Nicolina Silvana Romano-Lieber

Polifarmácia entre idosos do Município de São Paulo - Estudo SABE

Polypharmacy for the elderly and associated factors were assessed. A cross-sectional study was conducted using data from the SABE Study (Health, Well-being and Aging), 2006. 1,115 individuals representing 422,377 elderly aged 65 or more, living in Sao Paulo City, were interviewed. Polypharmacy was defined as the use of five or more medications. A multivariate regression logistics was used. Polypharmacy prevalence was 36%. Female (OR = 1.7; IC 95%: 1.0; 2.9), age over 75 years (OR = 1.9; CI 95%: 1.3; 2.7), higher income (OR = 1.8; CI 95%: 1.2; 2.8), working (OR = 1.8; CI 95%: 1.1; 2.9), regular self assessed health (OR = 1.6; CI 95%: 1.1; 2.3) or poor (OR = 2.6; CI 95%: 1.4; 4.9), hypertension (OR = 2.0; CI 95%: 1.4; 2.9), diabetes (OR = 4.1; CI 95%: 2.2; 7.5), rheumatic diseases (OR = 2.3; CI 95%: 1.5; 3.6) and cardiac problems (OR = 2.9; CI 95%: 1.9; 4.5) were associated positively with polypharmacy. Using only the public health system (OR = 0.5, 95% CI: 0.3; 0.7) was inversely associated with polypharmacy. Medicines for the cardiovascular system and for the alimentary tract and metabolism were the most used. The knowledge of factors associated with polypharmacy, such as those identified in this study, may be useful to alert health professionals about the importance of identifying and monitoring the elderly groups most vulnerable to polypharmacy.

Atenção farmacêutica em farmácias e drogarias: existe um processo de mudança?

Abstract A descriptive study was conducted with 91 pharmacists of the municipality of Jundiai (state of Sao Paulo) in order to learn about the professional practice of the pharmacists who work in pharmacies and their know-ledge and perceptions about Pharmaceutical Care (PC). Most of them were young (62.6% between 20 and 29 years old), female (63.7%), private institution graduates (90.1%), and were not the owners of the pharmacies (87.9%). They carried out administrative, technical and attention to patient activities, particularly providing guidance and dispensing medications; 67.0% followed their patients’ pharmacotherapeutic treatment up, but did not record any information regarding it. To 62.7% of the pharmacists, PC was related only to the guidan-ce and service provided, but those activities were not performed systematically and in an organized way, as recommended. Many (91.2%) considered necessary to work closer to their patients; however, they men-tioned difficulties including lack of time, of support from the pharmacy owner, and patient’s disinterest. Several of these difficulties have also been verified in other countries, suggesting that the PC practice: (a) requires a structural change and rearrangement of functions since, currently, the structure and the activities are adjusted to the commercial activity; (b) reveals a professional identity crisis and, consequen-tly, lack of social recognition and little insertion in the multiprofessional health team. Knowledge of PC proved to be limited, but the situation can change as the ongoing curriculum changes produce an effect on the education of the new pharmacists.Keywords: Pharmaceutical Services; Pharmaceutical Profession; Pharmacists; Pharmacy; Health Promotion.

Processo da implantação da política de medicamentos genéricos no Brasil

A generic drug policy has been implemented in Brazil since 1999. Several political and administrative stages transpired between enactment of the legislation and the actual marketing and consumption of these drugs. This article describes the policy implementation process and examines the countrys generic drug legislation, approved from 1999 to 2002. To contextualize these measures, the study compares articles published by two national periodicals and interviews with a government representative involved in drafting the legislation and a representative from the pharmaceutical industry. Generic drugs quickly gained considerable space in the Brazilian pharmaceutical market. Ongoing adaptation of the legislation, media support, and the governments involvement in spreading the policy were key success factors. The populations access to medicines did not increase significantly, but people can now purchase medicines at more affordable prices and with quality assurance and interchangeability.

Potential Drug-Drug Interactions in Prescriptions to Patients over 45 Years of Age in Primary Care, Southern Brazil

Background Few cross-sectional studies involving adults and elderly patients with major DDIs have been conducted in the primary care setting. The study aimed to investigate the prevalence of potential drug-drug interactions (DDIs) in patients treated in primary care. Methodology/Principal Findings A cross-sectional study involving patients aged 45 years or older was conducted at 25 Basic Health Units in the city of Maringá (southern Brazil) from May to December 2010. The data were collected from prescriptions at the pharmacy of the health unit at the time of the delivery of medication to the patient. After delivery, the researcher checked the electronic medical records of the patient. A total of 827 patients were investigated (mean age: 64.1; mean number of medications: 4.4). DDIs were identified in the Micromedex® database. The prevalence of potential DDIs and major DDIs was 63.0% and 12.1%, respectively. In both the univariate and multivariate analyses, the number of drugs prescribed was significantly associated with potential DDIs, with an increasing risk from three to five drugs (OR = 4.74; 95% CI: 2.90–7.73) to six or more drugs (OR = 23.03; 95% CI: 10.42–50.91). Forty drugs accounted for 122 pairs of major DDIs, the most frequent of which involved simvastatin (23.8%), captopril/enalapril (16.4%) and fluoxetine (16.4%). Conclusions/Significance This is the first large-scale study on primary care carried out in Latin America. Based on the findings, the estimated prevalence of potential DDIs was high, whereas clinically significant DDIs occurred in a smaller proportion. Exposing patients to a greater number of prescription drugs, especially three or more, proved to be a significant predictor of DDIs. Prescribers should be more aware of potential DDIs. Future studies should assess potential DDIs in primary care over a longer period of time.

Uso de medicamentos potencialmente inapropriados por idosos do Município de São Paulo, Brasil: Estudo SABE

Various medicines are considered unsuitable for older adults due to alterations in pharmacokinetics/pharmacodynamics, lack of therapeutic efficacy, and/or increased risk of adverse events exceeding potential benefits. The aim of this study was to determine the prevalence of potentially inappropriate medication among older adults in the city of São Paulo, Brazil. A population-based cross-sectional study was conducted in a sample of 1,254 individuals aged 60 years or older (participants in the SABE Study), representing the elderly population of the city in 2006. Potentially inappropriate medication was defined according to the Beers criteria. Prevalence of potentially inappropriate medication was 28%. Potentially inappropriate medication was associated with polypharmacy (p=0.001), two or more diseases (p=0.011), and female gender (p=0.007). Thirty-six potentially inappropriate medicines were identified, the majority of which involving prescription medications. Specific criteria are needed for the Brazilian population, in addition to awareness-raising on clinical pharmacology in older adults. Prescription protocols and software programs could assist in the process of rational prescribing in this age group.Alguns medicamentos sao considerados improprios para o idoso, devido a alteracoes na farmacocinetica e farmacodinâmica, por falta de eficacia terapeutica ou por um risco aumentado de efeitos adversos superando seus beneficios. Verificou-se a prevalencia do uso de medicamentos potencialmente inapropriados, segundo os criterios de Beers, por idosos do Municipio de Sao Paulo, Brasil, participantes do Estudo SABE. Trata-se de um estudo transversal, de base populacional, cuja amostra de 1.254 individuos com 60 anos ou mais representava a populacao idosa do municipio no ano de 2006. Verificou-se a prevalencia de 28% de uso de medicamentos potencialmente inapropriados. No modelo de regressao logistica multipla, as variaveis associadas ao uso foram uso de cinco medicamentos ou mais (p = 0,001), presenca de duas ou mais doencas (p = 0,011) e sexo feminino (p = 0,007). Identificou-se o uso de 36 medicamentos potencialmente inapropriados, a maioria de venda sob prescricao. Sao necessarios criterios especificos para a populacao brasileira e ampla divulgacao da farmacologia clinica do idoso. Protocolos ou softwares para prescricao tambem podem auxiliar a prescricao racional para esse grupo.

Circulation of antibodies against yellow fever virus in a simian population in the area of Porto Primavera Hydroelectric Plant, São Paulo, Brazil

Yellow fever (YF) is an acute viral infectious disease transmitted by mosquitoes which occurs in two distinct epidemiological cycles: sylvatic and urban. In the sylvatic cycle, the virus is maintained by monkeys infection and transovarian transmission in vectors. Surveillance of non-human primates is required for the detection of viral circulation during epizootics, and for the identification of unaffected or transition areas. An ELISA (enzyme-linked immunosorbent assay) was standardized for estimation of the prevalence of IgG antibodies against yellow fever virus in monkey sera (Alouatta caraya) from the reservoir area of Porto Primavera Hydroelectric Plant, in the state of São Paulo, Brazil. A total of 570 monkey sera samples were tested and none was reactive to antibodies against yellow fever virus. The results corroborate the epidemiology of yellow fever in the area. Even though it is considered a transition area, there were no reports to date of epizootics or yellow fever outbreaks in humans. Also, entomological investigations did not detect the presence of vectors of this arbovirus infection. ELISA proved to be fast, sensitive, an adequate assay, and an instrument for active search in the epidemiological surveillance of yellow fever allowing the implementation of prevention actions, even before the occurrence of epizootics.

Serologic survey for hantavirus infections among wild animals in rural areas of São Paulo State, Brazil

A serosurvey was conducted in wild animals captured close to two areas where hantavirus cardiopulmonary syndrome (HCPS) occurred in São Paulo State, Brazil. Serum samples from a total of 43 mammals were tested for antibodies reactive with Sin Nombre (SN) hantavirus using a strip immunoblot assay. RNAs from the blood clots of the positive samples were submitted to reverse transcriptase-polymerase chain reaction (RT-PCR). Two rodents of the genus Oligoryzomys were positive for hantavirus antibodies. These animals were captured in the Iguape region and represented 16.7% (2/12) of the sera from rodents and 100.0% (2/2) of the Oligoryzomys captured in that area. RT-PCR failed to amplify any viral cDNA. These results are in agreement with other data that suggest that members of this genus are important reservoirs of hantaviruses in Brazil.

Terminologia de incidentes com medicamentos no contexto hospitalar

In-hospital drug incidents cause problems for patients and additional costs for the health system. The variety of terms used to report them leads to disparities in research results and confuses the professionals that report them. This study aimed to review the terms used to describe drug incidents by collating them with the official concepts and definitions. PubMed, MEDLINE, IPA, and LILACS were searched to select studies published from January 1990 to December 2005. Thirty-three publications were selected. The supranational terminology recommended for describing drug incidents proved insufficient, but there was consensus that the expressions are used as a function of the type of incident. Adverse drug reaction is used when no intent is identified. Adverse drug event mainly describes incidents during hospitalization, and drug-related problem is used in studies on pharmaceutical care (use or lack of the drug). Still, the division between these categories is neither clear nor simple. Future studies on the relations between categories and multidisciplinary research on human error could support proposals for new concepts.

Condições de implantação e operação da farmacovigilância na indústria farmacêutica no Estado de São Paulo, Brasil

O desenvolvimento de novos produtos farmaceuticos e as limitacoes dos ensaios clinicos controlados tem sido responsaveis pelo aumento das possibilidades de eventos adversos a medicamentos. A farmacovigilância e essencial para detectar e avaliar eventos adversos a medicamentos reduzindo riscos e evitando gastos excessivos em saude publica. Este trabalho objetivou conhecer programas de farmacovigilância de industrias farmaceuticas sediadas no Estado de Sao Paulo, Brasil. Os dados foram coletados utilizando-se questionario enviado eletronicamente a 105 empresas, das quais 41,9% retornaram. O motivo principal para implantacao de programas foi atender exigencias regulatorias e a principal justificativa para sua ausencia foi producao limitada aos produtos fitoterapicos, ofici-nais e suplementos. Discutem-se as dificuldades para implantacao dos programas, os recursos utilizados e caracteristicas de alguns deles. Conclusoes: (a) a normatizacao e fonte de motivacao para o aumento dos programas e do numero de relatos mas e insuficiente sem esclarecimentos mais especificos; (b) os resultados dependem de envolvimento multisetorial; (c) o Servico de Atendimento ao Consumidor e importante fonte de relatos; (d) a estrutura da operacao do servico pode ser pouco dispendiosa em termos de recursos humanos e materiais.

Estratégias para a segurança do paciente no processo de uso de medicamentos após alta hospitalar

O atual movimento mundial para seguranca do paciente reforca a necessidade de desenvolver prevencao quaternaria - visando proteger os pacientes do excessivo intervencionismo diagnostico e terapeutico e minimizar o risco de iatrogenias - para evitar danos ao paciente e gastos desnecessarios ao sistema de saude. Em situacoes de transicao do cuidado, como alta hospitalar, a ocorrencia de eventos adversos relacionados ao uso de medicamentos pode resultar em readmissao hospitalar ou necessidade de atendimento ambulatorial ou em servicos de urgencia. Este artigo tem por objetivo discutir o gerenciamento da seguranca do paciente no processo de uso de medicamentos apos alta hospitalar. Com base em pesquisa bibliografica, realizou-se abordagem sobre estrategias utilizadas por equipe hospitalares, tais como reconciliacao medicamentosa, orientacao ao paciente e/ou cuidador, comunicacao por meio de resumo de alta, e seguimento domiciliar, alem da necessidade de atuacao interdisciplinar e interinstitucional para contribuir com a integralidade do cuidado. Concluise que o desenvolvimento de atividades de cuidado ao paciente em alta, pela equipe hospitalar, e a existencia de efetiva articulacao entre o hospital e demais servicos de saude podem representar importantes aliados neste grande desafio para a saude publica, que e a seguranca do paciente no processo de uso de medicamentos apos alta hospitalar.