Users satisfaction regarding the service provided in community pharmacies

During the last century, the pharmacy professionals have significantly being professionalized, the user is a high priority and not just limited to the sale of pharmaceuticals. As such, it is necessary to know the users, their needs and expectations, their opinions and preferences. This transversal study, observational, correlational, aimed to: determine the degree of satisfaction with the attendance in community pharmacies, if there is a relationship between factors of a personal nature (age and gender) and satisfaction, trying to identify which aspects improve in order to increase satisfaction levels. The sample consisted of 525 respondents. Data collection was conducted in the period from October 2012 to January 2013 in four locations in northern Portugal. It was used a questionnaire consisting of three parts: the first contained items of personal characterization, the second consisted of the scale "Pharmacy Services Questionnaire" (FSQ) validated for the Portuguese language, developed by Larson et al. (2002) and the last had questions about the respondents' opinion. The results showed that the degree of satisfaction with the services of community pharmacies was in majority an average to 39 % and good for 46,1% . Having in mind the factor by gender, females showed a higher degree of satisfaction. Regarding the age group, older users had the highest degree of satisfaction. It was concluded that, generally, community pharmacies bring a higher degree of satisfaction in the older and the female users. "How the pharmacy professionals explain possible side effects" and "how the pharmacy professional answers your questions.", are the two aspects that must be improved to achieve a higher degree of satisfaction. KEYWORDS Satisfaction, Users, Customer Service, Pharmacotherapy Monitoring, Community Pharmacie

Adesão à terapêutica em idosos polimedicados

Polypharmacy, consists of the simultaneous and chronic use of different drugs, is frequent in elderly people (age≥ 65 years) and commits the patient's adherence to therapy, necessary to a successfully treatment. Objectives: Review the scientific evidences of adherence to therapy and polypharmacy in elderly, since this age group is more vulnerable to the use of different drugs. Materials and Methods: A review of published studies between 2005 and July 2015 was carried out using the Pubmed, B-on and SciELO databases, to search the following terms: elderly, polypharmacy, multidrug, polymedicated elderly and therapy adherence. Were used as exclusion criteria: age under 65, seniors not polymedicated, studies in other languages than Portuguese or English, studies published before 2005. Of the 31 studies initially selected, 8 were excluded as meeting any of the exclusion criteria and 23 articles were included in the review. Results and Discussion: The aging process is associated to various diseases, contributing to polypharmacy. In fact, more than half of elderly taking four or more drugs daily and this number increase with the age. Other important problem related to polypharmacy in elderly is the therapy adherence. Besides the variations between studies, the authors indicate values of non-adherence between 20 and 60%, which results in a range of health problems arising out of the increasing of adverse effects, drug-drug interactions, being this risk associated to the number of drugs consumed. Conclusion: More than half of elderly are polymedicated, with a considerable proportion of elderly non-adherent to therapy, which is associated with consequent health risks

Therapy adherence in elderly of Northern Portugal

The elderly population has been growing significantly, leading to an increased prevalence of chronic diseases and consequent taking medication. The complex therapies of elderly can lead to therapy non-adherence, increasing several health risks. Aim This study aimed to estimate the prevalence of therapy adherence and associated factors. Material and Methods This cross-sectional study was based on a questionnaire, with MAT scale (measure of adherence to therapy) validated for the Portuguese population (Lima, 2001) based on the Morisky scale, applied to 52 elderly (≥65 years) from northern Portugal. To assess therapy adherence, those whose average adherence levels were ≥5, were called adherent. It was used descriptive statistics. The level of association between categories of variables was studied through the adjusted residuals (AdR) and the relationship between adherence to the therapeutic and the number of medications taken per day was studied using the Mann-Whitney U test, with a significance level of 5%. The study was approved by Ethics Committee. Results The sample consisted mainly of males elderly (61.5% vs. 38.5%), aged between 67 and 98 years (mean 82.71), and while 48.1% was between 75–84 years old. The participants shows high therapy adherence (96.2%). The non-adherent elderly are related to self-medication (AdR=4.3), with the high level of cholesterol (AdR=2.9) and chronic pain (AdR=2.9). The non-adherent elderly seem tend to take more drugs per day, although not statistically significant (P = 0.063). Conclusions This study shows that a large prevalence of elderly adhered to the therapy prescribed. Self-medication, having high cholesterol and chronic pain and higher number of different drugs per day seem related to non-adherence.info:eu-repo/semantics/publishedVersio

Biodiversity monitoring in wastewater oxidation ponds

In order to study the relationship between Wastewater Oxidation Ponds efficiency and maturation ponds ecological communities, two AGERE systems from Braga neighbouring villages were selected: Cabreiros, CAB and Tebosa, TEB. Every two weeks sampling campaigns were realized (March - July 2007) to gather wastewater simple samples at the systems inflow and outflow. Determinations of Biochemical and Chemical Oxygen Demand and Total Suspended Solids (BOD5, COD and TSS mg/L), Recovered Heterotrophics and Total and Fecal Coliforms (RH, TC and FC, CFU ml/L) were performed at UM-Biology Lab. The removal efficiencies were 10% higher at CAB for BOD5 and COD and 10% higher at TEB for TSS. RH removal was mostly higher than 95%, but on CAB 6 and 9 samples, was respectively null and weak. During almost all the sampling period TC and FC removal were about 100% at both systems, but on samples 6 and 9, TC and FC CFU/ml were higher at CAB outflow than at inflow. Samples from maturation ponds were also gathered and maintained in the lab for a month, as microcosms. The daily microscopic analysis showed that in CAB maturation pond Euglena, Scenedesmus and diatoms are generally predominant whereas in TEB maturation pond the constant presence of Lemna was concomitant with a lesser density and diversity of algae. The samples 6 and 9 from CAB maturation pond, showed an absence of eucaryotic heterotrophics probably associated with the weak or even null removal of TC and FC

Polypharmacy and potentially inappropriate medication in elderly of Northern Portugal

Introduction The growing aging of population and increasing prevalence of chronic diseases require the simultaneous use of drugs, lead to the issue of polypharmacy and potentially interactions and inappropriate use. Aim To characterize polymedicated elderly and related factors, identify potentially interactions and inappropriate medication in elderly. Material and Methods This cross-sectional study was based on a questionnaire applied to 69 elderly (≥65 years) from northern Portugal. It was considered as polymedicated seniors taking ≥5 drugs. Beers list and the Delafuente classification were used to evaluate the therapeutic and possible interactions. It was used descriptive statistics and a model of binary regression, with a significance of 5%. The study was approved by Ethics Committee. Results The sample consisted mainly of males (53.6% vs. 46.4%), aged between 66 and 99 years (mean 82.01), while 65.2% have more than 80 years. However, most elderly are not polymedicated (58%), on average 4.61 different drugs are administered per day (maximum=19), antihypertensives (36.2%) and antacids (30.04%) are the most prescribed. Hypertension and depression increase the risk of polymedication eightfold (P = 0.004) and fivefold (P = 0.011) respectively. Female gender seems increase the risk of polypharmacy threefold, although not statistically significant (P = 0.102), and regarding age, the older age group (>85 years) seems reduces the risk of polypharmacy in 0.6 fold, but also not statistically significant. According with Delafuente classification, 1.4% of elderly has potentially drug interactions (Omeprazole and Iron salts). According to the list of Beers, 5.8% of seniors take drugs that classified as having some indications (hydroxyzine, amitriptyline). Conclusions Regarding polypharmacy, 42% of elderly are polymedicated with an average of about 5 different drugs per day, antihypertensives and antacids the most prescribed. Hypertension and depression are highly associated with polypharmacy. We identified one potentially drug interaction and about 6% of elderly taking drugs that classified as having some indications.info:eu-repo/semantics/publishedVersio

Farmacoterapia no idoso: caraterização, adesão à terapêutica e medicamentos potencialmente inapropriados

Aging is a dynamic process in which biochemical and physiological changes are related to a higher frequency of pathological processes, which ultimately lead the human being to death. Part of these alterations and pathologies are improved using medicines, so older adults are great consumers of medicines. Several instruments have been used to evaluate the use of inappropriate medications in older adults, with Beers Criteria frequently used. The concept of medication adherence has undergone changes over time and represents the degree to which the patient’s behaviour corresponds and agrees with the recommendations of a doctor or other health professional. Medication non-adherence to entails a decrease in the quality of life of the patients and high costs for the health systems. Objectives: To characterize drug therapy in older adult users of a northern Portuguese community pharmacy, as well as to identify the presence of potentially inappropriate medications (PIMs) in the older adult and to assess medication adherence. Methods: Exploratory and descriptive study. The target population was older adult users of a community pharmacy in the municipality of Valpaços, Portugal. The data collection instrument used was a questionnaire applied in the form of a structured interview. The potentially inappropriate medications (PIMs) identification was based on the most recent version of the Beers Criteria published in 2019. The MAT (Measurement of Adherence to Treatments) scale was used to evaluate medication adherence. The statistical treatment included the calculation of absolute and relative frequencies, measures of central tendency and dispersion. Results: 60 older adult people were interviewed, 53.3% of them women. The average age was 78.35 years. Among these, 55.0% were married/had a non-marital partner, 71.7% lived accompanied, 26.7% had primary school education, 40.0% received less than 300 Euros monthly and 95.0% lived in the municipality of Valpaços. Each older adult person consumes on average 6 different types of medication per day. Major polymerization was present in 66.7% of older adults, and 94.2% of the drugs being prescribed by the physician. In 34.7% of the cases, the medication had been used for at least 1 year and only 3.4% reported feeling adverse reactions. Of the total 326 drugs identified, the most prescribed pharmacotherapeutic groups were drugs acting in the cardiovascular system 27.2% and in the digestive system 24.2%. Additionally, 15 drugs classified as potentially inappropriate medication were identified in the older adult. Most of the older adults (76.7%) did not adhere to drug therapy, these being mainly females with primary education, living with a partner and less than 300 euros/month. Conclusion: Polymedication and the use of potentially inappropriate medications are common in older adults. Medication adherence is low.O envelhecimento é um processo dinâmico que provoca alterações bioquímicas e fisiológicas, que ocasionam maior incidência de processos patológicos. Parte destas alterações e patologias são melhoradas recorrendo a medicamentos, pelo que os idosos são grandes consumidores de medicamentos. Têm sido criados diversos instrumentos para avaliação do uso de medicamentos inapropriados no idoso, sendo os Critérios de Beers dos mais frequentemente utilizados. O conceito de adesão à terapêutica, que tem sofrido alterações ao longo do tempo, representa o grau em que o comportamento do doente corresponde e concorda com as recomendações de um médico ou outro profissional de saúde. A não adesão à terapêutica acarreta diminuição da qualidade de vida dos doentes e elevados custos para os sistemas de saúde. Objetivos: Caracterizar a terapêutica medicamentosa nos idosos utentes de uma farmácia comunitária do interior Norte de Portugal, bem como identificar a presença de medicamentos potencialmente inapropriados (MPI) no idoso e avaliar a adesão ao regime terapêutico medicamentoso. Métodos: Estudo do tipo descritivo exploratório. A população alvo foram idosos utentes de uma farmácia comunitária no concelho de Valpaços, Portugal. O instrumento de recolha de dados utilizado foi um questionário aplicado sob a forma de entrevista estruturada. A identificação do uso de medicamentos potencialmente inapropriados (MPI) teve por base a versão mais recente dos Critérios de Beers, publicada em 2019. Foi utilizada a escala MAT (Medida de Adesão aos Tratamentos) para avaliar a adesão ao regime terapêutico medicamentoso. O tratamento estatístico incluiu o cálculo de frequências absolutas e relativas, medidas de tendência central e de dispersão. Resultados: Foram entrevistados 60 idosos, sendo 53,3% mulheres. A idade média foi de 78,4 anos. Verificou-se que 55,0% eram casados/ união de facto, 71,7% viviam acompanhados, 26,7% tinham concluído o 1º ciclo, 40,0% recebiam mensalmente menos de 300 euros e 95,0% viviam em Valpaços. Em média, cada idoso consome 6 medicamentos diferentes por dia. A polimedicação major esteve presente em 66,7%, sendo que 94,2% desses fármacos foram prescritos pelo médico. Em 34,7% dos casos, a medicação já era usada há pelo menos 1 ano e apenas 3,4% referiu sentir alguma reação adversa. Dos 326 fármacos identificados, os grupos farmacoterapêuticos mais prescritos foram medicamentos usados no sistema cardiovascular 27,2% e no sistema digestivo 24,2%. Identificaram-se 15 medicamentos potencialmente inapropriados em idosos. A maioria dos idosos (76,7%) não adere ao regime terapêutico medicamentoso, sendo estes principalmente do sexo feminino, com ensino primário, que viviam com companheiro e menos de 300 euros/mês. Conclusão: A polimedicação e a toma de medicamentos potencialmente inapropriados são frequentes nos idosos. A adesão à terapêutica medicamentosa é baixa.El envejecimiento es un proceso dinámico que provoca cambios bioquímicos y fisiológicos, que se relacionan con una mayor incidencia de procesos patológicos, que finalmente conducen a la muerte. Algunas de las alteraciones y patologías se mejoran con el uso de medicamentos, lo que lleva a que los ancianos sean grandes consumidores de medicamentos. Se han creado varios instrumentos para evaluar el uso de medicamentos inapropiados en el anciano, siendo los Criterios de Beers de los más utilizados. El concepto de adherencia al tratamiento ha cambiado con el tiempo y representa el grado en el que el comportamiento del paciente corresponde y está de acuerdo con las recomendaciones de un médico u otro profesional de salud. La no adherencia al tratamiento resulta en reducción de la calidad de vida de los pacientes y altos costos para los sistemas de salud. Objetivos: Caracterizar la farmacoterapia en usuarios ancianos de una farmacia comunitaria del norte de Portugal, así como identificar la presencia de medicamentos potencialmente inapropiados (MPI) en ancianos y evaluar la adherencia al régimen terapéutico. Métodos: Estudio descriptivo y exploratorio. La población en estudio fueron ancianos usuarios de una farmacia comunitaria en el municipio de Valpaços, Portugal. Se aplicó un cuestionario en forma de entrevista estructurada. La identificación del uso de medicamentos potencialmente inapropiados (MPI) se basó en la versión más reciente de los Criterios de Beers, publicada en 2019. La escala MAT (Medida de adherencia a los tratamientos) se utilizó para evaluar la adherencia al tratamiento con medicamentos. El tratamiento estadístico incluyó el cálculo de frecuencias absolutas y relativas, medidas de tendencia central y dispersión. Resultados: Se entrevistaron 60 personas mayores, de las cuales 53,3% eran mujeres. La edad media fue de 78,35 años. Se constató que el 55,0% estaba casado/ pareja de hecho, el 71,7% vivía acompañado, el 26,7% había completado la educación primaria, el 40,0% recibía menos de 300 euros al mes y el 95,0% vivía en Valpaços. Cada anciano consume, en promedio, 6 medicamentos diferentes al día. La polimedicación mayor estuvo presente en el 66,7% y el 94,2% de estos fármacos fueron prescritos por el médico. En el 34,7% de los casos, los medicamentos se utilizaban al menos hace 1 año, y solo el 3,4% informó haber experimentado reacciones adversas. De los 326 fármacos diferentes identificados, los grupos farmacoterapéuticos más prescritos fueron los usados para el sistema cardiovascular (27,2%) y para el sistema digestivo (24,2%). Se identificaron 15 medicamentos potencialmente inapropiados en ancianos. La mayoría de las personas mayores (76,7%) no cumple el régimen terapéutico, siendo mayoritariamente mujeres, con estudios primarios, viviendo en pareja y con menos de 300 euros/mes. Conclusión: La polimedicación y el uso de medicamentos potencialmente inapropiados son frecuentes en los ancianos. La adherencia a la terapia con medicamentos es bajainfo:eu-repo/semantics/publishedVersio

Characterization of medication use among the elderly of North Portugal

Aging associated with chronic comorbidities leads to Polypharmacy, but the complex therapies in elderly can lead to therapy non-adherence, increasing costs and several health risks. Objectives: To characterize medication use and related factors among northern Portuguese elderly. Methods: This cross-sectional population-based study was centered on a structured interview to 442 elderly (≥65 years), non-probabilistic sample by convenience, at home and institutions in northern Portugal. It was considered as polymedicated seniors taking ≥5 drugs daily. Beers criteria (2012) were used to evaluate the potentially inappropriate medication use. It was used descriptive statistics and univariate and multivariate statistical analysis, with a significance level of 5%. Results: The sample consisted mainly of females (56.6%), aged between 65 and 101 years (mean 76.84 ± 8.07). The prevalence of medication use was 97.3%. Most elderly are polymedicated (54.1%), on average 5.15 different drugs are administered per day. The most commonly prescribed groups were: cardiovascular drugs (82.8%), central nervous system agents (54.2%) and drugs with an effect on the digestive tract (40.9%). According to the Beers criteria, 53.5% of seniors taking potentially inappropriate medication. Polypharmacy was positively associated with living in littoral sub-region (p<0.001), having a reasonable (p=0.002) or poor health self-perception (p<0.001), self-reported chronic diseases (p<0.001) and number of doctors (p=0.003). Conclusions: Results shows a high proportion of medication use among the northern Portuguese elderly, including potentially inappropriate. The risk of polypharmacy is related to coastal region, perception of reasonably/poor health, chronic diseases and the number of doctors.info:eu-repo/semantics/publishedVersio

Caraterização e adesão à terapêutica farmacológica em diabéticos do Nordeste de Portugal

IA Diabetes mellitus é uma doença crónica com uma prevalência preocupante. A OMS indica que o número de indivíduos diabéticos quadruplicou entre 1980 e 2014 com valores de prevalência em adultos de 4,7% e 8,5% nesses anos, respetivamente. Objetivos: Determinar a prevalência de diferentes tipos de diabetes e a frequência do controlo glicémico, identificar mudanças nos hábitos de vida, caraterizar e determinar a adesão à terapêutica farmacológica. Materiais e Métodos: Foi desenvolvido um estudo descritivo-correlacional e transversal em 202 adultos diabéticos da região de Trás-os-Montes. A recolha de dados foi efetuada sob a forma de entrevista, através da aplicação de um questionário e da escala MAT (Medida de Adesão à Terapêutica) validada para a população portuguesa. Resultados: Dos 202 diabéticos, 73,8% apresentavam diabetes do tipo 2 enquanto 26,2% diabetes do tipo 1. 43,6% considera ter uma qualidade de vida “nem boa nem má” e 37,1% “boa” sendo que 52% responderam que teriam uma melhor qualidade de vida se não tivessem diabetes. Em relação ao controlo da doença, a maioria faz controlo glicémico diariamente (38,1%) e semanalmente (23,8%). Relativamente à mudança de estilos de vida, 89,6% dos participantes considera ser importante para controlar a diabetes, embora nem todos indiquem ter modificado hábitos de alimentação (60,4%) e de atividade física (33,7%) após o diagnóstico da doença. Os fármacos mais utilizados pelos diabéticos forma a metformina (46%) e a insulina (38%) tendo sido o uso de incretinomiméticos inibidores da Dipeptidil peptidase IV (DPP-4) mais baixo (13,9%). Deste novos fármacos, os mais usados foram associação de metformina com vildagliptina. Relativamente a este novo grupo de fármacos, 50% dos utilizadores indica que consegue controlar mais facilmente as glicémias, sendo que a maioria se encontra satisfeita com esta nova terapia. A prevalência de adesão à terapêutica farmacológica é elevada neste grupo de diabéticos (92,6%) tendo sido obtido um score de 5.67±0.49 (escala entre 1-6, em que médias menores que 5 pontos se consideram “não adesão”). Neste estudo, os fatores associados à adesão foram o género e a frequência do controlo glicémico. O género feminino é mais aderente e os diabéticos que controlam a glicémia pelo menos uma vez ao dia são mais aderentes que os que a controlam semanalmente. Discussão e Conclusões: Embora a adesão à terapêutica farmacológica e seja fundamental para o controlo da diabetes, a mudança de estilos de vida e o controlo da glicémia, são vistos pelos diabéticos como importantes fatores. Em conclusão, a majoria dos diabéticos adere à terapêutica farmacológica que consiste sobretudo em metformina e insulina.info:eu-repo/semantics/publishedVersio

Diabetes mellitus therapy adherence and therapy characterization in Northeast Portugal: classical vs dipeptidyl peptidase iv (dpp-4) inhibitors

Diabetes mellitus is a chronic disease characterizes by the absence of insulin production by the body or the inability of their effectively use. Aim: To determine prevalence of diabetes types, the frequency of glycemic control, identify change in eating habits and physical activity, characterize the pharmacological therapy concerning classic and novel therapeutic approaches and verify the therapy adherence in diabetics of northeast Portugal. Methods: A cross-sectional study was performed by applying an interview to 202 adult diabetics of Trás-os-Montes region (Portugal), based on a questionnaire, with MAT scale (measure of adherence to therapy) validated for the Portuguese population. Results: The results showed 73,8% and 26,2% diabetics of type 2 and type 1, respectively. Most of the total diabetics (38,1%) have controlled the glycemic once a day, 60.4% have modified eating habits and 89.7% increased the frequency of physical activity. The drugs more used were metformin (63) and insulin (52) and the use of incretin mimetics was low (13.9%, 28), with more expression of the association of metformin and vildagliptin (21). The prevalence of diabetics adherents to therapy was 92,6%. Conclusions: The majority of diabetics adhered to pharmacological therapy and the use of dipeptidyl peptidase IV (DPP-4) inhibitors remains low.info:eu-repo/semantics/publishedVersio