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OBJECTIVE To understand the current status of the research on rational drug use among the elderly population in Chinese elderly care facilities， and to provide ideas for future related research. METHODS Retrieved from PubMed， Web of Science， Embase， CNKI， Wanfang database and VIP， relevant literature about the research on rational drug use among the elderly population in Chinese elderly care facilities were collected to evaluate the current status of research on the rational drug use among the elderly population in elderly care facilities. RESULTS A total of 14 cross-sectional studies were included. All included studies were completed before 2019 and focused on the eastern coastal areas of China. The AXIS quality scores of the included studies showed a mean score of 11.14±2.25， with six studies having a quality score ＞10. The 14 studies examined a total of 5 770 older adults in elderly care facilities， involving 181 elderly care facilities. Eight studies reported the type of chronic disease in the older adult population of the elderly care facilities； seven studies reported the type of medication used. Nine studies had medication compliance as an outcome， among which seven studies used different analytical methods to analyze the factors influencing medication compliance. The results showed that age， education， duration of illness， type of elderly care facilities， and level of staff attention had significant influence on medication compliance in the elderly population in the elderly care facilities. CONCLUSIONS There is insufficient research related to rational drug use among the elderly population in the elderly care facilities in China， and there is a lack of interventional studies to assess the effectiveness of the rational drug use service in the elderly population in the elderly care facilities. Most of the current research is based on cross-sectional studies， focusing on medication compliance.
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Abstract: Introduction: The World Health Organization defined the compulsory need to redirect all educational, research and public health service activities of medical schools to meet all priority health needs, attributing to them this social responsibility role. Due to the emergency situation in the public health system caused by the COVID-19 pandemic, as a measure of social accountability, remote medical care services and online education were adopted in order to continue following the curricular program and to provide assistance to local city governments. Experience report: Two months before graduation, medical students followed-up on the monitoring of residents and COVID-19 healthcare professionals of forty-three ILPIs (Long-Term Elderly Care Facilities) in the city of Sao Jose do Rio Preto, state of Sao Paulo, Brazil. The medical students made daily telephone calls to all these ILPI units, requesting information, generally from the head nurses and owners, about the main COVID-19 symptoms that were detected in the residents and employees of these facilities. All the collected information was discussed daily with the teacher in charge of mentoring the program, fed into an online database and into a work schedule chart, then relayed to the local Municipal Health Secretariat. A COVID-19 contingency plan was devised by the team, authorized by the Local Health Secretariat and then presented to the ILPIs, aiming to offer them the best guidance throughout the pandemic. Discussion: the COVID-19 pandemic revealed the Health Education System's fragilities, limitations and capacity to adapt to this crisis, thus largely contributing to improving the training of new medical doctors. During the program, medical students faced many challenges, especially regarding the difficulty to contact some ILPIs by telephone, omitted or erroneous information provided by employees in these facilities and delays in reporting suspected cases. In spite of this scenario, daily contact with these facilities allowed the team to identify the ILPIs that were more adequately prepared and the ones that needed auditing and further supervision. Also, this daily contact established a bond between the team and the ILPIs. Conclusion: During the pandemic, it was possible to perform actions according to the logic of social accountability, demonstrating that remote online medical practice is a tool capable of both maintaining interns in contact with the practical aspects of medical care and providing medical assistance to the community and to the local government.
Resumo: Introdução: A Organização Mundial da Saúde definiu a obrigatoriedade do direcionamento das atividades de educação, pesquisa e serviços para atender às preocupações prioritárias de saúde como responsabilidade social das escolas médicas. Considerando a emergência em saúde pública em decorrência da Covid-19, decidiu-se utilizar a telemedicina e implementar o ensino remoto para continuar a programação curricular e prestar apoio à gestão municipal a partir do pressuposto da social accountability. Relato de experiência: A dois meses do fim da graduação, discentes de Medicina acompanharam as 43 instituições de longa permanência para idosos (Ilpis) - públicas e privadas - do município de São José do Rio Preto com o intuito de monitorar residentes e funcionários em relação à Covid-19. Por meio de ligações diárias para as Ilpis, eles solicitaram ao representante de cada unidade, geralmente enfermeiro responsável, ou ao proprietário do estabelecimento informações sobre os principais sintomas da Covid-19 detectados nos moradores e funcionários das instituições. Cotidianamente, essas informações eram registradas numa plataforma on-line, na planilha de organização do trabalho, e depois relatadas para a Secretaria Municipal de Saúde (SMS) e discutidas com o professor responsável pela mentoria. Um plano de contingência para a Covid-19 foi elaborado pela equipe, autorizado pela SMS e repassado às Ilpis, para orientá-las durante a pandemia. Discussão: A Covid-19 apontou as fragilidades, as limitações e a capacidade de adaptação do sistema educacional de saúde, o que possibilitou o aprimoramento da formação dos novos médicos. Durante o monitoramento, os discentes encontraram diversos desafios: dificuldade no contato telefônico com algumas Ilpis, informações omitidas ou fornecidas de forma equivocada pelos funcionários e atrasos na comunicação de casos suspeitos. Contudo, o contato diário permitiu reconhecer as Ilpis que se apresentavam mais adequadas e as que necessitavam de investigação e orientação, criando vínculo com as Ilpis. Conclusão: Durante a pandemia, foi possível realizar ações na lógica da social accountability, evidenciando que o teleatendimento é uma ferramenta que, ao mesmo tempo que mantém os internos nos cenários de práticas, presta assistência à comunidade e à gestão municipal durante a pandemia.