Complexidade da Farmacoterapia: influência nos desfechos clínicos dos pacientes e fatores de risco para idosos com doenças crônicas

• Ano de defesa: 2022
• Autor(a) principal: Conceição, Vanessa Alves da
• Orientador(a): Júnior, Divaldo Pereira de Lyra
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Programa de Pós-Graduação: Pós-Graduação em Ciências da Saúde
• Palavras-chave em Português: Idosos; Complexidade da farmacoterapia; Desfechos clínicos; Doenças crônicas; Risco cardiovascular
• Palavras-chave em Inglês: Elderly; Medication regimen complexity; Clinical outcomes; Chronic conditions; Cardiovascular risk
• Área do conhecimento CNPq: CIENCIAS DA SAUDE
• Link de acesso: https://ri.ufs.br/jspui/handle/riufs/18560

Introduction. Elderly people have a high prevalence of chronic conditions that contribute to increase cardiovascular risk. Usually, this situation requires multiple and continuous use of medicines, which can increase the medication regimen complexity (MRC). MRC is considered one of the factors associated with the worsening of patients' clinical outcomes. In Brazil, studies on MRC with a high level of scientific evidence are still incipient. Therefore, scientific evidence is needed to quantify which clinical outcomes and risk factors are associated with MRC, helping to plan interventions to optimize it. Objective. To analyze the influence of FC on the clinical outcomes of patients and on risk factors in the elderly with chronic conditions that contribute to cardiovascular risk. Methods. This study was carried out in three steps. In the first step, a systematic review with meta-analysis was carried out using the databases Cochrane Library, LILACS, PubMed, Scopus, EMBASE, Open Thesis and Web of Science to identify studies that evaluated the association between MRC and clinical outcomes of patients. In the second step, a cross-sectional study was carried out to evaluate the MRC of elderly people with chronic conditions that contribute to cardiovascular risk, treated at the outpatient clinic of a teaching hospital in a state in the Northeast of Brazil. In the third step, the protocol of a single-blind randomized clinical trial was developed, which will be carried out from August 2022 to August 2023, at the hospital. This work was approved by the Research Ethics Committee with CAAE: 76101417.5.0000.5546 and registration number: 3,011,991. Results. The meta-analysis showed that the MRC is associated with clinical outcomes: hospitalization (HR 1.20; 95%CI 1.14 to 1.27; I2 = 0%), hospital readmission (DMP 7.72; 95%CI 1 .19 to 14.25; I2 = 84%) and medication nonadherence (adjusted OR 1.05; 95%CI 1.02 to 1.07; I2 = 0%). In the cross- sectional study, a total of 102 medical records were analyzed. The mean age of the elderly was 69 ± 7.01 years. The mean MRC was 14.76 ± 6.98. Data analysis regarding the association between MRCI and drug interactions (p<0.001), potentially inappropriate drugs for the elderly (p=0.016), therapeutic duplicity (p=0.008), as well as health problems: hypertension (p= 0.048), diabetes mellitus (p= 0.002) and dyslipidemia (p= 0.002), showed statistical significance for all these variables. Multiple linear regression demonstrated the existence of a significant influence of the number of medicines on MRC scores (F(1. 100)= 1242.47; p < 0.001; R²ajustado= 0.92. In the third step, a single-blind randomized controlled clinical trial protocol was developed and registered in the Brazilian Registry of Clinical Trials (ReBEC), with the following registration number: RBR-9dyq9jr. Conclusion. The meta-analysis showed that MRC is a risk factor that can influence the clinical outcomes of patients. In the cross-sectional study, it was possible to observe risk factors that may be associated with increased MRC in elderly patients with chronic conditions that contribute to cardiovascular risk. The controlled trial protocol is necessary to prove in practice which risk factors are associated with MRC, as well as to measure the impact of MRC on the health outcomes of elderly patients with chronic conditions that contribute to cardiovascular risk.