Adaptação linguística e cultural do Medication Management Ability Assessment Tool para avaliação da capacidade de gestão da medicação dos idosos

Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2020, Universidade de Lisboa, Faculdade de Farmácia.A maioria dos idosos são incapazes de tomar os seus medicamentos conforme prescritos. A adesão é um comportamento complexo, que além da intenção, envolve também a capacidade para tomar os medicamentos. Desta forma, importa distinguir a intenção de tomar a medicação e a capacidade para o fazer. A toma diária de medicamentos é um processo metódico e rotineiro, que pode ser afetado por diversos erros sistemáticos, nomeadamente devidos à perda gradual de capacidade funcional (física, cognitiva e sensorial) para gerir a medicação. A avaliação da capacidade dos idosos para gerir a sua própria medicação pode constituir um passo importante para identificar potenciais incapacidades e necessidades. O objetivo deste estudo foi adaptar linguística e culturalmente o Medication Management Ability Assessment Tool (MMAA) para Portugal. A adaptação processou-se através de um ciclo de tradução/retroversão realizado por quatro peritos bilingues (dois portugueses/dois ingleses). A componente cultural foi acompanhada por um painel de peritos externos e por uma aferição longitudinal dos conceitos e constructos. Do processo de adaptação linguística e cultural do MMAA, obteve-se a versão pré-final do MMAA-PT, a ser pré-testada e validada na população idosa portuguesa. Este instrumento avalia a capacidade de gestão da medicação, através de um regime simulado. Tem uma duração de aplicação entre 45 a 60 minutos, prevendo-se a sua maior adequabilidade à aplicação no contexto clínico de reconciliação terapêutica e de investigação.Most seniors are unable to take their medications as prescribed. Adherence is a complex behaviour, which in addition to intention, also involves the ability to take medications. Therefore, it is important to distinguish the intention to take the medication and the ability to do so. Daily medication intake is a methodical and routine process, that can be affected by several systematic errors, namely due to the gradual loss of functional capacity (physical, cognitive and sensory) to manage the medication. Evaluation of the elderly’s ability to manage their own medication can be a significant step in identifying inabilities and potential needs. The aim of this study was to perform the linguistic and cultural adaptation of Medication Management Ability Assessment Tool (MMAA) to Portugal. The adaptation was started with the translation/back translation cycle completed by four independent bilingual experts (two Portuguese/two English). The cultural component was accomplished through an external expert meeting and a longitudinal screening of concepts and construct. From the linguistic and cultural adaptation process of the MMAA, the pre-final version of the MMAA-PT was obtained, to be pre-tested and validated in the elderly Portuguese population. This instrument assesses the medication management ability, using a simulated regimen. It has a predicted duration of application of between 45 and 60 minutes, with its greater suitability for application in the clinical context of therapeutic reconciliation and research.Com o patrocínio da Universidade de Évora

Assessment of the elderly’s functional ability to manage theirmedication: a systematic literature review

Background The evaluation of the elderly’s ability to manage medication through the use of a validated tool can be a significant step in identifying inabilities and needs, with the objective of increasing their self-care skills, and promoting successful aging. Aim of the review To identify studies assessing the elderly’s functional ability to manage their own medication. Method For the search strategy, the PICO method was used: P—Population(elderly), I—Instruments (tools for assessing medication management ability), C—Context (community) and O—Outcomes (functional ability to manage medication). Thefinal search query was run in MEDLINE/PubMed,CINAHL Plus, ISI Web of Science and Scopus. The whole process was developed according to the PRISMA statement. Results The search retrieved 8051 records. In each screening stage, the selection criteria were applied to eliminate records where at least one of the exclusion criteria was verified. At the end of this selection, we obtained a total of 18 papers (17 studies). The results allow the conclusion to be drawn that studies use several different instruments, most of them not validated. The authors agree that medication management abilities decrease as cognitive impairment increases, even if a lot of studies assess only the physical dimension. DRUGS was the instrument most often used. Conclusion Older adults’ ability to manage their medication should be assessed using tools specifically built and validate for the purpose. DRUGS (which uses the real regimen taken by the elderly) was the most widely used assessment instrument in the screened studies

Erros de distribuição em dose unitária: tipos e causas

Os erros de medicação são um problema de saúde pública com uma repercussão económica importante, afectando a qualidade de vida dos utentes e os custos em saúde. Ao nível da farmácia hospitalar, “que tem como principal função a dispensa dos medicamentos aos doentes de acordo com a prescrição médica, nas quantidades e especificações solicitadas, de forma segura e no prazo requerido, promovendo o uso seguro e racional do medicamento,” o erro de distribuição é definido como a discrepância entre a ordem prescrita pelo médico e o atendimento dessa ordem, podendo gerar oportunidades de erros de administração. Os erros classificam-se em função da etapa do circuito do medicamento em que ocorrem: prescrição, distribuição e administração. A distribuição de medicamentos em sistema de dose unitária (DMDU) está descrita como imperativo para aumentar a segurança no circuito do medicamento, prevendo uma distribuição diária de medicamentos, em dose individual unitária, para um período de 24 horas. Sempre que possível, a DMDU deverá apoiar-se em equipamentos semi-automáticos, para redução dos erros. Sendo a qualidade e segurança uma preocupação crescente e uma prioridade dos sistemas de saúde, os profissionais de saúde devem intervir activamente na melhoria dos sistemas de utilização dos medicamentos para garantir a segurança do doente. Consequentemente, vários estudos têm sido desenvolvidos para verificar os tipos de erros mais frequentes em farmácia hospitalar. Objectivo do estudo: identificar os principais erros de distribuição em dose unitária descritos na literatura nos últimos 5 anos e as suas causas, através de uma revisão sistemática

Cross-cultural validation and psychometric evaluation of the Self-Medication Assessment Tool (SMAT) for assessing and optimizing medication therapy management of older people

Background, rationale and objectives: The assessment of medication management ability in the elderly can be performed using specific tools, such as the Self-Medication Assessment Tool, which considers real and simulated regimens. The objective of this study was to perform the linguistic and cultural adaptation of the Self-Medication Assessment Tool to European Portuguese and determine its psychometric properties. Methods: The adaptation commenced with the translation/back translation cycle completed by 4 independent bilingual experts. The cultural component was accomplished through an external expert meeting and a longitudinal screening of concepts and construct. The pilot study was carried out in a sample of 150 Portuguese community-dwelling elders. Descriptive data, correlations, internal reliability, response consistency and exploratory factor analysis was conducted using SPSS Statistics (v22). Results: The pilot study was carried out in a sample of 150 community-dwelling elders: 112 (74.7%) participants were women; mean age was 74.73 ± 6.43 years. The Self-Medication Assessment Tool (Portuguese version) standard regimen (simulated medication regimen) mean scores were 20.92 ± 6.83 in functional ability and 38.75 ± 5.92 in cognitive ability; the real regimen (medication taken by the elderly) mean scores were 83.74 ± 15.86 in medication recall, 96.96 ± 11.39 in adherence self-report and 4.82 ± 10.1 in intentional non-adherence. Cronbach's α were 0.87 (functional ability), 0.84 (cognitive ability), 0.57 (medication recall), 0.94 (adherence self-report) and 0.79 (intentional non-adherence). The response consistency between test and re-test was verified. Conclusions: We have developed the European Portuguese version of the Self-Medication Assessment Tool with acceptable psychometric properties which can now be employed in the study of the elderly in clinical and research contexts

Key factors of the functional ability of older people to self-manage medications

Funding Information: This work was funded by the 4IE project (0499_4IE_PLUS_4_E) funded by Interreg V-A España-Portugal (POCTEP) 2017/2021 (https://4ie.eu/). Publisher Copyright: © 2021, The Author(s).Daily medication use can be affected by the gradual loss of functional ability. Thus, elderly patients are at risk for nonadherence due to functional decline, namely, decreases in cognitive skills and visual and manual dexterity. The main objective was to assess the ability of older people to self-manage their medication and to identify the main predictors for unintentional nonadherence. A cross-sectional study was conducted (2014–2017) in community centers and pharmacies. Functional assessment was performed with the Portuguese versions of the Drug Regimen Unassisted Grading Scale (DRUGS-PT) and the Self-Medication Assessment Tool (SMAT-PT). A purposive sample including 207 elderly patients was obtained. To identify the main predictors, binary logistic regression was performed. The average DRUGS-PT score was slightly lower than that in other studies. On the SMAT-PT, the greatest challenge for patients was identifying medications by reading labels/prescriptions. The main difficulties identified were medication memorization and correct schedule identification. The scores were higher with the real regimen than with the simulated regimen, underlining the difficulties for patients in receiving new information. Regarding the predictors of an older individual’s ability to self-manage medications, two explanatory models were obtained, with very high areas under the curve (> 90%). The main predictors identified were cognitive ability, level of schooling and daily medication consumption.publishersversionpublishe

Avaliação da capacidade funcional da população idosa na gestão da sua medicação

Tese de doutoramento, Farmácia (Farmacoepidemiologia), Universidade de Lisboa, Faculdade de Farmácia, 2017Aproximadamente 45% dos idosos são incapazes de tomar os seus medicamentos tal como prescritos. A adesão à medicação representa um comportamento complexo, que envolve tanto a intenção, como a capacidade para tomar os medicamentos. Desta forma, importa distinguir a intenção de tomar a medicação e a capacidade para o fazer. O consumo diário de medicamentos constitui um processo metódico, marcado pela rotina e que pode ser afetado por diversos erros sistemáticos associados, não só ao desconhecimento e iliteracia do doente, mas também à sua perda gradual de capacidade funcional (física, cognitiva e sensorial) para gerir a medicação. A diminuição das competências cognitivas, da acuidade visual ou da destreza manual apresentam um impacto significativo na não adesão (não intencional), podendo originar problemas de saúde decorrentes da ausência ou incorreta administração de medicamentos. Este trabalho apresentou como principal objetivo avaliar a capacidade funcional dos idosos residentes na comunidade para gerir a sua medicação, com recurso a instrumentos específicos, adaptados e validados para Portugal. Para tal, desenvolveu-se um plano de estudos dividido em três fases principais, caracterizadas por diferentes metodologias complementares. Fase 1 – Revisões da literatura – Efetuou-se uma revisão descritiva, de forma a identificar e caracterizar os instrumentos disponíveis para avaliar a capacidade funcional para gerir a medicação; e uma revisão sistemática com o objetivo de saber qual a capacidade funcional dos idosos para gerir a medicação, de acordo com os estudos publicados na literatura internacional e quais os instrumentos mais utilizados. Obteve-se um conjunto de quinze instrumentos de avaliação da capacidade de gestão da medicação, entre os quais, o mais utilizado em estudos posteriores foi o Drug Regimen Unassisted Grading Scale (DRUGS) e o mais atual, o Selfmedication Assessment Tool (SMAT). Enquanto o primeiro avalia a capacidade para gerir o regime de medicação real, o segundo avalia a capacidade para gerir, quer o real, quer um regime de medicação simulado (padrão).Fase 2 – Seleção, adaptação e validação dos instrumentos – Procedeu-se à seleção dos instrumentos de avaliação da capacidade dos idosos para gerir a medicação, de acordo com os resultados das revisões da literatura. Os instrumentos selecionados e para os quais se obteve autorização de trabalho, foram o DRUGS e o SMAT. Efetuou-se a sua adaptação linguística e cultural, seguida da validação dos instrumentos na população idosa portuguesa. A validação foi realizada em duas amostras independentes, cuja dimensão foi calculada a partir do número de itens de cada instrumento. A amostra foi selecionada por conveniência, entre os idosos residentes na região do Alentejo. Realizou-se uma análise teste-reteste para cada um dos instrumentos. No caso da validação do DRUGS-PT, foram entrevistados 50 idosos, em centros de dia/convívio; e no caso do SMAT-PT, a amostra foi de 150 idosos, entrevistados em farmácias comunitárias. Qualquer um dos instrumentos evidenciou propriedades psicométricas aceitáveis, as quais suportam a sua aplicabilidade em contexto clínico e de investigação. No final deste estudo obtiveram-se as versões Portuguesas finais de ambos os instrumentos, DRUGS-PT e SMAT-PT. Fase 3 – Avaliação da capacidade funcional dos idosos para gerir a sua medicação e estudo dos preditores – O último estudo, caracterizado pelo seu desenho transversal, foi efetuado numa amostra de 207 idosos, os quais foram avaliados com recurso aos instrumentos validados – DRUGS-PT (n=52) e SMAT-PT (n=155), respetivamente em centros de dia/convívio e farmácias comunitárias. Verificou-se que a capacidade funcional dos idosos para gerir a medicação se encontra associada à capacidade cognitiva. Tendo este facto sido confirmado, não só pelas análises individuais, mas também pela regressão logística efetuada para análise dos preditores, dos quais, o Mini-Mental State Examination e o Teste do Relógio constituíram parte relevante (área ROC ≈90%). Com a conclusão deste plano de estudos foi atingido o objetivo proposto inicialmente, gerando evidência científica e empírica que pode contribuir para o desenvolvimento de respostas integradas às dificuldades do idoso na gestão da sua medicação. Para tal, pode ajudar também, a disseminação dos resultados já publicados, bem como dos que se encontram em fase de submissão.About 45% of older people are unable to take their medicines as prescribed. Adherence represents a complex behaviour, which involves both the intention and the ability to take medication. In this way, it is important to distinguish the intention to take medicine and the ability to do so. The daily consumption of medication is a methodical process, marked by routine and that can be affected by several systematic errors associated, not only due to ignorance and illiteracy, but also to its gradual loss of functional ability (physical, cognitive and sensorial), in order to manage medication. Decreased cognitive skills, visual acuity and manual dexterity have a significant impact on non-adherence (non-intentional), which may lead to health problems as a result of the absence or incorrect medication administration. This work presented as its main objective to assess the functional ability of community-dwelling elderly to manage their own medication, with recourse to specific tools, validated and adapted to Portugal. For this purpose, a study plan was developed, divided into three main phases, characterized by different complementary methodologies. Phase 1 – Literature reviews – A descriptive review was carried out, to identify and characterize the available tools to assess functional ability to manage medication; and a systematic review with the objective of knowing the elderly functional ability to manage medication, according to studies published in the international literature and which tools were most used. It was obtained a set of fifteen tools to assess medication management ability, among which, the most used was the Drug Regimen Unassisted Grading Scale (DRUGS) and the most current Self-medication Assessment Tool (SMAT). The first assesses only the ability to manage a real medication regimen and the second assesses the ability to manage the real and a standard medication regimen (pattern).Phase 2 – Selection, adaptation and validation – The tools for assessing the elderly functional ability to manage medication were selected, according to the results of literature reviews. The selected tools, and for which work and research authorization was obtained, were DRUGS and SMAT. The linguistic and cultural adaptation was carried out, followed by the validation of the tools in the Portuguese elderly population. The validation was performed in two independent samples, whose dimension was calculated from the number of items of each tool. The convenience sample was selected among the community-dwelling elder in the Alentejo region. A test-retest analysis was run for each of the tools. In the case of DRUGS-PT, 50 elderly people were interviewed, in day and social centres; and in the case of SMAT-PT, the sample was constituted by 150 elderly people, interviewed in community pharmacies. Any of the tools showed acceptable psychometric properties, which support their applicability in clinical and research context. At the end of this study, the final Portuguese versions of both instruments, DRUGS-PT and SMAT-PT, were obtained. Phase 3 – Assessment of the elderly functional ability to manage their medication and study of the predictors – The last study, characterized by its cross-sectional design, was carried out on a sample of 207 elderly people, who were assessed using the validated tools – DRUGS-PT (n=52) and SMAT-PT (n=155), respectively in day/social centres and community pharmacies. It was verified that the functional ability of the elderly to manage medication is associated with the cognitive ability. This was confirmed not only by the individual analysis, but also by the logistic regression carried out to analyse the predictors, of which the Mini-Mental State Examination and Clock Tests were a relevant part (ROC area ≈90%). With the conclusion of this study plan, the initially proposed objective was achieved, generating scientific and empirical evidence that can contribute to the development of integrated responses to the difficulties of the elderly in their medication management. Hence, it can also help to disseminate the already published results, as well as those that are in a phase of submission

Policies for a successful aging: need of elderly functional ability assessment to manage their own medication

Background The correct medication use by community dwelling elders is essential for the preservation of their health and quality of life. In Portugal, there are validated tools to assess the activities of daily living abilities. However, there is none specifically built to assess the medication management ability. A tool’s validation allowing the assessment of the Portuguese elder’s functional ability to manage their own medication represents an essential step, in order to devise effective policies aiming the promotion of independence, health and autonomy for the longest possible period, through the implementation of support measures in this field (1-3). The high inability rates revealed as age advances reflects a high risk for the elders health. According to WHO data (2004), about 46% of the individuals with 60 years and over, presents some degree of inability, being the more frequently causes of this inability vision and hearing loss, dementia and osteoarthritis. All can be related with a decreasing ability to manage their own medication (non-intentional process) (4-6). The evaluation of the elder’s functional ability to manage their own medication through the application of a validated tool can be an important way to identify potential inabilities and needs of the elders in primary healthcare centers and plan policy strategies to increase their performance, self-care skills and successful aging. Objective The aim of this project is to assess the functional ability of the Portuguese elderly population to manage their own medication through the application of a specific and validated tool

Additional file 5 of Pharmacogenomic biomarkers as source of evidence of the effectiveness and safety of antidepressant therapy

Additional file 5: Supplementary File 5. Levels of evidence and GRADE of the studies included in the systematic literature review

Additional file 3 of Pharmacogenomic biomarkers as source of evidence of the effectiveness and safety of antidepressant therapy

Additional file 3: Supplementary File 3. Characterization of the studies/publications according to the type of study, number of samples and their characterization regarding sex, age, and population group

Additional file 2 of Pharmacogenomic biomarkers as source of evidence of the effectiveness and safety of antidepressant therapy

Additional file 2: Supplementary File 2. Identification of the studies/publications included in the systematic literature review, such as title, authors, country, and reference, generated by the reference management software Mendeley©