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- Initial medication adherence in newly diagnosed glaucoma patients: three adherence measuresPublication . Menino, Joana; Camacho, Pedro; Coelho, AndréAim: To determine initial medication adherence in newly diagnosed glaucoma patients treated with anti-glaucoma drugs. Methods: This retrospective and observational study included all patients diagnosed with glaucoma in the Primary Health Care units in Portugal during the years 2012 and 2013, which in consequence received a first prescription for anti-glaucoma drugs. Data were collected from electronic prescribing records of the primary care units and from pharmacy claims records. Initiation of glaucoma treatment and early discontinuation were measured, and the combination of (non)-initiation and early discontinuation accounted for the initial medication (non)-adherence. Results: A total of 3548 new glaucoma patients (40.1% male; 59.9% female) were included. 1133 (31.9%) patients were initially classified as non-users since there was no pharmacy claim found for their first prescription for glaucoma treatment. Additionally, 277 (11.5%) patients early discontinued their treatment, acquiring only their first prescription. Overall, the initial medication non-adherence rate was 39.7% since 1410 patients either didn't initiate treatment or discontinued it early. Conclusion: This study, reveals a major opportunity to improve glaucoma treatment and its control since a large proportion of patients fail to engage with their prescribed therapy, which implies that implementation of individual or group strategies that enable patients with glaucoma to correctly perform their treatment is still needed.
- Evaluation of the association between medication use and sleep quality among shift workers versus day workersPublication . Rosado, Magda Margarida; Carvalho, Lucinda Sofia; Coelho, AndréObjective: Different factors, such as medication use and shift work, can influence sleep quality. We aimed to determine the association between medication use and sleep quality in shift workers versus daytime workers. Materials and Methods: We conducted a quantitative cross-sectional study with a convenience sample of active workers. Online questionnaires were applied to assess sleep quality, sleepiness, medication use, and sociodemographic characteristics. Results: A total of 296 participants were included: 124 (41.89%) daytime workers and 172 (58.11%) shift workers. In total, 130 (43.92%) participants worked in the healthcare sector, 116 (39.19%), in industry, and 50 (16.89%), in other sectors. After a bivariate analysis, poor sleep quality was associated with the presence of sleep disorders (p < 0.001), type of work (shift or day work) (p < 0.001), and the use of sleeping medication (p < 0.001). Although shift workers had worse sleep quality, no differences were found regarding the use of medications that act directly on the central nervous system or with proven effects on sleep. No association was found between medication use and sleep quality. When adjusted for the different variables that were individually associated with poor sleep quality, through a logistic regression model, none showed an increased risk of poor sleep quality. Discussion: Despite the need for further research, our results have shown that sleep quality is influenced by many different factors whose impact must be evaluated in combination and not just in a bivariate manner. There are many factors individually associated with poor sleep quality, but when adjusted to each other, they have shown no increased risk of having poor sleep quality.
- Persistence with medical glaucoma therapy in newly diagnosed patientsPublication . Menino, Joana; Camacho, Pedro; Coelho, AndréBackground: Monotherapy, age, and side effects are significant risk factors for the discontinuation of antiglaucoma therapy. Long-term therapy persistence is crucial for slowing disease progression and preventing irreversible blindness. Therefore, it is essential to identify patients at higher risk of discontinuation. In this study, we aimed to evaluate the real-world persistence of antiglaucoma therapy in patients diagnosed with glaucoma in the primary healthcare units of the Lisbon and Tagus Valley regions. Methods: We conducted a retrospective longitudinal study by collecting data from the prescription records of new antiglaucoma drug users diagnosed with glaucoma between 2012 and 2013 in the Primary Health Care Units of the Lisbon and Tagus Valley Region. These patients were followed over 3 years. Therapy persistence was measured as the proportion of patients remaining on any antiglaucoma drug, regardless of any modifications or switching of drugs over time. Persistence was assessed at three time points: the end of the first, second, and third years of the observation period. Results: A total of 2138 patients treated using new antiglaucoma drugs (867 [40.6%] male patients; 1271 [59.4%] female patients) were included in the study. Over the observation period, the overall persistence rate decreased from 91.9% (n = 1965) in the first year to 67.3% (n = 1439) in the third year. Older patients (≥ 65 years) showed higher persistence rates, although there was a decrease over the 3-year follow-up period (from 1481 [92.7%] to 1124 [70.4%]). Additionally, participants initially treated with monotherapy showed higher persistence rates, ranging from 92.4% (n = 1186) in the first year to 70.2% (n = 901) in the third year. Conclusions: The findings highlight the importance of patient follow-up over time, as almost one in three new antiglaucoma therapy users completely discontinued treatment, potentially risking disease progression. This could be mitigated with proper use of these drugs. Further studies should utilize recent health information systems to explore the impact of medication adherence and persistence on the functional and structural outcomes in patients with glaucoma.
- DeSaFIo-ME: desnutrição, sarcopénia, fragilidade e medicação na pessoa idosaPublication . Cebola, Marisa; Tomás, Maria Teresa; Costa-Veiga, Ana; Rico, Miguel Toscano; Coelho, André; Mendes, Diana; Duque, Sofia; Galán-Mercant, Alejandro; Mendes, Lino; Marinho, Aníbal; Guerreiro, AntónioO envelhecimento ativo é definido pela Organização Mundial da Saúde (OMS) como o "processo de desenvolver e manter a capacidade funcional que promove o bem-estar da população idosa". No processo de envelhecimento são frequentes algumas alterações a nível físico, como alterações na composição corporal, diminuição na força muscular, flexibilidade, maior sensação de fadiga, que estão muitas vezes associadas a situações de doença. Ao associar ao processo de envelhecimento uma situação de doença, como obesidade, diabetes mellitus, dislipidemia, doença cardiovascular e alterações músculo-esqueléticas como a osteoartrite, osteoporose, entre outras, é previsível encontrar frequentemente diminuição da força muscular, flexibilidade e maior sensação de fadiga. Estas situações surgem mais cedo (por vezes a partir dos 30 anos e com maior intensidade a partir dos 50 anos), mas só mais tarde é que surgem os sinais e sintomas. Mas não tem que ser assim! As situações não são todas iguais! Há pessoas idosas que mantiveram estilos de vida saudáveis ao longo da sua vida e neste momento têm uma vida ativa e há outras em que as alterações fisiológicas são mais marcadas. A abordagem deve ser multidisciplinar para que todas as dimensões do envelhecimento sejam avaliadas e sejam preconizadas medidas que previnam/retardem o aparecimento/agravamento de situações mais específicas, nomeadamente desnutrição, sarcopénia e fragilidade. Com esta leitura pretende-se dar indicações para que se possa ter um estado nutricional adequado e manter hábitos de prática de atividade física.
- Drug-associated acute kidney disease: data from a world pharmacovigilance databasePublication . Baptista, Alexandre; Marreiros, Ana; Macedo, Ana; Coelho, AndréBackground: Drugs are a frequent cause of nephrotoxicity, especially in the context of acute kidney disease (AKD), with a significant number of cases being drug-associated. The WHO's VigiBase is a powerful tool for identifying drugs described and associated with the development of AKD. Methods: We retrieved data from the period 1968 to 2022 regarding notifications of adverse drug reactions (ADR). The extracted medications were evaluated for their nephrotoxicity based on the bibliographic score (BS) developed through pre-selected references. The main medications involved were classified as 'non-nephrotoxic', 'potentially nephrotoxic', and 'nephrotoxic'. We utilized the IC025 and reporting odds ratio (ROR) disproportionality indexes to study the relationship between medications and the odds of being included in an AKD notification. Results: During the period, a total of 33,932,051 notifications were obtained, revealing 435,677 cases related to drug-associated AKD following MedDRA term filtering, predominantly affecting males aged 45-64. We identified 8,991 active ingredients or suspected combinations associated with AKD development, with the ATC class A - Alimentary Tract and Metabolism being the most frequently described. Among the medications most strongly associated with this phenotype, classes J and N stood out. Among the most notable medications collected, 8.3% were classified as "non-nephrotoxic," 16.7% as "potentially nephrotoxic," and 75% as "known nephrotoxic." Notable active ingredients included cobicistat + elvitegravir + emtricitabine + tenofovir disoproxil (IC025 8.7; ROR 786.96), inotersen (IC025 7.7; ROR 604.57), emtricitabine + tenofovir disoproxil (IC025 7.9; ROR 432.36), esomeprazole (IC025 6.8; ROR 184.23), and pantoprazole (IC025 6.3; ROR 109.86), with proton pump inhibitors dominating the top four positions among the most frequently involved medications. Conclusion: AKD is a frequent adverse reaction in VigiBase, with a significantly high reported mortality rate. Evaluation of the notifications revealed medications with a high disproportionality index and a strong association with AKD. We also highlight the potential nephrotoxic role of less suspected medications. This study emphasizes the need to consider AKD as a condition potentially associated with iatrogenic etiology, highlighting various medications and their respective involvement in the various possible manifestations of AKD.
- Reconciliação da medicação: norma da DGS nº 018/2016, de 30/12/2016Publication . Direção-Geral da Saúde; Graça, Anabela; Coelho, AndréA reconciliação da medicação é um processo que contribui para manter atualizada a lista da medicação de cada doente, bem como outras informações importantes, nomeadamente reações adversas a medicamentos (RAM) e alergias, evitando discrepâncias entre a sua medicação habitual e a medicação instituída em cada momento de transição de cuidados. A transição de cuidados intra/inter instituições prestadoras de cuidados de saúde aumenta o risco de incidentes relacionados com a medicação e de admissões hospitalares evitáveis. A reconciliação da medicação é um processo baseado na evidência que contribui de forma significativa para a redução de incidentes relacionados com a medicação provocados por informação incompleta ou insuficiente sobre o doente e a medicação. A literatura mostra que (i) entre 10 a 70% das histórias medicamentosas contêm pelo menos um erro; (ii) até 1/3 desses erros têm o potencial de causar dano ao doente; (iii) mais de 50% dos erros de medicação ocorrem na transição entre cuidados; (iv) doentes com um ou mais medicamentos em falta na nota de alta têm um risco 2.3 vezes superior de serem readmitidos no hospital em relação aos que têm a informação medicamentosa correta; (v) 85% das discrepâncias são originadas por falhas no processo de recolha da informação sobre a medicação dos doentes. A reconciliação da medicação é um processo multidisciplinar e centrado no doente. Difere do processo habitual de revisão da medicação pela incorporação de outra informação, nomeadamente medicamentos não sujeitos a receita médica, produtos naturais e suplementos alimentares, bem como pelo recurso a outras fontes de informação (e.g. lista de medicação entregue pelo doente e/ou cuidadores; os próprios medicamentos entregues pelo doente; informação disponível nos sistemas informatizados). A educação dos doentes deve ser um foco prioritário no processo de reconciliação da medicação. O reconhecimento de que parte da informação é recolhida junto de fontes leigas em termos de saúde deve ser considerado e as instituições devem providenciar assistência para que a informação recolhida seja a mais exata quanto possível.
- Linkage between electronic prescribing data and pharmacy claims records to determine primary adherence: the case of antihypertensive therapy in the Lisbon and Tagus Valley Region, PortugalPublication . Coelho, AndréBackground: Hypertension (HT) is highly prevalent and a major risk factor for cardiovascular disease. Over 42% of Portuguese adults have HT. Even though the benefits of antihypertensive (AHT) drugs have been demonstrated, HT control remains inadequate. One major reason is that patients often fail to take their medications as prescribed. This paper aims to determine primary adherence to AHT therapy in newly diagnosed and treated hypertensive patients in Primary Health Care (PHC) units of Lisbon and Tagus Valley Health Region. Methods: This study reports data from a population-based, retrospective, cohort study from patients diagnosed with HT in PHC units of Lisbon and Tagus Valley Region from 1 January to 31 March 2011, with no prior use of AHT drugs. The primary adherence rate was expressed as the number of claims records/total number of prescriptions records. Data were collected from SIARS for each patient during a 2-year period. Results: Overall primary adherence rate was 58.5%, increasing with age. Rates were higher for men, living in the Lisbon Metropolitan Area and diagnosed with uncomplicated HT. Drugs acting on the renin-angiotensin system had the highest rates, increasing for fixed-dose combinations and diminishing with the increase of cost for the patient. Conclusions: Overall, almost 1 out of 2 prescribed AHT drugs were not dispensed. Until this study, little was known in Portugal about primary adherence. Our findings imply that the potential benefits of AHT therapy cannot be fully realized in this population.
- What people think about medicines and its prescription by doctors: a study in PortugalPublication . Santos, Margarida; Grilo, Ana; Andrade, Graça; Coelho, AndréDespite the general recognition of the benefits of adherence to medical regimes, it has been estimated that 50% of medicines prescribed for long-term illness are not taken as recommended. Adherence is a multidetermined process. The Extended Common‐Sense Model proposes the inclusion of beliefs about medicines as mediators between illness representations and adherence. Stronger beliefs about medicines and their harmful effects have been associated with higher levels of nonadherence. Objective: Explore general beliefs about medicines, and their recommendation by doctors among the Portuguese general population (age > 18 years) who use community pharmacy. Methodology: The two subscales, “general overuse” and general harm”, of the “The Beliefs about Medicines Questionnaire” (BMQ) and a sociodemographic questionnaire were used. IBM SPSS 26 software was used for statistical analysis. Results: A total of 847 Portuguese adults participated, 331 (39,1%) were 25-44 years of age; 427 (50,4%) concluded secondary education, and 198 (23,4%) reported having a chronic condition. The majority of participants endorse the belief that most medicines are addictive, and a large percentage agreed that they are toxic, that doctors overprescribed and could benefit from hearing patients; and that natural remedies are safer than medicines. Differences were found considering age (p=0,093), sex(p=0,08), and having active working (p=0,045) with stronger beliefs in young adults and adults, in males and no active workers. No differences were found considering the presence/absence of chronic disease". These results are discussed considering their possible contribution to the promotion of adherence through better communication with doctors, nurses, and pharmacists.
- Medicamentos de alta vigilância: norma nº 008/2023, de 19/12/2023Publication . Direção-Geral da Saúde; Coelho, AndréO Institute for Safe Medication Practices, entidade internacional de referência na área da segurança na medicação, recomenda que sejam adotadas estratégias dirigidas à prevenção dos incidentes relacionados com os MAV, nomeadamente através da: padronização da prescrição, armazenamento, dispensa, preparação e administração dos medicamentos LASA e MAM; publicitação de informações sobre estes medicamentos; restrição do acesso aos mesmos; uso de rótulos auxiliares e alertas automáticos; emprego de redundâncias (e.g. dupla verificação) e promoção da educação dos doentes. B. A falta de padronização / inexistência de protocolos/procedimentos de trabalho, conduzem a uma variabilidade na prestação de cuidados de saúde, aumentando o risco de ocorrência de incidentes relacionados com os MAV. A padronização de procedimentos deve abranger não só os procedimentos técnicos propriamente ditos (prescrição, dispensa, preparação e administração de medicamentos), mas também a comunicação de informação sobre o medicamento e o doente. Por essa razão, as instituições prestadoras de cuidados de saúde devem adotar práticas seguras relativamente à validação ou duplavalidação de procedimentos, ao reforço da atenção na preparação e administração de medicação, à correta documentação, bem como à monitorização da terapêutica, devendo essas práticas ser apoiadas em sistemas de informação e comunicação compatíveis e adequados.
- Conhecimentos, crenças e práticas sobre antibióticosPublication . Andrade, Graça; Coelho, André; Galvão, Andreia; Gonçalves, MargaridaObjetivos do estudo: 1) Analisar as crenças sobre medicamentos; 2) Avaliar e analisar o grau de conhecimentos sobre antibióticos; 3) Avaliar as perceções relativas á informação e fontes de informação sobre medicamentos; 4) Relacionar conhecimentos sobre antibióticos e variáveis sociodemográficas (grau de escolaridade, situação económica e género); 5) Relacionar crenças gerais sobre medicamentos e variáveis sociodemográficas (grau de escolaridade e género); 6) Relacionar conhecimentos sobre antibióticos e crenças gerais sobre medicamentos.