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Kogawa EM, Melo FF, Pires RG, Caetano PCC, de Lima Rodrigues J, Benito LAO, da Silva ICR, de Castro Cantuária AP, de Carvalho Sales-Peres SH. The changes on salivary flow rates, buffering capacity and chromogranin A levels in adults after bariatric surgery. Clin Oral Investig 2024; 28:159. [PMID: 38378939 DOI: 10.1007/s00784-024-05551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This study aimed to investigate changes in salivary flow rates, buffering capacity, and salivary chromogranin A (CHGA) levels in adults undergoing bariatric surgery (BS) compared with a non-obese control group. MATERIALS AND METHODS Salivary analyses were performed on 62 participants aged over 50 years, stratified into two groups matched for age and gender-individuals who had undergone bariatric surgery (BS) (n = 31) and a corresponding healthy control group (n = 31). Before saliva collection, participants completed a comprehensive 11-point visual numerical rating scale (NRS 0-10) xerostomia questionnaire, assessing subjective perceptions of two key aspects: dryness of the oral mucosa and resultant impact on oral functional ability. Three distinct saliva measurements were obtained: unstimulated whole saliva (UWS), stimulated whole saliva (SWS), and unstimulated upper labial saliva (ULS). The buffering capacity of unstimulated saliva was assessed using pH indicator strips, and concentrations of salivary Chromogranin A (CHGA) were quantified in stimulated saliva via enzyme-linked immunosorbent assay (ELISA). RESULTS After BS, more than 40% of BS group patients reported xerostomia, with 16.1% experiencing only mild symptoms without significant functional impact (p = 0.009). The prevalence of xerostomia and tongue dryness was higher in the BS group compared to the control group (p = 0.028 and p = 0.025, respectively). The comparative analysis unveiled no statistically significant differences in flow rates of unstimulated upper labial saliva (ULS), unstimulated whole saliva (UWS), and stimulated whole saliva (SWS) between the control group and patients who underwent bariatric surgery. However, in patients undergone BS with xerostomia, both ULS and UWS flow rates were significantly lower than in controls with xerostomia (p = 0.014 and p = 0.007, respectively). The buffering capacity was significantly lower in patients undergone BS than in controls (p = 0.009). No differences were found between groups regarding CHGA concentration and output values, nevertheless, higher values of CHGA concentrations were significantly correlated to lower flow rates. CONCLUSION According to the results, this study suggests that individuals undergoing BS may exhibit altered salivary buffering capacity and reduced unstimulated salivary flows in the presence of xerostomia. Additionally, the findings suggest that elevated concentration of salivary CHGA might be associated, in part, with salivary gland hypofunction. CLINICAL RELEVANCE The clinical significance of this study lies in highlighting the changes in salivary functions after BS. The identified salivary alterations might be attributed to adverse effects of BS such as vomiting, gastroesophageal reflux, and dehydration. Understanding these changes is crucial for healthcare professionals involved in the care of post-BS patients, as it sheds light on potential oral health challenges that may arise as a consequence of the surgical intervention. Monitoring and managing these salivary alterations can contribute to comprehensive patient care and enhance the overall postoperative experience for individuals undergoing BS.
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Affiliation(s)
- Evelyn Mikaela Kogawa
- Faculdade de Odontologia de Bauru, Universidade de São Paulo (USP), Bauru, SP, 17012-901, Brazil.
- Departamento de Odontologia, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil.
- Programa de Pós-Graduação em Odontologia, Universidade de Brasília, Brasília, DF, 70910-900, Brazil.
| | - Fabíola Ferreira Melo
- Programa de Pós-Graduação em Odontologia, Universidade de Brasília, Brasília, DF, 70910-900, Brazil
| | - Reuel Gomes Pires
- Curso de Odontologia, Universidade Católica de Brasília, Brasília, DF, 71966-700, Brazil
| | | | | | - Linconl Agudo Oliveira Benito
- Pós-Graduação em Ciências e Tecnologias em Saúde (PPGCTS), FCE, Universidade de Brasília, Brasília, DF, 72220-275, Brazil
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Torres-Atencio I, Carreira MB, Méndez A, Quintero M, Broce A, Oviedo DC, Rangel G, Villarreal AE, Tratner AE, Rodríguez-Araña S, Britton GB. Polypharmacy and Associated Health Outcomes in the PARI-HD Study. J Alzheimers Dis 2024; 98:287-300. [PMID: 38393905 DOI: 10.3233/jad-231001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Background A growing body of evidence points to potential risks associated with polypharmacy (using ≥5 medications) in older adults, but most evidence is derived from studies where racial and ethnic minorities remain underrepresented among research participants. Objective Investigate the association between polypharmacy and cognitive function, subjective health state, frailty, and falls in Hispanic older adults. Methods Panama Aging Research Initiative-Health Disparities (PARI-HD) is a community-based cohort study of older adults free of dementia at baseline. Cognitive function was measured with a neuropsychological test battery. Frailty assessment was based on the Fried criteria. Subjective health state and falls were self-reported. Linear and multinomial logistic regression analyses were used to examine association. Results Baseline evaluations of 468 individuals with a mean age of 69.9 years (SD = 6.8) were included. The median number of medications was 2 (IQR: 1-4); the rate of polypharmacy was 19.7% (95% confidence interval [CI] = 16.1-23.3). Polypharmacy was inversely associated with self-rated overall health (b =-5.89, p < 0.01). Polypharmacy users had 2.3 times higher odds of reporting two or more falls in the previous 12 months (odds ratio [OR] = 2.31, 95% CI = 1.06-5.04). Polypharmacy was independently associated with Fried's criteria for pre-frailty (OR = 2.90, 95% CI = 1.36-5.96) and frailty (OR = 5.14, 95% CI = 1.83-14.42). Polypharmacy was not associated with cognitive impairment. Conclusions These findings illustrate the potential risks associated with polypharmacy among older adults in Panama and may inform interventions to improve health outcomes in this population.
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Affiliation(s)
- Ivonne Torres-Atencio
- Departamento de Farmacología, Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Maria B Carreira
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
| | - Alondra Méndez
- Departamento de Farmacología, Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Maryonelly Quintero
- Departamento de Farmacología, Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Adriana Broce
- Departamento de Farmacología, Facultad de Medicina, Universidad de Panamá, Panama City, Panama
| | - Diana C Oviedo
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
- Escuela de Psicología, Universidad Católica Santa María La Antigua, Panama City, Panama
| | - Giselle Rangel
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
| | - Alcibiades E Villarreal
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
| | - Adam E Tratner
- Florida State University, Republic of Panama Campus, Ciudad del Saber, Panama City, Panama
| | - Sofía Rodríguez-Araña
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
| | - Gabrielle B Britton
- Centro de Neurociencias, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panama City, Panama
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Barrio-Cortes J, Benito-Sánchez B, Villimar-Rodriguez AI, Rujas M, Arroyo-Gallego P, Carlson J, Merino-Barbancho B, Roca-Umbert A, Castillo-Sanz A, Lupiáñez-Villanueva F, Fico G, Gómez-Gascón T. Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study. J Pharm Policy Pract 2023; 16:161. [PMID: 38017572 PMCID: PMC10683272 DOI: 10.1186/s40545-023-00665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patients with polypharmacy suffer from complex medical conditions involving a large healthcare burden. This study aimed to describe the characteristics and utilization of primary care (PC) and hospital care (HC) and factors associated in chronic patients with polypharmacy, stratifying by adjusted morbidity groups (AMG) risk level, sex and age, and comparing with non-polypharmacy. METHODS Cross-sectional study conducted in a Spanish basic healthcare area. Studied patients were those over 18 years with chronic diseases identified by the AMG tool from Madrid electronic clinical record, which was the data source. Sociodemographic, sociofunctional, clinical and healthcare utilization variables were described and compared by risk level, sex, age and having or not polypharmacy. Factors associated with healthcare utilization in polypharmacy patients were determined by a negative binomial regression model. RESULTS In the area studied, 61.3% patients had chronic diseases, of which 16.9% had polypharmacy vs. 83.1% without polypharmacy. Patients with polypharmacy (vs. non-polypharmacy) mean age was 82.7 (vs. 52.7), 68.9% (vs. 60.7%) were women, and 22.0% (vs. 1.2%) high risk. Their average number of chronic diseases was 4.8 (vs. 2.2), and 95.6% (vs. 56.9%) had multimorbidity. Their mean number of annual healthcare contacts was 30.3 (vs. 10.5), 25.9 (vs. 8.8) with PC and 4.4 (vs. 1.7) with HC. Factors associated with a greater PC utilization in patients with polypharmacy were elevated complexity, high risk level and dysrhythmia. Variables associated with a higher HC utilization were also increased complexity and high risk, in addition to male sex, being in palliative care, having a primary caregiver, suffering from neoplasia (specifically lymphoma or leukaemia) and arthritis, whereas older age and immobilization were negatively associated. CONCLUSIONS Polypharmacy population compared to non-polypharmacy was characterized by a more advanced age, predominance of women, high-risk, complexity, numerous comorbidities, dependency and remarkable healthcare utilization. These findings could help healthcare policy makers to optimize the distribution of resources and professionals within PC and HC systems, aiming for the improvement of polypharmacy management and rational use of medicines while reducing costs attributed to healthcare utilization by these patients.
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Affiliation(s)
- Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Ave. Reina Victoria, 21, 6Th Floor, 28003, Madrid, Spain
- Faculty of Health, Camilo José Cela University, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Research Network On Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain
| | - Beatriz Benito-Sánchez
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Ave. Reina Victoria, 21, 6Th Floor, 28003, Madrid, Spain.
| | | | - Miguel Rujas
- Technical University of Madrid (UPM), Madrid, Spain
| | | | | | | | | | | | | | | | - Tomás Gómez-Gascón
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Ave. Reina Victoria, 21, 6Th Floor, 28003, Madrid, Spain
- Research Network On Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain
- Research Institute Hospital, 12 de Octubre (imas12), Primary Care Management, Madrid, Spain
- Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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Derhem B, Özsari S. Frailty and Polypharmacy in Primary Care. Biol Res Nurs 2023; 25:658-663. [PMID: 37231714 DOI: 10.1177/10998004231179485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The Clinical Frailty Scale (CFS) is a clinical judgement-based frailty tool developed from the Canadian Study of Health and Aging. Many studies on the measurement of frailty and its effect on clinical outcomes have been conducted on patients hospitalized, especially in intensive care units. The purpose of this study is to examine the relationship between polypharmacy and frailty on outpatient older adult patients in primary care. MATERIALS AND METHOD This cross-sectional study included 298 patients who were aged ≥65 years and admitted to Yenimahalle Family Health Center between May-2022 and July-2022. Frailty was evaluated by using CFS. Polypharmacy was defined as five medications or more and "excessive polypharmacy" as 10 medications or more. The medications below five are grouped as "no polypharmacy". RESULTS There was a statistically significance between age groups, gender, smoking status, marital status, polypharmacy status, and FS (p = .003 and η2: .20; p < .001 and Cohen d: .80; p = .018 and Cohen d: .35; p < .001 and Cohen d: 1.10 and p < .001 and η2: 1.45 respectively). A strong, positive correlation was found between polypharmacy and the frailty score. CONCLUSION Polypharmacy, especially excessive polypharmacy, may be a promising adjunct to frailty in identifying older patients whose health is more likely to worsen. Providers in primary care should also consider frailty when prescribing drugs.
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Affiliation(s)
- Baki Derhem
- General Directorate of Public Health, The Ministry of Health of Turkey, Ankara, Turkey
| | - Süleyman Özsari
- Family Medicine Department, Bolu Abant İzzet Baysal University Medical Faculty, Bolu, Turkey
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Ferreira KRA, Ahmadi S, Sampaio RAC, Uchida MC. Outdoor gyms and physical function: A cross-sectional comparative study between active and sedentary older adults. J Bodyw Mov Ther 2023; 33:76-81. [PMID: 36775529 DOI: 10.1016/j.jbmt.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/23/2022] [Accepted: 09/18/2022] [Indexed: 11/16/2022]
Abstract
Outdoor gyms (OG) are public places designed for physical activity, especially for older adults. This is a cross-sectional study that aimed to compare morphofunctional characteristics of sedentary and active older adults regarding OG. The participants consisted of 194 older people divided into three groups: sedentary (n = 76, mean age = 70.5 ± 6.4 years, 38.7% male); OG + walking (n = 86; mean age = 69 ± 6.1 years; male 50.6%); and OG (n = 32; mean age = 70.3 ± 8.3 years; male 56.3%). Socioeconomic and morphofunctional characteristics, anthropometric measurements, body composition, and functional tests were collected. For comparison among groups ANOVA, for categorical variables the chi-square test or Fisher's exact test, and to verify factors related to gait speed logistic regression were used. We found that sedentary older adults had lower educational level and lower prevalence of polypharmacy. OG + walking participants had lower waist circumference and fat percentage, and better gait speed. Older people in the OG + walking were less likely to show gait difficulty (i.e., <1.0 m/s) in reference to the sedentary group. In addition, strength and better performance on the Timed Up and Go were also associated with gait speed >1 m/s. It is understood that the higher volume of physical activity performed by OG + walking may be one of the reasons why they obtained better indicators in health aspects. The findings, especially regarding the characterization of profiles of older adults who use OG, leads to the definition of public policies aimed at the real needs of this public.
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Affiliation(s)
| | - Shirko Ahmadi
- Applied Kinesiology Laboratory, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil; École de kinésiologie et des sciences de l'activité physique de la Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Ricardo Aurélio Carvalho Sampaio
- Applied Kinesiology Laboratory, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil; Postgraduate Program in Physical Education, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Marco Carlos Uchida
- Applied Kinesiology Laboratory, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
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Ramos KA, Boing AC, Andrade JM, Bof de Andrade F. Polypharmacy among older adults in Brazil: Association with sociodemographic factors and access to health services. DIALOGUES IN HEALTH 2022; 1:100078. [PMID: 38515895 PMCID: PMC10953922 DOI: 10.1016/j.dialog.2022.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 03/23/2024]
Abstract
Background Polypharmacy is common among older adults and is of public health concern, since pharmacological therapy influences the quality of care for older individuals. Few studies have addressed its prevalence and correlates in low or middle-income countries. Objective: To evaluate the prevalence of polypharmacy in a representative sample of the Brazilian older population and its association with sociodemographic conditions and factors related to access to health services. Methods Cross-sectional study with data from the last National Health Survey, conducted in 2019. The dependent variable was polypharmacy (five or more medications) and independent variables were: sociodemographic characteristics, general health conditions and access to health services indicator. Results The prevalence of polypharmacy was 19.2%. Polypharmacy was higher among those aged 80 years and over compared to those aged 60-69 years (prevalence ratio (PR) 1.47; 95% CI: 1.30; 1.66); individuals with complete elementary education (PR 1.35; 95% CI: 1.13; 1.60) versus those who did not go to school; with 3+ chronic diseases (PR 11.14; 95% CI: 7.94; 15.63); those with limitations in basic activities of daily life (PR 1.49; 95% CI: 1.35; 1.63) and possession of private medical health insurance (PR 1.32; 95% CI 1.19; 1.46). Being in a marital relationship was inversely associated with polypharmacy (PR 0.88; 95% CI: 0.80; 0.96). Conclusion Polypharmacy affects a significant proportion of the Brazilian older population and is associated with sociodemographic factors and access to health services.
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Affiliation(s)
- Karina Alves Ramos
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, MG, Brazil
| | | | - Juliana Mara Andrade
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, MG, Brazil
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Malta JS, Drummond PLDM, Silveira LP, Costa NL, Santos RMMD, Machado CJ, Reis AMM, de Pádua CAM. Effect of therapeutic regimens and polypharmacy on health-related quality of life of people with multiple myeloma: a cross-sectional study in Belo Horizonte, Brazil. Curr Med Res Opin 2022; 38:1275-1283. [PMID: 35083943 DOI: 10.1080/03007995.2022.2034387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Multiple myeloma (MM) is an incurable hematological cancer and its treatment is geared to promote better Health-Related Quality of Life (HRQoL). We aimed to assess HRQoL and compare scores between variables on therapeutic regimens and polypharmacy in MM patients. METHODS This cross-sectional study was performed from April/2019 to February/2020 in Belo Horizonte, Brazil. HRQoL scores were obtained by the QLQ-C30 and QLQ-MY20 instruments. Data were retrieved from interviews and medical records. Therapeutic regimens were grouped into thalidomide-containing regimens; bortezomib-containing regimens; bortezomib and thalidomide-containing regimens; other therapeutic regimens, and remission group. We performed univariate analyses by the Mann-Whitney method and adopted the Kruskal-Wallis test for multiple comparisons. Robust multiple linear regression was used to determine the association between independent variables and the HRQoL scores. RESULTS The sample included 225 participants and most patients (65.3%) were on active treatment and had worse scores concerning future perspective. Polypharmacy was associated with worse scores on all scales in the univariate analyses. We observed a difference in the global health and body image (p < .05) scales in the multiple comparisons with therapeutic regimens. The global health scale difference was found between groups with other regimens and the remission group (p < .05). The difference between the bortezomib and thalidomide-containing regimens and remission group was not statistically significant (p = .077) in the body image scale. The multiple linear regression maintained the association of polypharmacy with worse HRQoL scores. CONCLUSION We identified an independent association between HRQoL and polypharmacy in MM patients. However, there was no difference between the evaluated regimens, suggesting they are equivalent in Brazil about HRQoL.
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Affiliation(s)
- Jéssica Soares Malta
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
| | - Paula Lana de Miranda Drummond
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
- Fundação Ezequiel Dias - Funed, Belo Horizonte, Brasil
| | - Lívia Pena Silveira
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
- Hospital das Clínicas da UFMG, Belo Horizonte, Brasil
| | - Naiane Lima Costa
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
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Lee GB, Etherton-Beer C, Hosking SM, Pasco JA, Page AT. The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review. Ther Adv Drug Saf 2022; 13:20420986221100117. [PMID: 35814333 PMCID: PMC9260603 DOI: 10.1177/20420986221100117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
In the context of an ageing population, the burden of disease and medicine use is
also expected to increase. As such, medicine safety and preventing avoidable
medicine-related harm are major public health concerns, requiring further
research. Potentially suboptimal medicine regimens is an umbrella term that
captures a range of indicators that may increase the risk of medicine-related
harm, including polypharmacy, underprescribing and high-risk prescribing, such
as prescribing potentially inappropriate medicines. This narrative review aims
to provide a background and broad overview of the patterns and implications of
potentially suboptimal medicine regimens among older adults. Original research
published between 1990 and 2021 was searched for in MEDLINE, using key search
terms including polypharmacy, inappropriate prescribing, potentially
inappropriate medication lists, medication errors, drug interactions and drug
prescriptions, along with manual checking of reference lists. The review
summarizes the prevalence, risk factors and clinical outcomes of polypharmacy,
underprescribing and potentially inappropriate medicines. A synthesis of the
evidence regarding the longitudinal patterns of polypharmacy is also provided.
With an overview of the existing literature, we highlight a number of key gaps
in the literature. Directions for future research may include a longitudinal
investigation into the risk factors and outcomes of extended polypharmacy,
research focusing on the patterns and implications of underprescribing and
studies that evaluate the applicability of tools measuring potentially
inappropriate medicines to study settings.
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Affiliation(s)
- Georgie B Lee
- Epi-Centre for Healthy Ageing, Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, HERB-Building Level 3, C/- University Hospital Geelong, 285 Ryrie Street, P.O. Box 281, Geelong, VIC 3220, Australia
| | | | - Sarah M Hosking
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Julie A Pasco
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Amy T Page
- WA Centre for Health and Ageing, The University of Western Australia, Crawley, WA, Australia
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Samouei R, Keyvanara M. Identifying strategies for dealing with the aging population from the perspective of health system experts: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:210. [PMID: 36003233 PMCID: PMC9393960 DOI: 10.4103/jehp.jehp_1213_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/16/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM Given the growing trend of aging and the limited resources of the health system, the lack of long-term prior government planning, and reduced growth of the productive force of society, identifying strategies for planning and action to deal with future aging is very important. In this regard, the study was conducted to identify strategies for dealing with the aging population from the perspective of health system experts. METHODS The qualitative content analysis study was performed on 29 Iranian male and female experts in the aging and health scope from Isfahan, Tehran, Tabriz, and Babol who purposefully participated in the semi-structured interview. Data were classified by qualitative content analysis. RESULTS Two concepts emerged according to the participated experts' opinions, regarding the strategies of the Iranian health system in dealing with future aging: "executive policy" strategies, including "design, planning and implementation," "evaluation and standardization," "strengthening demand-driven" and "modeling national and international experiences," "preventive policies" strategy, which includes "Focus on prevention," "Focus on values and competencies," "Educational empowerment," "Knowledge-based empowerment," "Empowerment of age-related groups," "Economic empowerment," and "Social support." CONCLUSION The diversity and breadth of the mentioned strategies indicate the necessity of comprehensive readiness and adaptation of health services to the elderly conditions and characteristics. Purposeful planning and timely implementation of programs and policies to better address the health system with future aging will be possible by using practical strategies.
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Affiliation(s)
- Rahele Samouei
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahmoud Keyvanara
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Gharekhani A, Somi M, Ostadrahimi A, Hatefi A, Haji Kamanaj A, Hassannezhad S, Faramarzi E. Prevalence and Predicting Risk Factors of Polypharmacy in Azar Cohort Population. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH 2022; 21:e126922. [PMID: 36060920 PMCID: PMC9420226 DOI: 10.5812/ijpr-126922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/12/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022]
Abstract
Background As polypharmacy has some medically negative impacts, it has become a challenging issue for public health and affected people. Therefore, we decided to investigate the prevalence of polypharmacy and its predicting risk factors in the Azar cohort population. Methods In this cross-sectional population-based cohort study, the prevalence of polypharmacy was evaluated in 15,001 subjects who participated in the Azar cohort study. We measured demographic characteristics (age, gender, socioeconomic status, smoking status, marital status, and education level), physical activity level, body mass index (BMI), blood pressure, multimorbidity (coexistence of two or more chronic diseases (CDs)), and polypharmacy status (a daily intake of five or more medicines for a minimum of 90 days). Results Based on our results, 9.51% of the population had polypharmacy. The five most prescribed medications were drugs acting on the cardiovascular system (19.9%), central nervous system (16.7%), endocrine system (13.3%), NSAIDs (11.5%), and drugs used for musculoskeletal and joint diseases (11.4%). Being female, illiterate, and having the lowest tertile of physical activity level significantly increased the risk of polypharmacy. The risk of polypharmacy was 49.36 times higher in patients with four or more CDs than in those without. Conclusions Our study emphasized the importance of routine monitoring to evaluate polypharmacy among those aged 35 to 59 and the elderly. Physicians should carefully assess drug suitability, especially in multimorbid and obese patients, to prevent excessive polypharmacy and its potentially negative impacts.
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Affiliation(s)
- Afshin Gharekhani
- Department of Clinical Pharmacy (Pharmacotherapy), Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadhossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ayda Hatefi
- Student Research Committee, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Haji Kamanaj
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Hassannezhad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Golgahsht st., Tabriz, Iran.
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Tiguman GMB, Biase TMMA, Silva MT, Galvão TF. Prevalence and factors associated with polypharmacy and potential drug interactions in adults in Manaus, Amazonas state, Brazil: a cross-sectional population-based study, 2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021653. [PMID: 35730815 PMCID: PMC9887957 DOI: 10.1590/s2237-96222022000200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/20/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To assess the prevalence and factors associated with polypharmacy and the presence of potential drug interactions in Manaus, Amazonas state, Brazil, in 2019. METHODS This was a population-based cross-sectional study conducted with adults aged ≥ 18 years. The presence of drug interactions among people on a polypharmacy regimen (≥ 5 drugs) was investigated on the Micromedex database. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson regression model with robust variance, following hierarchical analysis and considering the complex sample design. RESULTS Of the 2,321 participants, 2.8% (95%CI 2.1;3.6) were on polypharmacy regimen, of whom, 74.0% presented drug interactions, usually with four or more drug interactions per person (40.4%) and high severity (59.5%). Polypharmacy was higher among older adults (PR = 3.24; 95%CI 1.25;8.42), people with poor health (PR = 2.54; 95%CI 1.14;5.67), previous hospitalization (PR = 1.90; 95%CI 1.09;3.32) and multimorbidity (PR = 3.20; 95%CI 1.53;6.67). CONCLUSION Polypharmacy was more frequent among older adults and people with medical problems, who presented more drug interactions.
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Affiliation(s)
| | | | - Marcus Tolentino Silva
- Universidade de Sorocaba, Programa de Pós-Graduação em Ciências
Farmacêuticas, Sorocaba, SP, Brazil
| | - Taís Freire Galvão
- Universidade Estadual de Campinas, Faculdade de Ciências
Farmacêuticas, Campinas, SP, Brazil
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Mello RP, Xavier MO, Tomasi E, Gonzalez MC, Demarco FF, Bielemann RM. Dysphagia Perception Among Community-Dwelling Older Adults from a Municipality in Southern Brazil. Dysphagia 2021; 37:879-888. [PMID: 34319457 DOI: 10.1007/s00455-021-10347-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
To analyse the prevalence of dysphagia perception and associated factors among community-dwelling older adults in Pelotas, Brazil. A total of 1447 community-dwelling individuals aged 60 and older participated in a cross-sectional population-based study carried out in 2014. Dysphagia perception was assessed using the following question: "Do you have swallowing difficulties? (Yes/No)". Independent variables included sociodemographic, behavioural and health characteristics. Poisson regression was used to obtain prevalence ratios. Dysphagia perception prevalence was 8.1%, higher among women (PR 1.63, 95% CI 1.07; 2.46) and in subjects older than 80 years (PR 1.88, 95% CI 1.16; 3.03). Older adults with 1-7 years of schooling were more likely to present dysphagia (PR 1.62; 95% CI 1.09; 2.40). Those who did not use dental prosthesis (PR 1.85; 95% CI 1.08; 3.16), who presented dry mouth sensation (PR 4.10; 95% CI 2.59; 6.51) and multimorbidity (PR 30.0; 95% CI 4.09; 219.45) were more likely to present dysphagia perception. The participants who consumed alcohol were 60% less likely to report dysphagia perception (PR 0.43; 95% CI 0.22; 0.86). One out of twelve older adults presented dysphagia perception, and associations with sociodemographic characteristics and other health problems were found. Early identification of dysphagia should be a public health and clinical concern.
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Affiliation(s)
| | - Mariana Otero Xavier
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro St. 1160-30 Floor, Pelotas, 96020220, Brazil.
| | - Elaine Tomasi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro St. 1160-30 Floor, Pelotas, 96020220, Brazil
| | - Maria Cristina Gonzalez
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Flávio Fernando Demarco
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro St. 1160-30 Floor, Pelotas, 96020220, Brazil.,Post-Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Renata Moraes Bielemann
- Nutrition College, Federal University of Pelotas, Pelotas, Brazil.,Post-Graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro St. 1160-30 Floor, Pelotas, 96020220, Brazil
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Andrade NDO, Alves AM, Luchesi BM, Martins TCR. Polimedicação em adultos e idosos cadastrados na Estratégia Saúde da Família. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: Verifica-se, no contexto global, a modificação do perfil da morbimortalidade em decorrência das transições demográfica e epidemiológica, relacionadas ao aumento do número de idosos e de doenças crônicas não-transmissíveis. Nesse cenário, a polimedicação tem se tornado frequente e, por conseguinte, seus danos são visualizados. O uso de múltiplos medicamentos amplia o risco de prescrições potencialmente inapropriadas, o que propicia interações farmacológicas, eventos adversos a medicamentos e hospitalizações. Soma-se a isso o ônus ao sistema de saúde e à assistência médica. Objetivo: Identificar os fatores associados à polimedicação em adultos mais velhos e idosos. Métodos: Trata-se de um estudo transversal e quantitativo, realizado em 2018 e 2019, com n=147 adultos (45-59 anos) e n=153 idosos (≥60 anos), cadastrados na Estratégia Saúde da Família (ESF) no município de Três Lagoas/MS. Foram coletados dados de caracterização sociodemográfica, estilo de vida, rede de apoio social e informações sobre saúde. Questionou-se o número de fármacos de uso contínuo tomados por dia, sendo considerada polifarmácia a utilização de cinco ou mais medicamentos. Foi conduzida uma regressão logística binomial para identificar os fatores associados à polifarmácia. Resultados: A prevalência de polifarmácia foi 10,2% (IC95% = [6,3%-16,2%]) para os adultos e 17,0% (IC95% = [11,9%-23,7%]) para os idosos. Estiveram associados à polifarmácia para o grupo de adultos o aumento da idade (OR=1,32; IC95%=1,10-1,59) e não possuir companheiro (OR=6,52; IC95%=1,59-26,81). Já para o grupo de idosos, os fatores associados foram ter sofrido pelo menos uma queda no último ano (OR=3,33; IC95%=1,13-9,85), ser tabagista (OR=5,04; IC95%=1,30-19,62), avaliar a saúde como regular (OR=4,10; IC95%=1,16-14,54) ou ruim/muito ruim (OR=6,59; IC95%=1,31-33,08). O consumo de álcool foi inversamente associado à polifarmácia (OR=0,15; IC95%=0,02-0,98) nos idosos. Conclusões: Diante dos potenciais riscos oferecidos pela polimedicação, torna-se imprescindível a distinção dos grupos em condição de maior vulnerabilidade ao uso de múltiplos medicamentos e um acompanhamento mais cauteloso, a fim de assegurar maior segurança na prescrição de fármacos na atenção primária e o aprimoramento do cuidado.
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Tiguman GMB, Silva MT, Galvão TF. Consumption and Lack of Access to Medicines and Associated Factors in the Brazilian Amazon: A Cross-Sectional Study, 2019. Front Pharmacol 2020; 11:586559. [PMID: 33123016 PMCID: PMC7573467 DOI: 10.3389/fphar.2020.586559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/14/2020] [Indexed: 01/20/2023] Open
Abstract
Objective We aimed to investigate the consumption and lack of access to medicines in the adult population of Manaus, Amazonas. Methods A population-based study was conducted in Manaus in 2019. Individuals aged ≥18 years were selected by probabilistic sampling performed in three stages. Study outcomes included the consumption of medicines in the previous fortnight and the lack of access to treatments in those who used any medicine. We calculated the prevalence ratios (PR) for the outcomes with 95% confidence intervals (CI) by Poisson regression with robust variance, considering the complex sampling design. Results Out of the 2,321 participants, 53.2% (95%CI 50.7-55.7%) consumed medicines, of which 14.4% (95% CI 11.9-16.8%) could not obtain appropriate treatments. Analgesics were the most used medicines (557/2,702; 21.4%), whereas antibiotics were the most inaccessible treatments (18/228; 7.9%). Lack of financial resources was the main reason for not accessing treatments (104/228; 45.6%). Consumption was significantly associated with older age (≥60 years: PR = 1.27; 95%CI 1.09-1.49), lower social class (D/E: PR = 0.84; 95%CI 0.72-0.99), lower educational level (p = 0.039), poor health status (PR = 1.30; 95%CI 1.11-1.52), use of health care services (PR = 1.37; 95%CI 1.26-1.49), and chronic diseases (PR = 1.36; 95%CI 1.22-1.52). Lack of access was higher in people with poor health status (PR = 2.46; 95%CI 1.50-4.04) and chronic diseases (PR = 1.84; 95%CI 1.16-2.92). Conclusion Half of Manaus' population used medicines, which was higher in socially privileged and sicker individuals. Among those, 14 in every 100 could not access drug therapies, which was more frequent in people with poor health and with chronic diseases.
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Affiliation(s)
| | - Marcus Tolentino Silva
- Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - Taís Freire Galvão
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Brazil
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Pereira LB, Gonçalves AMRF, Fernandes CSE, Fontanella AT, Francisco PMSB, Mengue SS, Borges RB, Pizzol TDSD, Costa KS. Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines. EINSTEIN-SAO PAULO 2020; 18:eAO5314. [PMID: 32785451 PMCID: PMC7416649 DOI: 10.31744/einstein_journal/2020ao5314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022] Open
Abstract
Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval − 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.
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Affiliation(s)
- Lucas Borges Pereira
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - Andréia Turmina Fontanella
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rogério Boff Borges
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tatiane da Silva Dal Pizzol
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Karen Sarmento Costa
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Arauna D, Cerda A, García-García JF, Wehinger S, Castro F, Méndez D, Alarcón M, Fuentes E, Palomo I. Polypharmacy Is Associated with Frailty, Nutritional Risk and Chronic Disease in Chilean Older Adults: Remarks from PIEI-ES Study. Clin Interv Aging 2020; 15:1013-1022. [PMID: 32636616 PMCID: PMC7334011 DOI: 10.2147/cia.s247444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022] Open
Abstract
AIM To analyze the relationship between polypharmacy and variables as frailty and other chronic comorbidities in Chilean older adults. DESIGN Cross-sectional study. PARTICIPANTS One thousand two hundred and five older adults aged 65 and older. METHODS The presence or absence of frailty syndrome was determined according to Fried criteria. Data collection was made through questionnaires conducted by an interview. RESULTS The prevalence of polypharmacy was 37.59%. The prevalence of hyperpolypharmacy was 2%. Increased prevalence of frailty was demonstrated regarding the progression of the state of polypharmacy. When analyzing the contribution of frailty respect polypharmacy condition, frail state, nutritional risk and obesity are founded as a factor associated with polypharmacy. Regarding chronic disease, hypertension (OR: 8.039, p<0.0001), type 2 diabetes (OR: 4.001, p<0.0001) and respiratory diseases (OR: 2.930, p<0.0001) were associated to polypharmacy. It was found a strong and significant positive correlation between polypharmacy prevalence and frailty score (polypharmacy condition, Spearman R: 0.89, p=0.033; hyperpolypharmacy condition, Spearman R: 0.94, p=0.016). When analyzing the contribution of the polypharmacy to the presence of frailty, polypharmacy condition (OR: 1.510, p<0.05), cognitive impairment (OR: 3.887, p<0.001), obesity (OR: 1.560, p<0.01) and nutritional risk (OR: 2.590, p<0.001) are associated to frailty. CONCLUSION Frailty and chronic conditions as nutritional risk, obesity, hypertension, type 2 diabetes and respiratory disease are an important risk factor for the development of polypharmacy in Chilean older adults. Likewise, polypharmacy condition was observed to be a risk factor for frailty, demonstrating the bidirectional relationship between both conditions. Frailty syndrome evaluation in Chilean older adults could be an important alternative for polypharmacy prevention.
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Affiliation(s)
- Diego Arauna
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Interdisciplinary Center on Aging, Universidad de Talca, Talca, Chile
| | - Alvaro Cerda
- Thematic Task Force on Healthy Aging, CUECH Research Network, Viña Del Mar, Chile
- Center of Excellence in Translational Medicine, CEMT-BIOREN, Department of Basic Sciences, Universidad de la Frontera, Temuco, Chile
| | | | - Sergio Wehinger
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Interdisciplinary Center on Aging, Universidad de Talca, Talca, Chile
| | - Felipe Castro
- School of Medicine, Universidad de Talca, Talca, Chile
| | - Diego Méndez
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Interdisciplinary Center on Aging, Universidad de Talca, Talca, Chile
| | - Marcelo Alarcón
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Interdisciplinary Center on Aging, Universidad de Talca, Talca, Chile
| | - Eduardo Fuentes
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Interdisciplinary Center on Aging, Universidad de Talca, Talca, Chile
- Thematic Task Force on Healthy Aging, CUECH Research Network, Viña Del Mar, Chile
| | - Iván Palomo
- Thrombosis Research Center, Department of Clinical Biochemistry and Immunohematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Interdisciplinary Center on Aging, Universidad de Talca, Talca, Chile
- Thematic Task Force on Healthy Aging, CUECH Research Network, Viña Del Mar, Chile
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Cerqueira SRPS, Santos LSD, Morelo EF, Santos Júnior ADCMD, Sousa CAFD, Gonçalves RT, Hans Neto G, Marques DDS, Sampaio RNR, Kurizky PS, Gomes CM. The interference of polypharmacy and the importance of clinical pharmacy advice in the treatment of leprosy: a case-control study. Rev Soc Bras Med Trop 2020; 53:e20200114. [PMID: 32491105 PMCID: PMC7269535 DOI: 10.1590/0037-8682-0114-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/14/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Although supervised doses are essential for reducing leprosy treatment failure, the impact of specific drug interactions has rarely been assessed. This study aimed to estimate the risk of leprosy treatment suspension in patients receiving polypharmacy. METHODS We performed this case-control study in which the primary outcome was defined as the need to discontinue multibacillary leprosy treatment for at least one supervised dose, and the main risk factor was the detection of polypharmacy. Multivariate analysis by logistic regression was used for calculating odds ratio (OR). RESULTS: This study included 103 patients, of whom 43 needed to discontinue leprosy treatment (hemolysis = 26, hepatitis = 2, hemolysis associated with hepatitis = 6, and suspected treatment resistance = 9) and the rest did not. The severity of drug interactions had no effect on treatment discontinuation. Patients who used five or more drugs in addition to leprosy treatment had almost a 4-fold greater risk of treatment suspension (OR, 3.88; 95% confidence interval: 1.79-9.12; p < 0.001). The number of drugs used also positively influenced the occurrence of hemolysis (p < 0.001). No patient presented evidence of molecular resistance to rifampicin, dapsone, or ofloxacin treatment, as evidenced by genetic sequencing detection of rpoB, folp1, and gyrA mutations. CONCLUSIONS: Polypharmacy has deleterious effects on the already difficult-to-adhere-to treatment of leprosy and polypharmacy induces hemolysis. Additional measures must be taken to avoid the undesirable effects of inadequate polypharmacy.
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Affiliation(s)
| | - Lais Sevilha Dos Santos
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil
| | - Elaine Faria Morelo
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.,Laboratório Central de Saúde Pública, Secretaria de Estado de Saúde do Distrito Federal, Brasília, DF, Brasil
| | | | - Carlos Augusto Felipe de Sousa
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.,Laboratório Central de Saúde Pública, Secretaria de Estado de Saúde do Distrito Federal, Brasília, DF, Brasil
| | | | - Gunter Hans Neto
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brasil
| | | | - Raimunda Nonata Ribeiro Sampaio
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.,Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brasil.,Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.,Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Brasília, DF, Brasil
| | - Patrícia Shu Kurizky
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.,Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brasil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.,Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brasil.,Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.,Universidade de Brasília, Núcleo de Medicina Tropical, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil
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Garcia MM, Azevedo PS, Mirelman A, Safatle LP, Iunes R, Bennie MC, Godman B, Guerra Junior AA. Funding and Service Organization to Achieve Universal Health Coverage for Medicines: An Economic Evaluation of the Best Investment and Service Organization for the Brazilian Scenario. Front Pharmacol 2020; 11:370. [PMID: 32351382 PMCID: PMC7175689 DOI: 10.3389/fphar.2020.00370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There are many health benefits since 31 years after the foundation of the National Health Service (NHS) in Brazil, especially the increase in life expectancy. However, family-income inequalities, insufficient funding, and suboptimal private sector-public sector collaboration are still areas for improvement. The efforts of Brazil to achieve universal health coverage (UHC) for medicines have resulted in increased public financing of medicines and their availability, reducing avoidable hospitalization and mortality. However, lack of access to medicines still remains. Due to historical reasons, pharmaceutical service organization in developing countries may have important differences from high-income countries. In some cases, developing countries finance and promote medicine access by using the public infrastructure of health care/medical units as dispensing sites and cover all costs of medicines dispensed. In contrast, many high-income countries use private community pharmacies and cover the costs of medicines dispensed plus a fee, which includes all logistic costs. In this study, we will undertake an economic evaluation to understand the funding needs of the Brazilian NHS to reduce inequalities in access to medicines through adopting a pharmaceutical service organization similar to that seen in many high-income countries with hiring/accrediting private pharmacies. METHODS We performed an economic evaluation of a model to provide access to medicines within public funds based on a decision tree model with two alternative scenarios public pharmacies (NHS, state-owned facilities) versus private pharmacies (NHS, agreements). The analysis assumed the perspective of the NHS. We identified the types of resources consumed, the amount, and costs in both scenarios. We also performed a budget impact forecast to estimate the incremental funding required to reduce inequalities in access to essential medicines in Brazil. FINDINGS The model without rebates for medicines estimated an incremental cost of US$3.1 billion in purchasing power parity (PPP) but with an increase in the average availability of medicines from 65% to 90% for citizens across the country irrespective of family income. This amount places the NHS in a very good position to negotiate extensive rebates without the need for external reference pricing for government purchases. Forecast scenarios above 35% rebates place the alternative of hiring private pharmacies as dominant. Higher rebate rates are feasible and may lead to savings of more than US$1.3 billion per year (30%). The impact of incremental funding is related to medicine access improvement of 25% in the second year when paying by dispensing fee. The estimate of the incremental budget in five years would be US$4.8 billion PPP. We have yet to explore the potential reduction in hospital and outpatient costs, as well as in lawsuits, with increased availability with the yearly expenses for these at US$9 billion and US$1.4 billion PPP respectively in 2017. INTERPRETATION The results of the economic evaluation demonstrate potential savings for the NHS and society. Achieving UHC for medicines reduces household expenses with health costs, health litigation, outpatient care, hospitalization, and mortality. An optimal private sector-public sector collaboration model with private community pharmacy accreditation is economically dominant with a feasible medicine price negotiation. The results show the potential to improve access to medicines by 25% for all income classes. This is most beneficial to the poorest families, whose medicines account for 76% of their total health expenses, with potential savings of lives and public resources.
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Affiliation(s)
- Marina Morgado Garcia
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
| | - Pamela Santos Azevedo
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
| | - Andrew Mirelman
- Centre for Health Economics, University of York, York, United Kingdom
| | - Leandro Pinheiro Safatle
- Department of Medicines Market Regulation - Brazilian Health Regulatory Agency (ANVISA), Brasília, Brazil
| | | | - Marion Clark Bennie
- Department of Pharmacoepidemiology, University of Strathclyde, Glasgow, United Kingdom
| | - Brian Godman
- Department of Pharmacoepidemiology, University of Strathclyde, Glasgow, United Kingdom
- Management School, University of Liverpool, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Augusto Afonso Guerra Junior
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
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Araújo LU, Santos DF, Bodevan EC, Cruz HLD, Souza JD, Silva-Barcellos NM. Patient safety in primary health care and polypharmacy: cross-sectional survey among patients with chronic diseases. Rev Lat Am Enfermagem 2019; 27:e3217. [PMID: 31826159 PMCID: PMC6896818 DOI: 10.1590/1518-8345.3123.3217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 08/08/2019] [Indexed: 01/20/2023] Open
Abstract
Objective: to characterize and determine the polypharmacy prevalence in patients with chronic diseases and to identify the factors associated, in order to improvement of pharmaceutical care focused on patient safety. Methods: cross-sectional study included 558 patients, covered by primary health care, using a household and structured questionnaire. We analyzed the data on polypharmacy and its clinical and socioeconomic factors. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio. Results: the results showed that polypharmacy (consumption of four or more drugs) was of 37.6%. The prevalence ratio analyses identified independent variables associated with polypharmacy: age (3.05), economic strata (0.33), way of medication acquisition through a combination of out-of-pocket and Brazilian public health system (1.44), diabetes and hypertension (2.11), comorbidities (coronary artery disease 2.26) and hospital admission (1.73). In the analyses, inappropriate medication use of the 278 patients (≥ 65 years) was associated with polypharmacy (prevalence ratio 4.04). Conclusion: polypharmacy study becomes an opportunity to guide the strategies for the patient safety to promote the medication without harm in chronic diseases.
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Affiliation(s)
- Lorena Ulhôa Araújo
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Farmácia, Diamantina, Minas Gerais, Brazil
| | - Delba Fonseca Santos
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Farmácia, Diamantina, Minas Gerais, Brazil
| | - Emerson Cotta Bodevan
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Matemática e Estatística, Diamantina, Minas Gerais, Brazil
| | - Hellen Lilliane da Cruz
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Farmácia, Diamantina, Minas Gerais, Brazil
| | - Jacqueline de Souza
- Universidade Federal de Ouro Preto, Escola de Farmácia, Ouro Preto, Minas Gerais, Brazil
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Khan N, Chattopadhyay K, Leonardi-Bee J. Incidence, prevalence, risk factors and health consequences of polypharmacy in adults in South Asia: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:2370-2377. [PMID: 31246733 DOI: 10.11124/jbisrir-d-18-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective of the systematic review is to summarize the incidence, prevalence, risk factors and health consequences of polypharmacy in adults in South Asia. INTRODUCTION Several studies have been conducted in South Asia on the incidence, prevalence, risk factors and health consequences of polypharmacy in adults. Until now, no systematic review has been conducted on this topic. INCLUSION CRITERIA Related epidemiological studies conducted on adults (aged 18 years and over) and residing in any country within South Asia (i.e. Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka) will be eligible for inclusion. METHODS MEDLINE, Embase, CINAHL, PsycINFO, BNI, Web of Science, Scopus and AMED databases will be searched to identify published studies. The search for unpublished studies will be undertaken in EThOS, OpenGrey and ProQuest Dissertations and Theses. Databases will be searched from their inception dates and no language restrictions will be applied. The JBI systematic review methodology will be followed to conduct the review. Data synthesis will be conducted using narrative synthesis and meta-analyses, where appropriate.
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Affiliation(s)
- Nusrat Khan
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare: a Joanna Briggs Institute Centre of Excellence
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21
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Santos BD, Nascimento MMGD, de Oliveira GCB, Nascimento YDA, Mambrini JVDM, Cid AS, Piovesan TGC, Fernandes LB, Martins UCDM, Neves CDM, da Silva DF, de Oliveira DR. Clinical Impact of a Comprehensive Medication Management Service in Primary Health Care. J Pharm Pract 2019; 34:265-271. [PMID: 31422732 DOI: 10.1177/0897190019866309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the clinical impact of a comprehensive medication management (CMM) service in a Brazilian primary health-care setting. METHODS A quasi-experimental study has been carried out between July 2014 and November 2016 with patients who received the service in the primary care setting of a Brazilian city (n = 1057). Factors associated with drug therapy problems (DTP) detection in the initial assessment were evaluated by performing univariate and multivariate analyzes. To evaluate the impact of the CMM service, a linear regression model was constructed from the difference between the initial and final values of the clinical and laboratory parameters adjusted by multiple variables. RESULTS A total of 1642 DTPs was identified, the most prevalent one being "nonadherence" (31.9%) and the "need for additional drug therapy" (22.9%). The use of 5 or more medications and the presence of 3 or more diseases were positively associated with the identification of 3 or more DTPs during the initial assessment. Even after multiple adjustments, a statistically significant reduction has been observed in the values of glycated hemoglobin, systolic blood pressure, low-density cholesterol, and total cholesterol. CONCLUSION The CMM service contributed to the resolution of DTP and showed positive clinical impact in primary health care in the studied setting.
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Affiliation(s)
- Bruna Damázio Santos
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Mariana Martins Gonzaga do Nascimento
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,Department of Pharmaceutical Products, College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Grazielli Cristina Batista de Oliveira
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,Municipal Government of Lagoa Santa (Prefeitura Municipal de Lagoa Santa), Lagoa Santa, Minas Gerais, Brazil
| | - Yone de Almeida Nascimento
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,Newton Paiva University Center (Centro Universitário Newton Paiva), Belo Horizonte, Brazil
| | - Juliana Vaz de Melo Mambrini
- Center for Studies on Aging and Public Health, René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Annaline Stiegert Cid
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,Pitágoras Faculty (Faculdade Pitágoras), Betim, Brazil
| | - Taíza Graziele Costa Piovesan
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Laura Barbosa Fernandes
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ursula Carolina de Morais Martins
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Carina de Morais Neves
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Danielle Fernandes da Silva
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,Municipal Government of Belo Horizonte (Prefeitura Municipal de Belo Horizonte), Belo Horizonte, Brazil
| | - Djenane Ramalho de Oliveira
- Center for Pharmaceutical Care Studies (Centro de Estudos em Atenção Farmacêutica), College of Pharmacy, 28114Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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Gomes MS, Amorim WW, Morais RS, Gama RS, Graia LT, Queiroga HM, Oliveira MG. Polypharmacy in older patients at primary care units in Brazil. Int J Clin Pharm 2019; 41:516-524. [PMID: 30680513 DOI: 10.1007/s11096-018-00780-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/31/2018] [Indexed: 01/03/2023]
Abstract
Background Despite extensive studies of polypharmacy in older patients, no consensus regarding the definition of this practice exists in the literature. Several studies have defined polypharmacy as problematic when considering only the numbers of medications used by patients. Objective This study aimed to assess the prevalence of polypharmacy prescribing by comparing two different definitions (quantitative and qualitative) and evaluating factors associated with this practice in older patients. Setting Twenty-three basic health units. Method A cross-sectional study involving 386 older adults who received a prescription after a medical consultation. Multivariate analyses were conducted using a Poisson regression with robust variance. Main outcome measure The main outcome measures included patients with a prescription of five or more medications (quantitative polypharmacy) and those with a prescription of five or more medications including at least one drug considered potentially inappropriate for older adults (qualitative polypharmacy). Results The frequency of quantitative polypharmacy was 20.5%. The results of an adjusted analysis showed that the frequency of quantitative polypharmacy was associated with a higher number of self-reported morbidities and the prescription of potentially inappropriate drugs. The prevalence of qualitative polypharmacy was 10.4%, and after adjustment, this outcome remained significantly associated with the presence of three or more self-reported morbidities. Conclusions The presence of multiple comorbidities was identified as the main factor associated with the prescription of both quantitative and qualitative polypharmacy.
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Affiliation(s)
- Milena Santos Gomes
- Programa de Mestrado em Saúde Coletiva, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Rio de Contas 58, Quadra 17, Lote 58, Candeias, Vitória da Conquista, Bahia, 45055-090, Brazil
| | - Welma Wildes Amorim
- Curso de Medicina, Campus de Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista, Brazil
| | | | | | | | | | - Márcio Galvão Oliveira
- Programa de Mestrado em Saúde Coletiva, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Rua Rio de Contas 58, Quadra 17, Lote 58, Candeias, Vitória da Conquista, Bahia, 45055-090, Brazil.
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23
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do Nascimento RCRM, Guerra AA, Alvares J, Gomes IC, Godman B, Bennie M, Kurdi AB, de Acurcio FA. Statin use in Brazil: findings and implications. Curr Med Res Opin 2018. [PMID: 29528246 DOI: 10.1080/03007995.2018.1451312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES Statins have become an integral part of treatment to reduce cardiac events in patients with cardiovascular disease. However, their use within the public healthcare system in Brazil is unknown. Consequently, we sought to determine and characterize statin use in primary healthcare delivered by the public health system (SUS) in Brazil and evaluate associated patient factors to improve future use. METHODS Cross-sectional study with a national representative sample from five Brazilian regions, derived from the National Survey on Access, Use and Promotion of Rational Use of Medicines using a multi-stage complex sampling plan. Patients over 18 years old were interviewed from July 2014 to May 2015. The prevalences of statin use and self-reported statin adherence were determined amongst medicine users. The associations between statin use and sociodemographic/health condition variables were assessed using logistic regression. RESULTS A total of 8803 patients were interviewed, of whom 6511 were medicine users. The prevalence of statin use was 9.4% with simvastatin (90.3%), atorvastatin (4.7%) and rosuvastatin (1.9%) being the most used statins. Poor adherence was described by 6.5% of patients. Statin use was significantly associated with age ≥65 years old, higher educational level, residence in the South, metabolic and heart diseases, alcohol consumption and polypharmacy. CONCLUSIONS This is the first population based study in Brazil to assess statin use in SUS primary healthcare patients. Addressing inequalities in access and use of medicines including statins is an important step in achieving the full benefit of statins in Brazil, with the findings guiding future research and policies.
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Affiliation(s)
- R C R M do Nascimento
- a Post-graduated Program of Medicines and Pharmaceutical Assistance, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
| | - A A Guerra
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - J Alvares
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - I C Gomes
- d Faculdade de Ciências Médicas , Belo Horizonte , Minas Gerais , Brazil
| | - B Godman
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
- f Division of Clinical Pharmacology , Karolinska Institutet , Stockholm , Sweden
- g Health Economics Centre , Liverpool University Management School , Liverpool , UK
| | - M Bennie
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - A B Kurdi
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - F A de Acurcio
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
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24
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Akerman M, de Freitas O. National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM): evaluation of pharmaceutical services in the primary health care. Rev Saude Publica 2017; 51:1s. [PMID: 29160468 PMCID: PMC5676376 DOI: 10.11606/s1518-8787.201705100supl2ed] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Marco Akerman
- Departamento de Política, Gestão e Saúde. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Osvaldo de Freitas
- Departamento de Ciências Farmacêuticas. Faculdade de Ciências Farmacêuticas. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
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