Description of the complexity of prescribed medication regimens in primary health care of Ribeirão Preto - SP

Introduction: Pharmacotherapy is the main therapeutic resource for the management of diseases. However, the number of drugs prescribed, dose frequency, and mode of administration can make the treatment more complex and influence treatment outcomes. The aim of this study was to measure the complexity of prescribed medication regimens in primary health care (PHC) services in Ribeirão Preto, Brazil. Methods: This cross-sectional study included 1,009 participants: 889 from primary health units and 120 from family health units in Ribeirão Preto, Brazil. Treatment complexity was assessed using the Medication Regimen Complexity Index (MRCI). Results: MRCI mean scores were 12.5 points (SD = 9.3) and dose frequency was the major contributor to increase the score. The complexity of pharmacotherapy showed a significant correlation with the number of prescribed medications (r = 0.93, p < 0.01), but not with patients' age (r = 0.28, p < 0.01). There is also no difference in complexity between the sexes (p = 0.83) and the types of primary health care service (p = 0.31). An analysis of variance revealed that patients with lower levels of education receive more complex prescriptions (p < 0.01). Conclusions: The pharmacotherapy prescribed in PHC services from Ribeirão Preto, Brazil is complex, and there is a need to concentrate efforts and adopt strategies to simplify drug prescription without compromising patient's clinical status. Keywords: Primary health care; drug prescriptions; drug therapy; medication regimen complexit

Description of the complexity of prescribed medication regimens in primary health care of Ribeirão Preto - SP

Introduction: Pharmacotherapy is the main therapeutic resource for the management of diseases. However, the number of drugs prescribed, dose frequency, and mode of administration can make the treatment more complex and influence treatment outcomes. The aim of this study was to measure the complexity of prescribed medication regimens in primary health care (PHC) services in Ribeirão Preto, Brazil. Methods: This cross-sectional study included 1,009 participants: 889 from primary health units and 120 from family health units in Ribeirão Preto, Brazil. Treatment complexity was assessed using the Medication Regimen Complexity Index (MRCI). Results: MRCI mean scores were 12.5 points (SD = 9.3) and dose frequency was the major contributor to increase the score. The complexity of pharmacotherapy showed a significant correlation with the number of prescribed medications (r = 0.93, p < 0.01), but not with patients' age (r = 0.28, p < 0.01). There is also no difference in complexity between the sexes (p = 0.83) and the types of primary health care service (p = 0.31). An analysis of variance revealed that patients with lower levels of education receive more complex prescriptions (p < 0.01). Conclusions: The pharmacotherapy prescribed in PHC services from Ribeirão Preto, Brazil is complex, and there is a need to concentrate efforts and adopt strategies to simplify drug prescription without compromising patient's clinical status. Keywords: Primary health care; drug prescriptions; drug therapy; medication regimen complexit

Drug-Induced Delirium among Older People

Although underdiagnosed, delirium is a common and potentially preventable problem in older patients, being associated with morbimortality. Drugs have been associated with the development of delirium in the geriatric population and may be considered the most easily reversible trigger. Polypharmacy, prescription of deliriogenic, anticholinergic and potentially inappropriate drugs are contributing factors for the occurrence of the disturb. Furthermore, changes in pharmacokinetic and pharmacodynamic parameters, which are intrinsic of the aged process, may contribute for cognitive impairment. Identification and reversal of clinical conditions associated with delirium are the first step to treat the disturbance, as well as mitigation of environmental factors and the exposition to deliriogenic drugs. Current evidence does not support the prescription of antipsychotics and benzodiazepines for the treatment of delirium. However, the judicious use of first- or second-generation antipsychotics can be considered in severe cases. Multi-component non-pharmacological, software-based intervention to identify medications that could contribute to delirium, predictive models, tools, training of health professionals and active actions of pharmacovigilance may contribute to the screening, prevention, and management of delirium in older people. Besides, it is also important to improve the report of drug-induced delirium in medical records, to develop properly risk management plans and avoid cascade iatrogenesis

Validated medication deprescribing instruments for patients with palliative care needs a systematic review

Objectives: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. Methods: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by 2 independent researchers. Experimental and observational studies were eligible for inclusion. Results: Out of the 5791 studies retrieved, after excluding duplicates (n = 1050), conducting title/abstract screening (n = 4741), and full reading (n = 41), only 1 study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to 2 groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. Conclusions: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only 1 of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear

Drug prescriptions and patients\' knowledge in Primary Health Care: comparative analysis of the traditional basic medical care service and the Family Health Strategy in the city of Ribeirão Preto- SP

A Estratégia de Saúde da Família (ESF) tem apresentado bons resultados em saúde e pode ser um instrumento importante para a efetivação do Uso Racional de Medicamentos (URM). A prescrição medicamentosa é um componente fundamental para a promoção do URM, portanto a ESF precisa ter uma abordagem diferenciada também em relação ao processo de prescrição. Este estudo transversal visa analisar comparativamente as prescrições provenientes do serviço de atendimento médico básico tradicional com aquelas provindas da ESF, assim como avaliar a compreensão dos pacientes sobre estas prescrições, no município de Ribeirão Preto- SP. Este estudo incluiu 1.053 participantes, os quais foram alocados em dois grupos: 932 usuários provenientes do modelo de atendimento básico tradicional (Grupo A - GA) e 121 usuários provenientes da ESF (Grupo B - GB). Foram coletados dados sociodemográficos e aplicou-se um instrumento para analisar a compreensão do usuário sobre a sua receita de medicamentos. As prescrições foram ainda copiadas e posteriormente analisadas de acordo com: conformidade com os itens exigidos por lei; indicadores de qualidade da prescrição propostos pela OMS; complexidade farmacoterapêutica; presença de interações medicamentosas. A maioria dos participantes era do sexo feminino (77,5%), possuía renda per capita de até um salário mínimo (67,2%) e a escolaridade correspondente ao ensino fundamental completo ou não (63,4%). A média de idade foi de 53,9 anos (DP= 17,5). Quanto à compreensão do paciente sobre a prescrição, 63,3% dos usuários do GA apresentaram compreensão insuficiente, no GB esta frequência foi de apenas 18,2%. As prescrições da ESF também se mostraram estatisticamente superiores quanto ao cumprimento dos aspectos legais: presença da forma farmacêutica (70,7% GA; 80,2% GB), dose (70,9% GA; 79,3% GB), posologia completa (63% GA; 75,2% GB), via de administração (58,3% GA; 83,5% GB), duração do tratamento (76,9% GA; 92,6% GB), endereço do prescritor (82,6% GA; 96,7% GB) e ausência de rasuras (90,3% GA; 96,7% GB). A média de medicamentos prescritos foi de 3,9 no GA (DP= 2,8) e 3,5 no GB (DP = 2,4). Em ambos os grupos cerca de 92% dos medicamentos foram prescritos pela denominação oficial, aproximadamente 91% constavam na lista de medicamentos essenciais do município. 11% das prescrições continham ao menos uma indicação de antibiótico. Medicamentos injetáveis constavam em 9,7% das prescrições do GA e 3,3% das do GB. A média de complexidade foi de 12,6 pontos no GA (DP= 9,4) e 11,8 pontos no GB (DP= 8,3). Em relação à presença de interações medicamentosas potencias, no GA a média de interações por prescrição foi de 2,5 (DP = 3,9), no GB o valor foi de 1,9 (DP= 2,6). Em conclusão, os resultados revelam práticas inapropriadas na prescrição de medicamentos em ambas as modalidades de atendimento primário, entretanto, os prescritores da ESF parecem estar mais preparados para realizar a prescrição racional de medicamentos, ainda que não estejam no padrão ideal.The Family Health Strategy (FHS) has shown good results in health and it is argued that this strategy can be an important tool for ensuring the Rational Use of Drugs (RUD). The rational prescription of drugs is a key component to promote RUD, thus the FHS must have a differential approach regarding drug prescription process too. This cross-sectional research aims to compare drug prescriptions derived from the traditional basic medical care service with those from the FHS, as well as to measure patients\' knowledge about these prescriptions, in Ribeirão Preto- SP. This study includes 1.053 participants, which were separated into two groups: 932 individuals coming from the traditional basic medical care service (Group A - GA) and 121 individuals from the FHS (Group B - GB). Sociodemographic data was collected and an instrument to analyze patient\'s knowledge about their prescription was applied. Prescriptions were also copied and analyzed according to: compliance with prescription standards demanded by the law; prescription quality indicators proposed by WHO; pharmacotherapeutic complexity; presence of drug interactions. Most participants were female (77.5%) had per capita income up to minimum wage (67.2%) and level of education corresponding to elementary school, complete or not (63.4%). The average age was 53.9 years (SD= 17.5). Regarding patient\'s knowledge about their prescriptions, 63.3% of GA individuals had insufficient knowledge; in GB this rate was only 18.2%. Furthermore, prescriptions from FHS also show statistically superior results about compliance with standards demanded by the law, such as: the presence of the pharmaceutical form (70.7% GA; 80.2% GB), dose (70.9% GA; 79.3% GB), comprehensive posology (63% GA; 75.2% GB), administration route (GA 58.3%; 83.5% GB), time of therapy (76.9% GA; 92.6% GB) prescriber\'s address(82.6% GA; GB 96.7%) and absence of erasures (90.3% GA; GB 96.7%). The average number of prescribed drugs was 3.9 in GA (SD = 2.8) and 3.5 in GB (SD = 2.4). In both groups about 92% of the drugs were prescribed by the official nomination, approximately 91% of prescribed drugs were listed on the Essential Medications List of the city and 11% of prescriptions had at least one antibiotic prescribed. Injectable drugs were prescribed in 9.7% of prescriptions from GA and 3.3% from GB. The average complexity was 12.6 points in GA (SD = 9.4) and 11.8 points in GB (SD = 8.3). About the existence of potential drug interactions, the average drug interactions by prescriptions in GA was 2.5 (SD = 3.9), in GB it was 1.9 (SD = 2.6). All things considered, the results reveal inappropriate practices in drug prescription in both modalities of Primary Health Care, nonetheless, prescribers from FHS seem to be more prepared to make rational drug prescription, although they are not still in the ideal pattern

Drug prescriptions and patients\' knowledge in Primary Health Care: comparative analysis of the traditional basic medical care service and the Family Health Strategy in the city of Ribeirão Preto- SP

A Estratégia de Saúde da Família (ESF) tem apresentado bons resultados em saúde e pode ser um instrumento importante para a efetivação do Uso Racional de Medicamentos (URM). A prescrição medicamentosa é um componente fundamental para a promoção do URM, portanto a ESF precisa ter uma abordagem diferenciada também em relação ao processo de prescrição. Este estudo transversal visa analisar comparativamente as prescrições provenientes do serviço de atendimento médico básico tradicional com aquelas provindas da ESF, assim como avaliar a compreensão dos pacientes sobre estas prescrições, no município de Ribeirão Preto- SP. Este estudo incluiu 1.053 participantes, os quais foram alocados em dois grupos: 932 usuários provenientes do modelo de atendimento básico tradicional (Grupo A - GA) e 121 usuários provenientes da ESF (Grupo B - GB). Foram coletados dados sociodemográficos e aplicou-se um instrumento para analisar a compreensão do usuário sobre a sua receita de medicamentos. As prescrições foram ainda copiadas e posteriormente analisadas de acordo com: conformidade com os itens exigidos por lei; indicadores de qualidade da prescrição propostos pela OMS; complexidade farmacoterapêutica; presença de interações medicamentosas. A maioria dos participantes era do sexo feminino (77,5%), possuía renda per capita de até um salário mínimo (67,2%) e a escolaridade correspondente ao ensino fundamental completo ou não (63,4%). A média de idade foi de 53,9 anos (DP= 17,5). Quanto à compreensão do paciente sobre a prescrição, 63,3% dos usuários do GA apresentaram compreensão insuficiente, no GB esta frequência foi de apenas 18,2%. As prescrições da ESF também se mostraram estatisticamente superiores quanto ao cumprimento dos aspectos legais: presença da forma farmacêutica (70,7% GA; 80,2% GB), dose (70,9% GA; 79,3% GB), posologia completa (63% GA; 75,2% GB), via de administração (58,3% GA; 83,5% GB), duração do tratamento (76,9% GA; 92,6% GB), endereço do prescritor (82,6% GA; 96,7% GB) e ausência de rasuras (90,3% GA; 96,7% GB). A média de medicamentos prescritos foi de 3,9 no GA (DP= 2,8) e 3,5 no GB (DP = 2,4). Em ambos os grupos cerca de 92% dos medicamentos foram prescritos pela denominação oficial, aproximadamente 91% constavam na lista de medicamentos essenciais do município. 11% das prescrições continham ao menos uma indicação de antibiótico. Medicamentos injetáveis constavam em 9,7% das prescrições do GA e 3,3% das do GB. A média de complexidade foi de 12,6 pontos no GA (DP= 9,4) e 11,8 pontos no GB (DP= 8,3). Em relação à presença de interações medicamentosas potencias, no GA a média de interações por prescrição foi de 2,5 (DP = 3,9), no GB o valor foi de 1,9 (DP= 2,6). Em conclusão, os resultados revelam práticas inapropriadas na prescrição de medicamentos em ambas as modalidades de atendimento primário, entretanto, os prescritores da ESF parecem estar mais preparados para realizar a prescrição racional de medicamentos, ainda que não estejam no padrão ideal.The Family Health Strategy (FHS) has shown good results in health and it is argued that this strategy can be an important tool for ensuring the Rational Use of Drugs (RUD). The rational prescription of drugs is a key component to promote RUD, thus the FHS must have a differential approach regarding drug prescription process too. This cross-sectional research aims to compare drug prescriptions derived from the traditional basic medical care service with those from the FHS, as well as to measure patients\' knowledge about these prescriptions, in Ribeirão Preto- SP. This study includes 1.053 participants, which were separated into two groups: 932 individuals coming from the traditional basic medical care service (Group A - GA) and 121 individuals from the FHS (Group B - GB). Sociodemographic data was collected and an instrument to analyze patient\'s knowledge about their prescription was applied. Prescriptions were also copied and analyzed according to: compliance with prescription standards demanded by the law; prescription quality indicators proposed by WHO; pharmacotherapeutic complexity; presence of drug interactions. Most participants were female (77.5%) had per capita income up to minimum wage (67.2%) and level of education corresponding to elementary school, complete or not (63.4%). The average age was 53.9 years (SD= 17.5). Regarding patient\'s knowledge about their prescriptions, 63.3% of GA individuals had insufficient knowledge; in GB this rate was only 18.2%. Furthermore, prescriptions from FHS also show statistically superior results about compliance with standards demanded by the law, such as: the presence of the pharmaceutical form (70.7% GA; 80.2% GB), dose (70.9% GA; 79.3% GB), comprehensive posology (63% GA; 75.2% GB), administration route (GA 58.3%; 83.5% GB), time of therapy (76.9% GA; 92.6% GB) prescriber\'s address(82.6% GA; GB 96.7%) and absence of erasures (90.3% GA; GB 96.7%). The average number of prescribed drugs was 3.9 in GA (SD = 2.8) and 3.5 in GB (SD = 2.4). In both groups about 92% of the drugs were prescribed by the official nomination, approximately 91% of prescribed drugs were listed on the Essential Medications List of the city and 11% of prescriptions had at least one antibiotic prescribed. Injectable drugs were prescribed in 9.7% of prescriptions from GA and 3.3% from GB. The average complexity was 12.6 points in GA (SD = 9.4) and 11.8 points in GB (SD = 8.3). About the existence of potential drug interactions, the average drug interactions by prescriptions in GA was 2.5 (SD = 3.9), in GB it was 1.9 (SD = 2.6). All things considered, the results reveal inappropriate practices in drug prescription in both modalities of Primary Health Care, nonetheless, prescribers from FHS seem to be more prepared to make rational drug prescription, although they are not still in the ideal pattern

Impact of the inclusion of a clinical pharmacist in the allogeneic hematopoietic stem-cell transplantation team

O transplante de células-tronco hematopoiéticas (TCTH) é uma das terapias mais importantes em hematologia. Entretanto, trata-se de um procedimento dispendioso, associado a morbimortalidade e que envolve uma farmacoterapia complexa. Neste cenário, destaca-se a possibilidade de contribuição do farmacêutico clínico. Este estudo objetivou avaliar o impacto da inserção do farmacêutico clínico na equipe de TCTH alogênico nos desfechos: mortalidade relacionada ao transplante, falha de enxertia, incidência de doença do enxerto contra o hospedeiro (DECH), tempo de internação, tempo para enxertia, número de reinternações, número de Problemas Relacionados à Farmacoterapia (PRFs), adesão e conhecimento sobre a farmacoterapia. Trata-se de um estudo de intervenção com controle histórico em que o farmacêutico atuou no grupo intervenção durante as fases: pré-TCTH, TCTH propriamente dito e pós-TCTH imediato. O acompanhamento farmacoterapêutico consistiu na monitorização diária (dias úteis) das prescrições e da condição clínica dos pacientes, identificação, monitorização e resolução de PRFs e participação nas discussões com a equipe clínica. Após a alta hospitalar, o farmacêutico realizou consultas, monitorando a adesão e o conhecimento sobre os medicamentos em uso. Ao todo, 33 indivíduos foram incluídos no grupo intervenção (GI) e 28 no grupo controle histórico (GC). Os dois grupos apresentaram características sociodemográficas e clínicas similares. A maior parte dos pacientes recebeu indicação para o TCTH em decorrência de uma doença hematológica maligna, com predomínio de medula óssea como principal fonte de células-tronco. A frequência de transplantes aparentados foi superior no GC (p = 0,0427). Foram encontrados 250 PRFs, esclarecidas 59 dúvidas da equipe e realizadas 309 intervenções no GI. Os PRFs decorreram principalmente de interações medicamentosas (36,80%), reações adversas à medicamentos (18,0%) e sobredoses (12,0%). As classes terapêuticas mais envolvidas foram os anti-infecciosos de uso sistêmico e os antineoplásicos e imunomoduladores. Obteve-se uma média de 9,36 (DP= 6,97) intervenções por paciente, abrangendo principalmente reduções de dose (19,09%), ajustes de horário de administração (18,12%), atividades educativas/qualificação da equipe (15,21%) e retirada de fármacos (10,68%). Quanto à aceitabilidade, 85,8% das intervenções foram aceitas, 3,9% foram aceitas com alterações, 7,1% não foram aceitas sem justificativa e 3,2% não foram aceitas com justificativa. As intervenções significantes ou muito significantes representaram 75,4% dos casos. Em média, cada paciente passou por 4,68 consultas farmacêuticas (DP = 1,91) durante o pós-TCTH imediato e o aumento no conhecimento e na adesão pôde ser evidenciado (p = 0,0001; p = 0,0115, respectivamente). Não foi possível demonstrar diferenças entre GI e GC na mortalidade, falha de enxertia, DECH, tempo de internação, tempo para enxertia e reinternações. Contudo, as intervenções farmacêuticas foram necessárias principalmente em pacientes com internações prolongadas (p < 0,001), que necessitaram de reinternações (p < 0,001), que utilizaram mais medicamentos (p < 0,001) e/ou que apresentaram DECH (p < 0,001) ou falha de enxertia (p = 0,010). Apesar da dificuldade na mensuração do impacto do acompanhamento farmacoterapêutico nos desfechos clínicos, é notável a contribuição em pontos relevantes do transplante. O farmacêutico realizou intervenções clinicamente relevantes e auxiliou no gerenciamento da farmacoterapia, contudo, a abordagem multidisciplinar é fundamental para maximizar os ganhos.Hematopoietic stem cell transplantation (HSCT) is one of the most important therapies in hematology. However, it is an expensive procedure, associated with substantial rates of morbidity and mortality and which involves highly complex pharmacotherapy. In this scenario, the potential contribution of the clinical pharmacist is highlighted. This study aimed to evaluate the impact of the inclusion of a clinical pharmacist in the allogeneic HSCT team on the outcomes: transplant-related mortality, graft failure, incidence of graft versus host disease (GVHD), length of hospital stay, time for grafting, number hospital readmissions, number of Drug Related Problems (DRPs), adherence and knowledge about pharmacotherapy. This is an interventional study with historical control in which the pharmacist performed tasks in the intervention group during the transplantation phases: preHSCT, HSCT itself and immediate post-HSCT. This professional daily reviewed prescriptions and patient\'s clinical condition, identified, monitored and solved DRPs and participated in discussions with the multidisciplinary team. After hospital discharge, the pharmacist also conducted consultations, monitoring adherence and knowledge about the drugs in use. 33 participants were included in the intervention group (IG) and 28 in the historical control group (CG). Both groups had similar sociodemographic and clinical characteristics. Most patients received an indication for HSCT due to malignant hematological diseases, with predominance of bone marrow as the main source of stem cells. The frequency of related transplants was higher in the CG (p = 0.0427). In the IG, a total of 250 DRPs were obtained, 59 team doubts were solved and 309 interventions were carried out. DRPs were mainly drug interactions (36.80%), adverse drug reactions (18.0%) and overdoses (12.0%). The therapeutic classes most involved were anti-infectives for systemic use, antineoplastic and immunomodulators. An average of 9.36 (SD = 6.97) interventions per patient was obtained, mainly covering dose reductions (19.09%), administration schedule adjustments (18.12%), educational activities (15.21 %) and drug withdrawal (10.68%). Regarding acceptability, 85.8% of the interventions were accepted, 3.9% were accepted with changes, 7.1% were not accepted without justification and 3.2% were not accepted with justification. Significant or very significant interventions represented 75.4% of cases. On average, each patient participated in 4.68 pharmaceutical consultations (SD = 1.91) during the immediate post-HSCT and the increase in knowledge and adherence could be proved (p = 0.0001; p = 0.0115, respectively). It was not possible to demonstrate differences between IG and CG in mortality, graft failure, GVHD, length of hospital stay, time for grafting and hospital readmissions. However, pharmaceutical interventions were necessary mainly in patients with prolonged hospitalizations (p <0.001), who required hospital readmissions (p <0.001), who used a greater number of drugs (p <0.001) and/or who presented GVHD (p <0.001) or graft failure (p = 0.010). Despite the difficulty in measuring the impact of pharmaceutical care on clinical outcomes, the contribution in relevant and measurable points of the transplant was remarkable. The pharmacist was able to perform clinically relevant interventions and to assist the HSCT team in pharmacotherapeutic management, however, the multidisciplinary approach is essential to maximize the achievements

CARACTERIZAÇÃO DO PERFIL DE INTERAÇÕES MEDICAMENTOSAS POTENCIAIS EM PRESCRIÇÕES DA ATENÇÃO PRIMÁRIA DE RIBEIRÃO PRETO - SPDOI: http://dx.doi.org/10.5892/ruvrd.v15i1.4037

Objetivo. Este estudo transversal visa traçar o perfil de interações medicamentosas potenciais nas prescrições da Atenção Primária à Saúde de Ribeirão Preto - SP, bem como comparar os resultados do modelo de atendimento básico tradicional com a Estratégia de Saúde da Família. Métodos. Para a análise de interações foram incluídas todas as prescrições que continham dois ou mais medicamentos (836 prescrições), alocadas em dois grupos: 744 provenientes do atendimento básico tradicional e 92 da Estratégia de Saúde da Família. A análise de interações potenciais, gravidade e grau de embasamento científico foi realizada por meio de consulta à base de dados do Micromedex®. Resultados. Constatou-se 2037 possíveis interações medicamentosas, contabilizando uma média de 2,5 interações por prescrição (DP = 3,9) no atendimento básico tradicional e de 1,9 (DP = 2,6) na Estratégia de Saúde da Família. Há evidências de que na Estratégia de Saúde da Família há um número menor de interações medicamentosas potenciais por prescrição (p &lt; 0,05). Verificou-se ainda associação positiva entre o número de interações medicamentosas e o número de medicamentos prescritos (p &lt; 0,01). Do total de interações potenciais, 97,2% foram consideradas de severidade moderada ou superior e 58,5% apresentaram embasamento científico bom ou excelente. Conclusão. Embora as prescrições provenientes da Estratégia de Saúde da Família apresentem um número menor de interações, a frequência obtida na Atenção Primária como um todo é preocupante e ainda está muito aquém do ideal