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Background Depression in older adults is a challenge for health systems in most low- and middle-income countries (LMICs). Digital strategies for the management of this condition have been emerging worldwide, but the effectiveness of most of them is still unclear, especially among older adults. Thus, we aim to assess the effectiveness and cost-effectiveness of a digital psychosocial intervention to treat depression among older adults living in socioeconomically deprived areas in Guarulhos, Brazil. Methods We will conduct a two-arm individually randomised controlled trial with 1:1 allocation ratio. Five hundred older adults aged 60 years or over with depressive symptomatology (9-item Patient Health Questionnaire score, PHQ-9 ≥ 10) and registered with one of the primary care clinics will be recruited to participate in this study. A 6-week digital psychosocial programme, named Viva Vida, will be delivered via WhatsApp to participants allocated to the intervention arm. The Viva Vida will send psychoeducational and behavioural activation audio and visual messages 4 days a week for 6 weeks. The control arm will only receive a single message with general information about depression. The primary outcome will be the proportion of depression recovery (PHQ-9 < 10) assessed at 3 months. The cost-effectiveness of the intervention will be assessed at 5 months. A detailed process evaluation will be used to explore context and important implementation outcomes. Discussion This programme was based on the PROACTIVE intervention and designed to be delivered without face-to-face contact. If effective, it could be a simple treatment option, appropriate not only when social distancing is required, but it could also be included as a regular public health programme to initiate depression treatment, particularly in LMICs where resources allocated to mental health are scarce. Trial registration Registro Brasileiro de Ensaios Clínicos (ReBEC), RBR-4c94dtn. Registered on 22 October 2021 (submitted on 03 August 2021).

Background: Pharmaceutical interventions aim to correct or prevent a drug-related problem (DRP) that might lead to negative clinical consequences and increase health care costs. Objective: To identify variables associated with the provision of pharmaceutical interventions by clinical pharmacists during hospitalization. Methods: In this retrospective cohort study, adult inpatients of the medical ward of the University Hospital of the University of São Paulo in São Paulo, Brazil, were followed from admission to discharge. Logistic regression models were used to evaluate the association between occurrence of at least 1 pharmaceutical intervention and the following baseline characteristics: sex, age, Charlson comorbidity index, renal failure, electrolyte imbalance, hemoglobin, platelet count, and use of a nasoenteric tube, as well as the number, second-level Anatomical Therapeutic Chemical (ATC) code, and administration route of prescribed medications. Results: A total of 148 patients were included in the study, of whom 75 (50.7%) were men. The mean age was 62.8 (95% confidence interval [CI] 59.9–65.8) years, and the mean length of the hospital stay was 10.7 (95% CI 8.4–13.1) days. Analgesics (ATC code N02), the most common type of medication, were prescribed to 144 (97.3%) of the patients. Pharmaceutical interventions were performed for only 49 (33.1%) of the patients. One out of every 4 of these interventions was intended to obtain information not provided in the prescription, to allow the prescription to be completed and dispensing to proceed. According to the multivariate analysis, the odds ratio (OR) of occurrence of at least 1 pharmaceutical intervention increased for patients with electrolyte imbalance (OR 2.68, 95% CI 1.09–6.63; p = 0.033), patients using 5 to 8 medications (OR 8.73, 95% CI 1.07–71.36; p = 0.043), patients using 9 or more medications (OR 10.39, 95% CI 1.28–84.05; p = 0.028), and patients using at least 1 systemic antibacterial (ATC code J01; OR 2.76, 95% CI 1.30–5.84; p = 0.008). Conclusions: The findings of this study could allow the identification, at the time of admission and possibly before the occurrence of a DRP, of patients at higher risk of requiring a pharmaceutical intervention later during their hospital stay. To optimize patient care, clinical pharmacists should closely follow inpatients with electrolyte imbalance, polypharmacy, and/or use of systemic antibacterials. RÉSUMÉ Contexte : Les interventions pharmaceutiques visent à corriger ou à prévenir un problème lié aux drogues (PLD), qui pourrait entraîner des conséquences cliniques négatives et accroître les coûts des soins de santé. Objectif : Déterminer les variables associées aux interventions pharmaceutiques des pharmaciens cliniques lors d’une hospitalisation. Méthodes : Dans cette étude de cohorte rétrospective, les patients adultes hospitalisés au Service de médecine de l’Hôpital universitaire de São Paulo au Brésil ont été suivis dès leur admission et jusqu’à leur sortie. Des modèles de régression logistique ont été utilisés pour évaluer l’association entre au moins une intervention pharmaceutique et les caractéristiques de base suivantes : sexe, âge, indice de comorbidité de Charlson, insuffisance rénale, déséquilibre électrolytique, hémoglobine, numération plaquettaire et utilisation d’un tube nasoentérique, et l’ensemble du groupe a subi une évaluation selon le nombre de médicaments prescrits au deuxième niveau des classifications du Système de classification anatomique thérapeutique chimique (ATC) et leur voie d’administration. Résultats : Cent-quarante-huit (148) patients ont été inclus dans cette étude; 75 d’entre eux (50,7 %) étaient des hommes. L’âge moyen était de 62,8 ans (95 % intervalle de confiance [IC] 59,9 - 65,8), et la durée moyenne du séjour à l’hôpital était de 10,7 jours (95 % IC 8,4 – 13,1). Des analgésiques (code ATC N02), type de médicament le plus répandu, ont été prescrits à 144 patients (97,3 %). Seuls 49 patients (33,1 %) ont fait l’objet d’une intervention pharmaceutique. Une de ces interventions sur quatre avait pour but d’obtenir des informations absentes dans la prescription mais indispensables à l’obtention de la validation de la prescription et de l’autorisation de distribution des médicaments. Selon l’analyse multivariée, le rapport de cotes (RC) de la nécessité d’au moins une intervention pharmaceutique augmentait pour les patients ayant un déséquilibre électrolytique (RC 2,68, 95 % IC 1,09 - 6,63; p = 0,033), les patients prenant entre cinq et huit médicaments (RC 8,73, 95 % IC 1,07 - 71,36; p = 0,043), les patients prenant au moins neuf médicaments (RC 10,39, 95 % IC 1,28 - 84,05; p = 0,028) et ceux utilisant au moins un antibactérien systémique (code ATC J01; RC 2,76, 95 % IC 1,30–5,84; p = 0,008). Conclusions : Les résultats de cette étude pourraient permettre d’identifier, à l’admission à l’hôpital et probablement avant l’apparition d’un PLD, les patients présentant des risques plus élevés, qui pourraient nécessiter une intervention pharmaceutique plus tard lors de leur séjour. Pour optimiser les soins aux patients, les pharmaciens cliniques doivent suivre étroitement les patients hospitalisés ayant un déséquilibre électrolytique, ceux qui nécessitent une polypharmacie et ceux qui utilisent des antibactériens systémiques.

Resumo Objetivo Identificar preditores do conhecimento inadequado sobre medicamentos prescritos a pacientes ambulatoriais muito idosos e seus cuidadores. Método O conhecimento sobre os medicamentos prescritos para 80 pacientes com 80 anos ou mais de idade foi avaliado por meio de um questionário validado, em uma entrevista realizada com os pacientes ou seus cuidadores (quando os pacientes apresentavam dificuldades de comunicação, demência ou qualquer necessidade de assistência para ajudá-los a usar medicamentos). Dois modelos de regressão logística hierárquica avaliaram a associação entre conhecimento inadequado sobre medicamentos e variáveis sociodemográficas e medicamentosas. Resultados Trinta e nove (48,8%) entrevistados eram cuidadores. Conhecimento inadequado foi encontrado em 81,5% (404/496) dos medicamentos prescritos. Forma de administração, Dose, Frequência e Duração do Tratamento foram os aspectos de maior conhecimento, enquanto Reações Adversas, Precauções, Interações e Contraindicações, os de menor. No primeiro modelo, o conhecimento inadequado foi associado à escolaridade do ensino fundamental completo ao médio incompleto (Razão de Chances (RC):0,12; p=0,018), do médio ao superior incompleto (RC:0,12; p<0,001), superior completo (RC:0,13; p<0,001), agentes que atuam no sistema renina-angiotensina (SRA) (RC:0,30; p=0,001), diuréticos (RC:0,31; p=0,013) e antitrombóticos (RC:12,59; p=0,027). No segundo modelo, os preditores foram cuidadores (RC:0,17; p<0,001), agentes que atuam no SRA (RC:0,33; p=0,002), diuréticos (RC:0,35; p=0,024) e antitrombóticos (RC:12,57; p=0,026). Conclusão A maioria dos medicamentos prescritos para pessoas muito idosas é pouco conhecida. Além disso, o aconselhamento acerca de informações sobre medicamentos deve ser mais intensivo para os pacientes do que para seus cuidadores, com foco em informações de segurança e ser direcionado a antitrombóticos.

DIDONE, T.V.N. Elderly: what do they know about prescribed drugs in use? 2015. 117f.