Medication regimen complexity in adults and the elderly in a primary healthcare setting: determination of high and low complexities

Background: The complexity of a medication regimen is related to the multiple characteristics of the prescribed regimen and can negatively influence the health outcomes of patients. Objective: To propose cut-off points in the complexity of pharmacotherapy to distinguish between patients with low and high complexities seen in a primary health care (PHC) setting to enable prioritization of patient management. Methods: This is a cross-sectional study, which included 517 adult and elderly patients, analyzing different cut-off points to define the strata of low and high pharmacotherapy complexities based on percentiles of the population evaluated. Data collection began with the solicitation of prescriptions, followed by a questionnaire that was administered by an interviewer. The complexity of a medication regimen was estimated from the Medication Regimen Complexity Index (MRCI). High complexity pharmacotherapy scores were analyzed from patient profiles, the use of health services, and pharmacotherapy. The criteria for subject inclusion in the sample population were as follows: inhabitant of the area covered by the municipality, 18 years or older, and being prescribed at least one drug during the collection period. Exclusion criteria at the time of collection were the use of any medication whose prescription was not available. All medications were accessed through the Primary Healthcare Service (PHS). Results: The median total pharmacotherapy complexity score was 8.5. High MRCI scores were correlated with age, medications taken with in the Brazilian PHS, having at least one potential drug-related problem, receiving up to eight years of schooling, number of medications and polypharmacy (five or more medicines), number of medical conditions, number of medical appointments, and number of cardiovascular diseases and endocrine metabolic diseases. We suggest different complexity tracks according to age (e.g., adult or elderly) that consider the pharmacotherapy and population coverage characteristics as high complexity limits. For the elderly patients, the tracks were as follows: MRCI≥25.4, MRCI≥20.9, MRCI≥17.5, MRCI≥15.7, MRCI≥14.0, and MRCI≥13.0. For adult patients, the limits of high complexity were MRCI≥25.1; MRCI ≥ 23.8; MRCI≥21.0; MRCI≥17.0; MRCI≥16.5; and MRCI≥15.5. Conclusion: The medication regimen complexity is associated with the patient's illness profile and problems with the use of drugs; therefore, the proposed scores can be useful in prioritizing patients for clinical care by pharmacists and other health professionals

Measurement complexity of adherence to medication

Dayani Galato, Fabiana Schuelter-Trevisol, Anna Paula PiovezanMaster Program in Health Sciences, University of Southern Santa Catarina (Unisul) Tubarão, Santa Catarina, BrazilAdherence to pharmacologic therapy is a major challenge for the rational use of medicines, particularly when it comes to antiretroviral drugs that require adherence to at least 95% of prescribed doses.1 Studies in this area are always important and contribute to medication adherence understanding, even though there is no reference test for measuring this. Recently, an article was published in this journal that proposes the determination of lamivudine plasma concentration to validate patient self-reported adherence to antiretroviral treatment.2 In that study, serum levels obtained after 3 hours of ingestion of the last dose of the drug were compared with patient reports that were classified into different levels of adherence, based on their recall of missed doses in the previous 7 days.It was hypothesized by the authors that the use of a biological marker for drug adherence was extremely important, given the relevance of the topic. However, we would like to draw attention to some points that may determine the success of the use of similar methods for this purpose. The formation of groups with similar anthropometric characteristics is relevant since the dose of lamivudine may have to be changed, depending, for example, on sex, weight, and age.3 Even information considered important by the authors of that study was not provided. There is a need for greater clarity on the eligibility criteria, especially with regard to the clinical stage of the disease, CD4 counts and viral load, associated diseases, and comorbidity, as well as the evaluation of kidney function and other medications used that can affect lamivudine pharmacokinetics.3View original paper by Minzi and colleague

Association between sarcopenia and quality of life in quilombola elderly in Brazil

Luiz Sinésio Silva Neto,1–3 Margô GO Karnikowski,2 Neila B Osório,3 Leonardo C Pereira,2 Marcilio B Mendes,1 Dayani Galato,2 Liana B Gomide Matheus,4 João Paulo C Matheus2,4 1School of Medicine, Federal University of Tocantins, Palmas, Tocantins, 2Graduate Program in Health Sciences and Technology, Ceilândia College, University of Brasilia, Federal District, 3Graduate Program in Education, Federal University of Tocantins, Palmas, Tocantins, 4School of Physiotherapy, Ceilândia College, University of Brasília, Federal District, Brazil Introduction: Currently, there is no single consensual definition of sarcopenia in the literature. This creates a challenge for the evaluation of its prevalence and its direct or indirect impact on the quality of life of elderly populations of different races and ethnicities. Furthermore, no studies as yet have analyzed these variables in populations of elderly subjects of the "quilombola" ethnic group. Objective: We aimed to verify the association between sarcopenia and quality of life in quilombola elderly using the Baumgartner and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Methods: This was a cross-sectional study of 70 male and female participants (mean age: 65.58±6.67 years). Quality of life was evaluated using the multidimensional 36-item Short-Form Health Survey (SF-36) of the Medical Outcomes Study. Sarcopenia was diagnosed according to the Baumgartner cutoff for appendicular skeletal muscle mass and the criteria recommended by the EWGSOP. Muscle mass and fat mass percentages were analyzed by dual-energy X-ray absorptiometry, while handgrip strength (HGS) was evaluated using a hand-held dynamometer. Physical performance was assessed through a gait speed test. Results: The prevalence of sarcopenia was 15% according to the Baumgartner cutoff and 10% according to EWGSOP criteria. Quilombola elderly classified as physically active or very active were at least six times less likely to develop sarcopenia than those classified as irregularly active or sedentary. HGS was negatively associated with a diagnosis of sarcopenia according to both sets of criteria. Subjects with sarcopenia reported lower scores than those without the condition on the physical role functioning and bodily pain domains of the SF-36. Conclusion: In this sample of quilombola elderly, quality of life was negatively associated with sarcopenia, regardless of the classification criteria used. Additionally, the results showed that diagnostic criteria for sarcopenia should include reductions in lean mass in addition to measures of functioning and physical performance because some subjects showed the former symptom without any alteration of the latter two variables. The cutoff value suggested by Baumgartner criteria were less accurate than that specified by the EWGSOP criteria because they do not consider functioning and physical performance. However, Baumgartner criteria were more sensitive in detecting sarcopenia because reductions in lean mass predict alterations in strength and walking speed. Keywords: sarcopenia, quality of life, elderly, quilombola, vulnerable group

Problemas relacionados aos medicamentos em idosos fragilizados da Zona da Mata Mineira, Brasil

OBJETIVO: Identificar os principais problemas de saúde, o perfil de utilização de medicamentos e os problemas relacionados aos medicamentos (PRMs) envolvidos no tratamento de idosos fragilizados da Zona da Mata Mineira. MÉTODOS: Foram avaliados prontuários de 260 idosos atendidos pelo Centro Mais Vida, Juiz de Fora-MG, entre agosto e setembro de 2010. As doenças foram agrupadas de acordo com a Classificação Internacional de Doenças - 10ª revisão, os medicamentos de acordo com o Anatomical Therapeutic Chemical Classification System e os PRMs de acordo com o Método Dáder. RESULTADOS: Observou-se que 73,8% dos idosos eram do sexo feminino e 42,7% possuíam entre 60 e 69 anos. Foram constatadas 1.300 doenças, sendo 31,07% do aparelho circulatório, 19,85% endócrinas, nutricionais e metabólicas e 13,46% do sistema osteomuscular e tecido conjuntivo. Dos 1.737 medicamentos, os mais prevalentes foram os do sistema cardiovascular (42,8%), seguidos pelos do trato alimentar e metabolismo (23,7%) e pelos do sistema nervoso (18,2%). Do total de medicamentos, 53,9% apresentaram algum PRM, sendo o PRM 1 (não utilização da medicação necessária) o mais frequente (37,4%). CONCLUSÃO: Os resultados evidenciam a necessidade da revisão dos esquemas terapêuticos dos idosos, visando o uso racional e efetivo dos medicamentos. Os dados apontam, ainda, a necessidade de aprofundar estudos de avaliação de riscos de PRM nessa população