Assessment of adherence to statin therapy in patients with coronary artery disease: comparison of three self-reporting measures.

OBJECTIVES: To investigate adherence to statin therapy using three self-reporting adherence measures in patients with coronary artery disease and to compare the three measures. METHODS: A cross-sectional study was carried out at a multidisciplinary outpatient clinic of cardiology at a teaching hospital in south-eastern Brazil in patients with coronary artery disease who were using statins. The sample consisted of 148 patients who were selected from April 2018 to February 2019. Adherence to statin therapy was determined by the Measure of Adherence to Treatment, Visual Analogue Scale of adherence and 7-day recall. A descriptive analysis and determination of the level of agreement between the adherence scales by the Cohen kappa coefficient were performed. RESULTS: The study included 148 patients (104 (70.3%) men, median age 62 years) diagnosed with coronary artery disease who were using statins. The adherence to statin therapy was 98.6% using the Measure of Adherence to Treatment, 95.9% with the Visual Analogue Scale and 95.3% with 7-day recall. Agreement between the Measure of Adherence to Treatment and the Visual Analogue Scale (0.277) and the Measure of Adherence to Treatment and 7-day recall (0.241) was low. There was a high level of agreement between the Visual Analogue Scale and 7-day recall (0.759). CONCLUSIONS: The adherence Visual Analogue Scale and 7-day recall were shown to be easy to apply, low-cost adherence measures to identify adherence to statins in patients with coronary artery disease. The Measure of Adherence to Treatment may also be used to provide information regarding the specific reasons for non-adherent behaviour.

Factors associated with the identification of drug therapy problems among older patients in Primary Health Care.

OBJECTIVE: To determine the frequency of drug therapy problems among older adults in Primary Health Care, and to analyze the factors associated with their identification in the initial patient assessment, carried out by pharmacists offering medication therapy management services. METHODS: A cross-sectional study conducted with data from 758 older adults followed up in medication therapy management services in Primary Health Care in the cities of Belo Horizonte, Betim, and Lagoa Santa (MG, Brazil). Univariate and multivariate analyses were performed to evaluate the factors associated with identification of four or more drug therapy problems in the initial clinical assessment. RESULTS: A total of 1,683 drug therapy problems were identified, 73.6% of older patients had at least one problem. The most frequent problems were nonadherence (23.0%) and the need for additional drug therapy (18.0%). Polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and aged 75 years or older remained positively and statistically associated with identification of four or more drug therapy problems (p<0.05). CONCLUSION: There is a high frequency of problems related to medication use among older users of Primary Health Care, and the medication therapy management services should be prioritized to the older patients, who present with polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and age ≥ 75 years, since they are more likely to have more drug therapy problems.

Medication regimen complexity of coronary artery disease patients.

OBJECTIVE: To determine the factors associated with the high complexity of medication regimen in patients with coronary artery disease. METHODS: A cross-sectional study was carried out in a multiprofessional cardiology outpatient clinic, in the Secondary Care of the Unified Health System, where sociodemographic (age, sex, and education), clinical (number of health conditions, cardiovascular diagnoses, and comorbidities) and pharmacotherapeutic (adherence, polypharmacy, and cardiovascular polypharmacy) characteristics were collected. These were related to complexity of medication regimen, measured through the medication regimen complexity index. The classification of high complexity of medication regimen was carried out using standardization for the older adults and stratification for adult patients, as suggested in the literature. RESULTS: The total complexity medication regimen of 148 patients had a median of 17.0 (interquartile range of 10.5). In the univariate analysis, the factors associated with high complexity were heart failure, diabetes mellitus, hypertension, five or more diseases, and non-adherence to treatment. In the final model, after logistic regression, there was a statistically significant association (p<0.05) with the variables diabetes mellitus, hypertension, and non-adherence. CONCLUSION: The high complexity of medication regimen in patients with coronary artery disease was associated with the presence of diabetes mellitus, hypertension, and reports of non-adherence to treatment.

Medication regimen complexity of coronary artery disease patients / Complexidade da farmacoterapia de pacientes com doença arterial coronariana

ABSTRACT Objective: To determine the factors associated with the high complexity of medication regimen in patients with coronary artery disease. Methods: A cross-sectional study was carried out in a multiprofessional cardiology outpatient clinic, in the Secondary Care of the Unified Health System, where sociodemographic (age, sex, and education), clinical (number of health conditions, cardiovascular diagnoses, and comorbidities) and pharmacotherapeutic (adherence, polypharmacy, and cardiovascular polypharmacy) characteristics were collected. These were related to complexity of medication regimen, measured through the medication regimen complexity index. The classification of high complexity of medication regimen was carried out using standardization for the older adults and stratification for adult patients, as suggested in the literature. Results: The total complexity medication regimen of 148 patients had a median of 17.0 (interquartile range of 10.5). In the univariate analysis, the factors associated with high complexity were heart failure, diabetes mellitus, hypertension, five or more diseases, and non-adherence to treatment. In the final model, after logistic regression, there was a statistically significant association (p<0.05) with the variables diabetes mellitus, hypertension, and non-adherence. Conclusion: The high complexity of medication regimen in patients with coronary artery disease was associated with the presence of diabetes mellitus, hypertension, and reports of non-adherence to treatment.

RESUMO Objetivo: Determinar os fatores associados à complexidade alta da farmacoterapia em pacientes com doença arterial coronariana. Métodos: Realizou-se um estudo transversal em um ambulatório multiprofissional de cardiologia na Atenção Secundária do Sistema Único de Saúde, de onde foram coletadas características sociodemográficas (idade, sexo e escolaridade), clínicas (número de condições de saúde, diagnósticos cardiovasculares e comorbidades) e farmacoterápicas (adesão, polifarmácia e polifarmácia cardiovascular). Essas características foram relacionadas com a complexidade da farmacoterapia, mensurada por meio do Índice de Complexidade da Farmacoterapia. A classificação em complexidade alta da farmacoterapia foi realizada empregando a normatização para idosos e a estratificação para pacientes adultos, sugeridas na literatura. Resultados: A complexidade da farmacoterapia total dos 148 pacientes apresentou mediana igual a 17,0 (amplitude interquartílica de 10,5). Na análise univariada, os fatores associados à complexidade alta foram insuficiência cardíaca, diabetes mellitus, hipertensão arterial, cinco ou mais doenças e não adesão. No modelo final, após regressão logística, houve associação estatisticamente significante (p<0,05) com as variáveis diabetes mellitus, hipertensão arterial e não adesão. Conclusão: A complexidade alta da farmacoterapia em pacientes com doença arterial coronariana foi associada à presença de diabetes mellitus, hipertensão arterial e relato de não adesão a medicamentos

Profile of use and access to statins in patients with coronary arterial disease in an outpatient clinic of a teaching hospital.

OBJECTIVE: The aim of the study is to describe statin use pattern and access among individuals with coronary artery disease of a secondary care service of the Brazilian Unified Health System. METHODS: This is a cross-sectional study carried out in a multi-professional outpatient cardiology clinic at a public, university, and general hospital in the state of Minas Gerais, Brazil. The level of adherence to the recommendations of intensity of the statin therapy of Brazilian and American dyslipidemia guidelines was established. The prescribed statin, adherence to treatment, access, and clinically relevant drug interactions with statins were identified. Access to statin was analyzed through the availability and acquisition capacity realms. RESULTS: The sample consisted of 148 patients who were selected from April 2018 to February 2019. Approximately 90% of patients were under 75 years old. The most prevalent cardiovascular diagnoses were acute myocardial infarction with ST-segment elevation and without ST-segment elevation. All patients had a very high cardiovascular risk. Polypharmacy and cardiovascular polypharmacy were identified in 91.2% and 74.3% of patients, respectively. We identified that 90.6% of the patients used a moderate-intensity statin, and simvastatin was the most common stain used. The level of adherence to the recommendations of Brazilian and American dyslipidemia guidelines for statin use was 9.4% and 21.6%, respectively. Total free access to statins by the Unified Health System was 44.6%, with 52.1% of respondents reporting that they received statins at the health center, 25.7% through the popular pharmacy program via copayment, and 33.8% from a private pharmacy. CONCLUSION: The level of adherence to the recommendations of U.S. and Brazilian guidelines of dyslipidemia for statin use was low. Most patients used a moderate intensity statin, despite having a high cardiovascular risk. Simvastatin was the most prescribed statin.

Emergency department visits of older adults within 30 days of discharge: analysis from the pharmacotherapy perspective / Visitas de idosos a departamentos de emergência em até 30 dias após a alta hospitalar: análise na perspectiva da farmacoterapia

ABSTRACT Objective To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge. Methods A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit. Results A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023). Conclusion The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.

RESUMO Objetivo Analisar, da perspectiva da farmacoterapia, os fatores associados à visita de idosos a departamentos de emergência em até 30 dias após a alta da internação índice. Métodos Foi realizado estudo transversal em hospital público geral, com idosos. Visita a departamento de emergência foi definido como a permanência do idoso nesse serviço por até 24 horas. A complexidade da farmacoterapia foi determinada usando o Medication Regimen Complexity Index. Os medicamentos potencialmente inapropriados para idosos foram classificados segundo os critérios American Geriatric Society/Beers , de 2015. O desfecho investigado foi a frequência de visita a departamento de emergência em 30 dias após a alta hospitalar. Regressão logística multivariada foi realizada para identificar os fatores associados à visita a departamento de emergência. Resultados No estudo, foram incluídos 255 idosos; 67 (26,3%) visitaram departamento emergência em 30 dias após a alta hospitalar. Polifarmácia e medicamentos potencialmente inapropriados para idosos não apresentaram associação estatística significante. O diagnóstico de insuficiência cardíaca e o índice da complexidade da farmacoterapia >16,5 apresentaram associação positiva com visita a departamento de emergência (RC=2,3; IC95%: 1,04-4,94; p=0,048; e RC=2,1; IC95%: 1,11-4,02; p=0,011), respectivamente. Ainda, o diagnóstico de diabetes mellitus e a doença renal crônica foram fatores de proteção para o desfecho (RC=0,4; IC95%: 0,20-0,73; p=0,004; e RC=0,3; IC95%: 0,13-0,86; p=0,023). Conclusão O diagnóstico de insuficiência cardíaca e o índice da complexidade da farmacoterapia >16,5 apresentaram associação positiva com ocorrência de visita a departamento de emergência dentro de 30 dias após a alta.

Potential drug interactions in drug therapy prescribed for older adults at hospital discharge: cross-sectional study.

BACKGROUND: Older adults with a range of comorbidities are often prescribed multiple medications, which favors drug interactions. OBJECTIVES: To establish the frequency of potential drug interactions in prescriptions at hospital discharge among older adults and to identify the associated factors. DESIGN AND SETTING: Cross-sectional study conducted in a public hospital. METHODS: An initial face-to-face interview, data collection from the electronic medical records (covering sociodemographic, clinical, functional and drug therapy-related variables) and telephone follow-up after discharge were conducted to confirm the medication prescribed at discharge. Drug interactions were identified through the Micromedex DrugReax software, along with interactions that should be avoided among the elderly, as per the 2015 American Geriatric Society/Beers criteria. Multivariable logistic regression was performed. RESULTS: Potential for drug interactions was identified in the discharge drug therapy of 67.8% of the 255 older adults evaluated (n = 172), and 54.5% (n = 145) of the drug interactions were major. Among the drug interactions that should be avoided among older adults, those that increase the risk of falls were the most frequent. The drug interactions thus identified were independently associated with polypharmacy (odds ratio, OR = 12.62; 95% confidence interval, CI 6.25-25.50; P = 0.00), diabetes mellitus (OR = 2.16; 95% CI 1.05-4.44; P = 0.04), hypothyroidism (OR = 7.29; 95% CI 2.03-26.10; P = 0.00), chronic kidney disease (OR = 3.41; 95% CI 1.09-10.64; P = 0.03) and hospitalization in geriatric units (OR = 0.45; 95% CI 0.22-0.89; P = 0.02). CONCLUSION: The frequency of potential drug interactions in drug therapy prescribed at discharge for these older adults was high. Polypharmacy, diabetes mellitus, hypothyroidism and chronic kidney disease were positively associated with occurrences of drug interactions, while hospitalization in geriatric units showed an inverse association.

Emergency department visits of older adults within 30 days of discharge: analysis from the pharmacotherapy perspective.

OBJECTIVE: To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge. METHODS: A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit. RESULTS: A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023). CONCLUSION: The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.

Potential drug interactions in drug therapy prescribed for older adults at hospital discharge: cross-sectional study

ABSTRACT BACKGROUND: Older adults with a range of comorbidities are often prescribed multiple medications, which favors drug interactions. OBJECTIVES: To establish the frequency of potential drug interactions in prescriptions at hospital discharge among older adults and to identify the associated factors. DESIGN AND SETTING: Cross-sectional study conducted in a public hospital. METHODS: An initial face-to-face interview, data collection from the electronic medical records (covering sociodemographic, clinical, functional and drug therapy-related variables) and telephone follow-up after discharge were conducted to confirm the medication prescribed at discharge. Drug interactions were identified through the Micromedex DrugReax software, along with interactions that should be avoided among the elderly, as per the 2015 American Geriatric Society/Beers criteria. Multivariable logistic regression was performed. RESULTS: Potential for drug interactions was identified in the discharge drug therapy of 67.8% of the 255 older adults evaluated (n = 172), and 54.5% (n = 145) of the drug interactions were major. Among the drug interactions that should be avoided among older adults, those that increase the risk of falls were the most frequent. The drug interactions thus identified were independently associated with polypharmacy (odds ratio, OR = 12.62; 95% confidence interval, CI 6.25-25.50; P = 0.00), diabetes mellitus (OR = 2.16; 95% CI 1.05-4.44; P = 0.04), hypothyroidism (OR = 7.29; 95% CI 2.03-26.10; P = 0.00), chronic kidney disease (OR = 3.41; 95% CI 1.09-10.64; P = 0.03) and hospitalization in geriatric units (OR = 0.45; 95% CI 0.22-0.89; P = 0.02). CONCLUSION: The frequency of potential drug interactions in drug therapy prescribed at discharge for these older adults was high. Polypharmacy, diabetes mellitus, hypothyroidism and chronic kidney disease were positively associated with occurrences of drug interactions, while hospitalization in geriatric units showed an inverse association.