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Pereira Júnior ADC, Miasso AI, Telles Filho PCP, Castilho ECD, Vedana KGG. Evaluation of Quality of Life of Primary Health Care Patients in Brazil: Influence of Drug Interactions, Common Mental Disorders, and Use of Psychiatric Medication. Community Ment Health J 2022; 58:240-248. [PMID: 33893600 DOI: 10.1007/s10597-021-00815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
The objectives of this study were to identify the interaction between drug interaction risk, common mental disorders, use of psychiatric medication and quality of life in patients treated in primary health care settings in Brazil. In this quantitative research, 452 patients were interviewed in ten basic Brazilian health units. Sociodemographic and pharmacotherapeutic questionnaires, use of psychiatric medication, prevalence of common mental disorders, and quality of life were utilised. The structural equation model was used to evaluate the relationships among the variables. The prevalence of drug interaction risk was 66.59%. The variables associated with drug interaction risk were polypharmacy and income. The use of psychiatric medication was associated with diagnosis of common mental disorders, income and gender. The use of psychiatric medication and common mental disorders negatively influenced quality of life.
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Affiliation(s)
- Assis do Carmo Pereira Júnior
- Ribeirão Preto School of Nursing, University of São Paulo - EERP-USP, Avenida dos Bandeirantes, 3900, University Campus - Bairro Monte Alegre, Ribeirão Preto, SP, 14040-902, Brazil.
| | - Adriana Inocenti Miasso
- Ribeirão Preto School of Nursing, University of São Paulo - EERP-USP, Avenida dos Bandeirantes, 3900, University Campus - Bairro Monte Alegre, Ribeirão Preto, SP, 14040-902, Brazil
| | | | - Ellen Carolina Dias Castilho
- Ribeirão Preto School of Nursing, University of São Paulo - EERP-USP, Avenida dos Bandeirantes, 3900, University Campus - Bairro Monte Alegre, Ribeirão Preto, SP, 14040-902, Brazil
| | - Kelly Graziani Giacchero Vedana
- Ribeirão Preto School of Nursing, University of São Paulo - EERP-USP, Avenida dos Bandeirantes, 3900, University Campus - Bairro Monte Alegre, Ribeirão Preto, SP, 14040-902, Brazil
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Prevalence and predictors of Potentially Inappropriate Psychotropic Medication in older adults with psychiatric illness. Asian J Psychiatr 2021; 66:102872. [PMID: 34627123 DOI: 10.1016/j.ajp.2021.102872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/26/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is limited information available on the use of Potentially Inappropriate Psychotropic (PIP) medication in older adults having a psychiatric illness. OBJECTIVE To determine the prevalence of and predictors of prescribing PIP medications in older adults with psychiatric illness. METHODS A cross-sectional study was carried out at a tertiary care hospital on 456 patients of either sex, with a median age of 65 years attending the psychiatry outpatient department. Evaluation of PIP medication was done using Beers criteria 2019 and Screening tool of Older Persons Potentially Inappropriate Medication (STOPP) criteria 2015. Bivariate logistic regression was used to find out the predictors of PIP prescribing. RESULTS Results of the study reflect that a staggering number of older adults, (more than 91% and 73%) out of a total of 456 patients were prescribed with at least one PIP medication identified by Beers criteria and STOPP criteria, respectively. Long-acting benzodiazepine (LABZD) like clonazepam was identified as one of the most commonly prescribed PIP medications by both sets of criteria. Further analysis revealed that older adults from rural background (Odds Ratio (OR) 2.60, 95% Confidence Interval (CI) 1.20-5.65; P = 0.015), Tricyclic Antidepressant (TCA) (OR 0.30, 95% CI 0.12-0.75; P = 0.010), LABZD (OR 33.72, 95% CI 11.27-100.85; P = < 0.001), atypical antipsychotics (OR 22.35, 95% CI 5.31-93.99; P = < 0.001) use were most common predictors for PIP medication prescribing. CONCLUSION The study suggests that the Beer criteria detects more PIP medication than the STOPP criteria.
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Ribeiro PRDS, Schlindwein AD. Benzodiazepine deprescription strategies in chronic users: a systematic review. Fam Pract 2021; 38:684-693. [PMID: 33907803 DOI: 10.1093/fampra/cmab017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND As long-term use of benzodiazepines increases, adverse effects also become more frequent, especially in elderly adults. Due the potential of causing dependence, poor patient adherence and a lack of awareness of side effects, deprescription is challenging. OBJECTIVE This study aimed to identify what are the effective approaches to motivate and promote deprescription of benzodiazepines. METHODS We used MeSH terms to search in five databases that were MEDLINE, Cochrane CENTRAL, LILACS, SCIELO and Science Direct. Then, we selected articles accordingly to inclusion and exclusion criteria. Risk of bias assessment for randomized controlled trials and prospective interventional studies was made using RoB 2.0 and ROBINS-I tools, respectively. For cohort studies, we used the clarity group by McMaster University tool. RESULTS Database search retrieved 412 results, and 11 studies were selected for analysis. Interventions focusing on patient education to improve community awareness about deprescription presented better discontinuation rates and more potential on motivating discussions about deprescribing with physicians. Interventions based on counselling by different health professionals were not well evaluated as they presented four of six studies as high, serious or critical risk of bias. CONCLUSIONS Although the comparison of different strategies was impaired by the high risk of bias in some studies, patient education focused interventions presented good results. Future studies should consider doing a follow-up of 6 months or longer with evaluation of withdrawal symptoms and sleep patterns, inclusion of young adults on the sample and some form of cognitive evaluation that might influence the results of the intervention.
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Affiliation(s)
| | - Aline Daiane Schlindwein
- Science and Technology Division, Directorate of Permanent Health Education, State Secretariat of Health of Santa Catarina, Brazil
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Oliveira ALML, Nascimento MMGD, Castro-Costa É, Firmo JOA, Lima-Costa MF, Loyola Filho AID. Increased use of benzodiazepines among older adults: Bambuí Project. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200029. [PMID: 32401915 DOI: 10.1590/1980-549720200029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults. OBJECTIVE To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years. METHODS The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance. RESULTS The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62). CONCLUSION This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.
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Affiliation(s)
| | | | - Érico Castro-Costa
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Josélia Oliveira Araújo Firmo
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Maria Fernanda Lima-Costa
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
| | - Antônio Ignácio de Loyola Filho
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brazil
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Magalhães MS, Santos FSD, Reis AMM. Factors associated with the use of potentially inappropriate medication by elderly patients prescribed at hospital discharge. EINSTEIN-SAO PAULO 2019; 18:eAO4877. [PMID: 31664332 PMCID: PMC6896600 DOI: 10.31744/einstein_journal/2020ao4877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/23/2019] [Indexed: 01/19/2023] Open
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.
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Bosio M, Satyro S, Bassin JP, Saggioro E, Dezotti M. Removal of pharmaceutically active compounds from synthetic and real aqueous mixtures and simultaneous disinfection by supported TiO 2/UV-A, H 2O 2/UV-A, and TiO 2/H 2O 2/UV-A processes. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:4288-4299. [PMID: 29717425 DOI: 10.1007/s11356-018-2108-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/23/2018] [Indexed: 05/25/2023]
Abstract
Pharmaceutically active compounds are carried into aquatic bodies along with domestic sewage, industrial and agricultural wastewater discharges. Psychotropic drugs, which can be toxic to the biota, have been detected in natural waters in different parts of the world. Conventional water treatments, such as activated sludge, do not properly remove these recalcitrant substances, so the development of processes able to eliminate these compounds becomes very important. Advanced oxidation processes are considered clean technologies, capable of achieving high rates of organic compounds degradation, and can be an efficient alternative to conventional treatments. In this study, the degradation of alprazolam, clonazepam, diazepam, lorazepam, and carbamazepine was evaluated through TiO2/UV-A, H2O2/UV-A, and TiO2/H2O2/UV-A, using sunlight and artificial irradiation. While using TiO2 in suspension, best results were found at [TiO2] = 0.1 g L-1. H2O2/UV-A displayed better results under acidic conditions, achieving from 60 to 80% of removal. When WWTP was used, degradation decreased around 50% for both processes, TiO2/UV-A and H2O2/UV-A, indicating a strong matrix effect. The combination of both processes was shown to be an adequate approach, since removal increased up to 90%. H2O2/UV-A was used for disinfecting the aqueous matrices, while mineralization was obtained by TiO2-photocatalysis.
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Affiliation(s)
- Morgana Bosio
- Center of Studies on Worker's Health and Human Ecology, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
- COPPE-Chemical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Suéllen Satyro
- Chemical & Biological Engineering, University of British Columbia, Vancouver, BC, Canada
| | - João Paulo Bassin
- COPPE-Chemical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Enrico Saggioro
- Sanitation and Environment Health Department, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | - Márcia Dezotti
- COPPE-Chemical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Garcia ALDF, Kaya ANM, Ferreira EA, Gris EF, Galato D. Self-medication and adherence to drug treatment: assessment of participants of the Universidade do Envelhecer (the University of Aging) program. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.180106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objectives : to evaluate the use of medication (for continuous use and self-medication) and adherence to treatment among elderly and non-elderly participants of the Universidade do Envelhecer (UniSer). Method : an observational, quantitative and cross-sectional study, using the interview technique, was carried out at UniSer with 215 subjects. A structured instrument was used for the collection of sociodemographic variables and self-medication data. The 1986 Morisky-Green-Levine Scale (MGL) and the Brief Medication Questionnaire (BMQ) regimen screening tool were used to assess adherence. Descriptive analyzes of the data were performed, and the chi-squared Test and Fisher’s Exact Test were applied to evaluate the association between variables of interest. Results : of the participants, 127 (59.1%) were elderly (< 60 years old), of whom 81.9% were women. Regarding self-medication, 22.9% of elderly and 21.7% of non-elderly persons practiced it in the previous seven days (p=0.848), even if they considered it dangerous (p=0.472). A total of 45.8% of the elderly and 55.6% of the non-elderly irrationally self-medicated within the analyzed period, while 76.4% of the elderly and 64.8% of the non-elderly used medications of continuous use (p=0.063). A total of 78.8% of the elderly and 76.1% of the non-elderly were not adherent to treatment (p=0.719) according to the MGL scale, while the BMQ Regimen Screen found that 36.7% of the elderly and 41.1% of the non-elderly were not adherent (p=0.595). Conclusion : these findings demonstrate that there were no significant differences between the groups studied and health education actions should be carried out with an emphasis on guidelines on adherence and the rational use of medicines.
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