ABSTRACT
BACKGROUND: Low medication literacy is prevalent among older adults and is associated with adverse drug events. The Medication Literacy Test for Older Adults (TELUMI) was developed and content validated in a previously published study. AIM: To evaluate the psychometric properties and provide norms for TELUMI scores. METHOD: This was a cross-sectional methodological study with older adults selected from the community and from two outpatient services. Descriptive item-analysis, exploratory factor analysis (EFA), item response theory (IRT), reliability, and validity analysis with schooling and health literacy were performed to test the psychometric properties of the TELUMI. The classification of the TELUMI scores was performed using percentile norms. RESULTS: A total of 344 participants, with a mean age of 68.7 years (standard deviation = 6.7), were included; most were female (66.6%), black/brown (61.8%), had low schooling level (60.2%) and low income (55.2%). The EFA pointed to the one-dimensional structure of TELUMI. A three-parameter logistic model was adopted for IRT. All items had an adequate difficulty index. One item had discrimination < 0.65, and three items had an unacceptable guessing index (< 0.35) and were excluded. The 29-item version of TELUMI had excellent internal consistency (KR20 = 0.89). There was a positive and strong association between TELUMI scores and health literacy and education level. The scores were classified as inadequate medication literacy (≤ 10.0 points), medium medication literacy (11-20 points), and adequate medication literacy (≥ 21 points). CONCLUSION: The results suggest that the 29-item version of TELUMI is psychometrically adequate for measuring medication literacy in older adults.
ABSTRACT
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.
