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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.
- Letter to the Editor Regarding the Article: "Inappropriate Prescribing to Elderly Patients in an Internal Medicine Ward"Publication . Simões, Pedro Augusto Gomes Rodrigues Marques; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesDear Editor, We read with interest an article about inappropriate prescribing to elderly patients in an internal medicine ward and a letter to the editor regarding the same paper. We developed a similar study in the Portuguese primary care setting with a nation-wide representative sample of 757 elderly patients in accordance to its distribution in Portuguese health regions and we found that 77% of them were on ≥ 5 medications (with a mean of 8.2) and that 68% had at least one potentially inappropriate medication according the to 2015 Beers Criteria (with a mean of 1.72). The most common potentially inappropriate pharmacological classes were proton pump inhibitors (45.6%), non-steroid anti-inflammatory agents (34.5%) and benzodiazepines (27.3%). As such, we were also surprised with the low proportion of inappropriate prescribing at admission and at discharge reported in the study. One of the explanations, that was already reported, is the restricted number of pharmacologica classes used. This does raise many questions. Are we managing the various problems of our population in the best way? Is it necessary to rethink the polypharmacy cut-off since with the aging of the population there is an increase in the number of chronic diseases and consequently an increase in the number of drugs necessary to control them? Do we have to practice according to the guidelines or according to our clinical judgement of pathophysiology? Does this defnition of fve drugs for polypharmacy put people at a higher risk of undermedication, instead of overmedication?5 Shouldn’t we think of a new defnition for polypharmacy that isn’t the same for all people, but which takes into account the burden of disease that it is subject to? E.g. does it make sense to use the same polypharmacy cut-off for a healthy individual and a post-myocardial infarction patient? We consider this issue as fundamental, since as already mentioned the management of multimorbidity and polypharmacy (more specifcally of potentially inappropriate medication) are essential pillars in the provision of health care nowadays, both in primary and secondary care. So this raises the question of time since, in medical education, when should this topic be addressed and by whom? It is also important to analyze if there are differences between the work at the different health care levels regarding the management of multimorbidity, polymedication and potentially inappropriate medication. Are we all working towards the same goal?
- Communication and health: doctor-patient relationship in patients with multimorbidity, an exploratory studyPublication . Simões, José Augusto Rodrigues; Alberto, Kathleen; Simões, Pedro Augusto Gomes Rodrigues Marques; Mauricio, Katia; Rosendo, Inês; Santiago, Luiz Miguel de Mendonça SoaresBackground. With the increase of average life expectancy and the aging of the population, an increase in multimorbidity has also been observed. Effective communication in the doctor–patient relationship is directly related to the promotion of health of patents with multimorbidity. One of the fundamental foundations of this doctor-patient relationship is the physician’s ability to establish an empathic relationship with the patent. Objectives. The objective of this study is to compare Family Medicine consultations and Hospital consultations in terms of empathic communication and the doctor-patient relationship in patents with multimorbidity. Material and methods. An exploratory observational cross-sectional study was carried out using elderly people with multimorbidity and applying the JSPE scale. Statistical analysis was performed using descriptive statistics and the non-parametric Mann–Whitney u test. Results. For all questions on the JSPE scale, the family physician scored higher than the hospital physician. Between the specialties, statistically significant differences were obtained. Conclusions. The differences between Family Medicine consultations and Hospital consultations has an impact on the results of the medical empathy felt by the patents. Other studies demonstrate the importance of empathy in the doctor-patient relationship, and in this study, we concluded that there is a greater degree of empathy felt by the patients in Family Medicine consultations compared to the lower degree of empathy felt by the patents in Hospital consultations.