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.

Objectives: Adherence to psychotropic medication is poor among individuals with bipolar disorder (BD). To understand treatment experiences and associated adherence among these individuals, we developed a novel construct of Clinical Net Benefit (CNB) using psychiatric symptoms, adverse effects and overall functioning assessments. We tested whether adherence differed across classes of CNB, whether individuals transitioned between classes over time, and whether these transitions were differentially associated with adherence. Methods: Data come from individuals aged 18+ during five years of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Latent class analysis identified groups of CNB. Latent transition analysis determined probabilities of transitioning between classes over time. Adherence was defined as taking 75%+ of medications as prescribed. Associations between CNB and adherence were tested using multiple logistic regression adjusting for sociodemographic characteristics. Results: Five classes of CNB were identified during the first two years (high, moderately high, moderate, moderately low, low), and four classes (removing moderately high) during the last three years. Adherence did not differ across classes or time points. Medication regimens differed by class; those with higher CNB taking fewer medications had lower odds of adherence while those with lower CNB taking more medications had higher odds of adherence compared with monotherapy. Probability of transitioning from higher to lower CNB, and lower to higher CNB was greatest over time. Conclusions: CNB is heterogeneous in individuals treated for BD, and movement between classes is not uncommon. Understanding why individuals adhere despite suboptimal CNB may provide novel insights into aspects influencing adherence.

No Brasil, poucos estudos investigaram a prevalência de medicamentos potencialmente inapropriados (MPIs) em idosos ambulatoriais. Este estudo visa determinar a prevalência de MPIs prescritos para estes pacientes, identificando os mais comumente envolvidos e verificando se a idade, o sexo e o número de medicamentos estão relacionados à prescrição de tais medicamentos. Foram coletadas prescrições de 3070 pacientes idosos (60 anos) em banco de dados, provenientes dos ambulatórios de Geriatria e Clínica Geral de um hospital universitário de atenção terciária em São Paulo-Brasil entre fevereiro e maio de 2008, que foram divididas de acordo com o sexo e faixa etária (60-69; 70-79 e 80). Os critérios de Beers versão 2003 foram utilizados para a avaliação de MPIs. A maior parte da casuística foi composta por mulheres em ambos os ambulatórios (66,6% na Clínica Geral e 77,7% na Geriatria). Os pacientes da Clínica Geral apresentaram média de idade de 71,3 anos e os da Geriatria, 80,1 anos. Na Clínica Geral a prevalência média de prescrição de MPIs foi de 37,6% e na Geriatria de 26,9%, sendo que em ambos as mulheres de 60-69 foram as que apresentaram a maior prevalência destes medicamentos. Os MPIs mais prescritos nos dois ambulatórios foram o carisoprodol, a fluoxetina e a amitriptilina, sendo que houve diferenças nos perfis de prescrições entre homens e mulheres. A chance de uso de MPI no sexo feminino é maior que no masculino (p<0,001); a chance de uso de MPI na faixa de 70-79 anos é menor que na faixa de 60-69 anos (p=0,030), assim como na faixa de 80 (p=0,024). Estas conclusões não dependem do ambulatório (p=0,164).O efeito de ambulatório depende do número de medicamentos (p=0,009). Se o número de medicamentos é < 9 a chance de uso de MPI na Clínica Geral é maior que na Geriatria (p=0,041). Quando o número de medicamentos é 7 ou 8, a chance de uso de MPI é maior do que quando são prescritos 1-4 medicamentos (p<0,001), nos dois ambulatórios (p=0,098). Quando são usados 9 medicamentos, a chance de uso de MPI depende do ambulatório (p=0,044). Na Geriatria, a chance de uso de um MPI é 8,2 vezes a RC na categoria 1-4 medicamentos; enquanto que na Clínica Geral a razão de chances é 4,6. As prevalências de MPIs encontradas foram semelhantes ao relatado na literatura e estão correlacionadas ao sexo feminino. A chance de prescrição de MPIs foi menor em pacientes com 70 anos; observou-se que se o número de medicamentos for <9, a chance de uso de MPI na Clínica Geral é maior que na Geriatria, porém, se o número de medicamentos for 9 não há diferença entre as chances de uso de MPI nos dois ambulatórios / In Brazil, few studies have investigated the prevalence of potentially inappropriate medications (PIMs) among elderly outpatients. This study aimed to determine the prevalence of PIMs prescribed to such patients, identify the medications most commonly involved and investigate whether age, sex and number of medications are related to the prescription of such medications. Prescriptions issued to 3,070 elderly patients (60 years) were gathered from a database. These patients were attended at the geriatric and general clinical outpatient services of a tertiary-level university hospital in São Paulo, Brazil, between February and May 2008. They were divided according to sex and age group (60- 69; 70-79; and 80 years). The Beers criteria (2003 version) were used to evaluate PIMs. The majority of the sample comprised women, at both outpatient services (66.6% in the general clinic and 77.7% in geriatrics). The mean age of the general clinical patients was 71.3 years and the mean for the geriatric patients was 80.1 years. At the general clinic, the mean prevalence of prescriptions of PIMs was 37.6%, and it was 26.9% at the geriatric clinic. At both outpatient services, women aged 60-69 years presented the highest prevalence of such medications. The PIMs most prescribed at the two outpatient services were carisoprodol, fluoxetine and amitriptyline, and there were differences in the prescription profiles between the men and women. The chances of using PIMs were greater for the women than for the men (p < 0.001). The chances of using PIMs in the 70-79 years group were lower than in the 60-69 years group (p = 0.030), and likewise for the group 80 years (p = 0.024). These conclusions were independent of the outpatient service (p = 0.164). The outpatient effect depended on the number of medications (p = 0.009). If the number of medications was < 9, the chances of using PIMs at the general clinic were greater than the chances at the geriatric clinic (p = 0.041). When the number of medications was 7 or 8, the chances of using PIMs were greater than when prescribed 1-4 medications (p < 0.001), at both outpatient services (p = 0.098). When 9 medications were used, the chances of using PIMs depended on the outpatient service (p = 0.044). At the geriatric clinic, the chances of using PIMs were 8.2 times greater than the chances in the category of 1-4 medications; while at the general clinic, the odds ratio was 4.6. The prevalence of PIMs encountered was similar to what has been reported in the literature, and it correlated with female sex. The chances of being prescribed PIMs were lower among patients 70 years. If the number of medications was < 9, the chances of using PIMs at the general clinic were greater than the chances at the geriatric clinic. However, if the number of medications was 9, there was no difference in the chances of using PIMs between the two outpatient services

Introduction: Medication adherence is vital to ensuring optimal patient outcomes, particularly amongst older adults prescribed polypharmacy. However, complex interventions aimed at improving adherence have shown only limited effectiveness. To maximise effectiveness, the Medical Research Council (MRC) supports the use of both evidence and theory in developing interventions. Feasibility and pilot testing is then recommended to optimise interventions in advance of definitive trials. The aim of this research was to develop a novel complex intervention (using evidence and theory) to improve adherence in older adults (prescribed polypharmacy) and to test the feasibility of delivering this in community pharmacies. Methods: The presented research models the MRC complex intervention framework and focuses on development and feasibility testing phases. Firstly, a systematic review was conducted to address an identified evidence gap in relation to theory-based adherence interventions previously delivered to older adults prescribed polypharmacy. Qualitative research was then conducted to explore older patients’ adherence behaviour and identify determinants (barriers, facilitators) to target for change. Using the Theoretical Domains Framework (TDF) as a lens, key domains were selected for targeting and mapped to behaviour change techniques (BCTs) using established methods. These BCTs formed the basis of a complex intervention that was delivered to older patients by community pharmacists (CPs) as part of a small-scale feasibility study. In addition to exploring older patients’ adherence behaviours, further research focused on CPs’ clinical behaviour in relation to providing medication adherence support (MAS). The qualitative TDF-based methods used in the patient study were extended and a mixed methods (qualitative, quantitative) approach was used to identify determinants influencing CPs’ behaviour. Key target domains were identified and mapped to BCTs that could be directed at CPs (e.g. in a training package) to improve future implementation of the patient intervention. Results: The systematic review found that adherence interventions delivered to older patients prescribed polypharmacy were rarely based on theory, supporting the need for further research. The qualitative research conducted with older patients identified eight key domains (e.g. ‘Beliefs about consequences’, Memory, attention and decision process’) that could be targeted and these domains were mapped to 11 BCTs (e.g. ‘Prompts/cues’, ‘Self-monitoring’) which formed the basis of a complex intervention. The feasibility study demonstrated that the intervention was highly acceptable to both patients and CPs but some modifications were suggested. It also highlighted the need for additional research that focuses on CPs’ behaviour (i.e. MAS provision). Findings from the mixed methods study on CPs’ behaviour led to the identification of seven key domains that could be targeted for change (e.g. ‘Skills’, ‘Motivation and goals’). Eighteen BCTs were then selected for inclusion in a training package (e.g. ‘Demonstration of the behaviour’) or for delivery alongside the patient intervention in future research (e.g. ‘Rewards/incentives’) to improve implementation. Discussion/Conclusion: The MRC framework served as a useful guide for developing a complex intervention to improve adherence in older patients prescribed polypharmacy. This systematic theory-based approach that involved explicitly linking theoretical domains to intervention components (BCTs) will aid future replication and understanding of how the intervention aims to bring about behaviour change. Aside from targeting patients’ adherence behaviours, this research emphasised the importance of exploring the behaviours of intervention providers (i.e. CPs) to enhance implementation. Future research will involve pilot testing a refined version of the patient intervention and CP training package to establish if a definitive trial of effectiveness (e.g. randomised controlled trial) is warranted.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Objetivos: Investigar o padrão de uso de medicamentos, incluindo prescritos e nãoprescritos e classificar polifarmácia em idosos do município de Porto Alegre, RS, Brasil; verificar a existência de trocas ou alterações no esquema posológico dos medicamentos usualmente utilizados e descrever a prevalência de eventos adversos relatados por idosos. Métodos: A pesquisa seguiu um modelo de estudo transversal. O instrumento de coleta de dados foi um questionário preenchido durante uma visita domiciliar. Questões discursivas foram analisadas através da técnica do Discurso do Sujeito Coletivo. Os medicamentos foram classificados de acordo com o Anatomical Therapeutic Chemical (ATC). As reações adversas relatadas foram classificadas através da Classificação Internacional de Doenças 10ª edição (CID-10). Resultados: Dos 215 entrevistados, 141 (66%) eram mulheres; 117 (54%) na faixa etária entre 60 e 70 anos; 157 (73%) brancos e 115 (53%) tinham cônjuge. Houve uma prevalência de uso de medicação em 195 (91%) idosos e 697 (84%) medicamentos haviam sido utilizados na semana anterior à entrevista. Do total da amostra, 71 (33%) responderam ter usado medicamento sem prescrição médica e 57 (27%) relataram polifarmácia na última semana. As classes terapêuticas mais comuns foram aquelas referentes ao aparelho cardiovascular 224 (32%), sistema nervoso 150 (22%) e aparelho digestivo e metabolismo 124 (18%). Dos entrevistados, 106 (49%) relataram já ter esquecido o horário de tomar o medicamento e 22 (10%) já haviam trocado as quantidades de medicamentos para mais ou para menos. Conclusões: Os dados mostram que existe uma tendência em consumir elevado número de medicamentos entre pessoas de faixa etária igual ou superior a 60 anos que vivem na comunidade. De grande importância é a detecção dos eventos adversos preveníveis para educação e prevenção. / Objectives: To investigate the patterns of medication use, including both prescription and non-prescription drugs and to describe the presence of polypharmacy for older people in Porto Alegre, Brazil. To determine whether elderly patient’s changes drug regimens and to describe the prevalence of self-reported adverse drugs events in older people. Methods: A cross-sectional study whose data were collected by questionnaire, which was answered during home visits. For qualitative data was employed thematic discourse analysis technique. Drugs were classified according to the Anatomic Therapeutic Classification codes (ATC). The self-reported adverse drugs events were described by CID-10, 1999. Results: From 215 interviewed, 141 (66%) were women; 117 (54%) were between 60 and 70 years old; 157 (73%) were white and 115 (53%) had lived with a partner. Last year, 74 (35%) had had one hospital admission and 187 (87%) had had at least one doctor visit. There was a prevalence of use of 195 (91%) medications by elderly people and 697 (84%) were used on the week before the interview. From the total, 71 (33%) confirmed the use of drugs without prescription and 57 (27%) had polypharmacy one week before. Cardiovascular 224 (32%) and central nervous system 150 (22%) and gastrointestinal drugs 124 (18%) were the most common classification. Female gender, old age and live without a partner was associated with drug utilization. 106 (49%) said they had forgotten the time of their medication intake and 22 (10%) said they had changed the drug’s quantities. Conclusions: There is a pattern of increased medication use by elderly people who live at this community. To evaluate the preventable adverse drug events in older people who live at this community is very important for designing preventive and educational programs.

Objetivos: Investigar o padrão de uso de medicamentos, incluindo prescritos e nãoprescritos e classificar polifarmácia em idosos do município de Porto Alegre, RS, Brasil; verificar a existência de trocas ou alterações no esquema posológico dos medicamentos usualmente utilizados e descrever a prevalência de eventos adversos relatados por idosos. Métodos: A pesquisa seguiu um modelo de estudo transversal. O instrumento de coleta de dados foi um questionário preenchido durante uma visita domiciliar. Questões discursivas foram analisadas através da técnica do Discurso do Sujeito Coletivo. Os medicamentos foram classificados de acordo com o Anatomical Therapeutic Chemical (ATC). As reações adversas relatadas foram classificadas através da Classificação Internacional de Doenças 10ª edição (CID-10). Resultados: Dos 215 entrevistados, 141 (66%) eram mulheres; 117 (54%) na faixa etária entre 60 e 70 anos; 157 (73%) brancos e 115 (53%) tinham cônjuge. Houve uma prevalência de uso de medicação em 195 (91%) idosos e 697 (84%) medicamentos haviam sido utilizados na semana anterior à entrevista. Do total da amostra, 71 (33%) responderam ter usado medicamento sem prescrição médica e 57 (27%) relataram polifarmácia na última semana. As classes terapêuticas mais comuns foram aquelas referentes ao aparelho cardiovascular 224 (32%), sistema nervoso 150 (22%) e aparelho digestivo e metabolismo 124 (18%). Dos entrevistados, 106 (49%) relataram já ter esquecido o horário de tomar o medicamento e 22 (10%) já haviam trocado as quantidades de medicamentos para mais ou para menos. Conclusões: Os dados mostram que existe uma tendência em consumir elevado número de medicamentos entre pessoas de faixa etária igual ou superior a 60 anos que vivem na comunidade. De grande importância é a detecção dos eventos adversos preveníveis para educação e prevenção. / Objectives: To investigate the patterns of medication use, including both prescription and non-prescription drugs and to describe the presence of polypharmacy for older people in Porto Alegre, Brazil. To determine whether elderly patient’s changes drug regimens and to describe the prevalence of self-reported adverse drugs events in older people. Methods: A cross-sectional study whose data were collected by questionnaire, which was answered during home visits. For qualitative data was employed thematic discourse analysis technique. Drugs were classified according to the Anatomic Therapeutic Classification codes (ATC). The self-reported adverse drugs events were described by CID-10, 1999. Results: From 215 interviewed, 141 (66%) were women; 117 (54%) were between 60 and 70 years old; 157 (73%) were white and 115 (53%) had lived with a partner. Last year, 74 (35%) had had one hospital admission and 187 (87%) had had at least one doctor visit. There was a prevalence of use of 195 (91%) medications by elderly people and 697 (84%) were used on the week before the interview. From the total, 71 (33%) confirmed the use of drugs without prescription and 57 (27%) had polypharmacy one week before. Cardiovascular 224 (32%) and central nervous system 150 (22%) and gastrointestinal drugs 124 (18%) were the most common classification. Female gender, old age and live without a partner was associated with drug utilization. 106 (49%) said they had forgotten the time of their medication intake and 22 (10%) said they had changed the drug’s quantities. Conclusions: There is a pattern of increased medication use by elderly people who live at this community. To evaluate the preventable adverse drug events in older people who live at this community is very important for designing preventive and educational programs.

Submitted by JUSSEMI BIAZON DALTIN null (jussemidaltin@bauru.sp.gov.br) on 2016-12-07T00:06:46Z No. of bitstreams: 1 Dissertacao de Mestrado - Jussemi.pdf: 2697527 bytes, checksum: a495bff84c4ebd015c2fa73b1fa5fb53 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-12-09T13:03:08Z (GMT) No. of bitstreams: 1 daltin_jb_me_bot.pdf: 2697527 bytes, checksum: a495bff84c4ebd015c2fa73b1fa5fb53 (MD5) / Made available in DSpace on 2016-12-09T13:03:08Z (GMT). No. of bitstreams: 1 daltin_jb_me_bot.pdf: 2697527 bytes, checksum: a495bff84c4ebd015c2fa73b1fa5fb53 (MD5) Previous issue date: 2016-11-08 / Objetivos: Analisar o perfil da prescrição de inibidores da colinesterase e de outros medicamentos em pacientes idosos portadores de demência da doença de Alzheimer (ddA) atendidos em centro de atenção a idosos no município de Bauru/SP. Métodos: Estudo de delineamento transversal, descritivo e analítico, realizado com idosos portadores de demência da doença de Alzheimer (ddA), do Programa Municipal de Atenção ao Idoso (PROMAI), no período de abril de 2015 a agosto de 2015. Participantes: 81 idosos (66 mulheres e 15 homens) que faziam acompanhamento no Programa Municipal de Atenção ao Idoso (PROMAI). Resultados: Dos idosos, 81,5% pertencia ao sexo feminino, 92,6% tinham 75 anos ou mais de idade, 64,2% não eram casados, 58% tinham até 4 anos de escolaridade, 60,5% tinham renda de até um salário mínimo, 60,5% tinham como cuidador principal as filhas e 90,1% residiam com algum familiar. Dentre as comorbidades mais comuns associadas às demências encontramos hipertensão arterial (29,6%), diabetes melitus (13,4%), hipotireoidismo (8,4%) e dislipidemias (7,8%). A capacidade cognitiva expressa pelo MEEM foi em média 14,5 pontos. A polifarmácia esteve presente em 63% dos idosos e, dentre eles, 77,8% faziam uso de algum MPI. A frequência de prescrição dos ICH foi: 54,9% rivastigmina, 33,3% donepezila e 11,8% galantamina. A memantina teve uma prevalência de prescrição de 2,5%. Dos motivos do não uso de tratamento para a ddA, os efeitos colaterais indesejáveis representaram 28% dos casos. Dos idosos estudados, 91% tinha acesso ao tratamento com os ICH através do programa de medicamentos do CEAF. O CDR (Clinical Dementia Rating) não foi encontrado na totalidade dos prontuários analisados. Conclusão: A polifarmácia esteve presente em 63% dos idosos estudados e 77,8% faziam uso de algum MPI. A polifarmácia teve associação estatisticamente positiva com o número de comorbidades (p=0,0018), escolaridade (p=0,0017), hipertensão arterial (p=0,0013) e diabetes melittus (p<0,01) e o uso de MPI apresentou associação estatisticamente positiva com a polifarmácia (p<0,01). Dos medicamentos para tratar a ddA a rivastigmina aparece com a maior prevalência de uso, 34,6%, e 30,9% não faziam uso de nenhum tratamento para a ddA. Efeitos colaterais indesejáveis e doença em estado avançado, 28%, aparecem como os principais motivos de não uso de medicamentos. / Objectives: To analyze the profile of prescribing cholinesterase inhibitors and other medications in elderly patients with Dementia of Alzheimer's disease (DAD) met in Center of attention for the elderly in the city of Bauru/SP. Methods: Study of transverse, descriptive and analytical design, conducted with elderly patients with Dementia of Alzheimer's disease (DAD), in the Municipal Program of Attention to the older persons (PROMAI), from April to August 2015. Participants: 81 elderly (66 women and 15 men) who were monitoring the Municipal program of Attention to the Elderly (PROMAI). Results: Of the elderly 81.5% belonged to the female, 92.6% were 75 years or older, 64.2% were unmarried, 58% had up to 4 years of schooling, 60.5% had incomes up to 1 minimum salary, 60.5% had as main caregiver daughters and 90.1% lived with a family member. Among the most prevalent comorbid associated with dementias found Hypertension (29.6%), Diabetes mellitus (13.4%), Hypothyroidism (8.4%) and dyslipidemias (7.8%). Cognitive ability expressed by the MMSE was an average of 14.5 points. The polypharmacy was present in 63% of the elderly and among the elderly 77.8% made use of some MPI. The frequency of prescription of (the) ICH was: 54.9% rivastigmine, 33.3% Donepezil and 11.8% galantamina. Memantine had a prevalence of prescription of 2.5%. The reasons of the non-use of treatment for DAD, the undesirable side effects accounted for 28% of the cases. The elderly studied 91% had access to treatment with the ICH trough medication program CEAF. The CDR (Clinical Dementia Rating) was not found in all the analyzed records. Conclusion: Polypharmacy was present in 63% of the elderly studied and 77.8% made use of some MPI. The polypharmacy had statistically positive association with the number of comorbid (p<0.01), education (p < 0.01), hypertension (p<0.01) and melittus diabetes (p<0.01) and the use of MPI presented statistically positive association with polypharmacy (p < 0.01). Of the medications to treatment DAD the rivastigmine appears with the higher prevalence of use, 34.6% and 30.9% did not use any treatment for DAD. Undesirable side effects and advanced-stage disease, 28%, appear as the main reasons for non-use of medicines

Objetivos: Investigar o padrão de uso de medicamentos, incluindo prescritos e nãoprescritos e classificar polifarmácia em idosos do município de Porto Alegre, RS, Brasil; verificar a existência de trocas ou alterações no esquema posológico dos medicamentos usualmente utilizados e descrever a prevalência de eventos adversos relatados por idosos. Métodos: A pesquisa seguiu um modelo de estudo transversal. O instrumento de coleta de dados foi um questionário preenchido durante uma visita domiciliar. Questões discursivas foram analisadas através da técnica do Discurso do Sujeito Coletivo. Os medicamentos foram classificados de acordo com o Anatomical Therapeutic Chemical (ATC). As reações adversas relatadas foram classificadas através da Classificação Internacional de Doenças 10ª edição (CID-10). Resultados: Dos 215 entrevistados, 141 (66%) eram mulheres; 117 (54%) na faixa etária entre 60 e 70 anos; 157 (73%) brancos e 115 (53%) tinham cônjuge. Houve uma prevalência de uso de medicação em 195 (91%) idosos e 697 (84%) medicamentos haviam sido utilizados na semana anterior à entrevista. Do total da amostra, 71 (33%) responderam ter usado medicamento sem prescrição médica e 57 (27%) relataram polifarmácia na última semana. As classes terapêuticas mais comuns foram aquelas referentes ao aparelho cardiovascular 224 (32%), sistema nervoso 150 (22%) e aparelho digestivo e metabolismo 124 (18%). Dos entrevistados, 106 (49%) relataram já ter esquecido o horário de tomar o medicamento e 22 (10%) já haviam trocado as quantidades de medicamentos para mais ou para menos. Conclusões: Os dados mostram que existe uma tendência em consumir elevado número de medicamentos entre pessoas de faixa etária igual ou superior a 60 anos que vivem na comunidade. De grande importância é a detecção dos eventos adversos preveníveis para educação e prevenção. / Objectives: To investigate the patterns of medication use, including both prescription and non-prescription drugs and to describe the presence of polypharmacy for older people in Porto Alegre, Brazil. To determine whether elderly patient’s changes drug regimens and to describe the prevalence of self-reported adverse drugs events in older people. Methods: A cross-sectional study whose data were collected by questionnaire, which was answered during home visits. For qualitative data was employed thematic discourse analysis technique. Drugs were classified according to the Anatomic Therapeutic Classification codes (ATC). The self-reported adverse drugs events were described by CID-10, 1999. Results: From 215 interviewed, 141 (66%) were women; 117 (54%) were between 60 and 70 years old; 157 (73%) were white and 115 (53%) had lived with a partner. Last year, 74 (35%) had had one hospital admission and 187 (87%) had had at least one doctor visit. There was a prevalence of use of 195 (91%) medications by elderly people and 697 (84%) were used on the week before the interview. From the total, 71 (33%) confirmed the use of drugs without prescription and 57 (27%) had polypharmacy one week before. Cardiovascular 224 (32%) and central nervous system 150 (22%) and gastrointestinal drugs 124 (18%) were the most common classification. Female gender, old age and live without a partner was associated with drug utilization. 106 (49%) said they had forgotten the time of their medication intake and 22 (10%) said they had changed the drug’s quantities. Conclusions: There is a pattern of increased medication use by elderly people who live at this community. To evaluate the preventable adverse drug events in older people who live at this community is very important for designing preventive and educational programs.

CNPQ / The medication reconciliation process (RIM) have great impact in preventing adverse events and errors related to drugs and is a formal process of obtaining a complete and accurate listing of household medication that is compared to the hospital prescription list. The discrepancies found during this process can cause harm to patients. This becomes more serious when polymedicated patients, using three or more medications at home, undergo surgical procedure of urgency. OBJECTIVE. Evaluate occurrence of discrepancies in the pharmacotherapy of surgical patients at a hospital in the state of Sergipe. METHODOLOGY. This was an observational study of descriptive exploratory, cross-sectional study between August and November 2014, to assess the occurrence of discrepancies in the pharmacotherapy of patients admitted to the surgical hospital admission. Polymedicated patients were considered those who used three or more drugs. In the initial interview we consider as sources of information the patient himself, the companion, the domestic use of drugs led to hospitalization and consultation of the record. Discrepancies were classified as unintentional variation among the drugs used before admission and the prescribed medication list after surgery may be: failure of drugs, differences in dose, differences in the frequency / schedule of administration, duplicity therapy and interaction between medications. The data were tabulated and analyzed. RESULTS. No período do estudo 422 pacientes foram admitidos no internamento pós-cirúrgico. Desses, 80 (19%) atenderam ao critério de inclusão, composto por 43 (53,8%) mulheres e 37 (46,3%) homens, com média de idade 64,14 anos ± 17,0. O motivo de internação mais prevalente foi amputação de membro inferior ou superior 33 (41,3%); a média de medicamentos do domicílio foi 4,7 ± 1,9. Foi encontrado um total de 444 discrepâncias, com uma média por paciente de 5,5 ± 2,78, as mais prevalentes foram interação, que representou mais da metade de todas as discrepâncias identificadas, 53,4% (n=237) e a omissão que constituiu 25,7% (n=114). Foram realizadas 106 intervenções e apenas n=15 (14,2%) foram aceitas. CONCLUSION. Polymedicated patients undergoing surgery require special care since they are under the care of medical specialists focused on meeting the reason for his hospitalization. The study suggests that the discrepancies found may represent high risk for safety of these patients, a more effective process of identification of home therapy is necessary when the patient is subjected to hospitalization; some comorbidities are related to the large number of medications. Thus, actions to promote patient safety in hospital admission and reduce medication errors should be practiced. / O processo de reconciliação de medicamentos (RM) tem grande impacto na prevenção de eventos adversos e erros relacionados a medicamentos e consiste num processo formal de obtenção de uma lista completa e precisa dos medicamentos do domicílio que é comparada com a lista de prescrição hospitalar. As discrepâncias encontradas durante esse processo podem causar danos aos pacientes. Isso se torna mais grave quando pacientes polimedicados, em uso de três ou mais medicamentos no domicílio, são submetidos a procedimento cirúrgico de urgência. OBJETIVO. Avaliar ocorrência de discrepâncias na farmacoterapia de pacientes cirúrgicos em um hospital do Estado de Sergipe. METODOLOGIA. Foi realizado um estudo observacional do tipo exploratório descritivo, de delineamento transversal entre Agosto e Novembro de 2014, para avaliação da ocorrência de discrepâncias na farmacoterapia de pacientes admitidos no internamento cirúrgico do hospital. Foram considerados pacientes polimedicados, aqueles que faziam uso de três ou mais medicamentos. Na entrevista inicial consideramos como fontes de informação o próprio paciente, o acompanhante, os medicamentos de uso domiciliar levados a internação e a consulta ao prontuário. As discrepâncias foram classificadas como qualquer variação não intencional entre os medicamentos utilizados antes da admissão e a lista de medicamentos prescrita após a intervenção cirúrgica podendo ser: omissão de medicamentos, diferenças na dose, diferenças na frequência/horário de administração, duplicidade terapêutica e interação entre medicamentos. Os dados obtidos foram tabulados e analisados. RESULTADOS. No período do estudo 422 pacientes foram admitidos no internamento pós-cirúrgico. Desses, 80 (19%) atenderam ao critério de inclusão, composto por 43 (53,8%) mulheres e 37 (46,3%) homens, com média de idade 64,14 anos ± 17,0. O motivo de internação mais prevalente foi amputação de membro inferior ou superior 33 (41,3%); a média de medicamentos do domicílio foi 4,7 ± 1,9. Foi encontrado um total de 444 discrepâncias, com uma média por paciente de 5,5 ± 2,78, as mais prevalentes foram interação, que representou mais da metade de todas as discrepâncias identificadas, 53,4% (n=237) e a omissão que constituiu 25,7% (n=114). Foram realizadas 106 intervenções e apenas n=15 (14,2%) foram aceitas. CONCLUSÃO. Os pacientes polimedicados submetidos a cirurgia requerem cuidados especiais uma vez que estão sob cuidados de médicos especialistas focados no atendimento do motivo do seu internamento. O estudo sugere que as discrepâncias encontradas podem representar alto risco para segurança desses pacientes, sendo necessário um processo mais efetivo de identificação da terapia domiciliar quando o paciente é submetido a internação; algumas comorbidades estão relacionadas ao elevado número de medicamentos em uso. Assim, ações que promovam a segurança do paciente na admissão hospitalar e reduzam os erros de medicamentos devem ser praticadas.