Antônio Ignácio de Loyola Filho

Estudo de base populacional sobre o consumo de medicamentos entre idosos: Projeto Bambuí

Investigou-se a prevalencia e fatores associados ao consumo de medicamentos prescritos e nao prescritos entre idosos (60 anos ou mais). Participaram deste trabalho 1.606 (92,2%) dos 1.742 idosos residentes na cidade de Bambui, Minas Gerais, Brasil. Entre os participantes, 1.281 (79,7%) e 274 (17,1%) haviam consumido medicamentos prescritos e nao prescritos nos ultimos noventa dias, respectivamente. O consumo de medicamentos prescritos esteve associado ao sexo feminino, idade (70-79 e > 80 anos), renda familiar (maior), estado de saude (pior) e numero de consultas medicas (maior). O uso de medicamentos nao prescritos apresentou associacao negativa com consulta medica e associacao positiva com sexo (feminino) e consulta a um farmaceutico. Os fatores associados ao consumo de medicamentos prescritos e nao prescritos verificados neste trabalho foram semelhantes aos observados em estudos conduzidos em outros paises. Diferentemente deles, nosso estudo mostrou um menor consumo de medicamentos prescritos entre idosos com pior situacao socio-economica. Nossos resultados sugerem, ainda, que a automedicacao entre idosos esteja sendo utilizada em substituicao a atencao formal a saude.

Prevalência e fatores associados à automedicação: resultados do projeto Bambuí

OBJECTIVE A population-based study was carried out in the municipality of Bambuí, Brazil (population: approx. 15,000 inhabitants), to determine the prevalence of self-medication and its associated factors. METHODS A random sample of 1,221 residents aged >18 years was selected. Of these, 796 reported use of medications in the last 90 days and were selected for this study (775 participated). Data was collected through home interviews. Study variables were divided in 3 groups: social and economic, health status and health service use indicators. Statistical analysis was performed using Pearsons Qui-square test, and odds ratios adjusted by multinomial logistic regression. RESULTS Of the total, 419 (54.0%) reported use of only prescribed medications, 133 (17.2%) took prescribed and over-the-counter medications, and 223 (28.8%) took only over-the-counter medications in the last 90 days. After adjusting for confounders, the following variables presented significant associations with exclusive use of self-medication: female sex (OR=0.6; IC95%=0.4 - 0.9); age (OR=0.4; IC95%=0.3 - 0.6 for 40-59 years old and OR=0.2; IC95%=0.1 - 0.5 for >60 years); >5 residents in the household (OR=2.1; 1.1 - 4.0); number of visits to a doctor in the previous 12 months (OR=0.2; IC95%=0.1 - 0.4 and OR=0.1; IC95%=0.0-0.1 for 1 visit and >2 visits, respectively); report of consulting a pharmacist in the previous 12 months (OR=1.9; IC95%=1.1 - 3.3); and reports of financial expenses with medications during this period (OR=0.5; IC95%=0.3 - 0.8). CONCLUSIONS The study results show that the prevalence of self-medication in the studied community was similar to that observed in developed countries. These results also suggest that self-medication works in place of the formal health attention in this community.

Estudo epidemiológico de base populacional sobre uso de medicamentos entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

The aim of this study was to investigate the use of medication and associated factors (sociodemographics, health conditions, and health services use) in a representative sample of 1,598 elderly individuals (60+ years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The dependent variable was the number of drugs used in the preceding two weeks. Prevalence of medication was 72.1%, and mean consumption was 2.18 drugs, most of which acting on the cardiovascular system. Use of medication (any amount) was independently associated with gender (female), age (80+ years), having consulted a physician, and presence of any chronic health condition. Use of five or more drugs was significantly associated with schooling (8+ years, OR=2.28), worse self-rated health (fair, OR = 5.45; bad/very bad, OR = 5.35). The results show that the types of medications used and factors associated with consumption were similar to those observed in other populations, suggesting some uniformity among various populations in the use of medication and its determinants.

Tendências nas condições de saúde e uso de serviços de saúde entre idosos brasileiros: um estudo baseado na Pesquisa Nacional por Amostra de Domicílios (1998, 2003)

This study examined trends in health conditions and use of health services by the Brazilian elderly, based on health data from the National Household Sample Surveys (PNAD) conducted in 1998 and 2003. 28,943 and 35,042 individuals aged > 60 years were included in the study, respectively. The results showed an improvement in health conditions in the study population during this period, as measured by self-rated health, having remained bedridden in the previous two weeks, ability to perform selected activities of daily living, number of chronic conditions, and self-reported arthritis. There was also an increase in the number of doctor and dentist visits from 1998 to 2003. The trends were consistent for both men and women. The results emphasize the importance of the PNAD health supplement as a source of information for the surveillance or monitoring of health and health-related conditions in the Brazilian elderly population.

Prevalence and sociodemographic characteristics associated with benzodiazepines use among community dwelling older adults: the Bambuí Health and Aging Study (BHAS)

OBJECTIVES To assess the prevalence and sociodemographic characteristics associated with benzodiazepine use among community-dwelling older adults. METHOD 1606 subjects, aged > 60 years, corresponding to 92% of the residents of Bambuí city, participated in this study. The information about medication use was obtained by means of a standard interview and the review of medication packaging. Substances were classified using the Anatomical Therapeutic Chemical Index. RESULTS The prevalence of benzodiazepine current use was 21.7% (26.7% among females and 14.0% among males). From these, 68.7% had been taking the medication for over one year, 31.3% for over five years and 53.2% were using long half-life benzodiazepines. The medication most frequently used was bromazepam (35.6%), followed by diazepam (22.5%), clonazepam (12.6%) and lorazepam (7.8%). After adjustment for confounders, female gender (RP = 1.93; CI95% = 1.51-2.46) was the only sociodemographic characteristic found to be independently associated with substance consumption. CONCLUSIONS The prevalence of benzodiazepine use in the study population was high, but within the variation observed in developed countries. Chronic use of benzodiazepines and long half-life medications predominated.

Influência da renda na associação entre disfunção cognitiva e polifarmácia: Projeto Bambuí

OBJETIVO: Avaliar a prevalencia da polifarmacia e a influencia da renda na associacao entre uso de medicamentos e disfuncao cognitiva, entre idosos. METODOS: Dos 1.606 integrantes da linha base da coorte de idosos de Bambui (Minas Gerais), iniciada em 1997, 1.554 participaram do estudo. Todos os participantes foram submetidos ao questionario mini-exame do estado mental. A associacao entre disfuncao cognitiva e polifarmacia foi testada por meio de regressoes ordinais multivariadas, realizadas para a populacao total e para cada um dos estratos de renda. RESULTADOS: A prevalencia de polifarmacia (consumo de dois ou mais medicamentos) foi de 70,4%, e o numero de medicamentos consumidos mostrou-se negativa e independentemente associado a disfuncao cognitiva (OR=0,72; IC 95%: 0,55;0,95). Quando estratificada pela renda pessoal ( 2), observou-se associacao negativa entre uso de medicamentos e disfuncao cognitiva entre idosos com renda mais baixa (OR=0,64; IC95%: 0,48;0,86), mas nao entre aqueles de renda mais elevada (OR=1,74; IC 95%: 0,81;3,74). CONCLUSOES: Com referencia a associacao entre disfuncao cognitiva e numero de medicamentos consumidos, os resultados indicam desigualdade social no uso de medicamentos. E possivel que esses idosos nao estejam consumindo os medicamentos necessarios ao adequado tratamento de seus problemas de saude.

Estudo de base populacional da subutilização de medicamentos por motivos financeiros entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

The aim of this study was to estimate the prevalence of cost-related underuse of medicines and associated factors in a representative sample of 1,134 elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. Prevalence of cost-related underuse was 12.9%. After adjustments in the multivariate model, cost-related underuse was higher in individuals with income less than twice the minimum wage (PR = 0.57; 95%CI: 0.34-0.97), without health plan coverage (PR = 0.68; CI95%: 0.46-0.99), with low frequencies of physician-patient dialogue concerning health/treatment (rarely/never, PR = 1.79; 95%CI: 1.10-2.90), with fair to poor self-rated health (PR = 1.66; 95%CI: 0.95-2.90 and PR = 2.49; 95%CI: 1.38-4.48, respectively), and with multiple comorbidities (one, PR = 2.51; 95%CI: 0.99-6.35; two, PR = 3.51; 95%CI: 1.40-8.72 and three or more, PR = 4.52; 95%CI: 1.79-11.41). Our results suggest adherence problems within this population due to a communication gap between seniors and physicians on treatment-related aspects and to the lack of health plan coverage. Especially worrisome is the high risk of cost-related underuse among elderly with poor health.

Fatores associados ao uso e à satisfação com os serviços de saúde entre usuários do Sistema Único de Saúde na Região Metropolitana de Belo Horizonte, estado de Minas Gerais, Brasil

The objective of this study was to examine factors associated with use and satisfaction with health services among National Health System (SUS) users in the Metropolitan Region of Belo Horizonte (RMBH), State of Minas Gerais, Brazil. A random sample of 8.604 adults participated. From them, 74% had one or more doctor visits in previous year and 68% would recommend the majority of the health professionals and services used. Older ages, female gender and higher formal education were positively and independently associated with use and satisfaction with the health services used; other characteristics associated with these outcomes were lifestyle and health status. Some of the above associations point out for the existence of the inverse care law. The results indicate that differences on use and satisfaction with health services, previously reported for more heterogeneous populations, are also observed among SUS users in the RMBH.

Características associadas ao uso de serviços odontológicos públicos pela população adulta brasileira

The scope of this study was to investigate the factors related to the use of dental services by Brazilian adults. Data were collected from 13,356 adults (35 to 44 years of age), participating in a nationwide epidemiological survey of oral health (SB-BRASIL 2003 Project). Data analysis was based on Poisson regression, which produced estimates of Prevalence Ratios as a measure of association. Data analysis showed that the use of dental services by adults was associated with: female gender, low education and income, living in the Northeastern and Southern regions and in small cities, complaints of toothache or gum pain, need for partial/total prosthesis, a greater amount of permanent teeth requiring treatment, demand for service due to some dental problems and evaluation of dental care received on a regular basis. These results showed that the population attended by the public service was socio-economically less privileged and had greater need for treatment. This situation reflects an historical abandonment of the adult population by the dental healthcare system in Brazil and poses a major challenge to the Unified Health Service, in light of its intended role to reduce inequalities and provide universal access to comprehensive care.

Capacidade funcional e uso de serviços de saúde por idosos da Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil: um estudo de base populacional

This study focused on the association between disability and use of health services among elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The study included 1,624 elderly patients (≥ 60 years) selected by representative sampling. The dependent variable was use of health services, based on three descriptors: number of physician visits, home consultations, and hospitalizations. The target independent variable was disability, including difficulty in performing activities of daily living (ADL) and instrumental activities of daily living (IADL). IADL was only associated with hospitalization (PR = 1.62; 95%CI: 1.16-2.26), while ADL was associated with hospitalization (PR = 1.73; 95%CI: 1.24-2.42) and home consultations (PR = 8.54; 95%CI: 4.22-17.27). The findings show increased use of health services (especially more costly ones) among older adults with disabilities, and that functional health dimensions have not oriented health services, still largely conditioned on the presence of diseases.This study focused on the association between disability and use of health services among elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The study included 1,624 elderly patients (≥ 60 years) selected by representative sampling. The dependent variable was use of health services, based on three descriptors: number of physician visits, home consultations, and hospitalizations. The target independent variable was disability, including difficulty in performing activities of daily living (ADL) and instrumental activities of daily living (IADL). IADL was only associated with hospitalization (PR = 1.62; 95%CI: 1.16-2.26), while ADL was associated with hospitalization (PR = 1.73; 95%CI: 1.24-2.42) and home consultations (PR = 8.54; 95%CI: 4.22-17.27). The findings show increased use of health services (especially more costly ones) among older adults with disabilities, and that functional health dimensions have not oriented health services, still largely conditioned on the presence of diseases.