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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.
- Multimorbidity daily life activities and socio-economic classification in the Central Portugal primary health care setting: an observational studyPublication . Santiago, Luiz Miguel de Mendonça Soares; Prazeres, José Filipe Chaves Pereira; Boto, Tânia; Mauricio, Katia; Rosendo, Inês; Simões, José Augusto RodriguesBackground. Multimorbidity (MM) is associated with decreased quality of life, mainly due to decreased functional capacity and increased use of health care. Objectives. Evaluate the prevalence of MM in older people of Central Portugal and understand the impact of MM on daily life activities (DLA) and how socioeconomic level influenced prevalence of MM. Material and methods. Observational study of data on age, sex, number of ICPC2 codes and Barthel (Bt) and Graffar (Gr) Indexes in clinical records of all aged between 65 to 99 years enrolled in the Health Centers of the Central Region of Portugal. The Bt was used to assess the dependence on DLA and the Gr the socioeconomic level. Results. Population of 190025, mean age of 80.16± 8.03 years. MM prevalence of 80% out of which, 52.9% were female and the majority was aged between 76-85 years (39.1%). Average number of health problems of 8.7 problems for males and 9.5 for females. The Bt and Gr Indexes filling for the studied sample were of, Barthel 7.4% and Graffar 4,9%. Older people without MM have higher dependency rates than those with MM (total dependence 7.4% vs 6.2% and severe dependence 20.1% vs 9.6%). MM in older people are mainly in the middle (55.3% vs 27.5%) and low (31.8% vs 19.6%) Graffar class, while the older people without MM are mainly at middle to upper (35.3%) and upper (17.6%) Graffar classes. Conclusions. Multimorbidity is mainly associated with lower social classes. Dependence for DLA appears unrelated to MM. Multimorbidity persons need special attention, based on socio-economic contexts.
- Key Factors to Consider in Team Meetings when Dealing with Multimorbidity in Primary Care: Results from a Delphi PanelPublication . Prazeres, José Filipe Chaves Pereira; Simões, José Augusto RodriguesBackground: Multimorbidity brings several difficulties and challenges to the daily work of primary care teams. Team meetings are opportunities to discuss approaches and solutions on how to best manage multimorbid patients. Objective: This qualitative study aimed to collect a consensus, from general practitioners that deal with multimorbid patients, about their perspectives regarding multimorbidity team meetings in primary care. Methods: The study followed a modified Delphi method with 15 Portuguese general practitioners. After every round of responses, results were analyzed, and justifications for non-consensual items were aggregated by the investigators, and then a new Delphi round with the revised questionnaire was again initiated. This process was repeated until consensus has been reached. Results: Overall, a list of 10 key themes associated with the ideal meeting was agreed: (a) definition; (b) setting; (c) duration; (d) frequency; (e) number of participants; (f) attendance; (g) requirement of patient’s presence; (h) number of patients/clinical cases; (i) structure of the meeting; and (j) sharing meeting results. The consensus was achieved after two Delphi rounds with a mean score between 7.9 and 8.7 (maximum score of 9.0 per key theme). Conclusion: The complexity of multimorbidity affects meetings’ periodicity, duration, and participants. Ideally, it should be an interprofessional primary care team meeting. Further research exploring meeting outcomes (organizational effectiveness and healthcare quality) of the proposed factors is needed before they can be recommended for general use.
- 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 impact on health-related quality of life of mixed mental and physical multimorbidity in adults aged 60 years and older: secondary analysis of primary care dataPublication . Prazeres, José Filipe Chaves Pereira; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesIntroduction Given the number of patients with mental conditions who receive treatment within the primary care (PC) context, and the high prevalence of multimorbidity (especially in older people), there is a need to study mental-physical multimorbidity (MPM) in this population and context. This study sought to identify the impact on health-related quality of life (QoL) of MPM in adults aged 60 years and older. Material and methods Secondary analysis of data derived from 251 primary health individuals. Data were collected via a sociodemographic and clinical questionnaire. Health-related QoL was assessed using the SF-12 instrument. Multiple linear regressions were performed for physical and mental health in MPM patients and in patients with physical-only multimorbidity. Results Mean age of participants was 70.6 years; 57.8% were female. Quali¬ty of life was lower in MPM patients than in those with physical-only multimorbidity. Regarding MPM patients, female sex, 75 years and over, and low income were associated with worse physical health. Female sex was also associated with worse mental health. Conclusions This study contributes to the global knowledge of MPM in older people, illuminates health-related QoL differences among MPM and physical- only multimorbidity patients, and highlights the importance of non-modi-fiable characteristics associated with deterioration of health-related QoL. Team collaboration between primary care physicians, psychiatrists (and other mental health providers), and social workers may be necessary to assess psychiatric and physical symptoms and provide for the care needs of older people with MPM.
- Positive psychology of Portuguese “desenrascanço” in multimorbidity: the general practitioners’ perspectivePublication . Prazeres, José Filipe Chaves Pereira; Simões, José Augusto Rodrigues; Lomas, TimThe untranslatable word desenrascanço, a Portuguese construct related to people’s ability to skilfully negotiate complex issues and to solve them with originality and creativity, was studied using a common medical complex scenario – multimorbidity. An online qualitative survey was carried out in the last trimester of 2018. A total of 117 general practitioners (GPs) completed the full survey. Ninety-one (77.8%) were familiar with the concept of desenrascanço. Responses were coded using thematic analysis. Desenrascanço is commonly used by GPs; 77 out of 91 GPs use desenrascanço in at least half of the appointments with multimorbid patients. Three components of desenrascanço were identified: adaptive response; creativity and art; and positivity. It could conceivably be hypothesised that the positive drive of desenrascanço (e.g. creativity) are used by GPs collectively to adapt to multimorbidity – a medical complex situation. Nonetheless, one should not forget that it may not be the ideal solution, as stated by participant GPs. Keywords: multimorbidity, primary care, desenrascanço, untranslatable word.
- Physiological markers and multimorbidityPublication . Ferreira, Gustavo Dias; Simões, José Augusto Rodrigues; Senaratna, Chamara; Pati, Sanghamitra; Timm, Pierre Fernando; Batista, Sandro Rodrigues; Nunes, Bruno PereiraBackground: Multimorbidity is the co-occurrence of two or more diseases in the same individual. One method to identify this condition at an early stage is the use of specific markers for various combinations of morbidities. Nonetheless, evidence related to physiological markers in multimorbidity is limited. Objective: The aim was to perform a systematic review to identify physiological markers associated with multimorbidity. Design: Articles available on PubMed, Register of Controlled Trials, Academic Search Premier, CINAHL, Scopus, SocINDEX, Web of Science, LILACS, and SciELO, from their inception to May 2018, were systematically searched and reviewed. The project was registered in PROSPERO under the number CRD42017055522. Results: The systematic search identified 922 papers. After evaluation, 18 articles were included in the full review reporting at least one physiological marker in coexisting diseases or which are strongly associated with the presence of multimorbidity in the future. Only five of these studies examined multimorbidity in general, identifying five physiological markers associated with multimorbidity, namely, dehydroepiandrosterone sulfate (DHEAS), interleukin 6 (IL-6), C-reactive protein (CRP), lipoprotein (Lp), and cystatin C (Cyst-C). Conclusions: There is a paucity of studies related to physiological markers in multimorbidity. DHEAS, IL-6, CRP, Lp, and Cyst-C could be the initial focus for further investigation of physiological markers related to multimorbidity.
- 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.