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- Prevalence Of Potentially Inappropriate Medication In The Older Adult Population Within Primary Care In Portugal: A Nationwide Cross-Sectional StudyPublication . Simões, Pedro Augusto Gomes Rodrigues Marques; Santiago, Luiz Miguel de Mendonça Soares; Maurício, Katia; Simões, José Augusto RodriguesBackground: In potentially inappropriate medications harm potentially outweighs benefits. Even appropriately prescribed medications may become inappropriate. They can lead to a high risk of adverse drug reactions, morbidity and mortality. The aim of this study was to determine the prevalence of potentially inappropriate medication in the older adult population attending primary care in Portugal and to identify associated sociodemographic and clinical factors. Methods: We conducted a cross-sectional, analytical study in primary care centres from the five Portuguese healthcare administrative regions and the two autonomous regions. We used a random sample of 757 older patients provided by the information department of the ministry of health (SPMS) and family doctors from the autonomous regions. Data collection occurred March 2018 and we studied sociodemographic characteristics, clinical profile and medication. We used 2015 Beers Criteria to assess potentially inappropriate medications. Logistic regression analyses were performed to determine associations between potentially inappropriate medications’ prescriptions and other variables. Results: Potentially inappropriate medication was present in 68.6% and 46.1% of the sample had two or more. The likelihood of having potentially inappropriate medication increased significantly with being female (OR=1.56 [1.05 to 2.31]), number of chronic health problems (OR=1.06 [1.01 to 1.13]), number of pharmacological subclasses (OR=1.40 [1.30 to 1.51]) and number of prescribers (OR=1.34 [1.09 to 1.65]). Proton-pump inhibitors, nonsteroidal anti-inflammatory drugs and benzodiazepines were the most commonly found ones. Conclusion: Potentially inappropriate medication in older adults was found to be a common occurrence in Portugal. It is important that doctors are aware of this problem, namely in the primary care setting due to the longitudinal care.
- Carta ao Editor a Propósito da Carta ao Editor “Polifarmácia e Utilização de Medicação Potencialmente Inapropriada no Idoso com Idade Igual ou Superior a 75 Anos: O Caso de uma Unidade de Saúde Familiar”Publication . Simões, Pedro Augusto Gomes Rodrigues Marques; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesCaro Editor, Lemos com interesse a carta ao editor acerca da polifarmácia e utilização de medicação potencialmente inapropriada (MPI) no idoso com idade igual ou superior a 75 anos.Num estudo similar, desenvolvido no âmbito dos Cuidados de Saúde Primários a nível nacional e com uma amostra representativa de 757 idosos com idade igual ou superior a 65 anos de acordo com a distribuição a nível nacional da população idosa, verificámos uma prevalência de polifarmácia de 77% (sobe para 82,6% quando consideramos a faixa etária ≥ 75 anos) e uma média de 8,2 medicamentos (8,7 medicamentos se ≥ 75 anos). A prevalência de pelo menos uma MPI foi de 68,6% (sobe para 72,1% se considerarmos apenas ≥ 75 anos), e os MPI mais prevalentes foram os inibidores da bomba de protões (presentes em 45,6% da nossa amostra), anti-inflamatórios não esteroides (em 34,5%) e benzodia-zepinas (em 27,3%). As diferenças encontradas dever-se-ão, provavelmente, às caraterísticas específicas da população estudada, bem como aos métodos de recolha de dados, informações que não ficam claras numa exposição tão curta como a feita em formato de carta ao editor. No nosso estudo verificámos que a probabilidade de um idoso estar sujeito a polifarmácia au-menta com a idade, número de doenças crónicas e o número de prescritores; enquanto que a probabilidade de um idoso estar sujeito a medicação potencialmente inapropriada aumenta com o ser mulher, número de doenças crónicas, número de medicamentos e número de prescritores. Concordamos e sublinhamos a importância dada à necessidade de ser revista periodicamente a medicação dos nos-sos utentes, principalmente dos mais idosos que têm maior probabilidade de sofrer eventos adversos aos medicamentos. Salientamos a necessidade de prescrição criteriosa dos medicamentos, com a utilização de ferramentas de apoio, sendo os critérios de Beers um bom exemplo de tal. Mas o uso de critérios implícitos que envolvam o nosso juízo clínico, de que os exemplos mais conhecidos são o Medication Appropriateness Index e o algoritmo de Garfinkel, devem ser referidos para utilização criteriosa. Uma vez que em muitos casos a medicação prescrita é apenas a ponta do iceberg do que os utentes tomam, devendo também considerar-se a toma de medicação de venda livre e de suplementos, cuja prevalência de consumo tem vindo a aumentar, mais importante ainda se torna este tema que deve ser baseado no conhecimento a adquirir ao nível pré--graduado e modelado pelas ferramentas acima referidas como auxiliares da melhor prática.
- Prevalence of polypharmacy in the older adult population within primary care in Portugal: a nationwide cross-sectional studyPublication . Simões, Pedro Augusto Gomes Rodrigues Marques; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesIntroduction Polypharmacy is commonly defined as the simultaneous use of five or more medications; however, there is a lack of consensus regarding the most appropriate definition. It is a significant predictor of morbidity and mortality. The aim of this study was to determine the prevalence of polypharmacy in the population of older adults attending primary care in Portugal and to identify associated sociodemographic and clinical factors. Material and methods We conducted a cross-sectional, analytical study in primary care centres from the five Portuguese healthcare administrative regions and the two autonomous regions. We used a random sample of 757 older adult patients provided by the information department of the ministry of health (SPMS) and family doctors from the autonomous regions. Data collection occurred in March 2018. The variables utilised were sociodemographic characteristics, clinical profile and medication. For each patient, polypharmacy was measured either by the concurrent use of ≥ 5 drugs or by the median number of drugs at the time of data collection. Logistic regression analyses were performed to determine associations between polypharmacy and other variables. Results Polypharmacy (≥ 5 drugs) was present in 77% of the sample. A cut-off of over the median number of drugs was present in 55%. The likelihood of having polypharmacy increased significantly with age (OR = 1.05 (1.02–1.08)), number of chronic health problems (OR = 1.24 (1.07–1.45)) and number of prescribers (OR = 4.71 (3.42–6.48)). Cardiovascular, metabolic and musculoskeletal medications were the most commonly involved in polypharmacy. Conclusions Polypharmacy was a very common occurrence in Portugal. Future primary healthcare policies should address polypharmacy.
- The Elderly’s Thoughts and Attitudes about Polypharmacy and Deprescribing: A Qualitative Pilot Study in PortugalPublication . Simões, Pedro Augusto Gomes Rodrigues Marques; Foreman, Nicole; Xavier, Beatriz de Oliveira; Prazeres, Filipe; Maricoto, Tiago; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesThe high prevalence of polypharmacy and potentially inappropriate medications in the elderly makes them a vulnerable group to adverse drug events. Deprescribing is the medication review plus cessation of potentially inappropriate medications with a health professional’s help. Several barriers and enablers influence it, and its knowledge can help health professionals. The objective of the study is to understand the Portuguese elderly’s attitudes and ideas about polypharmacy and deprescription. We made a qualitative approach through a focus group with elderly patients from an adult daycare center with transcription and codification into themes and subthemes based on previous frameworks. Eleven elderly patients participated in the focus group. The identified elderly’s ideas and attitudes could be clustered into five main barriers: appropriateness, process, influences, fear, and habit, and five main enablers: appropriateness, process, influences, dislike, and cost. Although the elderly’s strong beliefs regarding medication benefits and necessity prevail, contrary opinions regarding lack of benefit/necessity, drug interaction/side effects, and medication complexity/number may influence their willingness to deprescribe positively. The health professional’s influence and the patient’s trust in their doctors were perceived essential for decision-making as either a barrier or an enabler. The medication benefit was a big barrier, and side effects/drug interaction experiences are an important enabler.
- Physician empathy and patient enablement: survey in the Portuguese primary health carePublication . Simões, José Augusto Rodrigues; Prazeres, José Filipe Chaves Pereira; Maricoto, Tiago; Simões, Pedro Augusto Gomes Rodrigues Marques; Lourenço, Joana; Romano, João Pedro; Santiago, Luiz Miguel de Mendonça SoaresBackground: Empathy is the capacity to understand and resonate with the experiences of other people. Patient enablement is the degree to which a patient feels strengthened in terms of being able to deal with, understand and manage their disease. Methods: Secondary cross-sectional analysis of existing data from 2 independent datasets (456 primary health care patients), with the application of two validated questionnaires, Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and Patient Enablement Instrument (PEI). Objective: Evaluate medical empathy and patients’ enablement after consultation with their family doctors and to verify if there was an association between these two concepts. Results: The median value of JSPPPE-VP score was 6.60 (interquartile range 1.00) and of PEI/ICC score was of 1.83 (interquartile range 0.67). Regarding empathy (JSPPPE-VP), patients taking chronic medication had a slight but significantly higher median score than patients not taking them (6.70 versus 6.60, P = 0.049), although regression modelling did not confirm any relevant predictor of JSPPPE-VP score. Regarding enablement (PEI/ICC), we found significantly higher scores on younger patients, as well as, on more educated and professionally active ones (P < 0.001). Multivariable linear regression and Poisson regression modelling confirmed such variables as statistically significant potential predictors. Conclusions: A significant positive association was found between empathy score (JSPPPE-VP) and enablement score (PEI/ICC), when adjusted to sociodemographic cofactors. On this linear regression model, age category and educational level were also significantly associated with empathy score, with the same pattern found on bivariate analysis.
- Determining factors associated with inhaled therapy adherence on asthma and COPD: A systematic review and meta-analysis of the global literaturePublication . Monteiro, Constança Lourenço Pelicho; Maricoto, Tiago; Prazeres, José Filipe Chaves Pereira; Simões, Pedro Augusto Gomes Rodrigues Marques; Simões, José Augusto RodriguesBackground Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary Disease (COPD), considering its barriers and features. We reviewed the global literature reporting the main determinants for adherence on these patients. Methods Searches were made using the Cochrane Library, MEDLINE, EMBASE and ISI Web of Science databases. Analytical, observational and epidemiological studies (cohort, case-control and cross-sectional studies) were included, reporting association between any type of determinant and the adherence for inhaler therapy on Asthma or COPD. Random-effects meta-analysis were used to summarise the numerical effect estimates. Results 47 studies were included, including a total of 54.765 participants. In meta-analyses, the significant determinants of adherence to inhaled therapy were: older age [RR = 1.07 (1.03–1.10); I2 = 94; p < 0.0001] good disease knowledge/literacy [RR = 1.37 (1.28–1.47); I2 = 14; p = 0.33]; obesity [RR = 1.30 (1.12–1.50); I2 = 0; p = 0.37]; good cognitive performance [RR = 1.28 (1.17–1.40); I2 = 0; p = 0.62]; higher income [RR = 1.63 (1.05–2.56); I2 = 0; p = 0.52]; being employed [RR = 0.87 (0.83–0.90); I2 = 0; p = 0.76] and using multiple drugs/inhalers [RR = 0.81 (0.79–0.84); I2 = 0; p = 0.80]. Overall, the strength of the underlying evidence was only low to moderate. Conclusions Many determinants may be associated to patient's adherence, and personalised interventions should be taken in clinical practice to address it by gaining an understanding of their individual features.
- Deprescribing: a self-portrait about the reduction of polypharmacy in PortugalPublication . Simões, Pedro Augusto Gomes Rodrigues Marques; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesDrug use in older adults’ patients (≥65 years) is extensive, increases substantially with age, and is associated with many adverse outcomes. Polypharmacy is commonly defined as taking 5 or more medications daily and affects between 30 and 70% of older adults. Potentially inappropriate medication (PIM) refers to medication of which the harms outweigh the benefits, and its prevalence is 20 to 65%. Several strategies have been developed to identify inappropriate prescription patterns, the most common are Beers and STOPP/START criteria. Deprescription is a systematic process to of identifying and discontinuing drugs that are not beneficial or are not aligned with the patient’s care goal. Many deprescribing processes have been proposed, but none is widely used. This thesis aims to assess the knowledge of older adults about the deprescription, its effect on willingness to have regular medications deprescribed and their quality of life outcome. To achieve these objectives, we proposed to divide the project into three phases. The first two would be cross-sectional studies carried out at the national level and the last a non-pharmacological random clinical trial in the centre region of Portugal. Of the three phases, we have completed only the first two, the last has been postponed. In the first phase, we assessed the prevalence and patterns of polypharmacy and PIM in the Portuguese older adult population. In the second phase, we evaluated the barriers and facilitators of deprescribing perceived by Portuguese polymedicated older adults and their willingness to have regular medications deprescribed and to self-medicate. In the first study, we found that 77% of the sample had polypharmacy and 68.6% used at least one PIM. The likelihood of having polypharmacy increased with age, number of chronic health problems and number of prescribers; and the likelihood of having PIM increased with being female, number of chronic health problems, number of drugs and number of prescribers. The most common PIM were proton-pump inhibitors, nonsteroidal anti-inflammatory drugs, and benzodiazepines. In the second study, we found that 74% of the sample believed that drugs were generally beneficial. However, 19.9% indicated a high belief that drugs were harmful and 33.4% that they were generally overused. We also found that 61.8% were against the idea of deprescribing (against 24.6% who were in favour) and that 40% had a need to self-medicate. Those against being deprescribed had lower education level and a higher number of perceived morbidities than those not against being deprescribed; and the need to self-medication was associated with higher formal education, lower feeling of overuse of medication by doctors and a lower belief that medicines are harmful. Our results show that polypharmacy and PIM are very common occurrence in Portugal; and that most Portuguese older adults see mediation as beneficial and, therefore, are against the idea of being subject to deprescription. Self-medication is also common. These results will increase general practitioners, society and policy makers awareness for these problems and help them to better start addressing them. However, more research is needed to clarify the impact of deprescribing process in the Portuguese population health and well-being or, alternatively, to improve the process of prescription drugs, avoiding their excess.
- Deprescribing in primary care in Portugal (DePil17-20): a three-phase observational and experimental study protocolPublication . Simões, Pedro Augusto Gomes Rodrigues Marques; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesIntroduction: Polypharmacy is commonly defined as the simultaneous taking of five or more drugs. Deprescribing is the process of tapering or stopping medications with the aim of improving patient outcomes and optimising current therapy, and there are several tools aiming at identifying potentially inappropriate medications, especially in the elderly. The direct involvement of patients and their caregivers in the choice and administration of drugs has long been known to be very important, but it is not usually applied. The aim of this study is to assess the knowledge of older adults about deprescription, the effect on willingness to have regular medications deprescribed and its quality-of-life outcome. Methods and analysis: This study protocol comprises three phases. The first two phases will be nationwide and aim to evaluate the prevalence and patterns of polypharmacy and assess the barriers and facilitators of deprescribing perceived by older adults, as well as their willingness to have regular medications deprescribed and to self-medicate. The third and last phase will be a nonpharmacological randomised clinical study to measure older patients’ acceptance to have regular medications deprescribed and related quality of life. Ethics and dissemination: The study will be conducted in accordance with the principles expressed in the Declaration of Helsinki. It has been approved by the Ethics Committee of the University of Beira Interior and Portuguese National Data Protection Commission. Study results will be published in peer-reviewed journals and presented at national and international conferences. In short, no action will be taken without written consent from patients and doctors. Trial registration number >NCT03283735.
- COVID-19-Related Fear and Anxiety: Spiritual-Religious Coping in Healthcare Workers in PortugalPublication . Prazeres, José Filipe Chaves Pereira; Passos, Lígia; Simões, José Augusto Rodrigues; Simões, Pedro Augusto Gomes Rodrigues Marques; Martins, Carlos; Teixeira, AndreiaThe COVID-19 pandemic has negatively affected the mental health of the general population, and for healthcare workers (HCWs) it has been no different. Religiosity and spirituality are known coping strategies for mental illnesses, especially in stressful times. This study aimed to describe the role of spiritual-religious coping regarding fear and anxiety in relation to COVID-19 in HCWs in Portugal. A cross-sectional quantitative online survey was performed. Socio-demographic and health data were collected as well as the Duke University Religion Index, Spirituality Scale, Fear of COVID-19 Scale, and Coronavirus Anxiety Scale. Two hundred and twenty-two HCWs participated in the study, 74.3% were female and 81.1% were physicians. The median age was 37 years (Q1, Q3: 31, 51.3). Religiosity was neither a significant factor for coronavirus-related anxiety nor it was for fear of COVID-19. Participants with higher levels in the hope/optimism dimension of the Spirituality Scale showed less coronavirus-related anxiety. Female HCWs, non-physicians, and the ones with a previous history of anxiety presented higher levels of fear and/or anxiety related to COVID-19. HCWs’ levels of distress should be identified and reduced, so their work is not impaired.
- The link between happiness and health: a review of concepts, pathways and strategies for enhancing well-beingPublication . Mendes, Mafalda Pereira; Simões, Pedro Augusto Gomes Rodrigues Marques; Simões, José Augusto Rodrigues; Santiago, Luiz Miguel de Mendonça Soares; Prazeres, José Filipe Chaves Pereira; Maricoto, TiagoBackground. Recent years have seen a signifcant body of research independently associatng the presence of happiness and well-being with a lower risk of mortality and with an improved physical and mental health status, which presents a relevant impact on public health. Nonetheless, there are stll gaps in literature, and the underlying mechanisms are stll unclear. Objectves. this paper reviews literature regarding the main concepts and measurements associated with well-being, discussing pathways that link happiness to health and compiling strategies to improve it. Material and methods. A narratve literature review was performed gathering the most relevant artcles concerning concepts, defnitons and measurements associated with well-being, as well as regarding pathways and mechanisms that link happiness to health. The concepts and defnitons associated with happiness and well-being are discussed, and common constructs related to the later are then considered. Additonally, the available methods to measure happiness and well-being, and their limitatons, are analysed. Results. The main pathways that link mental to physical well-being include: 1) neurobiological processes, 2) the indirect impact on health behaviours, 3) the promoton of protectve psychosocial resources and 4) stress buffering effects. Conclusions. Happiness and well-being play a major role on human’s health, and many features and dimensions may be involved in this relatonship. Public health measures should focus on upstream determinants of health and well-being, but more research is needed in order to fll in some gaps, such as the variety of available instruments to address, evaluate and promote efcient interventon.