Implications of a defined daily dose fixed database for drug utilization research studies: The case of statins in Portugal

Aims Given the discrepancies between PDDs (prescribed daily doses) and DDDs (defined daily doses), we aimed to assess the extent of error in the results of an 18-year population-level study on statin utilization in Portugal. Methods The Portuguese regulatory agency provided data for the period 2000-2018 on statin dispensing (C10AA). The DDDs were gathered from the ATC/DDD database. DDDs were calculated by the DDD year-by-year approach (DDDYEAR) and by the DDD last-year approach (DDDLAST). PDDs were calculated according to the year-by-year approach (PDDYEAR). Statin annual utilization rates per 1000 inhabitants per day were also calculated. Percent errors were calculated for PDDYEAR and DDDYEAR units. Results The DDDYEAR approach revealed decreases in the consumption of atorvastatin, fluvastatin, lovastatin, pravastatin and simvastatin in 2009, when their DDD was modified. Conversely, the results from both DDDLAST and PDDYEAR approaches indicated gradual changes in the actual consumption of all statins in Portugal. Before 2009, atorvastatin, pravastatin and simvastatin utilization was greatly overestimated by DDDYEAR/1000 inhabitants/day. The average dose of lovastatin prescribed in the past 18 years (20 mg) was below the assigned DDDs during the study period, varying from 30 mg to 45 mg. Conversely, the PDD for fluvastatin was above the DDD values (ranging from 40 mg in 2000 to 70 mg in 2016). For atorvastatin, pravastatin and simvastatin, national PDDs were above the assigned DDD until the DDD modification in 2009. Conclusions A more dynamic system, based on national and annually updated DDDs, should be able to reduce discrepancies between DDDs and PDDs and the bias in utilization studies

Cross-cultural adaptation of Hypertension Knowledge Test into European Portuguese

We aim to validate a European-Portuguese version of the Hypertension Knowledge Test (HKT) questionnaire and examine its factorial structure with a confirmatory factor analysis (CFA). A process of translation and back-translation was performed. A cross-sectional study was developed in which all adult patients taking at least one antihypertensive drug were invited to participate. Data on personal and family history were collected, and the HKT, Strelec, and the Batalla questionnaires were administered. We enrolled 304 patients with a mean age of 68.12±10.83 years. The mean score of HKT was 15.33±2.79. CFA indicated that the construct being tested was unidimensional, and Cronbach’s alpha (α=0.65) showed that the instrument had an acceptable internal consistency. When evaluating concurrent validity, HKT was significantly correlated with the Batalla and Strelec scores. Thus, the Portuguese version of HKT (HKT-pt-PT) can be used either in research or in clinical practice. With this version, a potential standard exists to evaluate knowledge about hypertension, which could avoid the practice of using non-validated questionnaires in Portugal and allow the cross-sectional and longitudinal comparability of studies

Efeito da adesão à terapêutica no estado de saúde do idoso

The prevalence of chronic diseases increases with age, and the constant growth of the overall population makes adherence to therapy a major challenge. A solution to the problem of non-adherence to therapy prescribed by the physician population is the implementation, in community pharmacy, of stock monitoring and pharmacist intervention. We evaluated 54 elderly patients treated with at least 3 drugs with an autonomous life. Adherence to drugs prescription was observed by monitoring the patients, counting of medications not administered and historical progress of the lipid profile, blood glucose, blood pressure and cardiovascular risk in the beginning and end of the study. The purpose of this study was achieved in general, since the pharmaceutical intervention contributed to the adherence to therapy, thereby reducing the impact of risk factors associated with cardiovascular disease, and contribute to the promotion of quality of life for the elderly patients. A prevalência de doenças crónicas aumenta com o envelhecimento, e o constante crescimento do contingente populacional faz da adesão à terapêutica um grande desafio. Uma solução para o problema da não adesão à terapêutica prescrita pelo médico na população é a implementação, na farmácia comunitária, de ações de intervenção e acompanhamento farmacêutico. Foram avaliados 54 idosos medicados com pelo menos 3 medicamentos e que viviam de uma forma autónoma. A adesão à prescrição médica foi observada pelo acompanhamento dos doentes, contagem de medicamentos não administrados e evolução dos resultados do perfil lipídico, glicemia, pressão arterial e risco cardiovascular, no início e fim do estudo. O objetivo deste estudo foi na sua generalidade alcançado, uma vez que a intervenção farmacêutica contribuiu para a adesão à terapêutica, reduzindo deste modo o impacto de fatores de risco associados às doenças cardiovasculares, promovendo a qualidade de vida dos idosos.

Contribution of Different Patient Information Sources to Create the Best Possible Medication History

Introduction: Obtaining the best possible medication history is the crucial step in medication reconciliation. Our aim was to evaluate the potential contributions of the main data sources available - patient/caregiver, hospital medical records, and shared electronic health records - to obtain an accurate 'best possible medication history'. Material and Methods: An observational cross-sectional study was conducted. Adult patients taking at least one medicine were included. Patient interview was performed upon admission and this information was reconciled with hospital medical records and shared electronic health records, assessed retrospectively. Concordance between sources was assessed. In the shared electronic health records, information was collected for four time-periods: the preceding three, six, nine and 12-months. The proportion of omitted data between time-periods was analysed. Results: A total of 148 patients were admitted, with a mean age of 54.6 +/- 16.3 years. A total of 1639 medicines were retrieved. Only 29% were collected simultaneously in the three sources of information, 40% were only obtained in shared electronic health records and only 5% were obtained exclusively from patients. The total number of medicines gathered in shared electronic health records considering the different time frames were 778 (three-months), 1397 (six-months), 1748 (nine-months), and 1933 (12-months). Discussion: The use of shared electronic health records provides data that were omitted in the other data sources available and retrieving the information at six months is the most efficient procedure to establish the basis of the best possible medication history. Conclusion: Shared electronic health records should be the preferred source of information to supplement the patient or caregiver interview in order to increase the accuracy of best possible medication history of the patient, particularly if collected within the prior six months

The global financial crisis and developing countries

When the global financial crisis broke out in earnest in September 2008, it quickly became clear that developing countries would also be affected, but that the impacts would vary markedly. The Overseas Development Institute (ODI) coordinated a multi-country study over January-March 2009 involving developing country teams in 10 countries. This showed that, while the transmission mechanisms were similar in each (trade, private capital flows, remittances, aid), the effects varied by country, and much was not yet visible. As such, further country-specific monitoring was required. Most findings suggested that, as a result of time lags, the worst effects were yet to come. This synthesis of the effects of the global financial crisis on developing countries updates the description of the economic and social situation during the course of the crisis in 11 countries

Jobs, Votes and Legitimacy: the Political Economy of the Mozambican Cashew Processing Industry’s Revival

This article seeks to explain the revival of the Mozambican cashew processing industry after it was virtually wiped out by liberalisation policies at the turn of the millennium. Over the last decade state, private and external actors have cooperated to rehabilitate cashew processing with a concerted industrial policy and rents generated by protection. It is argued that such rent creation is a political process and that theories of ‘good governance’ and ‘developmental neopatrimonialism’ are unable to explain political support to the cashew sector in Mozambique. The ‘developmental state’ literature is a more useful guide not only to how the industry was rehabilitated, but also to where the political ‘will to develop’ originated in other contexts. Following from this discussion, it is argued that in Mozambique an elite ideology of nationalism, modernisation and anti-imperialism paved the way for protection of the cashew industry, while more active support was a result of more immediate concerns around finely balanced elections, inadequate employment generation in the broader economy and the faltering legitimacy of the ruling party