Resumo: O estudo ESSENCE avaliou o impacto do envio de mensagens de texto com lembretes do horário de uso dos medicamentos na adesão ao tratamento e na redução da pressão arterial em pacientes com hipertensão. Este ensaio clínico randomizado, cruzado, duplo-cego e controlado incluiu pacientes com idade de 30 a 69 anos, acompanhados em uma farmácia comunitária. As mensagens foram enviadas automaticamente por meio de um software e recebidas nos celulares dos participantes. O grupo 1 incluiu pacientes que receberam mensagens de texto informativas sobre medicamentos anti-hipertensivos e controle da hipertensão por 90 dias, enquanto o grupo 2 incluiu aqueles que receberam mensagens informativas associadas a mensagens de lembrete no horário de cada dose do medicamento por 90 dias. Após um período de washout de 30 dias, os grupos foram trocados e receberam intervenções por mais 90 dias. Os 157 indivíduos avaliados tinham uma média de idade de 52 (±8,8) anos, sendo a maioria do sexo feminino (76,4%). Não foi encontrada diferença significativa na adesão autorreferida intra e intergrupos antes e após o estudo. Uma redução significativa foi encontrada no período anterior ao estudo em ambos os grupos, e não entre os grupos, para as pressões arteriais sistólica e diastólica. Ao final do estudo, o grupo 1 apresentou uma pressão arterial média significativamente menor do que o grupo 2; no entanto, não foi possível diferenciar qual intervenção foi mais eficaz em termos de desfechos, apresentando um efeito equivalente entre as duas intervenções. Os resultados indicam a possibilidade de implementação de sistemas de envios de mensagens nos serviços de saúde.

Resumen: El estudio ESSENCE evaluó el impacto del envío de mensajes de texto recordando a las personas el horario de la medicación en la adhesión al tratamiento y en la reducción de la presión arterial en pacientes con hipertensión. Este ensayo clínico aleatorizado, cruzado, doble ciego y controlado incluyó a pacientes de 30 a 69 años, en seguimiento en una farmacia comunitaria. Los mensajes se enviaron automáticamente mediante un software y se recibieron en los teléfonos móviles de los participantes. El grupo 1 incluyó a pacientes que recibieron mensajes de texto informativos sobre medicamentos antihipertensivos y control de la hipertensión durante 90 días, mientras que el grupo 2 incluyó a quienes recibieron mensajes informativos asociados a mensajes recordatorios en el horario de cada dosis de medicamento durante 90 días. Tras un período de washout de 30 días, los grupos se cambiaron y recibieron intervenciones durante otros 90 días. Los 157 participantes evaluados tenían una edad media de 52 años (±8,8), y la mayoría eran mujeres (76,4%). No se encontraron diferencias significativas en la adhesión autoinformada intra e intergrupos antes y después del estudio. Se constató una reducción significativa en el período anterior al estudio en ambos grupos, y no entre los grupos, para las presiones arteriales sistólica y diastólica. Al final del estudio, el grupo 1 presentó una presión arterial media significativamente menor que la del grupo 2; sin embargo, no fue posible diferenciar qué intervención fue más efectiva en términos de resultados, presentando un efecto equivalente entre ambas intervenciones. Los resultados indican la posibilidad de implementar sistemas de mensajería en los servicios de salud.

Abstract: The ESSENCE study evaluated the effect of sending text messages with and without reminders of the time of medication use on adherence to medication treatment and the reduction of blood pressure in patients with hypertension. This was a randomized, crossover, double-blind, active-controlled clinical trial, which included patients aged 30-69 years, followed up at a community pharmacy. Messages were automatically sent using a software and were received on the participants’ smartphones. Group 1 included patients who received health information via text messages regarding antihypertensive medications and hypertension control for 90 days, whereas group 2 included those who received information messages along with reminder messages at the time of each drug dose for 90 days. After a 30-day washout period, the groups were switched and received interventions for another 90 days. The 157 evaluated individuals had a mean age of 52 (±8.8) years, and most were female (76.4%). No significant difference was found in intra- and inter-group self-reported adherence in the pre- and post-crossover periods. A significant reduction was found in the pre-crossover period in both groups rather than between the groups for systolic and diastolic blood pressures. At the end of the study, group 1 had a significantly lower mean blood pressure than group 2. However, we could not differentiate which intervention was more effective in terms of outcomes, thus presenting an equivalent effect between the two interventions. These results suggest the possibility of implementing message transmission in health services.

SUMMARY OBJECTIVE: This study aimed to assess older people’s knowledge of the purpose of drugs prescribed at medical appointments in primary care units and the possible factors related to their level of knowledge about their medications. METHODS: This was a cross-sectional study conducted in 22 basic health units in Brazil. Patients aged ≥60 years were included in this study (n=674). Knowledge of prescribed medications was assessed by comparing the responses to the questionnaire and the medication and prescription information. Multivariate analyses were conducted using the Poisson regression with robust variance. RESULTS: The mean age of the sample was 70.1 (standard deviation: ±7.1) years. Among 674 patients, 272 (40.4%) did not know the indication of at least 1 of their prescribed drugs; among them, 78 (11.6%) did not know the indication of any of their prescribed drugs. In the final multivariate analysis, polypharmacy, illiteracy, and cognitive impairment were found to be associated with misunderstanding the purpose of at least one prescribed drug. Moreover, illiteracy and cognitive impairment were associated with a greater misunderstanding of the purpose of all prescribed drugs. CONCLUSIONS: In the studied sample, patients demonstrated a high rate of misunderstanding of the purpose of prescribed drugs. Therefore, it is necessary for health services and professionals to implement strategies that increase the quality of the guidance and instructions given to older people in order to promote adherence to treatment.

Resumo A medição da pressão arterial no consultório está sujeita a erros; assim, a monitorização residencial da pressão arterial é utilizada para o monitoramento e diagnóstico da hipertensão. Descrever a viabilidade da monitorização residencial para avaliar a pressão arterial na atenção primária e comparar os valores da pressão arterial através da monitorização residencial e medida de consultório. Estudo transversal realizado com pacientes que utilizaram a monitorização residencial pela manhã e pela noite, em triplicata por sete dias consecutivos em domicílio. Foram incluídos pacientes maiores de 18 anos, com suspeita de hipertensão do avental branco, utilizando anti-hipertensivos ou intolerantes a monitorização ambulatorial. Foram excluídos pacientes que não seguiram o protocolo, aqueles que apresentavam ritmo cardíaco irregular ou mulheres grávidas. 134 pacientes participaram do estudo, 63,3% apresentaram pressão arterial alteradas em consultório e 48% pela monitorização residencial. A diferença média dos métodos foi de 10,1 mmHg para sistólica e 4,3 mmHg para diastólica. A prevalência de hipertensão do avental branco foi 19,4%. A monitorização residencial da pressão arterial no sistema de saúde brasileiro provou ser uma estratégia viável.

Abstract Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.

ABSTRACT BACKGROUND: Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.

SUMMARY OBJECTIVE: Cardiovascular risk stratification is an important clinical practice to estimate the severity of cardiovascular disease in patients with type 2 diabetes. This study aimed to compare the stratification of global cardiovascular risk with the specific risk stratification for patients with type 2 diabetes, seen at specialized outpatient clinics, and to evaluate possible differences in diagnoses and treatments. METHODS: A total of 122 patients with type 2 diabetes treated at two specialized outpatient clinics, from 2017 to 2019, were studied. The cardiovascular risk stratification calculators, global risk score, Cardiovascular Risk Stratification Calculator, and United Kingdom Prospective Diabetes Study-Risk Engine, were used to calculate the risk of death from cardiovascular disease. The agreement between these calculators was analyzed using the kappa index. The indications for the use of statins and acetylsalicylic acid for the group studied were evaluated according to the Brazilian Diabetes Society Guideline. RESULTS: There was a low degree of agreement among the three risk calculators. The global risk score calculator showed insignificant agreement with the Cardiovascular Risk Stratification Calculator (kappa=0.0816; p=0.0671). There was no agreement between the global risk score calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.099), or between the Cardiovascular Risk Stratification Calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.0095). CONCLUSION: The substantial disagreements among the cardiovascular risk calculators may lead to different diagnoses and may consequently influence therapeutic strategies. The findings herein highlight the need for specific validated cardiovascular risk calculators for patients with DM2 that can reliably estimate risk in these individuals.

Resumo A medição da pressão arterial no consultório está sujeita a erros; assim, a monitorização residencial da pressão arterial é utilizada para o monitoramento e diagnóstico da hipertensão. Descrever a viabilidade da monitorização residencial para avaliar a pressão arterial na atenção primária e comparar os valores da pressão arterial através da monitorização residencial e medida de consultório. Estudo transversal realizado com pacientes que utilizaram a monitorização residencial pela manhã e pela noite, em triplicata por sete dias consecutivos em domicílio. Foram incluídos pacientes maiores de 18 anos, com suspeita de hipertensão do avental branco, utilizando anti-hipertensivos ou intolerantes a monitorização ambulatorial. Foram excluídos pacientes que não seguiram o protocolo, aqueles que apresentavam ritmo cardíaco irregular ou mulheres grávidas. 134 pacientes participaram do estudo, 63,3% apresentaram pressão arterial alteradas em consultório e 48% pela monitorização residencial. A diferença média dos métodos foi de 10,1 mmHg para sistólica e 4,3 mmHg para diastólica. A prevalência de hipertensão do avental branco foi 19,4%. A monitorização residencial da pressão arterial no sistema de saúde brasileiro provou ser uma estratégia viável.

Abstract Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.