Patient safety in primary health care and polypharmacy: cross-sectional survey among patients with chronic diseases.

Lorena Ulhôa Araújo,Delba Fonseca Santos,Neila Márcia Silva-Barcellos,Emerson Cotta Bodevan,Hellen Lilliane Da Cruz,Jacqueline De Souza

doi:10.1590/1518-8345.3123.3217

Abstract

Objective:to characterize and determine the polypharmacy prevalence in patients with chronic diseases and to identify the factors associated, in order to improvement of pharmaceutical care focused on patient safety.Methods:cross-sectional study included 558 patients, covered by primary health care, using a household and structured questionnaire. We analyzed the data on polypharmacy and its clinical and socioeconomic factors. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio.Results:the results showed that polypharmacy (consumption of four or more drugs) was of 37.6%. The prevalence ratio analyses identified independent variables associated with polypharmacy: age (3.05), economic strata (0.33), way of medication acquisition through a combination of out-of-pocket and Brazilian public health system (1.44), diabetes and hypertension (2.11), comorbidities (coronary artery disease 2.26) and hospital admission (1.73). In the analyses, inappropriate medication use of the 278 patients (≥ 65 years) was associated with polypharmacy (prevalence ratio 4.04).Conclusion:polypharmacy study becomes an opportunity to guide the strategies for the patient safety to promote the medication without harm in chronic diseases.

Highlights

The World Health Organization (WHO), in 2017, has highlighted the polypharmacy as one of the key focus areas of its Third Global Patient Safety Challenge, Medication Without Harm
In the ten primary care units, 558 patients aged 18 years or older participated in the observational study period
The principal characteristics of the participants are illustrated in Tables 1 and 2

Summary

Introduction

The World Health Organization (WHO), in 2017, has highlighted the polypharmacy as one of the key focus areas of its Third Global Patient Safety Challenge, Medication Without Harm. The term polypharmacy, which is the routine use of four or more medications, represents a main patient safety issue[1]. In this context, it is necesary a team-based care approach patient centered, such as strategy for clinical decision making, collaboration, adherence to prescribed regimen and monitoring. Team-based care includes the patient, the patient’s primary care provider, and other professionals, such as cardiologists, nurses and pharmacists[2]. In primary health care (PHC) the risks to patients are much more related to the lack of monitoring during prolonged periods and the difficulties of access to health care. The patient safety is the comum practice, currently evolving towards primary care[3]

Objectives

Methods

Results

Discussion

Conclusion