Prevalência e fatores associados à utilização de medicamentos potencialmente inadequados para idosos de um serviço de gerenciamento da terapia medicamentosa na atenção primária à saúde

Abstract

Background: Potentially inappropriate medication (PIM) can cause more risks than benefits and its use is frequently reported. Objectives: Investigate PIM use according to Beers criteria among older adults followed in a comprehensive medication management (CMM) service and to describe its clinical outcomes and pharmaceutical interventions. Setting: CMM service in the Brazilian public primary health care system. Methods: All older adults followed in the CMM service were included in the study (n=389). Two methodological approaches were developed: (I) cross-sectional - the prevalence of PIM use and associated factors were identified (univariate Pearsons chisquare; multivariate analysis logistic regression); (II) prospective analysis - negative clinical outcomes potentially associated with PIM use and pharmaceutical interventions were described. Main outcome measure: PIM use, negative clinical outcomes and pharmaceutical interventions. Results: A prevalence of 48.3% of PIM use. After multivariate analysis, the use of five or more drugs remained independently and positively associated with PIM use. For 21.3% (n=57) of PIMs, a potential negative clinical outcome was identified. For most of them (n=45; 78.9%), a pharmaceutical intervention was performed to mitigate the harm or discontinue its use. This type of intervention was also the most frequent among all interventions (performed for 64.2% of PIMs). Conclusions: A high prevalence of PIM was detected and was associated with polypharmacy. A significant proportion of PIM showed potential negative clinical outcomes and the majority of pharmaceutical interventions aimed at its mitigation or PIM suspension. These results show the potential of CMM to reduce PIM use and the occurrence of adverse events associated to its use