Abstract Older adults have difficulty monitoring their drug therapy in the first thirty days following hospital discharge. This transition care period may trigger hospital readmissions. The study aims to identify the factors associated with the readmission of older adults 30 days after discharge from the perspective of drug therapy. This is a cross-sectional study and hospital admission within 30 days was defined as readmission to any hospital 30 days after discharge. The complexity of the drug therapy was established by the Medication Regimen Complexity Index (MRCI).. Readmission risks were predicted by the “Readmission Risk Score - RRS”. The multivariate logistic regression was used to identify factors associated with readmission within 30 days after discharge. Two hundred fifty-five older adults were included in the study, of which 32 (12.5%) had non-elective hospital readmission. A higher number of readmissions was observed with increased RRS value, suggesting a linear gradient effect. The variables included in the final logistic regression model were the diagnosis of cancer (OR=2.9, p=0.031), pneumonia (OR=2.3, p=0.055), and High MRCI (> 16.5) following discharge (OR=1.9, p=0.119). The cancer diagnosis is positively associated with hospital readmissions of older adults within 30 days.

Resumo O objetivo deste artigo é analisar a prevalência de polifarmácia e de polifarmácia excessiva, bem como seus fatores associados, entre idosos atendidos em duas Unidades Básicas de Saúde de Belo Horizonte-MG. Foi conduzido um estudo observacional transversal, realizado por meio de informações resultantes de uma entrevista estruturada ao paciente. Foram analisadas as associações individuais de cada variável explicativa com a polifarmácia e polifarmácia excessiva. Para as variáveis que apresentaram associação significativa com polifarmácia, foi realizada análise multivariada por meio do modelo de regressão logística. Os idosos utilizavam, em média, 5,2 fármacos. A prevalência de polifarmácia foi de 57,7% e de polifarmácia excessiva foi de 4,8%. Na análise univariada, mostraram-se associadas à polifarmácia as condições idade ≤ 70 anos, escolaridade > 8 anos, presença de mais de três doenças e presença de sintomas de depressão. Para polifarmácia excessiva, mostraram-se associadas as condições presença de mais de três doenças, autopercepção da saúde negativa e dependência parcial nas atividades instrumentais de vida diária. No modelo multivariado final para polifarmácia, permaneceram as variáveis idade ≤ 70 anos e presença de mais de três doenças.

Abstract The scope of this article is to analyze the prevalence of polymedication and excessive polypharmacy, as well as associated factors, among the elderly attended at two Basic Health Units in Belo Horizonte, State of Minas Gerais. A cross-sectional observational study was conducted using information obtained from a structured interview of the patient. The individual associations of each explanatory variable with polypharmacy and with excessive polypharmacy were analyzed. For the variables that showed a significant association with polypharmacy, multivariate analysis was performed using the logistic regression model. The elderly used, on average, 5.2 drugs. The prevalence of polymedication was 57.7% and excessive polypharmacy was 4.8%. In univariate analysis the conditions associated with polypharmacy were: age ≤ 70 years, schooling > 8 years, presence of more than three diseases and presenting symptoms of depression. For excessive polypharmacy, the presence of more than three diseases, self-perception of negative health, and partial dependence on instrumental activities of daily living were associated with the conditions. In the final multivariate model for polypharmacy, the age ≤ 70 years and presence of more than three disease variables remained.

RESUMO Objetivo: Avaliar se o uso de um dispositivo organizador de medicamentos eletrônico, mensal, equipado com um despertador, chamado Sistema Eletrônico para Uso Personalizado e Controlado de Medicamentos (Supermed), melhora a adesão à medicação de idosos com hipertensão. Métodos: Trata-se de um estudo qualiquantitativo, prospectivo, antes e depois, realizado com 32 pacientes idosos, com diagnóstico de hipertensão, recrutados em uma Unidade Básica de Saúde do Brasil. Resultados: Os principais desfechos foram a melhor adesão à medicação e o controle da pressão arterial após a intervenção com Supermed. Quanto à adesão medicamentosa, 81,2% dos pacientes eram “menos aderentes” no período pré-intervenção, e 96,9% eram “mais aderentes” no período pós-intervenção. Isso significa que 78,1% dos pacientes mudaram de “menos aderentes” para “mais aderentes” após a intervenção com Supermed (p<0,001). As diferenças da pressão arterial sistólica e diastólica média entre o dia da intervenção e pós-intervenção foram 18,5mmHg (p<0,0001) e 4,3mmHg (p<0,007), respectivamente, e as diferenças entre as médias da pressões arteriais sistólica e diastólica entre os períodos pré-intervenção e pós-intervenção foram de 21,6mmHg (p<0,001) e 4,7mmHg (p<0,001), respectivamente. Conclusão: O uso de Supermed melhorou de forma significativa a adesão medicamentosa e o controle da pressão arterial em uma população idosa hipertensa.

ABSTRACT Objective: To examine whether the use of a monthly electronic medication organizer device equipped with an alarm clock, called Electronic System for Personal and Controlled Use of Medications (Supermed), improves medication adherence of older adults with hypertension. Methods: This is a quali-quantitative, prospective, before-and-after study performed with 32 older adult patients with diagnosis of hypertension, who were recruited at a Primary Care Unit in Brazil. Results: The main outcome measures were improvement of medication adherence and blood pressure control after intervention with Supermed. Regarding medication adherence, 81.2% of patients were “less adherent” in the pre-intervention period, and 96.9% were “more adherent” in the post-intervention period. This means that 78.1% of patients changed from “less adherent” to “more adherent” after the intervention with Supermed (p<0.001). The mean systolic and diastolic blood pressure differences between intervention day and post-intervention were 18.5mmHg (p<0.0001) and 4.3mmHg (p<0.007), respectively, and the differences between mean systolic and diastolic blood pressure between pre-intervention and post-intervention were 21.6mmHg (p<0.001) and 4.7mmHg (p<0.001) respectively. Conclusion: The use of Supermed significantly improved self-reported medication adherence and blood pressure control in a hypertensive older adult population.

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

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

Resumo O objetivo deste artigo é analisar a prevalência de polifarmácia e de polifarmácia excessiva, bem como seus fatores associados, entre idosos atendidos em duas Unidades Básicas de Saúde de Belo Horizonte-MG. Foi conduzido um estudo observacional transversal, realizado por meio de informações resultantes de uma entrevista estruturada ao paciente. Foram analisadas as associações individuais de cada variável explicativa com a polifarmácia e polifarmácia excessiva. Para as variáveis que apresentaram associação significativa com polifarmácia, foi realizada análise multivariada por meio do modelo de regressão logística. Os idosos utilizavam, em média, 5,2 fármacos. A prevalência de polifarmácia foi de 57,7% e de polifarmácia excessiva foi de 4,8%. Na análise univariada, mostraram-se associadas à polifarmácia as condições idade ≤ 70 anos, escolaridade > 8 anos, presença de mais de três doenças e presença de sintomas de depressão. Para polifarmácia excessiva, mostraram-se associadas as condições presença de mais de três doenças, autopercepção da saúde negativa e dependência parcial nas atividades instrumentais de vida diária. No modelo multivariado final para polifarmácia, permaneceram as variáveis idade ≤ 70 anos e presença de mais de três doenças.

Abstract The scope of this article is to analyze the prevalence of polymedication and excessive polypharmacy, as well as associated factors, among the elderly attended at two Basic Health Units in Belo Horizonte, State of Minas Gerais. A cross-sectional observational study was conducted using information obtained from a structured interview of the patient. The individual associations of each explanatory variable with polypharmacy and with excessive polypharmacy were analyzed. For the variables that showed a significant association with polypharmacy, multivariate analysis was performed using the logistic regression model. The elderly used, on average, 5.2 drugs. The prevalence of polymedication was 57.7% and excessive polypharmacy was 4.8%. In univariate analysis the conditions associated with polypharmacy were: age ≤ 70 years, schooling > 8 years, presence of more than three diseases and presenting symptoms of depression. For excessive polypharmacy, the presence of more than three diseases, self-perception of negative health, and partial dependence on instrumental activities of daily living were associated with the conditions. In the final multivariate model for polypharmacy, the age ≤ 70 years and presence of more than three disease variables remained.

This study aims to analyze the new drugs registered in Brazil from 2003 to 2013 from the perspective of childcare needs, drug safety and considering the disease burden of the country. This is a retrospective cohort study including new drugs registered in Brazil between 2003 and 2013. Drug indications were related to the Disability-Adjusted Life Year (DALY) of the 2015 Global Burden of Disease Study. Association between the number of new drugs and DALY was determined by Spearman’s coefficient. Post-marketing safety alerts specific to the pediatric population have been identified in the WHO Drug Information Bulletin and on websites of drug regulatory agencies. A total of 134 new drugs were included in the cohort and 46 (34.3%) had a pediatric indication. There was no evidence of an association between the disease burden in children in Brazil and the number of pediatric drugs. The safety alert data associated with the pediatric population published after registration of the new drugs were scarce. The number of new drugs launched in Brazil with a pediatric indication was small, reflecting the international challenges of developing effective and safe medicines for children. No association was found between the number of new drugs and the disease burden.

Abstract INTRODUCTION: The concomitant use of antituberculosis and antiretroviral drugs, as well as drugs to treat other diseases, can cause drug-drug interactions. This study aimed to describe potential drug-drug interactions (pDDI) in patients with TB and HIV/AIDS co-infection, as well as to analyze possible associated factors. METHODS: This study was performed in a reference hospital for infectious and contagious diseases in the southeastern region of Brazil and evaluated adult patients co-infected with tuberculosis and HIV/AIDS. A cross-sectional study was conducted in which sociodemographic, clinical, and pharmacotherapeutic characteristics were assessed. The pDDI were identified using the Drug-Reax software. Association analysis was performed using either a chi-squared test or a Fisher’s exact test. Correlation analysis was performed using the Spearman’s coefficient. RESULTS: The study included 81 patients, of whom 77 (95.1%) were exposed to pDDI. The most frequent interactions were between antituberculosis and antiretroviral drugs, which can cause therapeutic ineffectiveness and major adverse reactions. A positive correlation was established between the number of associated diseases, the number of drugs used, and the number of pDDI. An association was identified between contraindicated and moderate pDDI with excessive polypharmacy and hospitalization. CONCLUSIONS: We found a high frequency of pDDI, especially among those hospitalized and those with excessive polypharmacy. These findings highlight the importance of pharmacists in the pharmacotherapeutic monitoring in these patients.

ABSTRACT BACKGROUND: Access to medicines is an important indicator of healthcare system quality and capacity to resolve problems. The healthcare system needs to ensure free access to medicines for elderly people, in order to provide greater effectiveness of disease control, thus reducing morbidity and mortality, and improving health and quality of life. OBJECTIVES: To analyze the frequency of free access to medication among older adults within primary care and determine the factors associated with free access. DESIGN AND SETTING: Cross-sectional study at two primary care units. METHODS: Free access was defined as provision of all medicines through pharmacies within the Brazilian National Health System and through the Brazilian program for free medicines in private pharmacies. We investigated the sociodemographic, clinical, functional and pharmacotherapeutic characteristics of older adults. Multivariate logistic regression was performed to identify factors associated with free access to medicines. RESULTS: This study included 227 older adults, among whom 91 (40.1%) had free full access to prescription drugs. A direct association with age ≤ 70 years and indirect associations with polypharmacy and multimorbidity (P < 0.05) were found. CONCLUSIONS: Age ≤ 70 years increases the likelihood of having free full access to medicines, and older adults with multimorbidity and polypharmacy use have a lower likelihood of access. Identification of factors associated with free access to medicines among elderly people provides elements to guide the Brazilian National Health System in implementing access improvement actions.

RESUMO Objetivo Analisar a frequência de uso de medicamentos potencialmente inapropriados para idosos na prescrição de alta hospitalar de idosos de um hospital público, considerando o Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos, e identificar os fatores associados. Métodos Pacientes com idade ≥60 anos, internados nas unidades de clínica médica e geriátrica de um hospital público, foram convidados para participar do estudo. As informações sobre o uso de medicamentos foram coletadas do prontuário eletrônico do paciente e confirmadas por contato telefônico. O Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos independente da condição clínica foi utilizado para a classificação dos medicamentos. Resultados Foram incluídos no estudo 255 idosos. A frequência de uso de medicamentos potencialmente inapropriados para idosos foi de 58,4%. O uso de medicamentos potencialmente inapropriados para idosos foi associado positivamente à presença de depressão (razão de chance de 2,208) e polifarmácia (razão de chance de 2,495). A internação em unidade de geriatria apresentou associação inversa com uso de medicamentos potencialmente inapropriados para idosos (razão de chance de 0,513). Conclusão A frequência de prescrição de medicamentos potencialmente inapropriados para idosos na alta hospitalar foi alta. Depressão e polifarmácia estiveram diretamente associadas ao uso de medicamentos potencialmente inapropriados para idosos. Ficar internado na clínica geriátrica mostrou-se fator protetor para uso de medicamentos potencialmente inapropriados para idosos. Estratégias para melhorar a farmacoterapia do idoso devem ser implementadas, visando à qualidade assistencial e à segurança na transição do cuidado.

ABSTRACT Objective To analyze the frequency of use of potentially inappropriate medication prescribed to elderly at hospital discharge from a public hospital, considering the Brazilian Consensus on Potentially Inappropriate Medication for Elderly, and to identify the associated factors. Methods Patients aged ≥60 years, admitted in clinical and geriatric units of a public hospital were invited to participate in the study. The information about the use of medicines was collected from the patient’s electronic record and through telephone contact. The Brazilian Consensus on Potentially Inappropriate Medication for Elderly was used to classify the medication, regardless of the clinical condition. Results A total of 255 elders were included in this study. The frequency of use of potentially inappropriate medication by elderly was 58.4%. The potentially inappropriate medication use in elderly was positively associated with the presence of depression (odds ratio of 2.208) and polypharmacy (odds ratio of 2.495). The hospitalization in a geriatric unit showed an inverse association with the potentially inappropriate medication use in elderly (odds ratio of 0.513). Conclusion The frequency of potentially inappropriate medication prescription to elderly upon hospital discharge was high. The presence of depression and polypharmacy were directly associated with use of potentially inappropriate medication in the elderly. Admission to the geriatric clinic has become a protection factor for the use of potentially inappropriate medication in elderly. Strategies to improve the elderly pharmacotherapy should implemented aiming at healthcare quality and safety in the transition of care.

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

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

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

Resumo O estudo tem por objetivo determinar a frequência de interações medicamentosas potenciais (IMP) entre idosos hospitalizados e os fatores associados. Estudo transversal realizado em um hospital de ensino. A variável dependente do estudo foi a ocorrência de IMP identificadas utilizando o software DrugReax. Também foram identificados os pacientes que desenvolveram reações adversas a medicamentos (RAM) relacionadas à manifestação clínica de IMP. Realizou-se regressão logística para analisar a associação da ocorrência de IMP e variáveis independentes. No estudo foram incluídos 237 idosos, a prevalência de IMP foi de 87,8 %, e de RAM relacionadas às interações foi de 6,8%. Identificou-se associação positiva entre a detecção de IMP (OR 8,6; IC95% 2,5-30,0), internação por diagnóstico de doença do aparelho circulatório e número de medicamentos superior que 14 (OR 9,8; IC95% 2,8-34,3). O estudo evidenciou uma elevada prevalência de IMP na farmacoterapia dos idosos, mas reduzida prevalência de RAM. Além disso, detectou associação positiva entre IMP e internação por diagnóstico de doença do aparelho circulatório e número de medicamentos superior a 14. A identificação de fatores associados às IMP permite direcionar medidas de prevenção para populações mais expostas à ocorrência de eventos adversos.

Abstract This study aims to determine the frequency of potential drug-drug interactions (PDI) in hospitalized elderly and associated factors. This is a cross-sectional study in a teaching hospital. The dependent variable was the occurrence of potential drug interactions identified using DrugReax software. Patients with adverse drug reactions (ADR) related to clinical manifestations of PDIs were also identified. Multivariate logistic regressions was performed to analyze the association between the occurrence of PDIs and independent variables. In total, 237 older adults were included in the study. The prevalence of PDIs and interaction-related ADRs was 87.8% and 6.8%, respectively. The multivariate analysis showed a positive association between the detection of PDIs (OR 8.6; 95% CI, 2.5-30.0), and hospitalization due to a diagnosed circulatory system disease and number of medications > 14 (OR 9.8; 95% CI, 2.8-34.3%). The study showed a high prevalence of PDIs in the drug treatment of the elderly, but a lower prevalence of ADRs, as well as a positive association between PDIs and hospitalization due to a diagnosed circulatory system disease and number of medications > 14. The identification of factors associated with PDIs guides prevention measures for people that are more exposed to adverse events.

RESUMO Objetivo: Determinar a frequência de problemas relacionados ao uso de medicamentos no tratamento de pacientes com tuberculose e HIV/AIDS. Métodos: Os dados foram obtidos por estudo transversal realizado entre setembro de 2015 e dezembro de 2016 em hospital referência em doenças infectocontagiosas de Belo Horizonte (MG), Brasil. As variáveis sociodemográficas, clínicas, comportamentais e farmacoterapêuticas foram avaliadas por questionário semiestruturado. Classificaram-se os problemas relacionados ao uso de medicamento empregando o método Pharmacotherapy Workup de atenção farmacêutica. Os fatores associados aos problemas relacionados ao uso de medicamentos de indicação, efetividade, segurança e adesão foram avaliados pela regressão logística múltipla. Resultados: Foram avaliados 81 pacientes, e 80% apresentaram pelo menos um problema relacionado ao uso de medicamentos, sendo os mais frequentes ligados à problemas relacionados ao uso de medicamentos de indicação e adesão. Os fatores associados aos problemas relacionados ao uso de medicamentos foram idade, estado civil, caso novo, etnia, tempo de diagnóstico do HIV e tempo de tratamento da tuberculose. Conclusão: A frequência de problemas relacionados ao uso de medicamentos em pacientes coinfectados foi alta, e a identificação dos principais problemas relacionados ao uso de medicamentos e dos fatores associados aos mesmos pode direcionar a equipe multiprofissional de saúde, para garantir o uso dos medicamentos mais indicados, efetivos, seguros e convenientes para a condição clínica dos pacientes. Os indivíduos coinfectados com tuberculose e HIV/AIDS maiores de 40 anos possuem maior chance de apresentarem problemas relacionados ao uso de medicamentos durante o tratamento, sendo os mais frequentes os que indicam a necessidade de medicamento para condição de saúde não tratada e não adesão ao tratamento. Pacientes mais idosos, solteiros ou não, que já trataram a tuberculose antes, com menor tempo de tratamento de tuberculose e maior tempo de diagnóstico de HIV/AIDS devem ter atenção especial no acompanhamento por uma equipe multiprofissional de saúde por indicarem maior chance de apresentar Problemas Relacionados ao uso de Medicamentos de não adesão à terapia.

ABSTRACT Objective: To determine the frequency of drug therapy problem in the treatment of patients with tuberculosis and HIV/AIDS. Methods: Data were obtained through a cross-sectional study conducted between September 2015 and December 2016 at a reference hospital in infectious diseases in Belo Horizonte (MG), Brazil. Sociodemographic, clinical, behavioral and pharmacotherapeutic variables were evaluated through a semi-structured questionnaire. Drug-related problems of pharmaceutical care were classified using the Pharmacotherapy Workup method. Factors associated with indication, effectiveness, safety and compliance drug therapy problem were assessed through multiple logistic regression. Results: We evaluated 81 patients, and 80% presented at least one drug therapy problem, with indication and adherence drug therapy problem being the most frequent. The factors associated with drug therapy problem were age, marital status, new case, ethnicity, time of HIV diagnosis and time to treat tuberculosis. Conclusion: The frequency of drug therapy problem in coinfected patients was high and the identification of the main drug therapy problem and associated factors may lead the multiprofessional health team to ensure the use of the most indicated, effective, safe and convenient medicines for the patients clinical condition. Tuberculosis and HIV/AIDS coinfected individuals aged over 40 years are more likely to have drug therapy problems during treatment; in that, the most frequente are those that signal toward need of medication for an untreated health condition and non-compliance to treatment. Thus, older patients, unmarried or married, who have treated tuberculosis before, with a shorter time to tuberculosis treatment and longer time to diagnose HIV/AIDS, should receive special attention and be better followed by a multiprofessional health team because they indicate a higher chance of presenting Problems related to the use of non-adherent drugs.

RESUMO Objetivo Desenvolver uma escala de atividade anticolinérgica abrangendo os medicamentos utilizados no Brasil, para aplicação no cuidado em saúde e em pesquisas farmacoepidemiológicas. Métodos Realizou-se revisão da literatura no PubMed/MEDLINE®para identificação das escalas de mensuração da atividade anticolinérgica. Iniciou-se a escala com os fármacos anticolinérgicos e aqueles com atividade anticolinérgica conhecida, relacionados segundo o nível 4, subgrupo químico, na classificação da Anatomical Therapeutic Chemical . Incluíram-se os fármacos com atividade anticolinérgica alta, descritos na lista de medicamentos potencialmente inapropriados para idosos, segundo o 2015 American Geriatrics Society Beers Criteria . Adicionaram-se os medicamentos que constavam em, no mínimo, duas escalas anticolinérgicas. Em seguida, verificaram-se os medicamentos constantes nas etapas anteriores comercializados no Brasil. A magnitude da atividade anticolinérgica foi estabelecida em escores com os valores de 1, 2 e 3. Resultados Foram identificados 273 medicamentos com atividade anticolinérgica, sendo 125 incluídos na escala. Destes, 45 (36,0%) receberam pontuação 3, 13 (10,4%) tiveram pontuação 2, e 67 (53,6%) pontuação 1. A maioria dos medicamentos da escala atuava nos sistemas nervoso e respiratório. Oito fármacos não constavam em escalas prévias. Conclusão A metodologia de desenvolvimento da escala brasileira de atividade anticolinérgica é simples, sistematizada, reprodutível e de fácil atualização. A escala permite avaliar o impacto da carga anticolinérgica nos resultados em saúde e pode contribuir com as pesquisas farmacoepidemiológicas, propiciando mensurações mais exatas da atividade anticolinérgica.

ABSTRACT Objective To develop a scale of anticholinergic activity drugs used in Brazil, to be applied in health care and pharmacoepidemiology research. Methods We performed a literature review on PubMed/MEDLINE® to identify previously published scales of anticholinergic drugs. This scale started with anticholinergic drugs, and those with known anticholinergic activity as per the 4th level, chemical-therapeutic subgroup, of the Anatomical Therapeutic Chemical classification. We also included drugs with high anticholinergic activity, as described in a list of potentially inappropriate medications for use in older adults, according to the 2015 American Geriatrics Society Beers Criteria. Drugs listed in at least two anticholinergic scales were added. Then we verified which drugs in the previous steps were marketed in Brazil. We assigned a score of 1, 2 and 3, based on their anticholinergic action. Results A total of 273 anticholinergic drugs were identified, of which 125 were included in the scale. We identified 45 (36.0%) drugs with a score of 3, 13 (10.4%) with a score of 2, and 67 (53.6%) with a score of 1. Drugs for the nervous and respiratory systems were the most frequent in the scale. Eight drugs were not present in previous scales. Conclusion The methodology used for development of the Brazilian anticholinergic activity scale is simple, systematized, reproducible and easy to update. The scale allows evaluating the impact of anticholinergic burden on health outcomes, and can potentially contribute to pharmacoepidemiology research, leading to more accurate measurements of anticholinergic activity.

Resumo O estudo tem por objetivo determinar a frequência de interações medicamentosas potenciais (IMP) entre idosos hospitalizados e os fatores associados. Estudo transversal realizado em um hospital de ensino. A variável dependente do estudo foi a ocorrência de IMP identificadas utilizando o software DrugReax. Também foram identificados os pacientes que desenvolveram reações adversas a medicamentos (RAM) relacionadas à manifestação clínica de IMP. Realizou-se regressão logística para analisar a associação da ocorrência de IMP e variáveis independentes. No estudo foram incluídos 237 idosos, a prevalência de IMP foi de 87,8 %, e de RAM relacionadas às interações foi de 6,8%. Identificou-se associação positiva entre a detecção de IMP (OR 8,6; IC95% 2,5-30,0), internação por diagnóstico de doença do aparelho circulatório e número de medicamentos superior que 14 (OR 9,8; IC95% 2,8-34,3). O estudo evidenciou uma elevada prevalência de IMP na farmacoterapia dos idosos, mas reduzida prevalência de RAM. Além disso, detectou associação positiva entre IMP e internação por diagnóstico de doença do aparelho circulatório e número de medicamentos superior a 14. A identificação de fatores associados às IMP permite direcionar medidas de prevenção para populações mais expostas à ocorrência de eventos adversos.

Abstract This study aims to determine the frequency of potential drug-drug interactions (PDI) in hospitalized elderly and associated factors. This is a cross-sectional study in a teaching hospital. The dependent variable was the occurrence of potential drug interactions identified using DrugReax software. Patients with adverse drug reactions (ADR) related to clinical manifestations of PDIs were also identified. Multivariate logistic regressions was performed to analyze the association between the occurrence of PDIs and independent variables. In total, 237 older adults were included in the study. The prevalence of PDIs and interaction-related ADRs was 87.8% and 6.8%, respectively. The multivariate analysis showed a positive association between the detection of PDIs (OR 8.6; 95% CI, 2.5-30.0), and hospitalization due to a diagnosed circulatory system disease and number of medications > 14 (OR 9.8; 95% CI, 2.8-34.3%). The study showed a high prevalence of PDIs in the drug treatment of the elderly, but a lower prevalence of ADRs, as well as a positive association between PDIs and hospitalization due to a diagnosed circulatory system disease and number of medications > 14. The identification of factors associated with PDIs guides prevention measures for people that are more exposed to adverse events.