Polypharmacy for the elderly and associated factors were assessed. A cross-sectional study was conducted using data from the SABE Study (Health, Well-being and Aging), 2006. 1,115 individuals representing 422,377 elderly aged 65 or more, living in São Paulo City, were interviewed. Polypharmacy was defined as the use of five or more medications. A multivariate regression logistics was used. Polypharmacy prevalence was 36%. Female (OR = 1.7; IC 95%: 1.0; 2.9), age over 75 years (OR = 1.9; CI 95%: 1.3; 2.7), higher income (OR = 1.8; CI 95%: 1.2; 2.8), working (OR = 1.8; CI 95%: 1.1; 2.9), regular self assessed health (OR = 1.6; CI 95%: 1.1; 2.3) or poor (OR = 2.6; CI 95%: 1.4; 4.9), hypertension (OR = 2.0; CI 95%: 1.4; 2.9), diabetes (OR = 4.1; CI 95%: 2.2; 7.5), rheumatic diseases (OR = 2.3; CI 95%: 1.5; 3.6) and cardiac problems (OR = 2.9; CI 95%: 1.9; 4.5) were associated positively with polypharmacy. Using only the public health system (OR = 0.5, 95% CI: 0.3; 0.7) was inversely associated with polypharmacy. Medicines for the cardiovascular system and for the alimentary tract and metabolism were the most used. The knowledge of factors associated with polypharmacy, such as those identified in this study, may be useful to alert health professionals about the importance of identifying and monitoring the elderly groups most vulnerable to polypharmacy.

Various medicines are considered unsuitable for older adults due to alterations in pharmacokinetics/pharmacodynamics, lack of therapeutic efficacy, and/or increased risk of adverse events exceeding potential benefits. The aim of this study was to determine the prevalence of potentially inappropriate medication among older adults in the city of São Paulo, Brazil. A population-based cross-sectional study was conducted in a sample of 1,254 individuals aged 60 years or older (participants in the SABE Study), representing the elderly population of the city in 2006. Potentially inappropriate medication was defined according to the Beers criteria. Prevalence of potentially inappropriate medication was 28%. Potentially inappropriate medication was associated with polypharmacy (p=0.001), two or more diseases (p=0.011), and female gender (p=0.007). Thirty-six potentially inappropriate medicines were identified, the majority of which involving prescription medications. Specific criteria are needed for the Brazilian population, in addition to awareness-raising on clinical pharmacology in older adults. Prescription protocols and software programs could assist in the process of rational prescribing in this age group.

for the Chronic Diseases and Informed Decisions (CHRONIDE) Group IMPORTANCE As the rate of publication of new and sometimes conflicting medical research increases, clinicians rely heavily on clinical practice guidelines (CPGs) to inform practice. However, CPGs are of widely variable quality, and there are no existing objective measures to rate the quality of CPGs.OBJECTIVE To systematically assess 421 CPGs for the management of common noncommunicable diseases in primary care using the validated Appraisal of Guidelines for Research and Evaluation Instrument, version II (AGREE-II) tool and elucidate the factors associated with quality of CPGs.EVIDENCE REVIEW MEDLINE, Embase, the Cochrane Library, and 12 websites for CPGs were searched for CPGs for the management of common noncommunicable diseases in primary care published between January 1, 2011, and August 30, 2017. The assessment of the quality of CPGs was performed by 3 appraisers using the 6 domains of the AGREE-II instrument. A multiple logistic regression was performed to identify factors associated with quality of CPGs.FINDINGS Of the 421 CPGs reviewed, 23.5% (99) were classified as high quality. Among included guidelines, clarity of presentation (70%) and scope and purpose (61%) had the highest median AGREE-II scores. The domains with the lowest median scores were applicability (22%) and rigor of development (33%). Factors associated with high-quality CPGs included having more than 20 authors (odds ratio, 9.08; 95% CI, 3.35-24.62), development at governmental institutions (odds ratio, 10.38; 95% CI, 2.72-39.60), and reporting funding (odds ratio, 10.34; 95% CI,. Year of publication, region, guideline version, and scope were not associated with quality among included CPGs.CONCLUSIONS AND RELEVANCE Primary care professionals and policymakers should be aware that CPGs in primary care are of widely variable quality, with less than 25% of included CPGs rated as high quality. High-quality CPGs were associated with a higher number of authors, governmental institutions, and the report of funding. Region of origin was not associated with quality of CPGs, which suggests that the improvement of the quality of CPGs should be an international concern.

BackgroundAnnually, non-communicable diseases (NCDs) kill 38 million people worldwide, with low and middle-income countries accounting for three-quarters of these deaths. High-quality clinical practice guidelines (CPGs) are fundamental to improving NCD management. The present study evaluated the methodological rigor and transparency of Brazilian CPGs that recommend pharmacological treatment for the most prevalent NCDs.MethodsWe conducted a systematic search for CPGs of the following NCDs: asthma, atrial fibrillation, benign prostatic hyperplasia, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease and/or stable angina, dementia, depression, diabetes, gastroesophageal reflux disease, hypercholesterolemia, hypertension, osteoarthritis, and osteoporosis. CPGs comprising pharmacological treatment recommendations were included. No language or year restrictions were applied. CPGs were excluded if they were merely for local use and referred to NCDs not listed above. CPG quality was independently assessed by two reviewers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II).Main Findings“Scope and purpose” and “clarity and presentation” domains received the highest scores. Sixteen of 26 CPGs were classified as low quality, and none were classified as high overall quality. No CPG was recommended without modification (77% were not recommended at all). After 2009, 2 domain scores (“rigor of development” and “clarity and presentation”) increased (61% and 73%, respectively). However, “rigor of development” was still rated < 30%.ConclusionBrazilian healthcare professionals should be concerned with CPG quality for the treatment of selected NCDs. Features that undermined AGREE II scores included the lack of a multidisciplinary team for the development group, no consideration of patients’ preferences, insufficient information regarding literature searches, lack of selection criteria, formulating recommendations, authors’ conflict of interest disclosures, and funding body influence.

BackgroundFew cross-sectional studies involving adults and elderly patients with major DDIs have been conducted in the primary care setting. The study aimed to investigate the prevalence of potential drug-drug interactions (DDIs) in patients treated in primary care.Methodology/Principal FindingsA cross-sectional study involving patients aged 45 years or older was conducted at 25 Basic Health Units in the city of Maringá (southern Brazil) from May to December 2010. The data were collected from prescriptions at the pharmacy of the health unit at the time of the delivery of medication to the patient. After delivery, the researcher checked the electronic medical records of the patient. A total of 827 patients were investigated (mean age: 64.1; mean number of medications: 4.4). DDIs were identified in the Micromedex® database. The prevalence of potential DDIs and major DDIs was 63.0% and 12.1%, respectively. In both the univariate and multivariate analyses, the number of drugs prescribed was significantly associated with potential DDIs, with an increasing risk from three to five drugs (OR = 4.74; 95% CI: 2.90–7.73) to six or more drugs (OR = 23.03; 95% CI: 10.42–50.91). Forty drugs accounted for 122 pairs of major DDIs, the most frequent of which involved simvastatin (23.8%), captopril/enalapril (16.4%) and fluoxetine (16.4%).Conclusions/SignificanceThis is the first large-scale study on primary care carried out in Latin America. Based on the findings, the estimated prevalence of potential DDIs was high, whereas clinically significant DDIs occurred in a smaller proportion. Exposing patients to a greater number of prescription drugs, especially three or more, proved to be a significant predictor of DDIs. Prescribers should be more aware of potential DDIs. Future studies should assess potential DDIs in primary care over a longer period of time.

RESUMO: Introdução: Automedicação retrata o princípio do próprio indivíduo buscar espontaneamente por algum medicamento que considere adequado para resolver um problema de saúde. Essa prática é ainda pouco explorada entre idosos de acordo com outros estudos baseados em dados populacionais. Objetivo: Examinar as tendências da prática de automedicação dos idosos do Estudo SABE entre 2006 e 2010. Método: Estudode base populacional cujos dados foram obtidos do Estudo Saúde, Bem-Estar e Envelhecimento (SABE). Aamostra de 2006 foi constituída de 1.258 idosos e a de 2010, de 865 idosos que utilizaram medicamentos. Resultados: Observou-se redução da automedicação de 42,3% em 2006 para 18,2% em 2010. Em ambos os períodos, as classes terapêuticas predominantes foram as dos medicamentos com ação no sistema nervoso (27,9% em 2006 e 29,6% em 2010) e trato alimentar e metabolismo (25,5% em 2006 e 35,9% em 2010). Entreos medicamentos mais usados nos anos de 2006 e 2010 estão os analgésicos/anti-inflamatórios e vitaminas. Houve tendência a declínio da utilização de medicamentos potencialmente inapropriados entre 2006 (26,4%) e 2010 (18,1%). Oidoso foi o principal responsável pela indicação da automedicação em 2006 (65,2%) e 2010 (66,5%). Conclusão: A extensão da prática de automedicação nos idosos do SABE apresentou redução entre 2006 e 2010, porém o emprego de medicamentos que oferecem risco à saúde ainda foi relatado. Desse modo, os achados reforçam a importância de monitorar, avaliar e educar continuamente os idosos acerca dos riscos e benefícios do consumo de medicamentos, sobretudo daqueles isentos de prescrição.

ResumoPara se conhecer a prática profissional de farmacêuti-cos que atuam em farmácias e drogarias, seus conhecimentos e percepções acerca da Atenção Farmacêutica (AF), realizou-se estudo descritivo com 91 farmacêuti-cos do município de Jundiaí-SP. A maioria era jovem (62,6% entre 20 e 29 anos), do sexo feminino (63,7%), graduada em instituições privadas (90,1%) e não proprietária do estabelecimento (87,9%). Desenvolviam atividades administrativas, técnicas e de atenção ao usuário, principalmente dispensação de medicamentos e orientação; 67,0% acompanhavam o tratamento farmacoterapêutico dos usuários, mas sem registrar informações. Para 62,7%, AF relacionava-se apenas à orientação e atendimento dispensados, mas tais atividades não eram realizadas de forma sistemática e organizada, como preconizado. Muitos (91,2%) consideravam necessário realizar trabalho mais intenso com os usuários, porém apontaram dificuldades como falta de tempo e de apoio dos proprietários e desinteresse dos usuários. Várias dessas dificuldades têm sido verificadas também em outros países, sugerindo que a prática da AF: (a) requer uma mudança estrutural e rearranjo de funções, uma vez que, atualmente, a estrutura e as atividades são adequadas à atividade comercial; (b) reflete uma crise de identidade profissional e, em consequência, falta de reconhecimento social e pouca inserção na equipe multiprofissional de saúde. O conhecimento sobre AF mostrou-se limitado, mas a situação pode vir a alterar-se à medida que as mudanças curriculares em curso surtam efeito na formação dos novos farmacêuticos.

Few Brazilian studies have focused on patient safety strategies for safe use of medications after discharge leading to limited knowledge of current safety practices developed in Brazilian hospitals. The present study aimed to understand the dynamics and challenges of care provided to patients by hospital providers focusing on safe use of medications after discharge. An exploratory study was conducted and data was collected through interviews with physicians, nurses, pharmacists and social workers at the Hospital Universitário da Universidade de São Paulo, in São Paulo, southeastern Brazil. Care practices regarding medication use during and following hospital stay including access to medicines after discharge, follow-up plans for coordinated, ongoing care, and barriers were investigated. The main strategy for safe use of medications after hospital discharge is to provide structured counseling for patients and particularly for caregivers of pediatric patients. The care team works to ensure access to the medications prescribed at discharge in special situations. Medication reconciliation is being implemented and home visits are limited to patients in critical condition with mobility problems. The main barriers identified in the study were limited information technology and human resources. It was concluded that there are some patient safety strategies in place but they are limited in scope and do not ensure coordinated, ongoing care after discharge. These findings point to a need to strengthen efforts to overcome the barriers identified to improve patient safety at the interface of hospital, primary care and the home setting. Keywords: Drugs; Medication Errors; Adverse Events; Hospital Discharge; Patient Safety; Public Health. Liete de Fátima Gouveia Marques ResumoNo Brasil, são escassos os estudos sobre estratégias para a segurança do paciente no processo de uso de medicamentos após a alta hospitalar, o que dificulta o conhecimento sobre a atuação de hospitais brasileiros nessa área. Neste artigo, buscou-se compreender a dinâmica e os desafios do cuidado fornecido ao paciente pela equipe hospitalar, visando à segurança no processo de uso de medicamentos após a alta hospitalar. Realizou-se pesquisa exploratória por meio de entrevistas com médicos, enfermeiros, farmacêuticos e assistentes sociais do Hospital Universitário da Universidade de São Paulo. Foram pesquisadas as atividades de cuidado com a farmacoterapia durante e após a hospitalização, incluindo o acesso a medicamentos após alta, a existência de articulação do hospital com outros serviços de saúde, e barreiras para desenvolver essas atividades. A principal estratégia adotada é a orientação de alta, realizada de forma estruturada, principalmente para cuidadores de pacientes pediátricos. Em situações específicas, ocorre mobilização da equipe para viabilização do acesso a medicamentos prescritos na alta. Reconciliação medicamentosa está em fase de implantação, e visita domiciliar é realizada apenas para pacientes críticos com problemas de locomoção....