Association between the morisky medication adherence scale and medication complexity and patient prescription knowledge in primary health care

The aim of the study was to check the association of the Morisky Medication Adherence Scale with the prescription complexity and with the patient’s level of knowledge about the prescription. A cross-sectional study was conducted by means of an interview and analysis of the prescription received by patients selected at Family Health Strategy Units. A Poisson regression model with robust variance was used to describe the association between the variables. Low adherence was significantly associated with highly complex prescriptions: Prevalence Ratio (PR) = 1.53; 95 % Confidence Interval (CI) = 1.28-1.82, in comparison with low and moderate complexity. Low adherence was also significantly associated with very low levels of knowledge: regarding the highest level (third tertile), the first and second tertiles had PR = 4.44; 95 % CI = 3.26-6.06 and PR = 3.22; 95 % CI = 2.33-4.47, respectively. The Morisky scale is useful to measure low adherence, with the advantage of being an easily understood instrument, which can be quickly administered, presenting simple interpretation and applicationColegio de Farmacéuticos de la Provincia de Buenos Aire

Association between the morisky medication adherence scale and medication complexity and patient prescription knowledge in primary health care

The aim of the study was to check the association of the Morisky Medication Adherence Scale with the prescription complexity and with the patient’s level of knowledge about the prescription. A cross-sectional study was conducted by means of an interview and analysis of the prescription received by patients selected at Family Health Strategy Units. A Poisson regression model with robust variance was used to describe the association between the variables. Low adherence was significantly associated with highly complex prescriptions: Prevalence Ratio (PR) = 1.53; 95 % Confidence Interval (CI) = 1.28-1.82, in comparison with low and moderate complexity. Low adherence was also significantly associated with very low levels of knowledge: regarding the highest level (third tertile), the first and second tertiles had PR = 4.44; 95 % CI = 3.26-6.06 and PR = 3.22; 95 % CI = 2.33-4.47, respectively. The Morisky scale is useful to measure low adherence, with the advantage of being an easily understood instrument, which can be quickly administered, presenting simple interpretation and applicationColegio de Farmacéuticos de la Provincia de Buenos Aire

Agreement between self-reported prepregnancy weight and measured firsttrimester weight in Brazilian women

Background: Self-reported pre-pregnancy weight and weight measured in the first trimester are both used to estimate pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) but there is limited information on how they compare, especially in low- and middle-income countries, where access to a weight scale can be limited. Thus, the main goal of this study was to evaluate the agreement between self-reported pre-pregnancy weight and weight measured during the first trimester of pregnancy among Brazilian women so as to assess whether self-reported pre-pregnancy weight is reliable and can be used for calculation of BMI and GWG. Methods: Data from the Brazilian Maternal and Child Nutrition Consortium (BMCNC, n = 5563) and the National Food and Nutritional Surveillance System (SISVAN, n = 393,095) were used to evaluate the agreement between selfreported pre-pregnancy weight and weights measured in three overlapping intervals (30–94, 30–60 and 30–45 days of pregnancy) and their impact in BMI classification. We calculated intraclass correlation and Lin’s concordance coefficients, constructed Bland and Altman plots, and determined Kappa coefficient for the categories of BMI. Results: The mean of the differences between self-reported and measured weights was 0.90 for both datasets in all time intervals. Bland and Altman plots showed that the majority of the difference laid in the ±2 kg interval and that the differences did not vary according to measured first-trimester BMI. Kappa coefficient values were > 0.80 for both datasets at all intervals. Using self-reported prepregnancy or measured weight would change, in total, the classification of BMI in 15.9, 13.5, and 12.2% of women in the BMCNC and 12.1, 10.7, and 10.2% in the SISVAN, at 30–94, 30–60 and 30–45 days, respectively. Conclusion: In Brazil, self-reported pre-pregnancy weight can be used for calculation of BMI and GWG when an early measurement of weight during pregnancy is not available. These results are especially important in a country where the majority of woman do not initiate prenatal care early in pregnancy

Uso de medicamentos por idosos em região do sul do Brasil

OBJECTIVE: To describe self-reported drug use by the elderly, evaluating the occurrence of polypharmacy and the influence of sociodemographic and health conditions on the use of medications. METHODS: A cross-sectional study comprising a sample of 215 elderly was carried out in Porto Alegre, Southern Brazil, in 2001 and 2002. Data on the use of medications were collected using questionnaires filled out during home visits. Drugs were classified according to the Anatomical-Therapeutical-Chemical Classification System. RESULTS: Of all respondents, 141 (66%) were women, 117 (54%) aged between 60 and 70 years old, 157 (73%) were white, 115 (53%) lived with a partner, and 145 (67%) had some schooling. The prevalence of the use of medications by the elderly was 91% (n=195). In the week previous to the interview, 697 drugs were used, an average of 3.2 drugs per person (SD=2.5). A total of 187 (87%) subjects had attended at least one medical visit in the last year and 71 (33%) confirmed the use of over-the-counter drugs. Polypharmacy was evidenced in 57 (27%) cases. CONCLUSIONS: There is a pattern of increased drug use by the elderly aged 60 years or more who lives in the study community and slight differences were determined by their health conditions and socioeconomic factors.OBJETIVO: Descrever o uso de medicamentos por idosos, avaliar a presença de polifarmácia, os efeitos de características sociodemográficas e as condições de saúde no uso da medicação. MÉTODOS: Pesquisa de estudo transversal, realizado em 2001 e 2002, em Porto Alegre, no Estado do Rio Grande do Sul, em uma amostra de 215 idosos. Os dados sobre o uso de medicamentos foram coletados por meio de um questionário preenchido durante visita domiciliar. Os medicamentos foram classificados de acordo com Anatomical-Therapeutical-Chemical Classification System. RESULTADOS: Dos entrevistados, 141 (66%) eram mulheres; 117 (54%) na faixa etária entre 60 e 70 anos, 157 (73%) brancos, 115 (53%) tinham companheiros(as) e 145 (67%) cursaram até o ensino fundamental. A prevalência de uso de medicação foi de 91% (n=195). Na semana anterior à entrevista foram utilizados 697 medicamentos, com média de 3,2 (DP=2,5) medicamentos por pessoa. Do total da amostra, 187 (87%) haviam realizado no mínimo uma consulta médica no último ano, 71 (33%) pessoas usavam medicamento sem prescrição médica e em 57 (27%) casos foi caracterizada polifarmácia. CONCLUSÕES: Constatou-se padrão elevado de uso de medicamentos entre pessoas de faixa etária igual ou superior a 60 anos que vivem na comunidade, com pequenas variações conforme as condições de saúde e características sociodemográficas

Brazilian Maternal and Child Nutrition Consortium : establishment, data harmonization and basic characteristics

Pooled data analysis in the feld of maternal and child nutrition rarely incorporates data from low- and middle-income countries and existing studies lack a description of the methods used to harmonize the data and to assess heterogeneity. We describe the creation of the Brazilian Maternal and Child Nutrition Consortium dataset, from multiple pooled longitudinal studies, having gestational weight gain (GWG) as an example. Investigators of the eligible studies published from 1990 to 2018 were invited to participate. We conducted consistency analysis, identifed outliers, and assessed heterogeneity for GWG. Outliers identifcation considered the longitudinal nature of the data. Heterogeneity was performed adjusting multilevel models. We identifed 68 studies and invited 59 for this initiative. Data from 29 studies were received, 21 were retained for analysis, resulting in a fnal sample of 17,344 women with 72,616 weight measurements. Fewer than 1% of all weight measurements were fagged as outliers. Women with pre-pregnancy obesity had lower values for GWG throughout pregnancy. GWG, birth length and weight were similar across the studies and remarkably similar to a Brazilian nationwide study. Pooled data analyses can increase the potential of addressing important questions regarding maternal and child health, especially in countries where research investment is limited

Factors Associated with Healthcare Services Utilization and Pharmacological Treatment in Individuals with Diabetes Diagnosis: Lessons from a Nationwide Program for Diabetes Mellitus Detection in Brazil

The Brazilian Nationwide Population Screening Program for Diabetes, conducted in 2001, diagnosed 346,168 new cases. Although unexpected, approximately 65,000 previously diabetic individuals participated. We describe their characteristics compared to new cases, based on data obtained by a follow-up study of a subsample of 4991 positively screened from a representative sample of 90,106 individuals. Two groups were analyzed regarding factors associated with adherence to treatment, healthcare services utilization, and compliance to pharmacological treatment: 497 with newly diagnosed diabetes and 257 individuals with previous diabetes diagnosis who were not under treatment at the screening program. For this group, healthcare service utilization was lower when compared with the new cases (OR = 0.06; 95% CI: 0.03–0.12). Diabetes status (OR = 0.23; 95% CI: 0.14–0.37), a healthy behavior score (OR = 0.53, 95% CI: 0.34–0.83), and glucose levels at screening (altered, OR = 5.01; 95% CI: 2.38–10.6 and likely and very likely DM OR = 11.2; 95% CI: 6.85–18.4) were independently associated with pharmacological treatment

Instrument to evaluate the level of knowledge about prescription in primary care

OBJECTIVE: To develop and test an instrument to evaluate patients' level of knowledge about drug prescription. METHODS: This study was conducted with users registered with the Family Health Strategy clinics of the city of Santa Cruz do Sul, Southern Brazil, selected by consecutive sampling. Name of the medication, therapeutic indication, drug dosage, times of administration, forms of use, duration of treatment, attitude when doses are missed, possible adverse effects and interactions were included in this study. Each item of the scale was weighted, according to the importance for safe prescribed drug use. The questionnaire was tested by applying an interview to users in 2006 and by analyzing 320 prescriptions. Descriptive statistics, prevalence ratios and chi-square test were calculated for categorical variables and the Tukey test was calculated to compare means. RESULTS: The level of knowledge about drug therapy was considered good in 11.3% of participants, fair in 42.5%, and insufficient in 46.3%. The highest levels of knowledge were observed in times of administration, therapeutic indication and duration of treatment. The lowest levels occurred in drug dosage, adverse effects and attitude when one or more drug doses are missed. CONCLUSIONS: The proposed instrument enabled the analysis of the magnitude of the gap existing between what the patients must know and what they actually know about their medications. Thus, key aspects of prevention, education and follow-up can be detected to avoid problems associated with unsafe drug use.OBJETIVO: Desarrollar y testar un instrumento para evaluación del nivel de conocimiento del paciente sobre prescripción de medicamentos. MÉTODOS: El estudio fue realizado con usuarios catastrados en las Unidades de Estrategia de Salud de la Familia de Santa Cruz do Sul, Sur de Brasil, reclutados por muestreo consecutivo. Se consideraron nombre del medicamento, indicación terapéutica, dosis, horarios de administración, forma de utilización, duración del tratamiento, actitud en el caso de olvido de dosis, posibles efectos adversos e interacciones. Cada ítem de la escala fue ponderado según importancia para la utilización segura del medicamento prescripto. El cuestionario fue testado por medio de entrevista en los usuarios en 2006 y análisis de 320 prescripciones. Se hicieron cálculos estadísticos descriptivos, tasas de prevalencias y chi-cuadrado para variables categóricas y prueba de Tukey para comparación de promedios. RESULTADOS: El nivel de conocimiento de la terapia medicamentosa fue considerado bueno para 11,3% de los entrevistados, regular para 42,5% e insuficiente para 46,3%. Los mayores niveles de conocimiento fueron observados en los horarios de administración, indicación terapéutica y duración del tratamiento. Los menores niveles ocurrieron en dosis, efectos adversos y qué hacer en caso de olvido de una o más dosis del medicamento. CONCLUSIONES: El instrumento propuesto permitió examinar la magnitud de la laguna existente entre lo que el paciente debe saber y lo que él realmente sabe sobre sus medicamentos. Así, se pudo detectar focos de prevención, educación y acompañamiento para evitarse problemas relacionados con la utilización no segura de los medicamentos.OBJETIVO: Desenvolver e testar um instrumento para avaliação do nível de conhecimento do paciente sobre a prescrição de medicamentos. MÉTODOS: O estudo foi realizado com usuários cadastrados nas Unidades de Estratégia de Saúde da Família de Santa Cruz do Sul, RS, recrutados por amostragem consecutiva. Foram considerados nome do medicamento, indicação terapêutica, dose, horários de administração, forma de utilização, duração do tratamento, atitude no caso de esquecimento de doses, possíveis efeitos adversos e interações. Cada item da escala foi ponderado segundo importância para a utilização segura do medicamento prescrito. O questionário foi testado por meio de entrevistas com os usuários em 2006 e pela análise de 320 prescrições. Foram calculadas estatísticas descritivas, razões de prevalências e qui-quadrado para variáveis categóricas e teste de Tukey para comparação de médias. RESULTADOS: O nível de conhecimento da terapia medicamentosa foi considerado bom para 11,3% dos entrevistados, regular para 42,5% e insuficiente para 46,3%. Os maiores níveis de conhecimento foram observados nos horários de administração, indicação terapêutica e duração do tratamento. Os menores níveis ocorreram em dose, efeitos adversos e o que fazer no caso de esquecimento de uma ou mais doses do medicamento. CONCLUSÕES: O instrumento proposto permitiu examinar a magnitude da lacuna existente entre o que o paciente deve saber e o que ele realmente sabe sobre seus medicamentos. Assim, é possível detectar focos de prevenção, educação e acompanhamento para evitar problemas relacionados à utilização não segura dos medicamentos

Concordância entre diferentes períodos recordatórios em estudos de utilização de medicamentos

Objective: To assess the agreement between three recall periods for self‑reported drug use using a 24‑hour recall period as reference. Methods: Participants were allocated into three groups with different recall periods of 7, 14 and 30 days and were interviewed at two different times. A 24‑hour recall questionnaire was answered during the first interview, and a questionnaire on drug use over the different recall periods tested was answered during the second interview. The agreement between the questionnaires was evaluated using percent agreement and kappa. Results: For continuous drugs, percent agreement varied between 92 and 99% and kappa varied between 0.71 and 0.97 for three periods tested. For drugs of occasional use, percent agreement varied between 63 and 81% and kappa varied between 0.27 and 0.52. The prevalence of drugs, particularly those of occasional use, increases with time. Conclusions: The high level of agreement between the three recall periods suggests that all of them are valid for the investigation of drugs of continuous use

Localização domiciliar dos medicamentos responsáveis pelas intoxicações mais frequentes na cidade de Porto Alegre

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Automedicação em crianças de 0–12 anos no Brasil : um estudo de base populacional

Objetive: Studies have shown that the practice of self-medicating children occurs worldwide and is independent of the country’s economic level, medication policies, or access to health services. This study aimed to estimate and characterize the prevalence of self-medication in the Brazilian population of children aged up to 12 years. Methods: We analyzed the data of 7528 children aged up to 12 years whose primary caregivers responded to the National Survey on Access, Use and Promotion of Rational Use of Medicines in Brazil (PNAUM), a cross-sectional population-based study conducted in 245 Brazilian municipalities. The prevalence of selfmedication was defined as the use of at least one medication without a doctor’s or dentist’s indication 15 days before the interview. Results: The prevalence of self-medication was 22.2% and was more frequent in older children belonging to poorer families and without health insurance. The acute conditions for which there was a higher frequency of self-medication were pain, fever, and cold/allergic rhinitis. Analgesics/antipyretics stood out among the most used medications for self-medication. Conclusions: The prevalence of self-medication to treat acute conditions was high in Brazilian children sampled in PNAUM, emphasizing the management of common symptoms such as pain, fever, and cold/allergic rhinitis in this age group. These findings reinforce the need for educational actions aimed at parents and caregivers.Objetivo: Estudos têm mostrado que a prática de automedicar crianças ocorre mundialmente e independe do nível econômico do país, das políticas de medicamentos ou do acesso aos serviços de saúde. O objetivo deste estudo foi estimar e caracterizar a prevalência de uso de medicamentos por automedicação na população brasileira de crianças de zero a 12 anos de idade. Métodos: Foram analisadas informações de 7.528 crianças de zero a 12 anos cujo cuidador principal respondeu à Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), estudo transversal de base populacional realizado em 245 municípios brasileiros. A prevalência de automedicação foi definida como o uso de pelo menos um medicamento sem indicação de médico ou dentista nos 15 dias anteriores à entrevista. Resultados: A prevalência de automedicação foi de 22,2% e foi mais frequente nas crianças mais velhas e pertencentes a famílias mais pobres e sem plano de saúde. As condições agudas para as quais houve maior frequência de automedicação foram dor, febre, resfriado e rinite alérgica. Analgésicos/antipiréticos destacaram-se entre os medicamentos mais utilizados por automedicação. Conclusões: A prevalência de automedicação no manejo de condições agudas foi elevada nas crianças brasileiras amostradas na PNAUM, com destaque para o manejo de sintomas comuns nessa faixa etária, como dor, febre, resfriado e rinite alérgica. Esses achados reforçam a necessidade de ações educativas voltadas aos pais e cuidadores