Prescription of potentially inappropriate medication for the elderly: comparing health service providers

Abstract

Objective: to compare the prescription of medications to elderly users of the SUS with users of a Supplementary Health Plan in the context of the Beers criteria. Method: a quantitative documental analysis using two databases, obtained from surveys conducted in the same municipal region, was performed. In the first database, the sample included 532 people aged 60 years or older, of both genders, who were users of the SUS. In the second, the sample was 239 people aged 60 years or older, irrespective of gender, who were users of the principal supplementary health plan. Statistical analyses to compare the data of the two databases were performed using Pearson’s Chi-squared Test and the extension of Fisher’s Exact test, with a significance level α equal to 5%. Results: The results showed significant differences in the use of medications and polypharmacy among the users of the two service providers. Moreover, there were statistically significant differences between the service providers, with SUS users using more non-steroidal anti-inflammatory drugs (p=0.01), long-lasting sulfonylureas (p=0.02) and Nifedipine (p=0.01), and the users of the Supplementary Health Care plan using more musculoskeletal relaxants (p=0.01), estrogen (p=0.01), amiodarone (p=0.01) and Doxazosin (p=0.01), which are potentially inappropriate for the elderly. Conclusion: there are differences between having health insurance or not in terms of the profile of drug use, including in medications which are potentially inappropriate for use among the elderly. The use of information technology that centralizes the data of the elderly, both in the SUS and in Supplementary Health, could reduce inappropriate or unnecessary prescriptions.

Factors Associated With PIM use in the Frail Elderly: A Cross-sectional Study

“…Private health plan affiliation is associated with a higher probability of medication use, due to the easier access of health plan users to medical care and, consequently, medication prescriptions, which may further increase the vulnerability of this population to drug therapy. 33 In the study by Silvestre et al 34 in Brazil, a lower prevalence of polypharmacy was found for elderly patients from the public health system (44.8%) compared to elderly affiliated to private health plan (64.7%). As noted, this study also found a high prevalence of polypharmacy (79.5%), a frequency lower than that found in studies conducted in the elderly with a lower average age covered by private health plans (62.8%), 35 as well as those attended by the public health system in Brazil.…”

Medicamentos potencialmente inapropriados prescritos a pacientes de um Centro de Referência em Atenção à Saúde da Pessoa Idosa

“…In the sample studied, about 95% of the old people had been followed by a geriatrician for more than a year 18 . So, one of the great challenges about these medications is the way they are prescribed, requiring greater attention in the assessment of risks and benefits when they cannot be avoided, so that, thus, the doctor can safely prescribe 27 .…”

Uso de medicamentos potencialmente inapropriados para idosos em Unidades de Atenção Primária à Saúde

“…A Atenção Primária à Saúde (APS) apresenta-se como a porta de entrada no sistema de saúde para todas as novas necessidades e problemas, fornecendo atenção para a pessoa e não para a doença, além de coordenar ou integrar a atenção fornecida em algum outro lugar ou por terceiros (STARFIELD, 2002). Assim, amplia-se na APS o papel da equipe multiprofissional de saúde, em especial quanto à necessidade de responsabilizarse pela adequada prescrição, dispensação e utilização dos medicamentos pelos idosos e no incentivo à adoção de medidas não farmacológicas para o manejo dos problemas de saúde (SILVESTRE et al, 2019). Os serviços farmacêuticos constituem-se no conjunto de atividades e processos de trabalho relacionados ao medicamento, protagonizados pelo farmacêutico e desenvolvidos no âmbito da atenção em saúde com vistas a potencializar sua resolubilidade.…”