Résumé
ABSTRACT BACKGROUND: Access to medicines is an important indicator of healthcare system quality and capacity to resolve problems. The healthcare system needs to ensure free access to medicines for elderly people, in order to provide greater effectiveness of disease control, thus reducing morbidity and mortality, and improving health and quality of life. OBJECTIVES: To analyze the frequency of free access to medication among older adults within primary care and determine the factors associated with free access. DESIGN AND SETTING: Cross-sectional study at two primary care units. METHODS: Free access was defined as provision of all medicines through pharmacies within the Brazilian National Health System and through the Brazilian program for free medicines in private pharmacies. We investigated the sociodemographic, clinical, functional and pharmacotherapeutic characteristics of older adults. Multivariate logistic regression was performed to identify factors associated with free access to medicines. RESULTS: This study included 227 older adults, among whom 91 (40.1%) had free full access to prescription drugs. A direct association with age ≤ 70 years and indirect associations with polypharmacy and multimorbidity (P < 0.05) were found. CONCLUSIONS: Age ≤ 70 years increases the likelihood of having free full access to medicines, and older adults with multimorbidity and polypharmacy use have a lower likelihood of access. Identification of factors associated with free access to medicines among elderly people provides elements to guide the Brazilian National Health System in implementing access improvement actions.
Sujets)
Humains , Sujet âgé , Qualité de vie , Soins de santé primaires , Brésil , Études transversales , Polypharmacie , Accessibilité des services de santéRésumé
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.
Sujets)
Humains , Mâle , Femelle , Adulte d'âge moyen , Sujet âgé , Sujet âgé de 80 ans ou plus , Soins de santé primaires , Éducation du patient comme sujet/normes , Compréhension , Médicaments sur ordonnance/administration et posologie , Brésil , Modèles logistiques , Études transversales , Entretiens comme sujet , Analyse multifactorielle , Niveau d'instructionRésumé
A transição do cuidado é complexa em virtude da vulnerabilidade dos eventos que comprometem a segurança e a efetividade da farmacoterapia. Outra fragilidade é o acesso aos medicamentos prescritos para uso domiciliar. Objetivo: Apresentar os resultados de um projeto de orientação ao paciente em alta e identificar a biodisponibilidade dos antimicrobianos orais dispensados. Método: estudo retrospectivo, descritivo e exploratório. Resultados: 138 pacientes foram atendidos no programa durante 12 meses e 37,7% eram provenientes do pronto socorro. Os beta lactâmicos e fluorquinolonas foram os antimicrobianos mais solicitados. Discussão: O programa implementado contribuiu para otimizar o controle e a prevenção de infecções associadas à assistência e à gestão hospitalar assim como para fortalecer o processo de transição dos cuidados terciários para os oferecidos pela Atenção Primária em Saúde.
Introduction: The transition of care is complex by virtue of the vulnerability of the events that jeopardize the reliability and effectiveness of pharmacotherapy. Another fragility is the access to prescription drugs for home use. Objective: To present the results of a Discharged Patient Guidance Project and to identify the biological availability of the oral antimicrobials dispensed. Method: It is a retrospective, descriptive, and exploratory study. Results: During 12 months, 138 patients were attended by the program and 37.7% came from Emergency Medical Services. Betalactams and fluoroquinolones were the most-requested antimicrobials. Discussion: The program helped optimize control and prevention of infections related to hospital assistance and management, as well as strengthen the transition process from tertiary health care to that offered by primary health care
Sujets)
Accès aux Médicaments Essentiels et aux Technologies de la Santé , Antibactériens , Sortie du patient , Bilan comparatif des médicaments , Soins de transitionRésumé
OBJETIVOS: Descrever a atuação do farmacêutico numa equipe multiprofissional, com ênfase no cuidado ao idoso hospitalizado, e intervenções farmacêuticas realizadas durante o seguimento farmacoterapêutico dos indivíduos atendidos. MÉTODOS: Estudo descritivo, exploratório, retrospectivo. A amostra englobou 24 pacientes com idade >60anos, atendidos pelo farmacêutico da equipe multiprofissional de cuidado ao idoso do Hospital Risoleta Tolentino Neves, Belo Horizonte, MG. A farmacoterapia foi analisada em relação ao número de medicamentos; indicação; dose; posologia; aspectos biofarmacêuticos relacionados à via de administração oral ou enteral; estabilidade; incompatibilidade e via de medicamentos parenterais; interações medicamentosas; efetividade e segurança. Verificou-se também a adequação dos medicamentos para idosos, segundo os critérios de Beers. Os medicamentos com atividade anticolinérgica foram identificados segundo Rudolph et al. e Chew et al. As informações foram registradas em instrumento de coleta de dados e a análise estatística descritiva foi realizada em SPSS 10.0. RESULTADOS: Houve diminuição na utilização de medicamentos potencialmente inapropriados para idosos, sendo que na prescrição de alta nenhum idoso estava em uso destes; oito (30%) utilizaram esses medicamentos na admissão; e cinco (20,8%), durante a internação hospitalar. O número de pacientes com prescrição de medicamentos anticolinérgicos reduziu-se de 19 (79,2%) durante a internação para quatro (16,6%) no momento da alta. Vinte e um (87,5%) pacientes demandaram intervenções farmacêuticas, sendo que 20 (83,3%) demandaram intervenções farmacêuticas junto ao médico. Realizou-se um ...
OBJECTIVE: To describe the role of pharmacists within a multiprofessional team, focusing on care of hospitalized elderly, and pharmacist interventions performed during pharmacotherapy follow up of individuals assisted. METHOD: Descriptive, exploratory and retrospective study. The sample involved 24 patients aged >60 years under the care of the pharmacist in the multiprofessional team for elderly care in the investigated hospital. Pharmacotherapy was analyzed in relation to the number of drugs, their indication, dosage, biopharmaceutical aspects related to the oral or enteral route of administration, stability, incompatibility and parenteral drug routes, drug interactions, effectiveness and safety. The adequacy to the elderly was analyzed according to Beers criteria. Drugs with anticholinergic activity were identified according to Rudolph et al. and Chew et al. Information was recorded on a data collection tool and the descriptive statistic analysis was carried out in SPSS 10.0. RESULTS: At the moment of hospital discharge, none of the subjects were making use of drugs potentially inappropriate for the elderly; eight (30.0%) patients were using such drugs when admitted to hospital; and five (20.8%) used such drugs during their hospitalization. The number of patients in use of anticholinergic drugs decreased from 19 (79.2%) during hospitalization to four (16.6%) at hospital discharge. Twenty one (87.5%) patients required pharmaceutical interventions and 20 (83.3%) required pharmaceutical interventions by the physician. A total of 163 pharmaceutical interventions were carried out, representing a mean of 6.79 interventions/patient and 82.2% acceptance. CONCLUSION: The role of pharmacists in caring for elderly optimizes pharmacotherapy and affects the safety and effectiveness of the aged care. .