Abstract This study aimed to describe potentially inappropriate medication (PIM) use according to the Beers criteria among older adults followed in a comprehensive medication management (CMM) service, the pharmacists´ interventions, and the clinical outcomes of PIM use. All older adults in a CMM service delivered in the Brazilian public primary care system were included in the study (n = 389). Two methodological approaches were developed: (I) cross-sectional - prevalence of PIM use and associated factors were identified (univariate analysis - Pearson’s chi-square; multivariate - logistic regression); (II) documental analysis of the negative clinical outcomes potentially associated with PIM use and pharmacists’ interventions. The prevalence of PIM use was 48.3%, and it was independently and positively associated with the use of ≥ 5 drugs. For 21.3% of PIMs, a potential negative clinical outcome was identified. The most common negative clinical outcome was hypotension (35.1% of the negative outcomes), fractures or diagnosis of osteoporosis (21.1%), and hypoglycemia (14.0%). For most of them (78.9%), an intervention was performed to mitigate harm or discontinue use. A high prevalence of PIM was detected and was associated with polypharmacy. A significant proportion of PIM showed potential negative clinical outcomes that were identified by clinical pharmacists, and the majority of pharmacists’ interventions aimed at its mitigation or deprescription. Overall, our findings reinforce the potential of CMM services for reducing PIM use and the occurrence of negative outcomes.

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

RESUMO Objetivo: Estimar a prevalência de interações medicamentosas entre idosos acompanhados em um Serviço de Gerenciamento da Terapia Medicamentosa na Atenção Primária e fatores associados. Métodos: Para definir as interações medicamentosas, foi utilizado o critério de Beers de 2015 e, em um segundo momento, as interações medicamentosas propostas por Dumbreck para pacientes com diabetes, depressão e insuficiência cardíaca. A análise dos fatores associados foi realizada por análise univariada (χ2 de Pearson) e multivariada (regressão logística). Foi adotado o nível de significância de 5% para todas as análises. Resultados: A média da idade da população foi de 70,2±7,8 anos, 52,2% estavam na faixa etária de 60 a 69 anos, e 61,3% eram do sexo feminino. Dentre os idosos, 94,5% usavam dois medicamentos ou mais (condição para que ocorressem interações medicamentosas). A prevalência de interações medicamentosas dos critérios de Beers foi de 4,9%. Após análise multivariada, doença do sistema nervoso central, arritmia, número de medicamentos e sexo feminino foram positivamente associados com presença de interações medicamentosas. A prevalência das interações medicamentosas propostas por Dumbreck foi de 27,2%. Após análise multivariada, número de medicamentos, insuficiência cardíaca e índice de comorbidade de Charlson superior a 1 foram positivamente associados com presença de interações medicamentosas. Conclusão: A abordagem holística e individualizada no gerenciamento da terapia medicamentosa de pacientes idosos é importante, tendo em vista a prevalência das interações medicamentosas e a necessidade de minimizar consequentes eventos adversos.

ABSTRACT Objective: To estimate the prevalence of drug interactions and associated factors among older adults followed up in a Comprehensive Medication Management Service at Primary Care. Methods: Firstly, the Beers criteria 2015 was used to define drug interactions; later, drug interactions proposed by Dumbreck for patients with diabetes, depression, and heart failure were evaluated. The associated factors were assessed by univariate (Pearson's χ2) and multivariate analyses (logistic regression). The significance level of 5% was set for all analyses. Results: The mean age of the studied population was 70.2±7.8 years; 52.2% were between 60 and 69 years, and 61.3% were female. Among the older adults, 94.5% used two or more drugs (condition for the occurrence of drug-drug interaction). The prevalence of drug interaction according to the Beers criteria was 4.9%. After multivariate analysis, diseases of the central nervous system, arrhythmia, number of medications, and female sex were positively associated with drug interaction. The prevalence of drug interaction according to Dumbreck was 27.2%. After multivariate analysis, the number of medications, the presence of heart failure, and Charlson comorbidity index greater than 1 were conditions positively associated with drug interactions. Conclusion: The holistic and individualized approach used in comprehensive medication management services for older patients is important, considering the prevalence of drug interactions and the need to minimize adverse events.

RESUMO Merleau-Ponty foi inovador ao colocar o corpo e a percepção como pontos centrais em sua proposta filosófica. No âmbito saúde, o pensamento desse filósofo permite o acesso ao conhecimento oriundo da corporeidade por parte de pessoas com doenças crônicas. O objetivo deste trabalho é ampliar a compreensão dos fenômenos atrelados ao uso cotidiano de medicamentos, usados em regimes medicamentosos cada vez mais complexos, por meio do pensamento do filósofo. Para tanto, descrevemos os passos de uma pesquisa ancorada na fenomenologia de Merleau-Ponty e estruturada na forma de uma cascata que se inicia pela definição da fenomenologia como uma nova epistemologia, a existência como paradigma e o corpo como teoria. Ainda, como metodologia, propomos o uso das estruturas da existência, o tempo, o espaço, a relação com o outro e a sexualidade, conectadas por meio do arco intencional para se alcançar a compreensão do fenômeno do uso de medicamentos.

ABSTRACT Merleau-Ponty innovated when giving primacy to the body and perception in his philosophical proposal. Within the field of health, his thinking gives us access to the knowledge gained from the corporeality of individuals with chronic diseases. The objective of this study was to expand the understanding of phenomena associated with the daily use of medication, which includes increasingly complex drug regimes, through the lens of Merleau-Ponty. To this end, we described the research steps anchored in his phenomenological philosophy and structured them in the form of a cascade, beginning with the definition of phenomenology as a new form of epistemology, existence as a paradigm, and the body as a theory. Furthermore, the methodology included the use of existential structures, namely, time, space, relationships with others, and sexuality, connected through the intentional arc to reach an understanding of the phenomenon of medication use.

RESUMEN Merleau-Ponty fue innovador al colocar el cuerpo y la percepción como puntos centrales en su propuesta filosófica. En el marco salud, el pensamiento de ese filósofo permite el acceso al conocimiento proveniente de la corporeidad por parte de personas con enfermedades crónicas. El objetivo de este trabajo es ampliar la comprensión de los fenómenos vinculados con el uso cotidiano de fármacos, utilizados en regímenes cada vez más complejos, mediante el pensamiento del filósofo. Para eso, describimos los pasos de una investigación anclada en la fenomenología de Merleau-Ponty y estructurada en la forma de una cascada que se inicia por la definición de la fenomenología como una nueva epistemología, la existencia como paradigma y el cuerpo como teoría. Como metodología, proponemos asimismo el uso de las estructuras de la existencia, el tiempo, el espacio, la relación con el otro y la sexualidad, conectadas por medio del arco intencional para alcanzarse la comprensión del fenómeno del uso de medicamentos.

ABSTRACT Merleau-Ponty innovated when giving primacy to the body and perception in his philosophical proposal. Within the field of health, his thinking gives us access to the knowledge gained from the corporeality of individuals with chronic diseases. The objective of this study was to expand the understanding of phenomena associated with the daily use of medication, which includes increasingly complex drug regimes, through the lens of Merleau-Ponty. To this end, we described the research steps anchored in his phenomenological philosophy and structured them in the form of a cascade, beginning with the definition of phenomenology as a new form of epistemology, existence as a paradigm, and the body as a theory. Furthermore, the methodology included the use of existential structures, namely, time, space, relationships with others, and sexuality, connected through the intentional arc to reach an understanding of the phenomenon of medication use.

RESUMEN Merleau-Ponty fue innovador al colocar el cuerpo y la percepción como puntos centrales en su propuesta filosófica. En el marco salud, el pensamiento de ese filósofo permite el acceso al conocimiento proveniente de la corporeidad por parte de personas con enfermedades crónicas. El objetivo de este trabajo es ampliar la comprensión de los fenómenos vinculados con el uso cotidiano de fármacos, utilizados en regímenes cada vez más complejos, mediante el pensamiento del filósofo. Para eso, describimos los pasos de una investigación anclada en la fenomenología de Merleau-Ponty y estructurada en la forma de una cascada que se inicia por la definición de la fenomenología como una nueva epistemología, la existencia como paradigma y el cuerpo como teoría. Como metodología, proponemos asimismo el uso de las estructuras de la existencia, el tiempo, el espacio, la relación con el otro y la sexualidad, conectadas por medio del arco intencional para alcanzarse la comprensión del fenómeno del uso de medicamentos.

RESUMO Merleau-Ponty foi inovador ao colocar o corpo e a percepção como pontos centrais em sua proposta filosófica. No âmbito saúde, o pensamento desse filósofo permite o acesso ao conhecimento oriundo da corporeidade por parte de pessoas com doenças crônicas. O objetivo deste trabalho é ampliar a compreensão dos fenômenos atrelados ao uso cotidiano de medicamentos, usados em regimes medicamentosos cada vez mais complexos, por meio do pensamento do filósofo. Para tanto, descrevemos os passos de uma pesquisa ancorada na fenomenologia de Merleau-Ponty e estruturada na forma de uma cascata que se inicia pela definição da fenomenologia como uma nova epistemologia, a existência como paradigma e o corpo como teoria. Ainda, como metodologia, propomos o uso das estruturas da existência, o tempo, o espaço, a relação com o outro e a sexualidade, conectadas por meio do arco intencional para se alcançar a compreensão do fenômeno do uso de medicamentos.

The standard of care therapy of chronic hepatitis C with the combination of pegylated interferon and ribavirin for 24 or 48 weeks was a remarkable accomplishment of the past decade. However, sustained virological responses rates of about 80% (genotypes 2-3) and 50% (geno 3 type 1) were not satisfactory especially for patients infected with genotype 1. Important advances in the biology of HCV have made possible the development of the direct-acting antiviral agents boceprevir and telaprevir with substantial increase in the rates of sustained virological response with shorter duration of therapy for a large number of patients. However, the complexity of triple therapy is higher and several new side effects are expected suggesting greater expertise in the patient management. Anemia and disgeusia are frequent with boceprevir while cutaneous rash, ranging from mild to severe, is expected with telaprevir. Higher risk of drug-drug interactions demand further clinical consideration of the previous well-known adverse events of pegylated interferon and ribavirin. Identification and prompt management of these potential new problems with boceprevir and telaprevir are crucial in clinical practice for optimizing treatment and assuring safety outcomes to HCV-genotype 1 patients.

O presente estudo observacional, longitudinal, não concorrente teve por objetivos avaliar o perfil dos pacientes atendidos por um serviço de acompanhamento farmacoterapêutico e descrever os 'problemas relacionados com medicamento' (PRM) encontrados; determinar a proporção de PRM dentre os problemas de saúde apresentados pela população estudada, classificá-los e identificar situações relacionadas com seu surgimento. O estudo foi realizado na Farmácia Escola do Centro Universitário Newton Paiva, em Belo Horizonte, MG, durante o período de novembro de 2001 a novembro de 2003. Foram avaliados 97 pacientes, maioria mulheres (66,0%), com até 8 anos de escolaridade (45,4%), média de idade de 56,7 ± 13,0 anos; média de 4 ± 2 doenças com diagnóstico; 7 ± 6 queixas e 4 ± 2 medicamentos por paciente. Foram identificados 912 problemas de saúde: 56,5% não controlados. Dos problemas não controlados, 380 (73,6%) eram PRM e desses 81 (21,3%) eram riscos de PRM. Dos 97 pacientes acompanhados 89 (91,7%) apresentaram pelo menos um PRM durante o acompanhamento. Os PRMs mais freqüentes foram relacionados à efetividade (53,2%), à necessidade (25,2%) e à segurança (21,6%). Observou-se grande número de problemas não controlados e a possibilidade de resolvê-los por meio da atenção farmacêutica, demonstrando o potencial resolutivo dessa prática.

This present observational, longitudinal, and non-concurrent study was developed with the purposes of evaluate the profile of patients attended by a pharmacotherapeutic follow-up service and describe the Drug-Related Problems (DRPs) found over there; determine the proportion of DRPs between the health problems presented by the studied population, classifying them and identifying the situations related with their appearance. The study was developed at the School Pharmacy of Newton Paiva University Center, Belo Horizonte, MG, during the period from 2001 November up to 2003 November. Ninety seven patients have been evaluated, the majority of female sex (66.0%), with up to 8 years of scholarship (45.4%), mean age of 56.7 ± 13.0 years; mean of 4 ± 2 diagnosed diseases; 7 ± 6 complaints and 4 ± 2 medications per patient. Nine hundred and twelve health problems have been identified: 56.5% uncontrolled. From the uncontrolled problems, 380 (73.6%) were DRPs and between these, 81 (21.3%) were risks for DRP. From the 97 followed-up patients, 89 (91.7%) have presented at least one DRP during the follow-up. The more frequent DRPs were related to effectiveness (53.2%), to necessity (25.2%) and to safety (21.6%). A great number of uncontrolled problems was observed, as well as the possibility to resolve them by means of pharmaceutical care, indicating so the resolutive potential of this practice.