Medicación potencialmente inapropiada en adultos mayores con necesidades paliativas en domicilio / Potentially inappropriate medication in older adults with palliative care at home

Resumen Introducción : Los adultos mayores con enfermedades crónicas avanzadas y necesidad de cuidados paliativos están más expuestos a la polifarmacia y a consumir medicación potencialmente inapropiada, la cual genera un alto riesgo de eventos adversos y alteración de la calidad de vida. El objetivo de este estudio fue describir la frecuencia de consumo de medicación potencialmente inapropiada de adultos mayores con necesidad de cuida dos paliativos que ingresaron a cuidados domiciliarios luego de una hospitalización. Métodos : Estudio de corte transversal observacional de registros de dispensación e historias clínicas electró nicas, de adultos mayores en un sistema de cuidados domiciliarios y con necesidades de cuidados paliativos según el rastreo con la herramienta NECPAL, los índices PROFUND y/o PALIAR. Se analizó el consumo de fárma cos durante los 180 días posteriores al ingreso a cuidados domiciliarios. Se clasificaron los fármacos como poten cialmente inapropiados según criterios de LESS-CHRON. Resultados : Se incluyeron 176 pacientes, edad prome dio 87.4 años, 67% mujeres; 78% eran pluripatológicos y 22% presentaban una enfermedad única crónica progre siva. La mortalidad a los 6 meses fue 73%. La mediana de consumo de fármacos por paciente fue 9.1 (RIC = 4-9.7). El 87% consumía medicación potencialmente inapropia da, principalmente antihipertensivos, benzodiacepinas y antipsicóticos. Conclusión : Este estudio observó que los adultos ma yores, con necesidad de cuidados paliativos en cuidados domiciliarios, tienen un alto consumo de medicación potencialmente inapropiada. Esto refuerza la necesidad de implementar intervenciones efectivas centradas en el paciente, para prevenir la prescripción inadecuada y estimular la de-prescripción.

Abstract Introduction : Older adults with advanced chronic diseases and palliative care needs are more exposed to polypharmacy and use of potentially inappropriate medication, which generates a high risk of adverse events and impaired quality of life. The objective of this study was to describe the frequency of potentially inappropriate medication use among older adults with palliative care needs receiving home care services after hospital discharge. Methods : Observational cross-sectional study of pharmacy dispensing and electronic health records, of older adults in a home care system and with palliative care needs according to the screening with the NECPAL tool or the PROFUND and/or PALIAR indexes. Dispensed medications during 180 days after admission to home care were analyzed. Medications were classified as po tentially inappropriate according to the LESS-CHRON criteria. Results : We included 176 patients, mean age 87.4 years, 67% were women; 73% were pluripathologic pa tients and 22% had one chronic progressive disease. Mortality at 6 months was 73%. Median frequency of dispensed medications per patient was 9.1 (IQR = 4-9.7). The frequency of potentially inappropriate medication dispensation among patients was 87%, mainly antihy pertensives, benzodiazepines and antipsychotics. Conclusion : This study observed that dispensation of potentially inappropriate medication among older adults with palliative care needs and home care services is very high. This emphasizes the need for effective patient-centered interventions to prevent inadequate prescription and stimulate de-prescription.

How multimorbidity relates to road traffic accident among older adults and elderly population: insights from longitudinal aging study in India (1st wave)

Background: Multimorbidity and road traffic accidents increase with increasing age. Supplemented with increasing life expectancy at birth, both multimorbidity and RTAs will contribute significantly to the growing disease burden of the country. The objective of the study was to determine the association between multimorbidity and RTAs among older adults (above 45 years) and the elderly (above 60 years) population in India. Methods: A secondary data analysis was conducted using the Longitudinal Ageing Study in India (LASI)-1st wave data (April 2017 to December 2018). Participants having at least two chronic health conditions were described as multimorbidity. Road traffic accidents (RTAs) was taken as the outcome variable. Univariate followed by multivariable logistic regression was conducted between the outcome variable and each explanatory variable. Results: Data extracted consisted of 34704 (51.1%) older adults and 31902 (47.9%) elderly. Multimorbidity was present in 25054 (37.6%) individuals. Among the RTA group, 325 (26.5%) individuals had multimorbidity. The elderly with multimorbidity (at least two) were associated with the RTA with an adjusted odds ratio (CI) of 0.55 (0.45-0.67) and p value of <0.001 in comparison to older adults. Clerical and skilled individuals with multimorbidity were associated with RTA in comparison to unemployed individuals with multimorbidity with an adjusted odds ratio (CI) of 1.40 (1.10-1.79) and p value of 0.007. Conclusions: The RTA was evident among males aged 45-60 years with multimorbidity. Clerical and skilled individuals with multimorbidity were more prone to RTA. These individuals should be encouraged to take necessary measures to promote healthy living and adhere to them.

Prevalence of diabetes mellitus and its associated comorbidities: a population based study

The purpose of this study was to quantify the prevalence and co-prevalence of common comorbidities of type 2 diabetes mellitus (T2DM). Literature search was conducted in PubMed for relevant articles published during the period from 2013 to 2023. Studies describing the prevalence rate of T2DM and its associated co-morbidities in INDIA in the past 10 years and the pharmaceutical antidiabetic treatment were identified. Out of 100 articles 10 studies conducted in India fulfilled the inclusion criteria regarding the prevalence rate of T2DM along with its associated co-morbidities. Studies revealed that comorbidity burden tended to increase in older age groups and was higher in men than women. Few studies demonstrated for the combination of hypertension (HTN) and hyperlipidaemia (67.5%), followed by overweight/obesity and HTN (66.0%), overweight/obesity and hyperlipidaemia (62.5%), HTN and chronic kidney disease (CKD) (22.4%), hyperlipidaemia and CKD (21.1%), HTN and cardiovascular disease (CVD) (20.2%), hyperlipidaemia and CVD (20.1%), overweight/obesity and CKD (19.1%) and overweight/obesity and CVD (17.0%). The most common conditions in patients with T2DM included HTN in 82.1%; overweight/obesity in 78.2%; hyperlipidaemia in 77.2%; CKD in 24.1%; and CVD in 21.6%. It was concluded from the study that the vast majority of patients with T2DM have multiple comorbidities. To ensure a comprehensive approach to patient management, the presence of multimorbidity should be considered in the context of clinical decision making.

Factores asociados con la fragilidad en un servicio ambulatorio de geriatría de un hospital universitario en Bogotá (Colombia) / Factors Associated with Frailty in the Geriatric Outpatient Service of a University Hospital in Bogotá (Colombia) / Fatores associados à fragilidade no ambulatório de geriatria de um hospital universitário de Bogotá (Colômbia)

Introducción: la fragilidad, entendida como un estado previo a la discapacidad, confiere mayor vulnerabi-lidad a estresores externos y contribuye a desenlaces negativos como caídas, hospitalización, discapacidad y mortalidad. El objetivo de este estudio fue identificar su prevalencia y evaluar los factores asociados en los pacientes del Servicio Ambulatorio de Geriatría del Hospital Universitario San Ignacio (husi) en Bogotá (Colombia). Materiales y métodos: estudio de corte transversal con 689 pacientes atendidos en la consulta externa de geriatría del husi entre agosto de 2016 y marzo de 2020. Mediante regresiones logísticas se iden-tificaron los factores relacionados con la fragilidad. Resultados: la prevalencia fue del 35.4 %. En el análisis bivariado, las variables asociadas con la fragilidad fueron edad mayor de 80 años (or: 2.07; ic95 %: 1.40-3.20; p = 0.001), sexo femenino (or: 1.40; ic95 %: 0.99-2.02; p = 0.03), multimorbilidad (or: 2.13; ic95 %: 1.40-2.90; p < 0.001) y malnutrición (or: 2.23; ic95 %: 1.22-4.07; p = 0.009). En el análisis multivariado, la multimor-bilidad (or: 2.46; ic95 %: 1.62-3.75; p = 0.001), la velocidad de la marcha lenta (or: 5.15; ic95 %: 3.0-8.60; p = 0.001) y el perímetro de pantorrilla bajo (or: 1.60; ic95 %: 1.03-2.50; p = 0.06) se vincularon con la fragilidad. Conclusión: la prevalencia de fragilidad en el servicio de geriatría del husies mayor a la de los referentes nacionales; adicionalmente, las variables analizadas coinciden con las encontradas en la literatura; todo esto respecto a la gran complejidad clínica de los pacientes. Es clave la detección de los factores que se asocian con fragilidad, a fin de intervenirlos y prevenir desenlaces adversos

Introduction: Frailty, understood as a pre-disability state, increases vulnerability to external stressors and contributes to negative outcomes such as falls, hospitalization, disability, and mortality. This study aims to identify the prevalence of frailty and assess the associated factors in patients attending the geriatric outpatient service of the Hospital Universitario San Ignacio (husi). Materials and methods: A cross-sectional study involving 689 patients treated at the husigeriatric outpatient clinic between August 2016 and March 2020. Logistic regressions were conducted to identify factors associated with frailty. Results: The prevalence of frailty was 35.4 %. In bivariate analysis, variables associated with frailty included age over 80 years (or: 2.07; ci95 %: 1.40-3.20; p = 0.001), female sex (or: 1.40; ci95 %:0.99-2.02; p= 0.03), multimorbidity (or: 2.13; ci95 %:1.40-2.90; p < 0.001) and malnutrition (or: 2.23; ci95 %: 1.22-4.07; p = 0.009). In multivariate analysis, multimorbidity (or: 2.46; ci95 %: 1.62-3.75; p = 0.001), slow walking speed (or: 5.15; ci95 %: 3.0-8.60; p = 0.001) and low calf perimeter (or: 1.60; ci95 %: 1.03-2.50; p = 0.06) were associated with frailty. Conclusion: The prevalence of frailty in our center exceeds national references; and the identified variables align with those reported in the literature; reflecting the considerable clin-ical complexity of our patients. Detecting factors associated with frailty is crucial for intervention and prevention of adverse outcomes

ntrodução: a fragilidade, entendida como um estado anterior à incapacidade, confere maior vulnerabi-lidade a estressores externos e contribui para desfechos negativos como quedas, hospitalização, incapa-cidade e mortalidade. O objetivo deste estudo foi identificar a prevalência e avaliar os fatores associados à fragilidade em pacientes do ambulatório de geriatria do Hospital Universitário San Ignacio (husi) de Bogotá, Colômbia. Materiais e métodos: estudo transversal com 689 pacientes atendidos no ambulatório de geriatria do husi entre agosto de 2016 e março de 2020. Foram realizadas regressões logísticas para identificar fatores associados à fragilidade. Resultados: a prevalência de fragilidade foi de 35.4 %. Na análise bivariada, as variáveis associadas à fragilidade foram: idade acima de 80 anos (or:2.07; ic95 %:1.40-3,20; p = 0.001), gênero feminino (or:1.40; ic95 %:0.99-2.02; p = 0.03), multimorbidade (or: 2.13; ic95 %: 1.40-2.90; p < 0.001) e desnutrição (or:2.23; ic95 %:1.22-4.07; p = 0.009). Na análise multivariada, multimorbidade (or:2.46; ic95 %: 1.62-3.75; p = 0.001), velocidade lenta de caminhada (or:5.15; ic95 %:3.0-8.60; p = 0.001) e baixa circunferência da panturrilha (or: 1.60; ic95 %: 1.03-2.50; p = 0.06) foram associados à fragilidade. Conclusão: a prevalência de fragilidade no husi é superior à das referências nacionais; adicionalmente, as variáveis associadas coincidem com as encontradas na literatura; tudo isso em relação à grande complexidade clínica dos nossos pacientes. É fundamental detectar os fatores associados à fragilidade para intervir e prevenir resultados adversos

Magnitude and pattern of multimorbidity among adult patients attending a primary care setting in Delhi, India

Background: Multimorbidity, “the coexistence of two or more chronic diseases”, is an upcoming & less addressed public health challenge for low and middle-income countries undergoing rapid demographic and epidemiological transition. This study was done to estimate the burden & pattern of multimorbidity in adults (?18 years) in a primary care setting. Methods: This cross-sectional study was carried out from January 2021 to March 2022 at a primary health centre in South Delhi. Data was collected by conducting exit interviews with 510 adult patients using a self-designed, pre-tested interview schedule. Data was analyzed using SPSS and Microsoft Excel. Results: Out of 510 study subjects interviewed, the overall magnitude of multimorbidity was 160 (31.4%). Almost half of the study subjects with multimorbidity had dyads, one-third had triads, and the rest had quadrads multimorbidity patterns. The leading triad was diabetes mellitus+hypertension+heart disease (12.3%), followed by diabetes mellitus+hypertension+chronic lung disease (10.5%). More than half of the study subjects with multimorbidity, 89 (55.6%), suffered from concordant MM. Conclusions: The study revealed that 31.4% of subjects had multimorbidity, which was almost equally distributed across the age groups. The burden was significantly higher among those aged 18-39 years. Hypertension and Heart disease were found to be the most frequent and the most concordant multimorbidity, respectively, associated with Diabetes mellitus.

Multimorbilidad en pacientes que viven con VIH y cáncer en México / Multimorbidity in people living with HIV and cancer in Mexico

Resumen Antecedentes: En las personas mayores que viven con VIH, las enfermedades no transmisibles se presentan antes que en la población general. Objetivo: Estimar la prevalencia de comorbilidades en personas mayores que viven con VIH y cáncer. Material y métodos: Estudio retrospectivo de todas las personas > 40 años que viven con VIH y cáncer, quienes entre 2010 y 2019 acudieron al Instituto Nacional de Cancerología. Se incluyeron datos sobre tipo de cáncer, comorbilidades y polifarmacia. Se aplicó el Inventario de Depresión de Beck-II. Resultados: De 125 pacientes, 69 % tenía al menos una comorbilidad y 32 %, dos o más; las comorbilidades más comunes fueron dislipemia (54 %), hipertensión (19 %), obesidad (14 %) y diabetes (12 %); 29 % de los pacientes ≥ 50 años disponía de densitometría ósea, de los cuales en 31 % se diagnosticó osteoporosis. Se aplicaron 56 cuestionarios; en 30 % se identificó depresión. La edad ≥ 50 años se asoció a multimorbilidad (p = 0.017). Conclusiones: Se reportó alta prevalencia de multimorbilidad en personas mayores que viven con VIH y cáncer, con escaso escrutinio de enfermedad ósea y salud mental. Se requiere un enfoque integral para mejorar el manejo de las enfermedades no transmisibles.

Abstract Background: Non-communicable diseases occur earlier in people living with HIV (PLWH) than in general population. Objective: The goal of this study was to estimate the prevalence of comorbidities in PLWH and cancer. Material and methods: In this retrospective study, we included PLWH > 40 years with a history of cancer, coming to the National Cancer Institute, between 2010 and 2019. Data collected included cancer type, comorbidities, frequency of polypharmacy, Patients were evaluated for depression with the Beck Inventory Depression-II Scale. Results: Of 125 patients, 69 % had at least one comorbidity; 32 % had two or more. Common comorbidities were dyslipidemia (54 %), hypertension (19 %), obesity (14 %), and diabetes (12 %). In patients ≥ 50 years, 29 (62 %) had a densitometry and 9 (31 %) had osteoporosis; 56 depression questionnaires were applied: 30 % had mild to severe depression. Being ≥ 50 years was associated with multimorbidity (p = 0.017). Conclusions: We report PLWH and cancer with a high prevalence of multimorbidity and poor screening of bone disease and mental health. An integrated approach to the PLWH is needed to improve the detection and management of non-communicable diseases.

Multimorbidity status and risk factors among adults aged 45-64 years in 15 provinces of China in 2018: Based on association rule analysis / 环境与职业医学

Background Multimorbidity imposes a heavy burden on individuals, families, and society. There are relatively few studies exploring patterns of multimorbidity among middle-aged adults in China. Objective To explore the current status of multimorbidity, associated risk factors, and multimorbidity patterns among adults aged 45-64 years in China, so as to provide a scientific basis to prevent and control multimorbidity in China. Methods A total of 5494 adults aged 45-64 years from the Chinese Health and Nutrition Survey (CHNS) in 2018 were selected. Of these, 2494 (45.39%) were men and 3000 (54.61%) were women. The nine diseases included were hypertension, diabetes, dyslipidaemia, obesity, mild cognitive impairment (MCI), myocardial infarction, stroke, asthma, and tumor. The prevalence of each disease or multimorbidity was expressed as N (%). Comparisons of multimorbidity prevalence between different groups were performed using the χ2 test or Cochran-Armitage trend test. Association rule with the Apriori algorithm was used to explore the pattern of multimorbidity, with parameters set at a minimum conditional support of 3.00%, a minimum rule confidence of 50.00%, and a lift of >1.20. Logistic regression was used to evaluate the associations between selected risk factors and multimorbidity. Results In 2018, 37.44% of participants reported multimorbidity in 15 provinces of China. The prevalence of diseases in descending order was dyslipidaemia (39.99%), hypertension (39.48%), obesity (16.42%), MCI (14.47%), diabetes (14.16%), tumor (1.09%), stroke (1.04%), myocardial infarction (0.71%), and asthma (0.64%). A total of seven multimorbidity patterns were identified in this group. Obesity paired with hypertension, and diabetes paired with dyslipidemia were the two major patterns of multimorbidity in the general population and age or sex subgroups. The multimorbidity patterns of different populations were concentrated in the combination of obesity, hypertension, diabetes, and dyslipidemia. The risk of multimorbidity was lower in females than in males (OR=0.85, 95%CI: 0.75, 0.97). The multimorbidity risk was 1.56 times higher in the 55-64 years group than in the 45-54 years group (OR=1.56, 95%CI: 1.40, 1.75). Drinking in the past year increased the risk of multimorbidity by 25% (OR=1.25, 95%CI: 1.08, 1.45) compared to no alcohol comsumption in the past year. High and medium levels of physical activity were associated with a decreased OR (high: OR=0.74, 95%CI: 0.65, 0.85; medium: OR=0.81, 95%CI: 0.70, 0.93) with low level of physical activity as reference. Conclusion In 2018, there was a high prevalence rate of multimorbidity among middle-aged adults in China. The main multimorbidity patterns were obesity-hypertension and diabetes-dyslipidemia. Surveillance and interventions should be strengthened particularly for men, individuals with alcohol consumption or insufficient physical activity, and those with major multimorbidity patterns.

Association between multimorbidity and utilization of medical and long-term care among older adults in a rural mountainous area in Japan / Journal of Rural Medicine

Objective: With the accelerated population aging, multimorbidity has become an important healthcare issue. However, few studies have examined multimorbidity and its impact on the use of medical and long-term care services in Japan. Therefore, this study aimed to examine the association between multimorbidity and the use of medical and long-term care services among older adults living in the depopulated mountainous areas of Japan.Patients and Methods: A cross-sectional study was conducted using insurance claims data from late-stage medical insurance and long-term care insurance (April 2017 to March 2018) for older adults ≥75 years residing in a mountainous area in the Tottori prefecture. In addition to the descriptive analysis, multiple generalized linear regressions with family gamma and log-link functions were used to examine the association between the number of morbidities and total annual medical and long-term care expenditures.Results: A total of 970 participants ≥75 years were included in the analysis. Participants who had two or more morbidities constituted 86.5% of the total sample. Furthermore, participants with mental disorders were found to have more comorbidities. The number of comorbidities is associated with higher medical and long-term care expenditures.Conclusion: Multimorbidity was dominant among late-stage older adults living in depopulated mountainous areas of Japan, and the number of morbidities was associated with higher economic costs of medical and long-term care services. Mitigating the impact of multimorbidity among older adults in depopulated regions of Japan is an urgent challenge. Future research should investigate the degree and effectiveness of social protections for vulnerable older adults living in remote areas.

Hospital discharge readiness and its influencing factors and nursing strategies in patients with chronic diseases with multiple diseases / 中国实用护理杂志

Objective:To explore the discharge readiness and influencing factors of patients with multimorbidity, and to formulate corresponding strategies to guide clinical work.Methods:In a cross-sectional study, 183 patients were surveyed by convenience sample method for Department of General Practice, the Third Hospital of Peking University February in to December 2022. Multiple linear regression was used to analyze the factors affecting discharge readiness.Results:All 183 coexisting patients, 95 males, 88 females, mean age (67.34 ± 10.36) years old. Mean discharge readiness was (109.83 ± 18.40). 54.9% of the factors for patients with multiple chronic diseases came from the perception of self-care disorder, hospitalization, stay, and preparation for discharge ( R2=0.549, P<0.05). Conclusions:The discharge readiness of patients with multiple chronic diseases in general medicine is at a high level, and clinical nursing staff should give early intervention to the patients who perceive self-care barriers, need to stay with them, have multiple hospitalization, and are not ready for discharge, so as to ensure that the patients are in a good state of discharge readiness.

Multimorbidity and use of health services in a population diagnosed with COVID-19 in a municipality in the Southern Region of Brazil, 2020-2021: a cross-sectional study / Multimorbilidad y uso de servicios de salud en una población diagnosticada con covid-19 en un municipio de la región sur de Brasil, 2020-2021: estudio transversal / Multimorbidade e uso de serviços de saúde em população diagnosticada com covid-19 em município da região Sul do Brasil, 2020-2021: estudo transversal

Abstract Objective: To assess association between multimorbidity and use of health services in a population diagnosed with COVID-19, in southern Brazil. Methods: This was a cross-sectional study with data from a longitudinal study carried out in the city of Rio Grande, Rio Grande do Sul, Brazil, in 2021 with all adult individuals diagnosed with COVID-19; descriptive analyses were performed and presented as proportions with 95% confidence intervals (95%CI); Poisson regression was performed and reported as prevalence ratios (PR) in order to assess association between multimorbidity (3 or more diseases) and healthcare service use. Results: In total, 2,919 participants were included, of which 40.4% had multimorbidity (≥ 2 diseases); the adjusted results showed that individuals with multimorbidity were more likely to use most of the services assessed, PR = 3.21 (95%CI 1.40;7.37), for Emergency Rooms. Conclusion: Multimorbidity was associated with using different types of health services.

Resumen Objetivo: Analizar la asociación entre multimorbilidad y uso de servicios de salud en una población diagnosticada con COVID-19, en el Sur de Brasil. Métodos: Estudio transversal con datos de un estudio longitudinal realizado en la ciudad de Río Grande, Rio Grande do Sul, Brasil, en el año 2021, con todos los individuos adultos diagnosticados con COVID-19; se realizaron análisis descriptivos y se presentaron como proporciones con intervalos de confianza del 95% (IC95%); se realizó una regresión de Poisson y se informó como razón de prevalencia (PR). Resultados: En total se incluyeron 2.919 participantes, de los cuales el 40,4% presentaba multimorbilidad (≥ 2 doenças); los resultados ajustados mostraron que los individuos con multimorbilidad tenían mayor probabilidad de utilizar la mayoría de los servicios evaluados, RP = 3,21 (IC95% 1,40;7,37) para unidades Primeros auxilios. Conclusión: La multimorbilidad se asoció con el uso de diferentes tipos de servicios de salud.

Resumo Objetivo: Analisar a associação entre multimorbidade e uso de serviços de saúde em uma população diagnosticada com covid-19, no Sul do Brasil. Métodos: Estudo transversal, utilizando-se dados de um estudo longitudinal realizado na cidade de Rio Grande, estado do Rio Grande do Sul, Brasil, em 2021, com todos os indivíduos adultos diagnosticados com covid-19; análises descritivas foram realizadas e apresentadas como proporções com intervalos de confiança de 95% (IC95%); a regressão de Poisson foi realizada e relatada como razão de prevalências (RP), para avaliar a associação entre multimorbidade e utilização de serviços de saúde. Resultados: Dos 2.919 participantes, 40,4% apresentavam multimorbidade (≥ 2 doenças); os resultados ajustados mostraram que indivíduos com multimorbidade (3 ou mais doenças) apresentaram maior probabilidade de utilização da maioria dos serviços avaliados (RP = 3,21; IC95% 1,40;7,37) em unidades de pronto-socorro. Conclusão: A multimorbidade esteve associada à utilização de diferentes tipos de serviços de saúde.

Multimorbidade em idosos e seus fatores associados em 2010 e 2021 / Multimorbidity in older adults and its associated factors in 2010 and 2021

Resumo O presente estudo teve como objetivo comparar os fatores associados à multimorbidade em idosos de 60 a 69 anos, em 2010 e 2021. Trata-se de um estudo transversal comparativo, composto por dois estudos transversais. Ambas as coletas de dados foram realizadas de forma individual por entrevistadores treinados e deu-se por inquérito domiciliar, no município de Coxilha-RS, Brasil. Utilizou-se para análise inferencial bivariada, exato de Fisher e qui-quadrado, e multivariada o teste de regressão de Poisson com variância robusta com nível de significância de p 0,05. Detectou-se que a prevalência de multimorbidade teve uma diminuição significativa, passando de 66,5% em 2010, para 41,6% em 2021. Ser dependente para atividades básicas e instrumentais da vida diária associou-se a maior prevalência para a multimorbidade no ano de 2010, contudo no ano de 2021 o ser dependente para atividades instrumentais, não saber ler/escrever e não trabalhar apresentou maior prevalência para a multimorbidade. Por fim, concluise que as condições de saúde dos idosos diferiram significativamente apontando que os cuidados de saúde também precisam ser reavaliados para tornarem-se mais efetivos

Abstract The present study aimed to compare the factors associated with multimorbidity in older adults aged 60 to 69 years, in 2010 and 2021. This is a comparative cross-sectional study, comprised of other two cross-sectional studies. Both data collections were individually conducted by trained interviewers through household surveys in the municipality of Coxilha-RS, Brazil. Bivariate inferential analysis was conducted using Fisher's exact test and chi-square test, while multivariate analysis employed Poisson regression with robust variance with a significance level of p 0.05. It was observed that the prevalence of multimorbidity significantly decreased, decreasing from 66.5% in 2010 to 41.6% in 2021. Dependency for basic and instrumental activities of daily living was associated with higher prevalence of multimorbidity in the year 2010. However, in 2021, being dependent on instrumental activities, being unable to read/write, and being unemployed showed higher prevalence for multimorbidity. In conclusion, it is evident that the health conditions of older adults differed significantly over the years, highlighting the necessity for a reevaluation of healthcare practices to become more effective

Multimorbidade e utilização de serviços de saúde no município de São Paulo, Brasil: prevalência e fatores associados / Multimorbidity and utilization of health services in the city of São Paulo, Brazil: prevalence and associated factors

Resumo O objetivo foi estimar a prevalência de multimorbidade no município de São Paulo e verificar os fatores associados à utilização de serviços de saúde. Estudo transversal de base populacional a partir do Inquérito de Saúde do Município de São Paulo (ISA-Capital 2015), em que foi realizada análise descritiva e foram elaborados modelos de regressão logística utilizando como desfecho a multimorbidade e variáveis independentes sociodemográficas, de condições de vida e utilização de serviços de saúde. Participaram 3.184 indivíduos com 20 anos ou mais, idade média de 43,8 anos. A prevalência de multimorbidade foi de 50,7% entre as mulheres, 62,5% entre os que relataram algum problema de saúde e 55,1% entre os que utilizaram serviços de saúde nas duas últimas semanas. Foi identificada maior prevalência nos indivíduos que usaram serviço de saúde por problema de saúde mental (66,1%) e que informaram maiores despesas com saúde no último mês (55,4%). A multimorbidade foi mais frequente com o envelhecimento, na população com nível econômico mais elevado, com pior autoavaliação de saúde, que utilizou serviços de saúde há seis meses ou menos, que relatou problema de saúde, que tinha plano de saúde e fazia uso da polifarmácia.

Abstract The scope of this paper was to estimate the prevalence of multimorbidity in the city of São Paulo and to verify the factors associated with the utilization of the health services. It involved a population based cross-sectional study based on data from the Health Survey in the city of São Paulo, in which descriptive analysis was conducted, and logistic regression models were developed using multimorbidity and sociodemographic independent variables, living conditions and use of health services as the outcome. A total of 3,184 individuals aged 20 years or older participated, with a mean age of 43.8 years. The prevalence of multimorbidity was 50.7% among women, 62.5% among those who reported some health problem and 55.1% among those who had recourse to health services in the last 2 weeks. A higher prevalence was identified among those who used the health service due to a mental health problem (66.1%), and in those who reported higher health expenditures in the preceding month (55.4%). Multimorbidity was more frequently associated with aging, in the population with a higher economic status, with worse self-rated health, who frequented health services for 6 months or less, who reported a health problem, or who had a health plan and opted for polypharmacy.

Temporal Pattern and Spatial Distribution of Tuberculosis Prevalence Associated with Multimorbidity in Brazil

ABSTRACT Background: Four main chronic conditions may be involved in the tuberculosis pathogenic process and/or clinical evolution: HIV/AIDS, diabetes mellitus, mental illness, and Chronic Obstructive Pulmonary Disease. This study aimed to determine the spatiotemporal pattern of tuberculosis (TB) associated with multimorbidity in Brazil. Methods: Ecological study use data from the Notifiable Diseases Information System (SINAN), collected from the electronic portal of the Department of Informatics of the SUS (DATASUS). These data included TB cases that were reported between 2007 and 2021 and were associated with two or more chronic clinical health conditions (multimorbidity). Results: A total of 7,795 cases of TB associated with multimorbidity were recorded, with an average growth trend of 4.6% per year (95% Confidence Interval (CI): 3.3-5.9; p<0.001) and higher growth in the first temporal segment (2007 to 2011) (8.9%; 95%CI: 4.2-13.9; p=0.002). The spatial analysis, after Bayesian smoothing, highlighted the main municipalities states of the study, namely: São Paulo (19.8%; n = 297), Porto Alegre (23.6%; n = 354), and Rio de Janeiro (44.8%; n = 672). The proportion of extremely poor (β=-0.002), the bolsa família program (β=0.002), the average per-person income (β=0.001), and the percentage of the population living in households with a density of more than 2 people per bedroom (β=0.001) were related to chronic health conditions. Conclusions: These findings will stimulate public action to manage this situation. However, as this is still a recent topic in the literature, we encourage the development of studies on the synergistic characteristics of TB and other clinical conditions.

Pluripatología en internación: características de pacientes internados en clínica médica / Pluripathology among inpatients: characteristics of hos pitalized patients in medical clinic wards

Resumen Introducción: El objetivo del trabajo fue determinar prevalencia de pluripatología y polifarmacia entre in ternados en salas de clínica médica de un hospital de agudos, sus características sociodemográficas y clínicas. Métodos: estudio observacional, prospectivo, longitu dinal, descriptivo y analítico. Se incluyeron los pacientes internados en clínica médica del Hospital Tornú entre mayo y septiembre, 2019 mediante muestreo consecuti vo. Se relevaron datos de las historias clínicas. Se evaluó dependencia funcional y pronóstico mediante índices Barthel, Charlson y score PROFUND. Resultados: Se registraron 170 pacientes (58% mascu linos). La edad de mujeres fue significativamente mayor (mediana 79 años; p= 0.002). Prevalencia de pluripatolo gía 32%; polifarmacia 38%; hipertensión 48%; diabetes 27%; deterioro cognitivo 15%; insuficiencia cardíaca 14%; accidente cerebrovascular 12%; anemia 24%; enfermedad renal crónica 10%. Reingresos 10% (94% con reinterna ción precoz; 94% con motivo de reingreso relacionado con internación previa). Mortalidad general: 12%. Los pacientes pluripatológicos presentaron edad elevada (78% > 65 años), mayor frecuencia de polifarmacia (p < 0.0001) y de dependencia (p = 0.001). La mortalidad en pluripatológicos (22%) fue mayor que en el resto (p = 0.0095) y presentaron valores más elevados índice de Charlson y score PROFUND (p < 0.0001). No hubo diferencias significativas en estadía hospitalaria ni en reinternaciones. Conclusiones: La presencia de pacientes con pluri patología se presenta como una realidad cotidiana en nuestros servicios de internación. Este estudio revela la importancia de la consideración de este tipo de pa cientes en el ámbito público debido a su frecuencia y características, demandas sanitarias y costes.

Abstract Introduction: The purpose of this study was to de termine the prevalence of pluripathology and polyphar macy among hospitalized patients in internal medicine wards at an acute care hospital, including their socio-demographic and clinical characteristics. Methods: Observational, prospective, longitudinal, descriptive and analytical study. All patients hospital ized in the internal medicine ward at Hospital Tornú from May to September 2019 were included through consecutive sampling. Data from medical records were collected. Functional dependency and prognosis were assessed using the Barthel, Charlson and PROFUND Indexes. Results: 170 patients (58% male) were registered. Wom en were significantly older. Pluripathology prevalence: 32%; polypharmacy 38%; high BP: 48%; diabetes: 27%; cognitive impairment 15%; heart failure: 14%; stroke: 12%; anemia: 24%; CKD 10%. Total readmissions 10% (94% with early readmissions; 94% with readmissions related to a previous hospitalization). Global Mortality: 12%. Patients with pluripathology were elderly (78% > 65 years old) with a higher polypharmacy frequency (p < 0.0001) and functional dependence (p = 0.001). Mortality in patients with pluripathology (22%) was higher than in others (p = 0.0095) with higher Charlson and PROFUND scores (p < 0.0001). There were no significant differences in terms of hospital stay or readmissions. Conclusions: Pluripathological patients are common in our inpatient hospital department. This study reveals the importance of considering this type of patients in public hospitals due to its frequency, characteristics and healthcare utilization and costs.

What is the burden of multimorbidity and the factors associated with its occurrence in elderly Brazilians? / ¿Cuál es la carga de multimorbilidad y los factores asociados a su ocurrencia en personas mayores brasileñas? / Qual é a carga de multimorbidade e os fatores associados à sua ocorrência em pessoas idosas brasileiras?

ABSTRACT Objective: To estimate the prevalence of multimorbidity in elderly people and its association with sociodemographic characteristics, lifestyle, and anthropometry. Methods: This was a cross-sectional study using data from the National Health Survey, 2019. A total of 22,728 elderly individuals from all 27 Brazilian states were randomly selected. Poisson regression models with robust variance were employed, and a significance level of 5% was adopted. Results: The prevalence of multimorbidity was 51.6% (95% CI: 50.4-52.7), with the highest estimates observed in the South and Southeast. Multimorbidity was associated with being female (aPR = 1.33; 95% CI: 1.27-1.39), being 80 years old or older (aPR = 1.12; 95% CI: 1.05-1.19), having low education (aPR = 1.16; 95% CI: 1.07-1.25), past cigarette use (aPR = 1.16; 95% CI: 1.11-1.21), insufficient physical activity (aPR = 1.13; 95% CI: 1.06-1.21), and screen use for 3 hours or more per day (aPR = 1.13; 95% CI: 1.08-1.18). Conclusion: Multimorbidity affects more than half of the elderly population in Brazil and is associated with social, demographic, and behavioral factors.

RESUMEN Objetivo: Estimar la prevalencia de multimorbilidad en personas mayores y su asociación con características sociodemográficas, estilo de vida y antropometría. Métodos: Estudio transversal, con datos de la Encuesta Nacional de Salud, 2019. Se seleccionaron aleatoriamente 22.728 personas mayores de los 27 estados brasileños. Se emplearon modelos de regresión de Poisson con varianza robusta y se adoptó un nivel de significancia del 5%. Resultados: La prevalencia de multimorbilidad fue del 51,6% (IC95%: 50,4-52,7), siendo las mayores estimaciones observadas en el Sur y Sudeste. La multimorbilidad se asoció con el sexo femenino (RPa=1,33; IC95%: 1,27-1,39), tener 80 años o más (RPa= 1,12; IC95%: 1,05-1,19), baja escolaridad (RPa=1,16; IC95%:1,07-1,25), consumo de cigarrillo en el pasado (RPa=1,16; IC95%:1,11-1,21), práctica insuficiente de actividad física (RPa= 1,13; IC95%:1,06-1,21) y uso de pantallas por 3 horas o más al día (RPa=1,13; IC95%:1,08-1,18). Conclusión: La multimorbilidad afecta a más de la mitad de la población anciana de Brasil y está asociada a factores sociales, demográficos y conductuales.

RESUMO Objetivo: Estimar a prevalência de multimorbidade em pessoas idosas e sua associação com características sociodemográficas, estilo de vida e antropometria. Métodos: Estudo transversal, com dados da Pesquisa Nacional de Saúde, 2019. Foram selecionadas aleatoriamente 22.728 pessoas idosas dos 27 estados brasileiros. Empregaram-se modelos de regressão de Poisson com variância robusta e adotou-se um nível de significância de 5%. Resultados: A prevalência de multimorbidade foi de 51,6% (IC95%: 50,4-52,7), sendo as maiores estimativas observadas no Sul e Sudeste. A multimorbidade foi associada ao sexo feminino (RPa=1,33; IC95%: 1,27-1,39), ter 80 anos ou mais (RPa= 1,12; IC95%: 1,05-1,19), baixa escolaridade (RPa=1,16; IC95%:1,07-1,25), consumo de cigarro no passado (RPa=1,16; IC95%:1,11-1,21), prática insuficiente de atividade física (RPa= 1,13; IC95%:1,06-1,21) e uso de telas por 3 horas ou mais por dia (RPa=1,13; IC95%:1,08-1,18). Conclusão: A multimorbidade afeta mais da metade da população idosa do Brasil e está associada a fatores sociais, demográficos e comportamentais.

Multimorbidity patterns and associated factors in a megacity: a cross-sectional study

ABSTRACT OBJECTIVE To identify empirical patterns of multimorbidity and quantify their associations with socioeconomic, behavioral characteristics, and health outcomes in the megacity of São Paulo. METHODS This was a cross-sectional study conducted through household interviews with residents aged 20 years or older in urban areas (n = 3,184). Latent class analysis was used to identify patterns among the co-existence of 22 health conditions. Age-adjusted prevalence ratios were estimated using Poisson regression. RESULTS The analysis of latent classes showed 4 patterns of multimorbidity, whereas 58.6% of individuals were classified in the low disease probability group, followed by participants presenting cardiovascular conditions (15.9%), respiratory conditions (12.8%), and rheumatic, musculoskeletal, and emotional conditions (12.8%). Older individuals, with lower schooling and lower household income, presented higher multimorbidity prevalence in cardiovascular, respiratory, rheumatic, musculoskeletal, and emotional conditions patterns compared with the low disease probability pattern. CONCLUSION The results showed four distinct patterns of multimorbidity in the megacity population, and these patterns are clinically recognizable and theoretically plausible. The identification of trends between patterns would make it feasible to estimate the magnitude of the challenge for the organization of health care policies.

Multimorbidity patterns as predictors of sleeping medication use: a population-based study in women in Southern Brazil / Padrões de multimorbidade como preditores do uso de medicamentos para dormir: um estudo de base populacional em mulheres no Sul do Brasil

ABSTRACT Objective: To explore the relationship between different patterns of multimorbidity and the use of sleeping medications in women. Methods: Population-based cross-sectional study with 1,128 women (aged 20-69 years) in Southern Brazil. Data on sleeping medications were obtained from the question "Do you take/use any medication to be able to sleep?" and identified by the Anatomical Therapeutic and Chemical classification. Multimorbidity patterns were derived by the Principal Component Analysis of 26 chronic conditions and two obesity parameters (≥30 kg/m2; ≥40 kg/m2). The association was analyzed by Poisson regression with robust variance using different adjustment models, stratified by age. Results: Three multimorbidity patterns were derived: cardiometabolic, endocrine-articular, and psychosomatic. Age stratification showed a change in effect in the relationship investigated. Women under 45 years and high score of cardiometabolic and endocrine-articular patterns were about twice as likely to use sleeping medications [prevalence ratio (PR) 1.85, 95% confidence interval (CI) 1.09-3.12; PR 2.04, 95%CI 1.18-3.51, respectively]. Those with psychosomatic pattern were around five times more likely [PR 4.91, 95%CI 3.00-8.04]. Conclusions: The study provided the first evidence on the association researched and demonstrated that young women (<45 years) with a high score of the identified patterns are up to five times more likely to use sleeping medications, configuring early use. This unprecedented finding suggests the need for greater health promotion for young adults and actions to raise awareness about risks and the clear indication of the use of sleeping medications.

RESUMO Objetivo: Explorar a relação entre diferentes padrões de multimorbidade e o uso de medicamentos para dormir em mulheres. Métodos: Estudo transversal de base populacional com 1.128 mulheres (20-69 anos) no Sul do Brasil. Dados sobre medicamentos para dormir foram obtidos por meio da pergunta "Você toma/usa algum medicamento para conseguir dormir?" e identificados pela Classificação Anatômica Terapêutica e Química. Os padrões de multimorbidade foram derivados pela Análise de Componentes Principais de 26 condições crônicas e dois parâmetros de obesidade (≥30 kg/m2; ≥40 kg/m2). A associação foi analisada por regressão de Poisson com variância robusta utilizando diferentes modelos de ajuste, estratificados por idade. Resultados: Foram derivados três padrões de multimorbidade: cardiometabólico, endócrino-articular e psicossomático. A estratificação etária mostrou mudança de efeito na relação investigada. Mulheres com idade inferior a 45 anos e alto escore nos padrões cardiometabólico e endócrino-articular tiveram cerca de duas vezes mais probabilidade de usar medicamentos para dormir [razão de prevalência (RP) 1,85, intervalo de confiança (IC) 95% 1,09-3,12; RP 2,04, IC95% 1,18-3,51, respectivamente]. Aquelas com padrão psicossomático tiveram cerca de cinco vezes mais probabilidade (RP 4,91, IC95% 3,00-8,04). Conclusões: O estudo forneceu as primeiras evidências sobre a associação investigada e demonstrou que mulheres jovens (<45 anos) com alto escore dos padrões identificados têm até cinco vezes mais probabilidade de usar medicamentos para dormir, configurando uso precoce. Essa constatação inédita sugere a necessidade de maior promoção da saúde dos jovens e de ações de conscientização sobre os riscos e da indicação clara do uso de medicamentos para dormir.

Effect of primary health care on the association between multimorbidity and emergency service utilization: National Health Survey, 2019 / Efeito da Atenção Primária à Saúde na associação entre multimorbidade e utilização dos serviços de emergência: Pesquisa Nacional de Saúde (PNS), 2019

ABSTRACT Objective: To examine the effect of Primary Health Care (PHC) on the association between multimorbidity and emergency service utilization among adults in Brazil. Methods: This is a cross-sectional, nationwide household-based study using data from the 2019 National Health Survey. Poisson regression was used to assess emergency service utilization among individuals with multimorbidity. The interaction of variables such as Family Health coverage and orientation to PHC in these associations was also evaluated. Results: The prevalence of multimorbidity was 31.2% (95%CI 30.9-31.5), Family Health coverage was 71.8% (95%CI 71.4-72.0), and low orientation of services toward PHC was 70% (95%CI 69.1-70.9). Emergency service utilization had a prevalence of 2.0% (95%CI 1.9-2.0), being twice as high among individuals with multimorbidity (3.1; 95%CI 2.9-3.3) compared to those without this condition (1.4; 95%CI 1.3-1.5). However, individuals with multimorbidity and Family Health coverage had a 20% lower prevalence of emergency service utilization than those without Family Health coverage (PR 0.8; 95%CI 0.6-0.9). The association between emergency service utilization and multimorbidity was not modified by the evaluation of the service as highly oriented toward PHC (p=0.956). Conclusion: The study showed that Family Health coverage exerted a positive effect on the association between multimorbidity and emergency service utilization.

RESUMO Objetivo: Verificar o efeito da Atenção Primária à Saúde (APS) na associação entre multimorbidade e utilização dos serviços de emergência em adultos do Brasil. Métodos: Trata-se de um estudo transversal, de base domiciliar em âmbito nacional, sendo utilizados dados da Pesquisa Nacional de Saúde (PNS) de 2019. A regressão de Poisson foi aplicada para avaliar a utilização do serviço de emergência entre pessoas com multimorbidade. Também foi avaliada a interação das variáveis cobertura de Saúde da Família e orientação para a APS nessas associações. Resultados: A prevalência de multimorbidade foi de 31,2% (IC95% 30,9-31,5), a cobertura de Saúde da Família foi de 71,8% (IC95% 71,4-72,0) e a baixa orientação dos serviços para a APS foi de 70% (IC95% 69,1-70,9). O uso do serviço de emergência apresentou uma prevalência de 2,0% (IC 95% 1,9-2,0), sendo duas vezes maior entre indivíduos com multimorbidade (3,1; IC95% 2,9-3,3) em comparação com aqueles sem essa condição (1,4; IC95% 1,3-1,5). No entanto, pessoas com multimorbidade e cobertura de Saúde da Família apresentaram prevalência de utilização de serviços de emergência 20% menor do que aquelas sem cobertura de Saúde da Família (RP 0,8; IC95% 0,6-0,9). A associação entre o uso do serviço de emergência e a multimorbidade não foi modificada pela avaliação do serviço, como altamente orientado para a APS (p=0,956). Conclusão: O estudo evidenciou que a cobertura de Saúde da Família exerceu um efeito positivo na associação entre multimorbidade e utilização dos serviços de emergência.

Chronic noncommunicable diseases and absenteeism from work: National Survey of Health, 2019 / Doenças crônicas não transmissíveis e absenteísmo no trabalho: Pesquisa Nacional de Saúde 2019

ABSTRACT Objective: To evaluate the association between burden of disease and multimorbidity and absenteeism in Brazil. Methods: This is a cross-sectional study using data from the National Survey of Health 2019. The assessed outcome was absenteeism from work. The burden of disease was assessed by simply counting a list of 14 morbidities and multimorbidity was defined as: ≥two chronic diseases. Poisson regression models stratified by sex were used to estimate crude and adjusted prevalence ratios and their respective 95% confidence intervals. Results: Of the 96,131,029 employed individuals, 38.5% reported absenteeism (95%CI 32.9-44.3). The most prevalent morbidities among women who reported absenteeism were back problems (50.8%), depression (42.9%), and hypertension (41.6%); and among men, hypertension (39.7%), chronic back pain (34.1%), and dyslipidemia (19.9%), among those who reported absenteeism. Having multimorbidity increased the report of absenteeism among women by 73% (95%CI 1.01-2.96); among men, there was no association after progressive adjustment for sociodemographic and health factors [PR 1.27 (95%CI 0.96-1.71)]. Conclusion: The burden of disease and multimorbidity are highly prevalent among employed individuals and are strongly related to absenteeism from work, especially among women. In this sense, workers must be the target of interventions to reduce the impact of chronic noncommunicable diseases.

RESUMO Objetivo: Avaliar a associação entre carga de morbidade e multimorbidade e absenteísmo no Brasil. Método: Estudo transversal utilizando dados da Pesquisa Nacional de Saúde 2019. O desfecho avaliado foi absenteísmo no trabalho. Carga de morbidade foi avaliada pela contagem simples de uma lista de 14 morbidades e multimorbidade foi definida como: ≥duas doenças crônicas. Modelos de regressão de Poisson estratificados por sexo foram utilizados para estimar as razões de prevalência brutas e ajustadas e seus respectivos intervalos de confiança de 95% Resultado: Dos 96.131.029 indivíduos em condição de ocupação, 38,5% relataram absenteísmo (IC95% 32,9-44,3). As morbidades mais prevalentes entre as mulheres que relataram absenteísmo foram: problemas de coluna (50,8%), depressão (42,9%) e hipertensão (41,6%); e entre os homens foram: hipertensão (39,7%), problema crônico de coluna (34,1%) e dislipidemia (19,9%), entre aqueles que relataram absenteísmo. Ter multimorbidade aumentou 73% o relato de absenteísmo na população feminina (IC95% 1,01-2,96), entre os homens não houve associação após ajuste progressivo por fatores sociodemográficos e de saúde [RP 1,27 (IC95% 0,96-1,71)]. Conclusão: A carga de morbidade e a multimorbidade são altamente prevalentes entre indivíduos em condição de ocupação e está fortemente relacionada com o absenteísmo no trabalho, especialmente entre as mulheres. Nesse sentido, trabalhadores devem ser alvo de intervenções que visem reduzir o impacto das condições crônicas não transmissíveis entre eles.

Pharmacotherapeutic follow-up of a patient with multimorbities: experience report / Acompanhamento farmacoterapêutico em paciente com multimorbidades: um relato de experiência / Seguimiento farmacoterapéutico en pacientes con multimorbilidad: informe de una experiencia

Chronic non-communicable diseases are growing global health problems. The objective of this study was to promote pharmaceutical care for a patient with multimorbidities in order to improve its quality of life. A pharmacotherapeutic follow-up was performed using the SOAP method, registered in the form of clinical evolution, along with laboratory tests, anthropometric measurements and application of validated instruments to assess pharmacological adherence, mental health and quality of life. The report deals with a female patient, 55 years old, obese and dyslipidemic, sedentary, hypertensive, diabetic and on the control phase of breast cancer. Self-medication with antibiotics and a proton pump inhibitor was identified. Despite the good pharmacological adherence, the patient had decompensated diabetes, accompanied by dyslipidemia without treatment and interruption of supplements. After pharmacological and non- pharmacological interventions, the patient showed a significant improvement in the reduction of anthropometric measurements and in biochemical parameters. At the end of the follow-up, pharmaceutical care proved to be fundamental in identifying the patient's health problems, contributing to obtain a more rational pharmacotherapy.

As doenças crônicas não transmissíveis são problemas de saúde globais crescentes. O objetivo deste estudo foi promover a assistência farmacêutica a um paciente com multimorbidades, a fim de melhorar sua qualidade de vida. Foi realizado acompanhamento farmacoterapêutico pelo método SOAP e aplicação de instrumentos validados para avaliar adesão farmacológica, saúde mental e qualidade de vida. O relato trata de uma paciente do sexo feminino, 55 anos, obesa e dislipidêmica, sedentária, hipertensa, diabética e em fase de controle do câncer de mama. Foi identificada automedicação com antibióticos e inibidor de bomba de prótons. Apesar da boa adesão farmacológica, a paciente apresentava diabetes descompensado, acompanhada de dislipidemia sem tratamento e interrupção das suplementações. Após intervenções farmacológicas e não farmacológicas, a paciente apresentou melhora significativa na redução das medidas antropométricas e nos parâmetros bioquímicos. Ao final do acompanhamento, a assistência farmacêutica mostrou-se fundamental na identificação dos problemas de saúde do paciente.

Las enfermedades crónicas no transmisibles constituyen un creciente problema de salud mundial. El objetivo de este estudio fue promover la asistencia farmacéutica a un paciente con multimorbilidades para mejorar su calidad de vida. Se realizó seguimiento farmacoterapéutico por el método SOAP y aplicación de instrumentos validados para evaluar adherencia farmacológica, salud mental y calidad de vida. O relato trata de uma paciente do sexo feminino, 55 anos, obesa e dislipidêmica, sedentária, hipertensa, diabética e em fase de controle do câncer de mama. Se identificó automedicación con antibióticos e inhibidor de la bomba de protones. A pesar del buen cumplimiento farmacológico, la paciente presentó diabetes descompensada, acompañada de dislipidemia no tratada e interrupción de la suplementación. Tras intervenciones farmacológicas y no farmacológicas, la paciente mostró una mejoría significativa en la reducción de las medidas antropométricas y los parámetros bioquímicos. Al final del seguimiento, la asistencia farmacéutica demostró ser fundamental en la identificación de los problemas de salud del paciente.