamiento mas prolongado (p < 0,001) y con los pacientes con valores da International Normalized Ratio (inr) fuera del rango terapeutico (p = 0,022). El conocimiento no adecuado se asocio al menor nivel educativo (p < 0,001), al sedentarismo (p = 0,027), al menor tiempo de acompanamiento en ambulatorio (p < 0,001) y a los pacientes con valores de inr fuera del rango terapéutico (p = 0,012 ). Conclusión: Con base en los resultados se evidencia la necesidad de estrategias de educacion en salud que atiendan a ese publico, teniendo en cuenta la comprension individual y la adhesion farmacologica como algo crucial en la terapia.

Abstract Objective: To investigate the pharmacological adherence and the knowledge of patients undergoing oral anticoagulation therapy with outpatients follow-up. Method: Cross-sectional study with quantitative approach. Results: 222 patients were evaluated, of which 60.8 % were classified as non-adherents and 63.1 % had inadequate knowledge regarding oral anticoagulant. Non-adherence was related to longer treatment time (p <0.001) and to patients with inr values outside the therapeutic range (p = 0.022). Inadequate knowledge was associated with low educational level (p < 0.001), sedentary lifestyle (p = 0.027), shorter outpatient follow-up (p < 0.001), and patients with inr values outside the therapeutic range (p = 0.012). Conclusion: In view of the results, it is evident the need for health education strategies that address this public, considering individual understanding and pharmacological adherence as crucial in therapy.

Actual Condition Survey of Risk and Benefit Communication for Consumers and Patients on Pharmaceuticals / 医薬品情報学

Objective:It is necessary to obtain appropriate drug information (DI)so that appropriate medical care is provided for the consumers,patients. Thorough studies have not been done on institutions that offer DI for patients in Japan and the state of its dissemination. The purpose of this study is to find levels of recognition of the institutions providing medical information and the actual state of its usage.Method:In order to find the levels of recognition of the institutions that provide DI to general consumers and the state of usage of the information provided by them,we conducted questionnaire surveys using online panels. We also conducted a study to find subjective comprehension on DI by the panels. The surveys were conducted twice using the same questionnaire in order to robust the outcomes of the study.Results:We received 1,095 valid responses from the first survey and 1,086 from the second survey respectively. No significant differences were found between the two surveys. Although the levels of recognition vary for the four representative public institutions providing DI,DI provided by these institutions has been barely utilized by the respondents. As the sources of DI that have been used most,almost the same numbers of respondents replied that they used Internet search engines to access them in addition to medical doctors and pharmacists. Regarding the levels of comprehension for the provided DI,the respondents tended to have shown high levels of understanding on maintaining medication compliance,but low on safety information. There was a positive correlation between age and the understanding of the DI.Conclusion: The study implies that the environment to provide DI for patients still needs to be improved, and the respondents didnʼt understand DI enoughly. Therefore,it is necessary to study further for the creation and communication of truly user-friendly DI.

Impact of a drug dispensing model at a Community Pharmacy in Goiânia, Goiás, Brazil

Although dispensing of medication has been addressed by theoretical models, studies that confirm the impact of this service are still needed. The objective was to evaluate the impact of a new model of medicine dispensing system on patients' medication knowledge, adherence to treatment and satisfaction. One hundred and four patients attending the dispensing service of a community pharmacy between 21 January 2013 and 20 April 2013 were included in this intervention study. The impact of the service on patients' medication knowledge, adherence to treatment and satisfaction was assessed by using validated questionnaires at two time points: at the moment of medication dispensing and 30 days thereafter by telephone contact. Statistical analysis was performed by McNemar's test, and a p<0.05 was set as statistically significant. The number of patients showing insufficient knowledge about medications decreased by 50% (p < 0.05), and the number of those showing sufficient knowledge was three times greater (p < 0.05) after medicine dispensing. A high level of satisfaction was observed. Improvement of medication adherence, however, was not observed. The proposed system model for drug dispensing improved patients' knowledge about medication and satisfaction

Adaptação Transcultural do Oral Anticoagulation Knowledge Test para o Português do Brasil / Cross-cultural Adaptation of the Oral Anticoagulation Knowledge Test to the Brazilian Portuguese

Resumo O conhecimento dos pacientes sobre o tratamento com anticoagulantes orais pode favorecer o alcance dos resultados terapêuticos e a prevenção de eventos adversos relacionados à farmacoterapia. No Brasil, observa-se a ausência de instrumentos validados para avaliação do conhecimento do paciente sobre o tratamento com a varfarina. O objetivo deste estudo foi realizar a adaptação transcultural do instrumento Oral Anticoagulation Knowledge (OAK) Test do inglês para o português do Brasil. Trata-se de estudo metodológico desenvolvido em uma clínica de anticoagulação de um hospital público universitário. O estudo compreendeu as etapas de tradução inicial, síntese das traduções, retrotradução, revisão pelo comitê de especialistas e pré-teste com 30 indivíduos. A equivalência semântica foi obtida através da análise do significado referencial e geral de cada item. A equivalência conceitual dos itens buscou demonstrar a relevância e a aceitabilidade do instrumento. Com o processo de adaptação transcultural foi obtida a versão final do OAK Test em língua portuguesa do Brasil, intitulada “Teste de Conhecimento sobre Anticoagulação Oral”. Constatou-se uma equivalência semântica e conceitual adequada entre a versão adaptada e a original, bem como uma excelente aceitabilidade desse instrumento.

Abstract Patients’ knowledge about oral anticoagulant therapy may favor the achievement of therapeutic results and the prevention of adverse pharmacotherapy-related events. Brazil lacks validated instruments for assessing the patient’s knowledge about treatment with warfarin. This study aimed to perform the cross-cultural adaptation of the Oral Anticoagulation Knowledge (OAK) Test instrument from English into Portuguese. This is a methodological study developed in an anticoagulation clinic of a public university hospital. The study included initial translation, synthesis of translations, back-translation, review by the experts committee and pre-testing with 30 individuals. We obtained semantic equivalence through the analysis of the referential and general meaning of each item. The conceptual equivalence of the items sought to demonstrate the relevance and acceptability of the instrument. The process of cross-cultural adaptation produced the final version of the OAK Test in Brazilian Portuguese entitled “Teste de Conhecimento sobre Anticoagulação Oral”. There was a suitable semantic and conceptual equivalence between the adapted version and the original version, as well as an excellent acceptability of this instrument.

Beneficial effects of a pharmaceutical care program on outpatients with inflammatory bowel disease

This study aimed to evaluate the effects of aPharmaceutical Care (PC) program among outpatientswith Inflammatory bowel diseases (IBD) in an outpatientdepartment of a tertiary care teaching hospital in RibeiraoPreto, Brazil. Patients with IBD were randomizedinto two groups, one to receive PC procedures (PCG;N=18) and a control group (CG; N=17). Both groupswere followed for one year and compared at six (T6),and 12 (T12), months of study. Patients were assessedfor treatment compliance, knowledge about treatment,clinical colitis activity index, and quality of life (SF-36). In PCG patients, the number of adherent patientssignificantly increased from 28% to 72% (p<0.05), andin the percent score for patient knowledge increasedfrom 80% to 100% (p≤0.0001) from T0 to T12. Therewas a significant decrease in clinical activity indexesfrom T6 to T12 in PCG patients (median; range: 2.20;0.99­3.77 versus 1.90; 0.99­3.77; p=0.02), but not inthe CG group (1.69; 0.99­3.77 versus 1.69; 0.99­3.48).Quality of life questionnaire rvealed increased scoresfor mental health domain at T12 in both PCG (57.5versus 65.3; p=0.04) and CG (56.9 versus 67.0; p=0.01)groups. The PC program was associated with increasedcompliance, better mental health-related quality of life,and enhanced knowledge about treatment.(AU)

Factors influencing the preference for purchasing generic drugs in a Southern Brazilian city

ABSTRACT OBJECTIVE The objective of this study is to identify factors associated with the preference for purchasing generic drugs in a medium-sized municipality in Southern Brazil. METHODS We have analyzed data from a population-based cross-sectional study conducted in 2012 with a sample of 2,856 adults (≥ 20 years old). The preference for purchasing generic drugs was the main outcome. The explanatory variables were the demographic and socioeconomic variables. Statistical analyses included Poisson regressions. RESULTS The preference for purchasing generic drugs was 63.2% (95%CI 61.4-64.9). The variables correlated with this preference in the fully adjusted models were: male (prevalence ratio [PR] = 1.08; 95%CI 1.03-1.14), age of 20-39 years (PR = 1.10; 95%CI 1.02-1.20), low socioeconomic status (PR = 1.15; 95%CI 1.03-1.28), and good knowledge about generic drugs (PR= 4.66; 95%CI 2.89-7.52). Among those who preferred to purchase generic drugs, 55.1% have reported accepting to replace the prescribed drug (if not a generic) with the equivalent generic drug. Another correlate of the preference for purchasing generic drugs was because individuals consider their quality equivalent to reference medicines (PR = 2.15; 95%CI 1.93-2.41). CONCLUSIONS Knowledge about generic drugs was the main correlate of the preference for purchasing generic drugs. The greater the knowledge or positive perception about generic drugs, the greater is the preference to purchase them. Therefore, educational campaigns for healthcare professionals and consumers appear to be the best strategy for expanding the use of generic drugs in Brazil.

Prevalence and risk factors of inadequate medicine home storage: a community-based study

ABSTRACT OBJECTIVE Assess the extent of inadequate home storage of medicines andidentify important risk factors. METHODS A cross-sectional survey based on a probability sample in the community, conducted in 267 households in Cuité, State of Paraíba, Northeast Brazil, in 2014. Logistic regression was used to study the risk factors. RESULTS The prevalence of households with inadequate storage was 76.0%. Problems with storage include direct exposure to sunlight in 10.9% of households, the presence of dust in 23.6%, and storage within reach of children in 76.0%. Medications no longer used are usually disposed of into the environment in 92.1% of households. Inadequate storage is more likely when home organization of medications is the responsibility of a male subject (OR = 1.729) or an older person (OR = 1.029), when out of date medicines are found (OR = 2.963), and in households with no children (OR = 2.088). CONCLUSIONS Physicians and pharmacists should advise patients on how to adequately store medicines at home, especially when the person in charge of medications is a male or an older adult, and if there are no children in the household.

Psychological model of ART adherence behaviors in persons living with HIV/AIDS in Mexico: a structural equation analysis

ABSTRACT OBJECTIVE The objective of this study has been to test the ability of variables of a psychological model to predict antiretroviral therapy medication adherence behavior. METHODS We have conducted a cross-sectional study among 172 persons living with HIV/AIDS (PLWHA), who completed four self-administered assessments: 1) the Psychological Variables and Adherence Behaviors Questionnaire, 2) the Stress-Related Situation Scale to assess the variable of Personality, 3) The Zung Depression Scale, and 4) the Duke-UNC Functional Social Support Questionnaire. Structural equation modeling was used to construct a model to predict medication adherence behaviors. RESULTS Out of all the participants, 141 (82%) have been considered 100% adherent to antiretroviral therapy. Structural equation modeling has confirmed the direct effect that personality (decision-making and tolerance of frustration) has on motives to behave, or act accordingly, which was in turn directly related to medication adherence behaviors. In addition, these behaviors have had a direct and significant effect on viral load, as well as an indirect effect on CD4 cell count. The final model demonstrates the congruence between theory and data (x2/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index = 0.94, comparative fit index = 0.98, root mean square error of approximation = 0.05), accounting for 55.7% of the variance. CONCLUSIONS The results of this study support our theoretical model as a conceptual framework for the prediction of medication adherence behaviors in persons living with HIV/AIDS. Implications for designing, implementing, and evaluating intervention programs based on the model are to be discussed.

Avaliação da compreensão da farmacoterapia entre idosos atendidos na Atenção Primária à Saúde de Belo Horizonte, MG, Brasil / An evaluation of elderly people´s understanding of pharmacotherapy among those treated in the Primary Healthcare System in Belo Horizonte, Brazil

Resumo Os idosos apresentam maior número de doenças, levando a maior uso de medicamentos e a farmacoterapia mais complexa. O objetivo do estudo foi avaliar o nível de compreensão da farmacoterapia entre idosos e fatores associados. Realizou-se estudo transversal analítico em Unidades Básicas de Saúde. Foram investigadas as características sociodemográficas, clínicas, funcionais e relativas ao uso de medicamentos. O nível de compreensão foi obtido após a análise de concordância entre a resposta do entrevistado e a informação contida na prescrição para: nome do medicamento, dose, frequência, indicação, precauções e efeitos adversos. O nível global de compreensão foi classificado como insuficiente em caso de discordância ≥ 30%. Dos 227 idosos entrevistados, 51,1% apresentaram compreensão insuficiente em relação aos medicamentos. Realizou-se regressão logística multivariada para observar os fatores associados à compreensão da farmacoterapia, sendo menor escolaridade e dependência para uso dos medicamentos os que apresentaram associação com a compreensão insuficiente (p < 0,05). É necessário implementar estratégias para aumentar a qualidade das orientações fornecidas aos idosos e garantir seu cumprimento.

Abstract There are a greater number of elderly people with diseases which has led to a greater use in medication and complexity in pharmacotherapy. The aim of this study was to understand the level of understanding on pharmacotherapy amongst the elderly and associated factors. An analytical transversal study was carried out in the Primary Health Care Units. Sociodemographic, clinical, and functional characteristics relative to the use of medication were explored. The level of understanding was obtained after a concordance analysis had been done based on the responses from the interviewees and the information on the medical prescriptions such as: name of medication, dosage, frequency, indication, precautions and side effects. The global level of understanding was classified as insufficient in cases where the discordance was ≥ 30%. Of the 227 elderly people interviewed, 51.1% showed an insufficient understanding in relation to their medication. We carried out multivariate logistic regression to observe the factors associated with an understanding of pharmacotherapy. We noted that those with a low level of education and a dependency on the use of medication showed insufficient understanding. (p < 0,05). It is necessary to implement strategies to increase the quality of the guidance given to the elderly and to ensure compliance.

GRAU DE CONHECIMENTO DOS PACIENTES SOBRE O TRATAMENTO: ESTRATÉGIA PARA USO RACIONAL DE MEDICAMENTOS / LEVEL OF KNOWLEDGE OF PATIENTS ON TREATMENT: STRATEGY FOR THE USE OF MEDICINES RATIONAL / NIVEL DE CONOCIMIENTO DE LOS PACIENTES EN TRATAMIENTO: ESTRATEGIA PARA USO RACIONAL DE LOS MEDICAMENTOS

Objetivo: o presente estudo verificou o conhecimento dos pacientes sobre seu tratamento medicamentoso após consulta médica e dispensação em Estratégia de Saúde da Família (ESF) no Município de Missão Velha-CE. Método: caracterizou-se como um estudo do tipo exploratório descritivo com abordagem quantitativa, de delineamento transversal e prospectivo. Resultados: entre os 94 pacientes entrevistados, 82% afirmou ter sido orientado quanto à posologia, 78% quanto à duração do tratamento e 63% quanto à finalidade terapêutica do medicamento prescrito durante a consulta médica, que durou em média 4,82 minutos. Foram prescritos 1,95 medicamentos em média. Os auxiliares de farmácia foram responsáveis pela dispensação de medicamentos de 39,4% dos entrevistados, enquanto o farmacêutico não foi citado por nenhum. Conclusão: acredita-se que seria necessário um maior tempo de consulta médica no intuito de melhorar o processo de comunicação entre médico e paciente, que por sua vez pode impactar na baixa adesão do paciente ao tratamento prescrito. Enquanto que a ausência do profissional farmacêutico no ato da dispensação do medicamento pode comprometer a garantia de segurança, qualidade e adesão terapêutica, bem como o uso racional dos medicamentos.

Objective: this study evaluated the patients' knowledge about their medical treatment after medical consultation and dispensing in the Family Health Strategy (FHS) in the municipality of Missão Velha - CE. Method: it was characterized as a descriptive exploratory study with a quantitative approach, prospective cross-sectional design. Results: of the 94 patients interviewed, 82% claimed to have been instructed as to the dosage, 78% as the duration of treatment and 63% for the medicinal use of the drug prescribed during medical consultation, which lasted an average of 4.82 minutes. 1.95 medications were prescribed on average. The pharmacy assistants were responsible for dispensing medications 39.4% of respondents, while the pharmacist was not mentioned by any. Conclusion: is credited it would take a larger medical consultation time in order to improve the communication process between physician and patient, which in turn may impact the low patient adherence to prescribed treatment. While the absence of the pharmacist in the drug dispensing Act may compromise the safety, quality assurance and adherence, as well as the rational use of medicines.

Objetivo: este estudio evaluó el conocimiento de los pacientes sobre su tratamiento médico después de la consulta médica y dispensación en la Estrategia Salud de la Familia (ESF) en el municipio de Missão Velha-CE. Método: se caracteriza por ser un estudio exploratorio descriptivo con un enfoque cuantitativo, diseño prospectivo y transversal. Resultados: de los 94 pacientes entrevistados, el 82% afirmó haber sido instruido en cuanto a la dosis, el 78% como la duración del tratamiento y el 63% para el uso medicinal de la droga prescrita durante la consulta médica, que duró una media de 4,82 minutos. 1.95 medicamentos fueron prescritos en promedio. Los auxiliares de farmacia eran responsables de la dispensación de medicamentos 39,4% de los encuestados, mientras que el farmacéutico no fue mencionado por ninguna. Conclusión: se acredita que tomaría un tiempo de consulta médica más grande con el fin de mejorar el proceso de comunicación entre el médico y el paciente, que a su vez puede afectar la adherencia baja del paciente al tratamiento prescrito. Mientras que la ausencia del farmacéutico en la dispensación de fármacos Ley puede comprometer la seguridad, garantía de calidad y la adhesión, así como el uso racional de los medicamentos.