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Abstract(s)
O presente trabalho encontra-se dividido em três capítulos.
No primeiro capítulo é descrito todo o trabalho de investigação acerca do consumo de medicamentos numa população idosa, especificamente em idosos com Diabetes Mellitus. Atualmente o envelhecimento da população encontra-se em fase de crescimento, sendo que em Portugal estima-se que, entre 1970 e 2014, a percentagem de população idosa aumentou de 9,7% para 20,3%. Verifica-se ainda um aumento da prevalência de doenças crónicas com a idade, como por exemplo a Diabetes Mellitus. Por conseguinte, surge a necessidade de haver maior exigência nos cuidados de saúde e maior utilização de medicamentos, o que contribui para a presença de polimedicação e polimedicação excessiva na população idosa. Este trabalho teve como principal objetivo estudar o consumo de medicamentos em idosos institucionalizados, com ênfase na doença Diabetes Mellitus, e compreender a qualidade de vida relacionada com a saúde destes mesmos. Para isso, foram aplicados questionários a 100 idosos voluntários residentes em cinco instituições localizadas na região Norte e Centro de Portugal. Os dados foram recolhidos entre julho e agosto de 2017, sendo posteriormente analisados estatisticamente com o apoio do software informático Statistical Package for the Social Sciences (SPSS) — versão 24.0. Do total de 100 idosos inquiridos, com idades compreendidas entre os 65 e 101 anos e uma média de idades de 83,98 ? 7,32, 60 eram do sexo feminino e 38 apresentavam Diabetes Mellitus. Relativamente ao número de medicamentos consumidos, 91 (91%) idosos encontravam-se polimedicados e 47 (47%) apresentavam polimedicação excessiva. Verificou-se ainda que o grupo farmacoterapêutico mais utilizado pelos idosos foi o do Aparelho Cardiovascular, com 92% de utilizadores e, dentro deste grupo, os anti-hipertensores foram os mais indicados. Relativamente ao tratamento antidiabético, verificou-se que 60,5% dos idosos utilizam antidiabéticos orais (ADO) isoladamente — sendo a metformina o mais utilizado —, 15,8% utilizam insulina isolada e 23,7% utilizam ADO em combinação com insulina. Constatou-se ainda que os idosos diabéticos consomem maior número de medicamentos por dia (10,5 ? 3,5) comparativamente aos não diabéticos (8,7 ? 4,1), apresentam maior percentagem de polimedicação excessiva e de doenças cardiovasculares, nomeadamente HTA e/ou AVC. Quanto à qualidade de vida relacionada com a saúde dos idosos, foi aplicado o questionário SF-36 e através dos scores médios obtidos, inferiu-se que os indivíduos do sexo masculino apresentam melhor qualidade de vida e que, de um modo geral, a qualidade de vida da população idosa em estudo pode ser classificada como moderada. Os idosos encontram-se mais limitados a nível dos aspetos físicos, com um score de 28,5 e menos limitados a nível da dor corporal, com um score de 58,9. Verificou-se ainda que os idosos com polimedicação excessiva obtiveram piores scores nos domínios da capacidade funcional, aspetos físicos, vitalidade, aspetos sociais, aspetos emocionais e saúde mental, comparativamente aos idosos não polimedicados. O segundo capítulo incide sobre o estágio efetuado em Farmácia Comunitária e descreve todas as atividades desenvolvidas e os conhecimentos adquiridos neste. Foi possível constatar que o farmacêutico, para além de ser o principal responsável pela dispensa dos medicamentos, é também responsável pelo acompanhamento do doente, estabelecendo uma ligação muito importante com este.
Por fim, o terceiro capítulo descreve as atividades desenvolvidas e experiência adquirida ao longo do estágio em Farmácia Hospitalar. Neste estágio pude acompanhar as atividades realizadas pelo farmacêutico no setor de ambulatório, na distribuição em dose unitária, na farmacotecnia e na gestão e armazenamento de medicamentos e produtos farmacêuticos.
This thesis is divided into three chapters. In the first chapter is described all the research work about the consumption of drugs in an elderly population, specifically elderly with Diabetes Mellitus. Nowadays population aging is growing, being estimated that in Portugal, between 1970 and 2014, the percentage of elderly population increased from 9.7% to 20.3%. There is also an increase in the prevalence of chronic diseases with age, such as Diabetes Mellitus disease. Therefore, there is a need for greater demands on healthcare and greater use of medicines, contributing to the presence of polypharmacy and excessive polypharmacy in elderly population. The main aim of this investigation was to study the consumption of drugs in institutionalized elderly, with the emphasis on Diabetes Mellitus disease, and to understand the elderly’s health-relate quality of life. In order to do this, questionnaires were applied to 100 elderly volunteers living in five nursing homes located in North and Central region of Portugal. The data was collected between July and August 2017 and were then statistically processed with the software Statistical Package for the Social Sciences (SPSS) — version 24.0. Of the 100 elderly participants, aged 65 to 101 years and a mean age of 83.98 ? 7.32, 60 were female and 38 had Diabetes Mellitus. Considering the number of drugs consumed, 91 (91%) elderly were polymedicated and 47 (47%) had excessive polypharmacy. It was also verified that the pharmacotherapeutic group most used by the elderly was the Cardiovascular System, with 92% of users and, within this group, antihypertensive drugs were the most indicated. Relative to antidiabetic treatment, 60.5% of elderly, used isolated oral antidiabetics — metformin was the most used —, 15.8% used isolated insulin and 23.7% used oral antidiabetics in combination with insulin. It was also observed that elderly with diabetes take more medications daily (10.5 ? 3.5) compared to non-diabetics (8.7 ? 4.1), have a higher percentage of excessive polypharmacy and cardiovascular diseases, in particular hypertension and/or CVA. As to elderly’s health-relate quality of life, the SF-36 questionnaire was applied and based on the average scores obtained, it was inferred that men have a better quality of life and that, in general, elderly population quality of life under study can be classified as moderate. The elderly are more limited in role-physical, with a score of 28.5 and less limited in body pain, with a score of 58.9. It was also verified that the elderly with excessive polypharmacy obtained worse scores in the physical functioning, role-physical, vitality, social functioning, role-emotional and mental health, compared to non-polymedicated elderly. The second chapter focuses on the Community Pharmacy internship’s report and describes all the activities developed and the knowledge acquired. It was possible noticed that the pharmacist, besides being the main responsible for dispensing medicines, is also responsible for the patient follow up, establishing a very important connection with it. Finally, the third chapter describes the activities developed and the experience obtained during the hospital pharmacy internship. During this internship, I was able to follow the activities performed by the pharmacist in the ambulatory sector, in the unit dose distribution, in the pharmacy compounding and in the logistics and storage of pharmaceutical products.
This thesis is divided into three chapters. In the first chapter is described all the research work about the consumption of drugs in an elderly population, specifically elderly with Diabetes Mellitus. Nowadays population aging is growing, being estimated that in Portugal, between 1970 and 2014, the percentage of elderly population increased from 9.7% to 20.3%. There is also an increase in the prevalence of chronic diseases with age, such as Diabetes Mellitus disease. Therefore, there is a need for greater demands on healthcare and greater use of medicines, contributing to the presence of polypharmacy and excessive polypharmacy in elderly population. The main aim of this investigation was to study the consumption of drugs in institutionalized elderly, with the emphasis on Diabetes Mellitus disease, and to understand the elderly’s health-relate quality of life. In order to do this, questionnaires were applied to 100 elderly volunteers living in five nursing homes located in North and Central region of Portugal. The data was collected between July and August 2017 and were then statistically processed with the software Statistical Package for the Social Sciences (SPSS) — version 24.0. Of the 100 elderly participants, aged 65 to 101 years and a mean age of 83.98 ? 7.32, 60 were female and 38 had Diabetes Mellitus. Considering the number of drugs consumed, 91 (91%) elderly were polymedicated and 47 (47%) had excessive polypharmacy. It was also verified that the pharmacotherapeutic group most used by the elderly was the Cardiovascular System, with 92% of users and, within this group, antihypertensive drugs were the most indicated. Relative to antidiabetic treatment, 60.5% of elderly, used isolated oral antidiabetics — metformin was the most used —, 15.8% used isolated insulin and 23.7% used oral antidiabetics in combination with insulin. It was also observed that elderly with diabetes take more medications daily (10.5 ? 3.5) compared to non-diabetics (8.7 ? 4.1), have a higher percentage of excessive polypharmacy and cardiovascular diseases, in particular hypertension and/or CVA. As to elderly’s health-relate quality of life, the SF-36 questionnaire was applied and based on the average scores obtained, it was inferred that men have a better quality of life and that, in general, elderly population quality of life under study can be classified as moderate. The elderly are more limited in role-physical, with a score of 28.5 and less limited in body pain, with a score of 58.9. It was also verified that the elderly with excessive polypharmacy obtained worse scores in the physical functioning, role-physical, vitality, social functioning, role-emotional and mental health, compared to non-polymedicated elderly. The second chapter focuses on the Community Pharmacy internship’s report and describes all the activities developed and the knowledge acquired. It was possible noticed that the pharmacist, besides being the main responsible for dispensing medicines, is also responsible for the patient follow up, establishing a very important connection with it. Finally, the third chapter describes the activities developed and the experience obtained during the hospital pharmacy internship. During this internship, I was able to follow the activities performed by the pharmacist in the ambulatory sector, in the unit dose distribution, in the pharmacy compounding and in the logistics and storage of pharmaceutical products.
Description
Keywords
Diabetes Mellitus Farmácia Comunitária Farmácia Hospitalar Idosos Institucionalizados Polimedicação Polimedicação Excessiva Qualidade de Vida