Estudos de utilização de medicamentos: uma síntese de artigos publicados no Brasil e América Latina

[Consumption of non-standard medication in indigenous health: rational usage?]

The study analyzed the consumption of non-standard medication in the health of indigenous peoples, emphasizing the rationality of pharmacotherapy, by conducting a cross-sectional study of secondary data from 2018 and 2019 in the Minas Gerais/Espírito Santo Special Sanitary Indigenous Health Districts. These medicines were classified by Anatomical Therapeutic Chemical Classification. Non-parametric tests were applied to compare the origin of prescription and the form of acquisition, assessing access to medication. Rationality was verified through the consumption profile and the therapeutic option in the list of standardized medicines. A total of 104,928 pharmaceutical presentations were consumed, 66,967 (66%) for the alimentary tract and metabolism, 17,705 (17%) for the nervous system, and 12,961 (12%) for the cardiovascular system. With respect to medicines consumed per region, 171 (90%) out of 190 had a therapeutic option. Prescriptions were more from the SUS. Differences were found in the way the medicines were acquired. The study pointed to significant consumption of non-standard medicines, and there may be failings in therapeutic rationality. In indigenous health, ethnocultural and social issues are challenges to access to medicines with rational use.

Evolution of publications on health of the older adults in the Journal Ciência & Saúde Coletiva

The present study analyzed the profile of publications related to the health of the older adults in the Journal Ciência & Saúde Coletiva, in terms of quantitative evolution, methodological approach, thematic and institutions involved. The selection of articles considered the title, abstract and descriptors and covered all the content published between 1996 and 2019. The articles included were classified according to the year of publication, type, theme, methodological approach and institutional link of the first author. Data analysis was based on absolute and relative frequencies, in addition to summary (mean) and variability (standard deviation) measures. The results showed a consistent increase in publications on the health of the older adults in the Journal Ciência & Saúde Coletiva, with a predominance of the quantitative approach, mainly focused on investigating the topic related to health conditions and the use of health services and supplies. In the majority, the main author was linked to a public teaching/research institution, located in the Southeast region. The results indicate that the journal contributed to give greater visibility to the health of the older adults, but that the publications on this theme reproduce the inequality observed in the national scientific production.

Challenges facing drug utilization research in the Latin American region

PURPOSE

The International Society of Pharmacoepidemiology (ISPE) in collaboration with the Latin America Drug Utilization Research Group (LatAm DURG), the Medicines Utilization Research in Africa (MURIA) group, and the Uppsala Monitoring Center, is leading an initiative to understand challenges to drug utilization research (DUR) in the Latin American (LatAm) and African regions with the goal of communicating results and proposing solutions to these challenges in four scientific publications. The purpose of this first manuscript is to identify the main challenges associated with DUR in the LatAm region.

METHODS

Drug utilization (DU) researchers in the LatAm region voluntarily participated in multiple discussions, contributed with local data and reviewed successive drafts and the final manuscript. Additionally, we carried out a literature review to identify the most relevant publications related to DU studies from the LatAm region.

RESULTS

Multiple challenges were identified in the LatAm region for DUR including socioeconomic inequality, access to medical care, complexity of the healthcare system, limited investment in research and development, limited institutional and organization resources, language barriers, limited health education and literacy. Further, there is limited use of local DUR data by decision makers particularly in the identification of emerging health needs coming from social and demographic transitions.

CONCLUSIONS

The LatAm region faces challenges to DUR which are inherent in the healthcare and political systems, and potential solutions should target changes to the system.

Use of medicines by adults in primary care: Survey on health services in Minas Gerais, Brazil

INTRODUCTION

Inappropriate use and increase of health care spending reinforce the need to extend our knowledge about the quality of medication use.

OBJECTIVES

To describe and evaluate the profile of medication use in a representative sample of adult users of primary care services in the Unified Health System (SUS) of Minas Gerais.

METHOD

Cross-sectional study, with 1,159 interviewees in 104 municipalities and 253 health care services. Data on sociodemographic characteristics, health conditions and use of medicines were collected, and these variables were stratified by age group. Univariate and multivariate analyses, using logistic regression, were conducted to identify predictors of self-medication. We set a significance level of 5% for all tests.

RESULTS

The prevalence of medication use was 81.8%, with an average of 2.67 medicines per user, which increased with age. The most used drugs were losartan, hydrochlorothiazide and simvastatin, which differed between age groups. Significant self-medication was observed not only in young adults but also in the elderly. The predictors of self-medication were: being a young adult, having a higher level of education, not having chronic diseases, having worse self-perception of health and not adhering to prescription drugs. Young and elderly adults showed characteristics that made them more vulnerable in relation to the rational use of medicines.

CONCLUSION

This study can contribute to improving primary care, where it identified problems related to the extent of medication use, especially among young adults and the elderly in Minas Gerais.

Medication consumption in a Brazilian area covered by the Family Health Strategy: Prevalence and associated factors

Abstract Objective: The aim of the present study was to determine the prevalence and factors associated with the medication consumption among users registered in the Family Health Strategy (FHS) of Rondonópolis, Mato Grosso State, Brazil. Method: The population was constituted of all adult residents in the area covered by the FHS. The Poisson regression model with robust variance was used to the statistical analysis. Results: There were included 553 participants, of which 72% were women. The mean age was 48 years. The prevalence of medication consumption was about 74.9% (n = 414). The most consumed class medication was drugs that act on the cardiovascular system (42.2%). The factors associated with medication consumption were female gender (PR = 1.21; CI95%: 1.07 - 1.38), diagnosed morbidity (PR = 1.83; CI95%: 1.61 - 2.08) and be bedridden in the last month (PR = 1.14; 95% CI95%: 1.02 - 1.26). Moreover, 72.7% of the interviewees obtained the medicines in public pharmacies. Conclusion and implications for practice: Women, people diagnosed with morbidities and those participants who were bedridden during the last month showed the highest levels of drug consumption. Nursing professionals in promoting the rational use of medications can contribute to integral care to FHS users.

Medications used in pediatric cystic fibrosis population

Objective

To describe the drug utilization profile used by pediatric cystic fibrosis patients.

Methods

A transversal study comprising the analysis of records and interviews with caregivers of pediatric patient in a reference center of Southern Brazil. We collected information about patients’ clinical condition, medication used and household therapy.

Results

Out of 78 patients participating in the study, prevailing characteristics were: female, self-declared white color, mutation F508del and countryside resident. Forty-three patients had health monitoring exclusively in the hospital’s outpatient division. We analyzed 509 prescribed medication (6.5 medication/patient). The caregiver acknowledged the correct indication in 83% of cases. Patients with pulmonary complications and diseases and/or comorbities related to the cystic fibrosis had an increased quantity of prescribed medication. Vitamins, pancreatic enzymes, hypertonic saline solution, dornase alpha, acid ursodesoxicolic and inhalation antibiotics were most commonly prescribed. Out of the sum of medication, 265 (52.1%) were registered in the Relação Nacional de Medicamentos Essenciais , 26.7% were registered in the basic component and 25.4% were registered in the specialized component of pharmaceutical assistance. Seventy-four interviewees informed difficulty in the acquisition of at least one prescribed medication. Most of the reports acknowledge the State Health Department as the place to find and receive medication for cystic fibrosis.

Conclusion

This study allowed reaching a deeper understanding about therapy, caring needed with patients with cystic fibrosis, highlighting to implement strategies that might contribute to enhance life quality and to execute the patients’ therapy plan.

Prevalence of medicine use among Brazilian adults: a systematic review

The use of medicine in adults has been assessed by some population-based studies in Brazil, but to date there has been no overall estimate of the prevalence of drug consumption. We therefore aimed to estimate the prevalence of medicine use as measured in previously reported cross-sectional studies among Brazilian adults. We conducted a systematic review of the literature, searching in MEDLINE, Embase among others to a date ending January 2017. Two researchers selected the studies, extracted data and assessed methodological quality of those chosen for inclusion. The consumption prevalence were combined in meta-analyses, the heterogeneity measured by I2 and investigated by subgroup analyses and meta-regression. The search identified 4,005 publications, of which 14 were ultimately included in the study. Most studies (12/14) measured the consumption over the previous 15 days, finding a consumption prevalence of 49.1% (95% CI: 48.5-49.6%, I2 = 100%). The recall period explains part of the heterogeneity found (R2 = 23%, p = 0.048), however the subgroup analysis did not allow for more homogeneous results. The use of medications occurs among almost half of all Brazilian adults. Appropriate pharmaceutical assistance and care are necessary to ensure the rational use of these technologies.

ESTRATÉGIA SAÚDE DA FAMÍLIA E USO RACIONAL DE MEDICAMENTOS: O TRABALHO DOS AGENTES COMUNITÁRIOS EM PALMAS (TO)

Resumo Procurou-se analisar as ações dos agentes comunitários de saúde referentes à orientação da comunidade sobre o uso racional de medicamentos na Estratégia Saúde da Família em Palmas, capital do estado do Tocantins. Tratou-se de estudo descritivo-exploratório, de abordagem quantitativa, realizado com 246 agentes entre janeiro e abril de 2014. A coleta de dados foi por questionário, objetivando verificar a formação e a informação específica sobre medicamentos e os riscos da farmacoterapia no trabalho dos participantes da pesquisa. Observou-se que 88% dos agentes não realizaram curso de capacitação sobre medicamentos; 75,5% consideraram não ter conhecimento suficiente para dar orientações sobre medicamentos; 80,41% informaram que em nenhuma vez foram discutidos pela equipe temas sobre medicamentos; e 90,20% sentiam necessidade dessa formação. O estudo revelou que esses profissionais buscavam informações em várias fontes – as bulas de medicamentos constituíam a principal (71,14%). Dos agentes comunitários de saúde, respectivamente 52,46% e 50% referenciaram o enfermeiro para solucionar problemas e sanar dúvidas sobre farmacoterapia. Dentre eles, 68,03% consideraram importante orientar as famílias, mas afirmaram precisar de educação permanente. Evidenciou-se a necessidade de qualificação e formação do agente comunitário na promoção do uso racional de medicamentos, considerando o seu papel como promotor de saúde na comunidade.

Uso contínuo de medicamentos e condições de trabalho entre motoristas de caminhão

Resumo Os motoristas de caminhão têm sido pouco explorados quanto aos problemas de saúde que os acometem e, principalmente, quanto ao seu perfil de consumo de medicamentos. Este estudo teve o objetivo de determinar o uso contínuo de medicamentos, por motoristas de caminhão, e identificar as características profissionais associadas. Para a sua realização, conduziu-se um estudo transversal com motoristas de caminhão estacionados no Pátio de Triagem do Porto de Paranaguá, Paraná, Brasil. Realizou-se uma entrevista com obtenção de dados socioeconômicos, problemas de saúde, condições de trabalho e uso contínuo de medicamentos. Dos motoristas avaliados (n = 665), 21,1% referiram utilizar algum medicamento continuamente, com destaque para o captopril (10,7%), metformina (10,3%), omeprazol (6,2%) e sinvastatina (6,2%). Motoristas com dezesseis anos ou mais de experiência profissional (RP 1,67; IC 95% 1,11-2,51), proprietários do próprio caminhão (RP 1,38; IC 95% 1,03-1,86) e que não possuíam vínculo empregatício formal (RP 1,49; IC 95% 1,11-2,00) apresentaram maior prevalência de uso contínuo de medicamentos. Observa-se que algumas condições de trabalho têm importante papel do uso contínuo de medicamentos pelos motoristas de caminhão.

Promoção do uso racional de medicamentos: uma proposta de modelo avaliativo da gestão municipal

RESUMO O artigo propõe um modelo avaliativo da gestão municipal na promoção do uso racional de medicamentos. Análises documentais, revisão de literatura e reuniões com grupos de interessados orientaram a elaboração do modelo. Para a sua validação, utilizou-se a técnica de conferência de consenso. A matriz é composta por 28 indicadores agregados nas dimensões estruturais e operacionais. O estudo possibilitou a explicitação e o entendimento dos objetivos e metas da intervenção, indicando a possibilidade de o modelo expressar a atuação da gestão na promoção do uso racional de medicamentos. E concluiu, pela plausibilidade do modelo avaliativo, a sua pertinência em estudos dessa natureza.

Sociodemographic profile of medicines users in Brazil: results from the 2014 PNAUM survey

OBJECTIVE

To analyze the prevalence of medicine use by the Brazilian population and its distribution according to sociodemographic factors.

METHODS

Study using data from the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a nationwide household survey of a representative sample of the Brazilian urban population. The data were collected between September 2013 and February 2014. The overall use of medicines, defined as the use of any medicine, use of medicines for treating chronic medical conditions and for acute health conditions, was evaluated. The independent variables included gender, age group, socioeconomic position, and region of Brazil. Analyzes included prevalence calculations, 95% confidence intervals (95%CI) and Pearson Chi-square tests to evaluate the differences between groups, considering a 5% level of significance.

RESULTS

The prevalence of medicines use was 50.7% (95%CI 49.3-52.2), with 39.3% (95%CI 37.5-41.1) accounting for men and 61.0% (95%CI 59.3-62.6) for women. Medicines use was observed to increase with increasing age, except among children within the zero to four years age group. The lowest prevalence for medicines use was found among those with a low socioeconomic position and those who reside in the North region of Brazil. The prevalence of medicine use to treat chronic diseases was 24.3% (95%CI 23.3-25.4), whereas it was 33.7% (95%CI 32.1-35.4) for treating acute diseases.

CONCLUSIONS

We found extensive variability in the prevalence of medicines use across regions of Brazil. The poorest regions (North, Northeast, and Midwest) have a lower prevalence of medicines use to treat chronic diseases, indicating the need to minimize inequalities in access to medicines within the country.

OBJETIVO

Analisar a prevalência do uso de medicamentos pela população brasileira e sua distribuição segundo aspectos sociodemográficos.

MÉTODOS

Estudo com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), pesquisa nacional de base populacional, realizada entre setembro de 2013 e fevereiro de 2014 em residências de municípios urbanos. Avaliou-se o uso de todos os medicamentos (global), uso de medicamentos para doenças crônicas e uso de medicamentos para doenças agudas. As variáveis independentes utilizadas foram sexo, idade, classificação econômica e região do País. Foram calculados prevalências e intervalos de confiança de 95% (IC95%) e aplicado teste Qui-quadrado de Pearson para avaliação das diferenças entre os grupos, considerando o nível de significância de 5%.

RESULTADOS

A prevalência global de uso de medicamentos foi de 50,7% (IC95% 49,3-52,2), sendo 39,3% (IC95% 37,5-41,1) no sexo masculino e 61,0% (IC95% 59,3-62,6) no sexo feminino. Observou-se aumento nas prevalências de uso com a idade (exceto de zero a quatro anos). As menores prevalências de uso ocorreram no grupo mais pobre e na região Norte do País. A prevalência de uso de medicamentos para doenças crônicas foi de 24,3% (IC95% 23,3-25,4) e para doenças agudas foi de 33,7% (IC95% 32,1-35,4).

CONCLUSÕES

Existe grande variabilidade nas prevalências globais de uso de medicamentos por regiões brasileiras. As regiões consideradas mais pobres (Norte, Nordeste e Centro-Oeste) apresentam menores prevalências de uso de medicamentos para doenças crônicas, o que indica a necessidade de minimizar as desigualdades no acesso aos medicamentos dentro do País.

[Antidepressants: use, adherence and awareness among medical students]

This study assessed the degree of adherence and drug-related awareness and opinions regarding the importance of guidance with respect to treatment among medical students who use antidepressants. It is a cross-sectional descriptive study, carried out in a public Medical School in the state of Sao Paulo, Brazil. Of the 289 students interviewed, 33 (11.4%) use or had already used antidepressants, with fluoxetine being the most prescribed. The nurse was not cited as being responsible for guidance on the antidepressant. Although most students had received guidance on antidepressants, they did not heed guidance and still had doubts regarding their use. There was a statistically significant association regarding the consumption of other drugs in addition to antidepressants and the existence of side effects, as well as regarding an increase of the dosage without medical consultation and the existence of such side effects. Actions are necessary to acknowledge the importance of the teaching of psychopharmacology in the training of the medical professional and for greater harmony between theory and practice.

Systematic review of cross-national drug utilization studies in Latin America: methods and comparability

PURPOSE

We systematically review the cross-national drug utilization studies performed in Latin America (LA) in order to analyze the methods applied and assess the validity of the data to ensure the comparability.

METHODS

A systematic search in Medline, Embase, and BIREME was performed. Drug utilization studies including LA countries and comparing drug exposure data on volume were included. The data validity was judged independently by two authors as having low, medium, high, or unclear risk of bias.

RESULTS

Out of 1191 articles, 25 were kept for full text reading. Finally, five studies were selected. Eight different Latin American countries were involved in the comparisons. The selected studies analyzed wholesale data from a private research company collecting information from the private healthcare sector. In three studies, a high risk of bias in the extrapolation method applied was identified. In one study, a risk of data collection bias was detected. The most frequent limitation detected by the original authors was related to the unavailability of information from the public sector in LA.

CONCLUSION

Drug utilization studies comparing data cross-nationally are scarce in LA. In general, validity of the comparisons is hampered by a potential risk of extrapolation bias given the lack of available data on drug consumption from the public healthcare sector. Setting up systems to remediate this situation is a future challenge for researchers and (supra)national authorities in the region.

Adverse events caused by potential drug-drug interactions in an intensive care unit of a teaching hospital

OBJECTIVE

To evaluate the incidence of potential drug-drug interactions in an intensive care unit of a hospital, focusing on antimicrobial drugs.

METHODS

This cross-sectional study analyzed electronic prescriptions of patients admitted to the intensive care unit of a teaching hospital between January 1 and March 31, 2014 and assessed potential drug-drug interactions associated with antimicrobial drugs. Antimicrobial drug consumption levels were expressed in daily doses per 100 patient-days. The search and classification of the interactions were based on the Micromedex® system.

RESULTS

The daily prescriptions of 82 patients were analyzed, totaling 656 prescriptions. Antimicrobial drugs represented 25% of all prescription drugs, with meropenem, vancomycin and ceftriaxone being the most prescribed medications. According to the approach of daily dose per 100 patient-days, the most commonly used antimicrobial drugs were cefepime, meropenem, sulfamethoxazole + trimethoprim and ciprofloxacin. The mean number of interactions per patient was 2.6. Among the interactions, 51% were classified as contraindicated or significantly severe. Highly significant interactions (clinical value 1 and 2) were observed with a prevalence of 98%.

CONCLUSION

The current study demonstrated that antimicrobial drugs are frequently prescribed in intensive care units and present a very high number of potential drug-drug interactions, with most of them being considered highly significant.

[Factors associated with use of medication during first pregnancies in Rio Branco, Acre State, Brazil]

This cross-sectional study in a sample of 887 primigravidae in Rio Branco, Acre State, Brazil aimed to analyze factors associated with the use of medicines during the first pregnancy. Information was obtained from interviews and prenatal cards. Medicines were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System of the World Health Organization and risk categories according to the U.S. Food and Drug Administration. Mean age was 21 years and mean number of medicines used was 2.42. The most frequently consumed medicines were antianemics (47.5%), supplements and vitamins (18.7%), analgesics (13.8%), and antibiotics (10.5%). In the risk categorization, 69.3% belonged to category A, 22.3% to B, 7.6% to C, and 0.8% to D. The odds of having used risky medicines were higher among primigravidae in unit B (OR = 2.10; 95%CI: 1.26-3.50), in the 19 to 24-year age bracket (OR = 2.79; 95%CI: 1.58-4.93), and in the presence of a medical prescription (OR = 1.86; 95%CI: 1.18-2.95). Essential drugs were less used by women with higher family income (OR = 0.63; 95%CI: 0.42-0.96) and those who had received private prenatal care (OR = 0.53; 95%CI: 0.38-0.74).

Perfil das exposições a medicamentos por mulheres em idade reprodutiva atendidas por um Centro de Informações Toxicológicas

O objetivo deste artigo é descrever os dados epidemiológicos referentes às exposições a medicamentos por mulheres em idade fértil atendidas por um Centro de Informações Toxicológicas. Realizou-se um estudo com mulheres em idade fértil, expostas a medicamentos entre 2007 e 2011. Foram estudadas variáveis relacionadas às pacientes, à ocorrência e ao medicamento envolvido, totalizando 777 notificações. Os dados foram obtidos do Sistema de Informação de Agravos de Notificação e processadas com o uso do programa Epi Info. A maioria das ocorrências (90,5%) foi intencional, em 33,7% dos casos foram utilizados de dois a três medicamentos e a frequência de hospitalização foi de 35,6%. Os medicamentos com atuação no Sistema Nervoso Central foram responsáveis por 59,9% das ocorrências, destacando-se os antiepilépticos (21,2%) e os antidepressivos (20,7%). Os principais fatores associados à hospitalização das pacientes foram: demora no atendimento após a ocorrência da exposição, pacientes com nível superior, contato com dois ou mais medicamentos e exposições a antiepilépticos e antidepressivos. Os resultados obtidos mostraram que as exposições a medicamentos representam um grave problema à saúde de mulheres em idade fértil e contribuem para o aumento das internações hospitalares.

Analysis of the pharmaceutical assistance cycle in Romelândia, Santa Catarina, Brazil

The Pharmaceutical Assistance Cycle (PA) is the basis for healthcare services through which pharmaceutical assistance and expertise can be implemented in a functional and structured way to meet public health demands, adhere to the Brazilian Ministry of Health vision, and strike a balance in the contemporary struggle for health equity. The aim of this research is to analyze the effectiveness of the PA cycle in the city of Romelândia (SC), through a study conducted at a Primary Healthcare Unit in the municipality. For the study, 120 patients (service users) and seven healthcare professionals were interviewed. The majority of patients confirmed that they were given advice and instruction on dosage during the dispensing process, as well as advice on the recommended use of medicines and course duration. A small number of service users, 4.1%, said that they received instructions on adverse drug interactions; 36.6% commented on a lack of access to medicines available in the municipal pharmacy, and 71.4% of the health professionals interviewed, identified non-availability of medicines in the pharmacy as the most pressing and telling problem facing the service. There is also no local Pharmacy and Therapeutics Committee, and the only selection criteria is the Ministry of Health essential medicines list. Our study has therefore identified several weaknesses facing the city healthcare service, namely: the shortage of medicines; a lack of resolute professional communication between pharmacist and service user; a lack of patient counseling during the dispensing process, and a lack of communication regarding patient follow-up treatment and wellbeing.

Uso de antimicrobianos pela população da cidade de Jataí (GO), Brasil

Um dos fatores que contribui para a emergência de microrganismos multirresistentes é a utilização inadequada de antimicrobianos. Neste estudo foram visitados 192 domicílios para aplicação de um questionário a respeito dos hábitos de consumo de antimicrobianos de todos os moradores. Os dados revelaram que 6,8% dos participantes utilizaram antimicrobianos nos últimos meses. Os usuários eram predominantemente do sexo feminino, idade entre 20 e 59 anos e renda de 1 a 3 salário mínimos. Do total, 9,1% fizeram uso de antimicrobianos sem prescrição e 4,6% não concluíram o tratamento, alegando melhora dos sintomas ou devido aos efeitos colaterais. O motivo mais relatado para o tratamento foi infecção de orofaringe. Foi constatado também o uso de antimicrobianos de forma desnecessária, como para o tratamento de febre, gripe e alergia. Entre os entrevistados, 20,5% possuem o hábito de indicar antimicrobianos para familiares e amigos. Este trabalho foi conduzido antes da proibição legal da venda de antimicrobianos sem receita médica. Grande parte dos entrevistados desconhece os riscos da utilização inadequada e foi observado um percentual considerável de indivíduos que indicam estas drogas a outros. Com a implantação da lei que proíbe a venda sem prescrição é esperado que este problema seja minimizado.

Crenças e comportamentos de pessoas com doença arterial coronária

O estudo descreveu crenças e comportamentos sobre causas e medidas de controle da doença arterial coronária (DAC). Cem adultos foram entrevistados em ambulatório público, em Salvador (BA). Os resultados foram analisados em percentuais, médias e por técnica de análise de dados qualitativos. Predominaram homens, idade < 60 anos, cor negra, baixas escolaridade e renda, casados e sem ocupação. A média de crenças para a causa da DAC foi de 1,53 por participante incluindo fatores comportamentais, biológicos, relacionais e religiosos e representaram sobretudo acúmulo de excessos quanto às tensões cotidianas e alimentação. A maioria dos participantes não considerou a enfermidade de caráter crônico acreditando que o tratamento não duraria a vida toda e na cura da doença. A média de crenças para medidas de controle foi de 1,45 prevalecendo seguimento do regime alimentar e uso das medicações. Predominou sedentarismo, redução do tabagismo e consumo de bebida alcoólica, preparo de alimentos com menos sal e gordura saturada, maior consumo de carnes brancas, alimentos cozidos e industrializados. Apenas 66% cumpriam a receita médica. O entendimento insatisfatório sobre causas e medidas de controle da DAC torna essencial a implementação de cuidados contemplando as distintas condições de vida e saúde e projetos para o cuidar de si.

[Use of medication among hospital workers]

Although medication is acknowledged as a key element in treating health problems, there is little information available on the use of medication by hospital workers. To estimate the prevalence and describe the patterns of medication consumption by hospital workers and to identify the factors associated with such consumption in this population, data from the "PROSEC" baseline cohort were analyzed (n=417). The prevalence of overall medication consumption was 72.4%, most of which was for nervous complaints (25.4%), especially analgesics (17.8%). Use of any amount of medication was independently associated with gender, number of medically diagnosed conditions and health problem in the two weeks prior to the interview. Use of a drug was significantly associated with income whereas self-diagnosed health problems were independently related with the use of two or more pharmaceutical products. The high prevalence of medication usage in this population, with analgesics being the most consumed medication, should be seen as a cause for concern, since many consumers are unaware that these products are not exempt from risk. Women and individuals in poor health are the main candidates for intervention programs in order to promote adequate and proper use of these pharmaceutical products.

[Patient awareness about drugs prescribed after medical appointment and prescription]

Information provided to patients about medication is important for the success of the treatment, since the lack of such information is one of the main reasons why patients fail to take medicines as prescribed. The aim of this study was to verify patients' awareness about prescribed drugs distributed at the Grão Pará (Santa Catarina) primary healthcare unit after a medical appointment. One hundred and eleven patients were interviewed, seventy after a medical appointment and forty-one after drugs were distributed. Patient awareness was tested by asking questions about the name, usage, dosage, length of treatment, side effects, and precautions. After a medical appointment 28.5% of patients were classified as having a good level of awareness, 17.1% fair and 64.4% insufficient. After drugs were distributed 4.9% of patients were classified as having a good level of awareness, 87.8% fair and 7.3% insufficient. The majority of those interviewed had a low level of awareness about the use of the prescribed drugs. Results after drugs were distributed were better in comparison to results after a medical appointment, suggesting the importance of the pharmacist in informing patients about the correct use of drugs.

Eventos adversos na terapia farmacológica pediátrica: revisão integrativa da literatura

Trata-se de uma revisão integrativa da literatura realizada em bases de dados online, no período entre 2003-2009, com o objetivo de identificar as evidências disponíveis sobre os principais eventos adversos relacionados a medicamentos na clientela pediátrica e propor estratégias para a redução dos mesmos. Evidenciou-se a inadequação da apresentação dos fármacos direcionada ao atendimento das necessidades terapêuticas específicas das crianças. Entende-se que a tomada de decisão do enfermeiro sobre o aprazamento seguro, o preparo e a administração de fármacos, deve estar baseada em avaliação criteriosa e individualiza de cada cliente. Assim, é necessário que o profissional esteja embasado cientificamente, para implementar intervenções eficazes que sejam capazes de reduzir e, até mesmo, evitar os eventos adversos oriundos da uni ou polifarmácia.

Intervenção interdisciplinar enquanto estratégia para o Uso Racional de Medicamentos em idosos

A presente pesquisa avaliou a efetividade de intervenções interdisciplinares, envolvendo médicos, farmacêuticos e nutricionistas, destinadas à promoção do Uso Racional dos Medicamentos. Trata-se de um estudo de caráter prospectivo e analítico, com uma população de mulheres idosas, onde a efetividade da intervenção foi avaliada de acordo com indicadores de Uso Racional dos Medicamentos preconizados pela Organização Mundial de Saúde. As análises estatísticas foram realizadas utilizando-se do teste t ou one-way ANOVA para variáveis discretas, e o teste de qui-quadrado para avaliação categórica das variáveis. Após a intervenção, houve uma redução média no consumo de medicamentos em relação às consultas da pré-intervenção (p=0,001). Os medicamentos utilizados na terapêutica cardiovascular foram os mais consumidos, o que se encontra em consonância com as doenças autoreferidas pelas idosas. Foi possível verificar que a intervenção interdisciplinar em idosas pôde contribuir para melhoria dos indicadores de Uso Racional dos Medicamentos, em especial os de prescrição.

[Knowledge level for prescription of nonsteroidal anti-inflammatory by dentists in São José dos Campos, São Paulo State, Brazil]

The abusive use of drugs in clinical routine of dentistry represents a problem of public health. Studies have demonstrated that the effectiveness of anti-hypertensive drugs was decreased by the simultaneous use of Nonsteroidal Anti-Inflammatory Drugs (NAIDs), mainly in elderly patients with primary hypertension. This study was to evaluate the scientific knowledge of the dentists working at the public health service in São José dos Campos, São Paulo, Brazil. This research characterized the scientific upgrade of the dentists concerning the prescription of NAIDs to hypertensive patients. The methods included a questionnaire filled up by the 92 dentists of the public health service in São José dos Campos. The results were statistically analyzed by the Wald and Fisher Tests to evaluate the probability of statistical associations between the studied issues (p-value<0.05). The results showed that the professional knowledge for prescription of NAIDs for hypertensive patients was insufficient. The pharmacological interactions between NAIDs and anti-hypertensive drugs were almost totally unknown. The conclusion was that the update courses in dentistry skills do not offer enough knowledge for pharmacological practices in dentistry.

Dificuldades de indivíduos com doença arterial coronária para seguir tratamento medicamentoso

OBJETIVO: Descrever as dificuldades encontradas por indivíduos com doença arterial coronária para o seguimento de tratamento medicamentoso. MÉTODOS: Estudo descritivo de corte transversal que incluiu 100 adultos entrevistados em hospital público, em Salvador-BA e os resultados foram analisados em percentuais e médias. RESULTADOS: Predominou homens, média de idade de 58,7±10,9 anos, cor/etnia negra, baixa escolaridade e renda. Dentre os participantes, 34% não cumpriam integralmente a receita médica em razão de condições econômicas deficitárias, esquecimento e falta de orientação dos profissionais da saúde. A compra de, pelo menos uma medicação, era feita por 89%. Dos 81 indivíduos com a receita na entrevista, 57 (70,4%) utilizavam cinco ou mais medicamentos diariamente e 67 (82,7%) não sabiam o nome de todas as medicações por causa do controle delas ser feito pelo familiar, esquecimento, limitações para leitura da receita e falta de hábito de consultá-la. CONCLUSÃO: Constatou-se baixo seguimento e entendimento das medicações prescritas. O baixo nível socioeconômico e a abordagem interdisciplinar insatisfatória parecem constituir fatores para estes achados.