Yes / Background: In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalisation. Deprescribing is a strategy to reduce problematic polypharmacy. All stakeholders should be actively involved in developing a person-centred deprescribing process that involves shared decision-making. Objective: To co-design an intervention, supported by a logic model, to increase the engagement of older people living with frailty in the process of deprescribing. Design: Experience-based co-design is an approach to service improvement, which uses service users and providers to identify problems and design solutions. This was used to create a person-centred intervention with the potential to improve the quality and outcomes of the deprescribing process. A ‘trigger film’ showing older people talking about their healthcare experiences was created and facilitated discussions about current problems in the deprescribing process. Problems were then prioritised and appropriate solutions were developed. Review located the solutions in the context of current processes and procedures. An ideal care pathway and a complex intervention to deliver better care were developed. Setting and participants: Older people living with frailty, their informal carers and professionals living and/or working in West Yorkshire, England, UK. Deprescribing was considered in the context of primary care. Results: The current deprescribing process differed from an ideal pathway. A complex intervention containing seven elements was required to move towards the ideal pathway. Three of these elements were prototyped and four still need development. The complex intervention responded to priorities about (a) clarity for older people about what was happening at all stages in the deprescribing process and (b) the quality of one-to-one consultations. Conclusions: Priorities for improving the current deprescribing process were successfully identified. Solutions were developed and structured as a complex intervention. Further work is underway to (a) complete the prototyping of the intervention and (b) conduct feasibility testing. / National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC)

Background Based on changes in pharmacokinetics and –dynamics in elderly patients, there are potentially inappropriate medications (PIM) that should be avoided in patients aged ≥ 65 years. Current studies showed prescription rates of PIM between 22.5 and 28.4 % in the primary care setting. The evidence concerning reasons for PIM prescription by FPs is limited. Methods This mixed method study consisted of three research parts: 1) semi-standardized content analysis of patients’ records, 2) qualitative interviews with FPs using a) open questions and b) selected patient-specific case vignettes and 3) qualitative interviews with FPs’ medical assistants. The integration of qualitative interviews was used to explain the quantitative results (triangulation design). PIM were identified according to the German PRISCUS list. Descriptive and multivariate statistical analysis was done using SPSS 22.0. Qualitative content analysis of interviews was used to classify the content of the interviews for indicating pertinent categories. All data were pseudonymously recorded and analyzed. Results Content analysis of 1846 patients’ records and interviews with 7 related FPs were conducted. Elderly patients [n = 1241, mean age: 76, females: 56.6 %] were characterized in average by 8.3 documented chronic diagnosis. 23.9 % of elderly patients received at least one PIM prescription. Sedatives/hypnotics were the most frequent prescribed PIM-drugs (13.7 %). Mental disorders, gender and number of long-term medication were detected as predictors for the probability of a PIM prescription. Common reported reasons for PIM prescription by FPs concerned limited knowledge regarding PIM, limited applicability of PIM lists in daily practice, lack of time, having no alternatives in medication, stronger patient-related factors than age that influence prescription, own bad experiences regarding changes of medication or refusal of following prescriptions of sedative/hypnotics. Conclusions It is essential to see FPs in a complex decision making situation with several influencing factors on their prescribing, including: patient-oriented prioritization, FPs’ experiences in daily practice, FPs’ knowledge regarding existing recommendations and their trust in it and organizational characteristics of FPs’ daily medical practice. These pros and cons of PIM prescription in elderly patients should be considered in FPs’ advanced training.

The general aim of this thesis was to examine the effect of interventions on the usage of inappropriate and hazardous multi-medication in the elderly ≥75 years with ≥5 drugs. Methods: Paper I describes a cluster randomization of nursing homes, the outcomes were; number of drugs, health status and evaluations. A randomized controlled trial concerning elderly in ordinary homes was performed in paper II and the outcomes were; EQ-5D index, EQ VAS and prescription quality. In paper III a cohort study was carried out and the outcomes were; medication appropriateness index, EQ-5D index and EQ VAS. In paper IV, registered nurses from the nursing homes study were interviewed in a descriptive study with a qualitative approach. Results:There was a significant reduction of number of drugs used per patient at the intervention nursing homes (p<0.05). Monitoring and evaluation of medications were significantly more frequent at the intervention homes (p<0.01). The registered nurses at the nursing homes described a self-made role in their profession and the leadership was not at sight. Drug treatment seems to be a passive process without own reflection. Extreme polypharmacy was persistent in all three groups of elderly living in ordinary homes and there was an unchanged frequency of drug-risk indicators. In the cohort study a lower medication quality was shown to be associated with a lower quality of life. EQ-5D index was statistically significantly different among the groups as was EQ VAS. Conclusion: The nursing home study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. More attention must be focused on the complexity of the nursing process; medication management must be promoted in teamwork with the physician. The resistance to change prescriptions in accordance with the intervention underlines the need of new strategies for improving prescription quality. Since medication quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment in shared decision with the patient.

Bakgrund: Det naturliga åldrandet och intag av många läkemedel medför en ökad risk för läkemedelsbiverkningar. För att äldre personer ska känna sig trygga med sin läkemedelsbe-handling är det viktigt att få tillräckligt med information. Delaktighet är en förutsättning för partnerskapet i personcentrerad vård vilket innebär att vårdpersonal och patient ska dela på information, samtal och beslutsfattande.Syfte: Syftet med studien var att beskriva äldre personers upplevelser av delaktighet i läke-medelsbehandling.Metod: För studien valdes kvalitativ design. Semistrukturerade intervjuer genomfördes med 16 deltagare som var i åldrarna 75-94 år, 12 av deltagarna var kvinnor och 4 män. Samtliga av deltagarna bodde i eget boende. Insamlad data analyserades med hjälp av manifest och latent innehållsanalys enligt Graneheim och Lundman.Resultat: Efter analys av innehållet framkom ett tema, delaktighet – en balans mellan auto-nomi och kunskap, och fyra underliggande kategorier, att vara nöjd med sin läkemedelsbe-handling, att sträva efter mer kunskap, att vara en del i beslutsfattandet samt upplevelsen av delaktighet utifrån vårdpersonalens stöd och information.Slutsats: De äldre beskriver olika behov av att vara delaktiga i sin egen läkemedelsbehand-ling och därför bör alla patienter få möjligheten att välja graden av delaktighet. För att upp-fylla detta är det viktigt att personcentrerad vård tillämpas av vårdpersonal för att vården ska kunna anpassas efter individens behov. / Background: Natural aging and consumption of many drugs increases the risk of drug side effects. For older people to feel safe with their medication, it is important for them to get suf-ficient information. Participation is a precondition for partnership in person-centered care, which means that health professionals and patients have to share information, discussion and decision making.Aim: The aim of the study was to describe older people's experiences of participation in the drug therapy.Method: Qualitative design was chosen for the study. Semi-structured interviews were con-ducted with 16 participants who were aged 75-94 years, 12 of the participants were women and 4 were men. All of the participants lived in their own homes. Collected data were ana-lyzed using manifest and latent content analysis according to Granheim and Lundman.Result: After content analysis a theme appear: participation - a balance between autonomi and knowledge. Four underlying categories were identified: to be satisfied with their drug therapy, to strive for more knowledge, to be part of decision-making and the experience of participation on the basis of health care personnel support and information.Conclusion: The elderly describe different needs to be involved in their own drug therapy, and all patients should therefore have the opportunity to choose their degree of participation. To fulfill this objective, it is important that person-centered care is applied by medical profes-sionals so that care can be adapted to individual needs.

The application of multiple medications has successively increased during a number of years and has thereby increased the potential risks of adverse drug reactions, interactions and non-adherence to drug therapy. This may result in unnecessary health expenditure, directly due to redundant drug sales, and indirectly due to the increased hospitalization caused by drug-related problems. The overall aim of this thesis was to investigate the occurrence and development of drug use, multiple medication, and polypharmacy in an entire national population by using individual-based data on dispensed drugs. The studies (I-V) in the thesis are based on data of dispensed prescription drugs for up to 6.2 million individuals obtained from the Swedish Prescribed Drug Register. The data in the studies cover different periods of time between July 2005-Sept 2008, and the data have been analyzed on the basis of epidemiological measures and statistical methods. The major conclusions of the studies are: the prevalence of dispensed drugs and multiple medications was extensive in all age groups and was higher for females than for males. Multiple medications should be regarded as a risk in terms of potential drug-drug interactions and adverse drug reactions in all age groups (I). Regional differences in the prevalence of polypharmacy were observed and partly explained by the regional age distribution in Sweden. The use of a novel weighted polypharmacy index indicated regional differences in drug therapy for individuals with polypharmacy (II). The number of drugs used by an individual not only increased the potential risks associated with multiple drug use, but also the potential burden of an increased therapeutic intensity, especially for elderly (III). Individuals with ten or more drugs accounted for almost fifty percent of the total acquisition costs of dispensed drugs. Therefore, interventions with a focus on the reduction of the number of prescription drugs for the small group of patients with a large number of different drugs may also result in a substantial reduction in the total drug costs (IV). In spite of national and regional efforts to reduce polypharmacy, the prevalence of polypharmacy and excessive polypharmacy and the mean number of drugs per individual continued to increase in Sweden 2005-2008 (V). The observed year-by-year increase in polypharmacy underlines the importance of monitoring the development of drug use in all ages. Individual-based registers studies of dispensed drugs provide high quality data and could serve as the basis for further research and also in terms of training health care personnel. It can also be used as a base for interventions and the evaluation of drug use. To enable better comparisons on drug use and its consequences, there is a need for standards concerning measurements, classification and criteria which encompass all types of medications. For clinicians, there is a need for information concerning the patient’s actual use of all different types of medications.

Background: Dietary supplements (DS) use has increased in the U.S. in the past 20 years. More than half of the U.S. population reported using DS. There are few studies to our knowledge that have assessed DS use specifically for older adults. In this study we purposed to evaluate the trend of using DS among older adults and to test the association between using DS and several demographics, socioeconomics and health characteristics. The second objective was to evaluate the reasons behind using DS among older adults using a nationally representative database. Methods: This is a cross sectional study using the most recent National Health and Nutrition Examination Survey (NHANES) database 2009-2012. It is a nationally representative sample of noninstitutionalized adults in the U.S. Frequency and weighted percentage (standard error) were reported for dichotomous variables. Multiple logistic regressions model analyses were used to evaluate the predictors of DS use after testing model assumptions, multicollinearity, and outliers. P values 0.05 were considered significant. All the statistical analyses were conducted using SAS software version 9.4. Results: Out of 2625 older adult participants (65 years and older) 70.5% of them reported using DS in the past 30 days. Female, non-hispanic white, obese, overweight and excellent and very good self-reported health status participants were more likely to use DS. Multivitamin-multiminerals (MVMM), calcium and vitamin D were the most commonly reported supplements among older adults. 71% of oldest old (80≥ years) reported taking DS and prescription medication in the past 30 days concomitantly and 73% of polypharmacy users reported using DS. To stay healthy, to improve overall health and for bone health were the most commonly reported reasons behind using DS. Conclusion: majority of older adult participants reported using DS in the past 30 days. Health care professionals need to evaluate the dietary supplement information from older adults in order to improve health care.

O processo de envelhecimento traz consigo diversas modificação no âmbito pessoal e biológico do indivíduo. Expandindo-se essas transformações, para o âmbito populacional, na questão da saúde, delimita-se um crescente prevalências das denominadas doenças crônicas não transmissíveis. Nesta lógica, um maior número de moléstias crônicas, leva os indivíduos a ingerirem uma maior quantidade de fármacos, sejam eles prescritos por via clínica ou mesmo pela própria automedicação. Em vista disso, o presente trabalho objetivou realizar um levantamento epidemiológico para se traçar o perfil de saúde dos idosos de uma cidade do interior paulista, enfocando-se a presença de doenças crônicas não transmissíveis, medicamentos utilizados, a presença de polifarmácia e a qualidade de vida. A amostra foi composta por 241 idosos residentes da cidade de Duartina, SP. Primeiramente realizou-se um questionário geral para se determinar a presença de doenças e caracterização geral da amostra. Após, os idosos passaram pelo questionário de qualidade de vida e por um questionário sobre os medicamentos utilizados. A partir dos dados deste último, através do site drugs.com determinou-se a presença e os níveis de polifarmácia. Nos resultados, pode-se observar uma considerável prevalência de diabetes, dislipidemias e hipertensão, sendo as idosas as mais afetadas. Quanto ao uso dos fármacos, 22,7% utilizam, ao menos, cinco medicamentos distintos ao dia. Na análise da polifarmácia, 30% não apresentaram interações, 68% apresentaram nível moderado e 2% elevado. Através da correlação de Pearson, identificou-se que com o aumento do número de medicamentos utilizados, houve aumento do nível da intensidade da polifarmácia (p < 0,0001 e r = 0,81). Quanto à qualidade de vida, todos as áreas apresentaram índices relativamente altos, sendo o domínio físico com a melhor média e o ambiental com pior. Na análise por questão, os piores índices ficaram com dor, dependência de medicamentos e sentimentos negativos. Com a Correlação de Spearman, determinou-se que o aumento dos índices de polifarmácia diminuem a qualidade vida (p = 0,03 e r = -0,57). Deste modo, conclui-se que, nos idosos, há uma elevada prevalência de hipertensão, diabetes e das dislipidemias, bem como um considerável uso de diferentes medicamentos diariamente. Anexo a estes dados, a qualidade de vida apresentou índices adequados, sendo afetada negativamente pelo aumento do uso diários de medicamentos. / The process of aging brings with it several modifications in the personal and biological scope of the individual. Expanding these transformations, for the population, in the health issue, delimits a growing prevalence of so-called chronic non-communicable diseases. In this logic, a greater number of chronic diseases, leads individuals to ingest a greater amount of drugs, whether they are prescribed clinically or even by self-medication. In view of this, the present study aimed to carry out an epidemiological survey to trace the health profile of the elderly in a city in the interior of the state of São Paulo, focusing on the presence of chronic noncommunicable diseases, medications used, the presence of polypharmacy and the quality of life. The sample consisted of 241 elderly residents of the city of Duartina, SP. Firstly, a general questionnaire was carried out to determine the presence of diseases and the general characterization of the sample. Afterwards, the elderly passed the quality of life questionnaire and a questionnaire about the medications used. From the data of the latter, through the website drugs.com was determined the presence and levels of polypharmacy. In the results, a considerable prevalence of diabetes, dyslipidemia and hypertension can be observed, with the elderly being the most affected. As for drug use, 22.7% use at least five different drugs a day. In the analysis of polypharmacy, 30% did not present interactions, 68% presented moderate level and 2% elevated. Through the Pearson correlation, it was identified that with the increase in the number of medications used, there was an increase in the level of polypharmacy intensity (p <0.0001 and r = 0.81). As for the quality of life, all the areas presented relatively high indexes, being the physical domain with the best average and the environmental one with worse. In the analysis by question, the worst indexes were pain, drug dependence and negative feelings. With Spearman\'s correlation, it was determined that the increase in polypharmacy indexes decreased the quality of life (p = 0.03 and r = -0.57). Thus, it is concluded that in the elderly, there is a high prevalence of hypertension, diabetes and dyslipidemias, as well as a considerable use of different drugs daily. Annexed to these data, the quality of life presented adequate indexes, being negatively affected by the increase in the daily use of medicines.

No Brasil, o câncer atualmente é a segunda causa de morte e algumas das explicações devem-se ao fato do melhor controle das doenças infectocontagiosas e ao envelhecimento populacional global, uma vez que o câncer é considerado uma doença cuja idade média está acima de 60 anos. As comorbidades as quais estão diretamente associadas ao envelhecimento e o uso de diversos medicamentos são necessários para o controle adequado das outras patologias, por outro lado, representa um importante fator de risco para resultados negativos de saúde. A conciliação de medicamentos visa a redução de medicamentos desnecessários, com uma avaliação criteriosa do farmacêutico, que pode ajudar a otimizar a terapia medicamentosa, reduzir custos, aumentar a conformidade e reduzir a toxicidade e eventos adversos relacionados aos medicamentos. OBJETIVO: Avaliar a prevalência da polifarmácia, automedicação, a adesão e conhecimento da farmacoterapia domiciliar; as principais dúvidas e as necessidades de orientação em relação à farmacoterapia em geral; harmonização farmacoterapêutica, discrepâncias, interações medicamentosas, medicamentos inapropriados para idosos e duplicidade terapêutica. CASUÍSTICA E MÉTODOS: Pacientes admitidos dos pelo Serviço de Oncologia Clínica e Ginecologia do HCFMRPUSP com idade igual ou superior a 60 anos e diagnóstico confirmado de neoplasia maligna. Foram aplicados os testes de adesão e conhecimento da farmacoterapia domiciliar e após a saída hospitalar do paciente realizada a revisão das farmacoterapias (domiciliar e hospitalar) e a conciliação de medicamentos. RESULTADOS: Foram incluídos 157 pacientes, idade média 68,4 anos, maioria do gênero feminino (60,5%), raça branca (84,1%), ensino básico (40,1%), neoplasia maligna em mama feminina (26,1%), em uso de polifarmácia (70,7%) e adepto de automedicação (50,3%), em que o uso de medicamentos (p= 0,01) e a automedicação (p= <0,01) foram significativamente correlacionados com o gênero feminino. Na farmacoterapia domiciliar, a média de conhecimento total foi de 62,9% e maioria caracterizada como não aderente (73,4%), o armazenamento dos medicamentos foi prevalente na cozinha (51%) e as principais dúvidas relacionam-se à caligrafia (79%). A harmonização farmacoterapêutica foi observada em 82,3% dos pacientes. A discrepância foi observada em 90,5% dos pacientes, prevalecendo a omissão (304). Foi significativamente diferente a interação medicamentosa quando comparada as farmacoterapias, domiciliar e hospitalar (p <0,01). Em ambas farmacoterapias, a maioria dos pacientes fez uso de medicamentos inapropriados para idosos, 84,1% (132 pacientes) e 85,3% (134 pacientes), respectivamente. A duplicidade terapêutica observada foi mínima, 18 pacientes (11,7%) na farmacoterapia domiciliar e 29 pacientes (18,8%) na hospitalar. CONCLUSÃO: a inserção do cuidado farmacêutico pode contribuir na educação do paciente em relação aos riscos da automedicação, melhoria no conhecimento, adesão e armazenamento dos medicamentos; e o processo de conciliação de medicamentos pode auxiliar a prática clínica na harmonização farmacoterapêutica e reduzir as discrepâncias, principalmente em relação à omissão. A inclusão de sistemas de alertas na prescrição médica pode reduzir os riscos de interações medicamentosas e uso de medicamentos inapropriados para idosos. / In Brazil, cancer is currently the second cause of death and some of the explanation is due to better control of infectious diseases and global aging, since cancer is considered a disease whose average age is over 60 years. Comorbidities that are directly associated with aging and the use of several medications are necessary for the adequate control of other pathologies, on the other hand, it represents an important risk factor for negative health outcomes. Medication reconciliation is aimed at reducing unnecessary medications, with careful evaluation by the pharmacist, which can help optimize drug therapy, reduce costs, increase compliance, and reduce toxicity and drug-related adverse events. OBJECTIVE: To evaluate the prevalence of polypharmacy, self-medication, adherence and knowledge of home pharmacotherapy; the main doubts and orientation needs regarding pharmacotherapy in general; pharmacotherapeutic harmonization, discrepancies, drug interactions, inappropriate medications for the elderly and therapeutic duplicity. MATERIALS AND METHODS: Patients admitted to the HCFMRP-USP Clinical Oncology and Gynecology Service aged 60 years or older and confirmed diagnosis of malignant neoplasia. The adherence tests and knowledge of home pharmacotherapy were applied and after the patient\'s hospital discharge, the pharmacotherapies (home and hospital) and medication reconciliation were reviewed. RESULTS: A total of 157 patients, mean age 68.4 years old, female (60.5%), Caucasian (84.1%), primary education (40.1%) and malignant neoplasia (P = 0.01) and self-medication (p = <0.01), using polypharmacy (70.7%) and adept of self-medication (50.3%), Were significantly correlated with the female gender. In home pharmacotherapy, the mean total knowledge was 62.9% and most characterized as non-adherent (73.4%), drug storage was prevalent in the kitchen (51%) and the main doubts related to calligraphy (79%). Pharmacotherapeutic harmonization was observed in 82.3% of the patients. The discrepancy was observed in 90.5% of the patients, with omission prevailing (304). Drug interaction was significantly different when compared to pharmacotherapies, home and hospital (p <0.01). In both pharmacotherapies, the majority of patients used drugs inappropriate for the elderly, 84.1% (132 patients) and 85.3% (134 patients), respectively. The therapeutic duplicity observed was minimal, 18 patients (11.7%) in the home pharmacotherapy and 29 patients (18.8%) in the hospital. CONCLUSION: the insertion of pharmaceutical care can contribute to the education of the patient in relation to the risks of self-medication, improved knowledge, adherence and storage of medications; and the medication reconciliation process can help clinical practice in pharmacotherapeutic harmonization and reduce discrepancies, especially in relation to omission. The inclusion of alert systems in the medical prescription can reduce the risks of drug interactions and the use of drugs inappropriate for the elderly.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-17T21:44:34Z No. of bitstreams: 1 ClemilsonSilvaBarros.pdf: 3746819 bytes, checksum: 3083b6b09f87ef3bd885880557df0540 (MD5) / Made available in DSpace on 2017-05-17T21:44:34Z (GMT). No. of bitstreams: 1 ClemilsonSilvaBarros.pdf: 3746819 bytes, checksum: 3083b6b09f87ef3bd885880557df0540 (MD5) Previous issue date: 2016-05-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão (FAPEMA) / Introduction: Systemic arterial hypertension (SAH) and diabetes mellitus (DM) are among the most prevalent chronic diseases in Brazil and are considered important public health problem and are responsible for heavy costs for countries, due to the high consumption of medicines and hospital admissions. The objective of this study is to Characterize the use of polypharmacy and associated factors in hypertensive and diabetic, assisted by the Health Strategy of the Family. Methodology: The study was a cross-sectional, descriptive, focused on achieving more cost-effective therapeutic results for the health of participants. The sample was not probabilistic and comprised 171 patients, both genders, above 18 years and patients with hypertension and /or DM, linked to a Basic Health Unit of São Luís, BR. Results: The study showed a female predominance (69.59%), self-declared brown color (56.14%), average age of 60.53 (± 11.41) years, with the most prevalent age group of 61-70 years (34.50%), incomplete primary education (47.37%), household income of ½ to 1 minimum wage salary (44.44%) and married (38.59%) and also indicated increased prevalence of cardiovascular risk. It was also produced a list of 85 drugs in use, with an average of 5.31 (± 11.56), where most of the population uses 1-4 drugs 88.88% with daily intaking of 1 to 4 times (84.79%), most of them purchase the product (49.12%). The most prevalent drugs were: Losartan 74.11%, 67.05% metformin, glibenclamide HCTZ 55.65% and 44.18%. The study also included 19 (11.11%) polymedicated, of these, 11 (9.6%) are non-adherent and 10 (33.33%) take 5-8 medications per day, and 14 (16.1%) do not consider themselves healthy. The most significant IMC in this study was 18-25 kg / m² with 11 (14.5%). Discussion: The knowledge of sociodemographic characteristics and health, community health indicators and their priority needs is important to draw health action steps that become safe and cost effective treatment in patients on polypharmacy. Conclusion: Knowing the profile of these users is critical to adjust the services offered and develop cost-effective measures to respond positively to their major requirements, improving services to the population, reducing the morbidity and mortality rates and increasing the quality of life. / Introdução: A Hipertensão Arterial Sistêmica (HAS) e o Diabetes Mellitus (DM) estão entre as doenças crônicas mais prevalentes no Brasil e são considerados importante problema de saúde pública e motivadores de fortes despesas para o país, devido ao elevado consumo de medicamentos e de internações hospitalares. Objetivo: Caracterizar o uso de polifarmácia e seus fatores associados em hipertensos e diabéticos, assistidos pela Estratégia de Saúde da Família. Metodologia: O estudo é do tipo transversal, focado em atingir resultados terapêuticos mais custo-efetivos para a saúde dos participantes. A amostra foi não probabilística e composta por 171 pacientes, de ambos os sexos, maiores de 18 anos e portadores de HA e/ou DM, vinculados a uma Unidade Básica de Saúde de São Luís. Resultados: O estudo mostrou predominância do sexo feminino (69,59%), cor auto declarada parda (56,14%), média de idade de 60,53 (± 11,41) anos, tendo como faixa etária mais prevalente de 61 a 70 anos (34,50%), ensino fundamental incompleto (47,37%), renda familiar baixa de ½ a 1 salário mínimo (44,44%) e casados (38,59%). Ocorreu, também, prevalência de risco cardiovascular para ambos os sexos. Obteve-se, ainda, uma relação de 85 medicamentos em uso, com média de 5,31(± 11,56), onde a maioria da população faz uso de 1 a 4 medicamentos (88,88%), com quantidade de tomada/dia de 1 a 4 vezes/dia 84,79%, a maioria compra o medicamento 49,12%. Os medicamentos mais prevalentes foram: a Losartana 74,11%, a metformina 67,05%, hidroclorotiazida 55,65% e Glibenclamida 44,18%.O estudo contou ainda com 19(11,11%) de usuários polimedicados,destes,11(9,6%) não são aderentes, 10(33,33%) tomam de 5 a 8 medicamentos por dia e 14(16,1%) não se consideram saudáveis. O índice de massa corporal (IMC) mais expressivo nesse estudo foi de 18-25 kg/m² com 11(14,5%). Discussão: O conhecimento das características sociodemográficas e de saúde, dos indicadores de saúde da comunidade e sua necessidades prioritárias são importantes para traçar medidas de ação em saúde que torne seguro e custo efetivo o tratamento em pacientes em polifarmácia. Conclusão: Conhecer o perfil desses usuários é fundamental para ajustar os serviços oferecidos e desenvolver medidas custo-efetivas que respondam positivamente às necessidades majoritárias deles, melhorando o atendimento a população, diminuindo as taxas de morbimortalidade e aumentando a qualidade de vida.

Polypharmacy entails the use of multiple drugs taken at the same time to manage the various comorbidities common among elderly patients. Polypharmacy is associated with increased health care spending due to drug duplication, adverse drug events, and medication noncompliance. Medication reconciliation has been shown to reduce the problems seen with polypharmacy. The purpose of this project was to review published evidence to develop a staff education program on medication reconciliation in a primary care setting and determine the efficacy of the program in relation to staff confidence and knowledge levels concerning medication reconciliation. The project was guided by Nola Pender's health promotion model. The education program was modeled after a medical staff education program on medication reconciliation and included a medication assessment questionnaire and its use when evaluating a patient's medications. The pretest and posttest questionnaire obtained from the education materials was administered to clinical staff at the practice site before and after presenting the education material. Data were analyzed for statistical changes after the education program using a t test. Results showed that participants increased their confidence and knowledge of medication reconciliation from an average score of 2.19 (SD 0.20) before the education to 4.37 (SD 0.12) (p < 0.001) on a 5-point confidence scale after the education. This staff education program will promote positive social change by increasing nurses' knowledge and confidence of medication reconciliation and potentially reducing the incidence of polypharmacy and its negative effects among the elderly patients.