Qualificação do uso de medicamentos em uma instituição de longa permanência privada para idosos em Belo Horizonte: um programa integrado.

Abstract

The growth of the elderly population in Brazil increases the demand for long-term care facilities (LTCF). In turn, institutionalized elderly people need specialized care due to pathophysiologic changes and polypharmacy, which predispose them to drug-related problems (DRPs). This study aimed to describe an integrated program for qualifying the use of medicines at a LTCFs in Belo Horizonte. This is a descriptive longitudinal quasi-experimental type effectiveness/implementation of an integrated program for qualifying the use of medicines in four stages. In step I, the readjustment of the medication distribution system was described. In step II, we proceeded with the analysis of the prescriptions of the elderly (n = 17) in order to identify potential DRPs. For such, potential drug interactions were identified using Drug Reax®; potentially inappropriate medicine (PIM) according to the Beers criterion (2019); and pharmacotherapeutic omissions (PO), according to the Screening Tool to Alert to Right Treatment (START) (2015). In step III, a team of six pharmacists provided comprehensive medication management (CMM) services, identifying and resolving real DRPs and classifying them according to the Pharmacotherapy Workup method. In step IV, the impact of CMM on clinical and laboratory parameters was evaluated, comparing clinical parameters at the beginning and at the end of the integrated program using the t test and adopting a 5% level of statistical significance. An average age of 82.4 years was identified; most women (82.3%); and utilization of an average of 11.9 medications/elderly. 180 potential PRMs were identified (144 potential drug interactions; 26 PIM; and 10 PO). 121 CMM consultations, 76 pharmaceutical interventions (87% accepted) and 96 real DRPs were identified (76% resolved). There was a statistically significant difference between initial and final means of minimum systolic blood pressure (SBP) (112.4 ± 3.7 versus 95.0 ± 3.4; p = 0.004), maximum SBP (132.3 ± 4.2 versus 118.8 ± 6 , 1; p = 0.049), minimum diastolic blood pressure (DBP) (75.9 ± 5.7 versus 62.8 ± 1.1; p = 0.017) and maximum DBP (92.9 ± 4.5 versus 77.2 ± 2.7 ; p = 0.006). The differences in serum lipids and glycated haemoglobin were not statistically significant. The program demonstrated a positive impact on the health of the elderly, showing the effectiveness and viability of its implementation in LTCFs.