Drug utilization research in a primary mental health services in Northeast of Brazil

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w w w . e l s e v i e r . p t / r p s p

Original

article

Drug

utilization

research

in

a

primary

mental

health

service

in

Northeast

of

Brazil

Thais

Teles

de

Souza

a

_,

_Wellington

_Barros

_da

_Silva

b

_,

Jullyana

de

Souza

Siqueira

Quintans

c

_,

_Alexandre

_Sherlley

_Casimiro

_Onofre

d

_,

Fabiana

Botelho

de

Miranda

Onofre

d

_,

_Lucindo

_José

_{Quintans-Júnior}

e,∗

a_Programa_de_{Pós-graduac¸ão}_em_Ciências_{Farmacêuticas,}_Universidade_Federal_do_Paraná,_Brazil b_Departamento_de_Fisiologia,_Universidade_Federal_de_Sergipe,_Brazil

c_Campus_de_Ciências_da_Saúde_de_Lagarto,_Universidade_Federal_de_Sergipe,_Brazil d_Departamento_de_Fisiologia,_Universidade_Federal_de_Sergipe,_Brazil

e_Departamento_de_Fisiologia,_Universidade_Federal_de_Sergipe,_Brazil

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received30May2011

Accepted20March2012

Availableonline15May2012

Keywords:

Psychosocialcarecenter

Drugutilizationresearch

Mentalhealth

a

b

s

t

r

a

c

t

ThePsychosocialCareCenter(CAPS)isacommunity-basedmentalhealthserviceinBrazil,

whichaimstopromotethepsychosocialrehabilitationofpatients.Accordingly,thisstudy

describesthedruguseevaluationinaprimarymentalhealthserviceinNortheastofBrazil.

Setting:CAPS‘ValterCorreia’,SãoCristovão,Sergipe,Brazil.

Methods:Across-sectionalstudywasconductedbetweenAugust2009andMay2010.

Ini-tially,Medicalrecordswerereviewedandevaluated.Then,weappliedinterviewswiththe

patients(and/ortheirinformal/familycaregivers)attendedattheCAPS.Informationswere

obtainedregardingtodemographicandclinicalfeatures,diagnosesanddrugsprescribed.

AllpatientsregisteredintheCAPSwereincludedinthestudy.Theresultswerestatistically

analyzedusingtheEpiInfoandwerecomparedwithresultsfromliterature.

Results:TheCAPS‘ValterCorreia’consistsof101registeredpatients,themajorityweremale

(58.4%),illiterate(51.5%),withoutmonthlyincome(49.5%)andtheaverageageofthem42.2

years(SD=12.0).Schizophreniawasthemostfrequentmentaldisorder(31.5%).Theaverage

numberofmedicationsbypatientswas3.11(SD=1.41),andtheoldergroupofpatients

(75-80years)presentedthelargestconsumptionofmedications(5.50drugs/patient).The

psychiatricdrugclassmostfrequentlyprescribedwasantipsychotics(44.8%).

Angiotensin-convertingenzymeinhibitorswerethemostprevalentnon-psychiatrictherapeuticclass

(15.8%).Itwasdetected133drug-druginteractions(3.0%mild,54.1%moderate,29.3%severe

and13.5%contraindicated).

Conclusion: Theresultsrevealedtheneedformonitoringthepharmacotherapyofpatients

withmentaldisorderstoencouragetherationaluseofmedications.

reserved.

∗ _{Corresponding}_author.

E-mailaddresses:lucindo jr@yahoo.com.br,lucindo@pq.cnpq.br(L.J.Quintans-Júnior).

(2)

Estudo

de

utilizac¸ão

de

medicamentos

em

um

servic¸o

de

saúde

mental

primário

no

Nordeste

do

Brasil

Palavraschave:

CentrodeAtenc¸ãoPsicossocial

EstudodeUtilizac¸ão

demedicamentos

SaúdeMental

R

e

s

u

m

o

OCentrodeAtenc¸ãoPsicossocial(CAPS)éumservic¸odesaúdementaldebasecomunitária

noBrasil,quevisapromoverareabilitac¸ãopsicossocialdospacientes.Opresenteestudo

descreveaavaliac¸ãodousodemedicamentosemumservicedesaúdementalprimáriono

NordestedoBrasil.

Ambiente:CAPS«ValterCorreia»,SãoCristovão,Sergipe,Brasil.

Métodos:Estudotransversalfoirealizadoentreagostode2009emaiode2010.Inicialmente,

osregistrosmédicosforamrevisadoseavaliados.Emseguida,foramrealizadasentrevistas

comospacientes(e/ouseuscuidadores)atendidosnoCAPS.Informac¸õesforamobtidas

sobreascaracterísticasdemográﬁcaseclínicas,diagnósticosemedicamentosprescritos.

TodosospacientescadastradosnoCAPSforamincluídosnoestudo.Osresultadosforam

analisadosestatisticamenteutilizandooprogramaEpiInfoeforamcomparadoscomos

resultadosdaliteratura.

Resultados:OCAPS“ValterCorreia”écompostopor101pacientescadastrados,amaioriado

sexomasculino(58,4%),analfabetos(51,5%),semrendamensal(49,5%)eamédiadeidade

deleserade42,2anos(DP=12,0).Aesquizofreniafoiotranstornomentalmaisfreqüente

(31,5%).Onúmeromédiodemedicamentosporpacientesfoide3,11(DP=1,41),eogrupo

depacientesmaisvelhos(75-80anos)apresentouomaiorconsumodemedicamentos(5,50

medicamentos/paciente).Aclassedemedicamentospsiquiátricosmaisprescritafoiados

antipsicóticos(44,8%).Aclassedosinibidoresdaenzimaconversoradaangiotensinafoia

maisprevalenteclassenão-psiquiátrica(15,8%).Foramdetectadas133interac¸ões

medica-mentosasfármaco-fármaco(3,0%deseveridadeleve,54,1%moderada,29,3%gravee13,5%

contra-indicada).

Conclusão:Osresultadosdemonstramanecessidadedeacompanhamentoda

farmacoter-apiadepacientescomtranstornosmentaisparaincentivarousoracionaldemedicamentos.

direitosreservados.

Introduction

Mentaldisorders representahealthproblemofsocial

rele-vancefortheirhighincidenceinpopulationsfromdifferent

countries and culturally distinct societies. We estimated

17–35%prevalenceofmentaldisordersinBrazilian

popula-tion.However,thesedisordersarestillfarfromreceivingan

adequateimportance.1–4

Inthiscontext,theintroductionofpsychosocialcare

cen-ters(CAPS)wereoneofsomehealthservicescreated,basedon

Brazilianpsychiatricreform.TheCAPSarecharacterizedbya

daycareservice,whichisproposedasanalternativetoa

psy-chiatrichospital.Itsmainobjectiveistoofferapsychosocial

rehabilitationtotheirpatients.5

The sociodemographic characteristics of CAPS patients

haveanimportantinﬂuencetoimprove theirassistance.2,6

Moreover, psychotropicdrugs cause adverse events,which

compromisestheadherencetotreatmentandthenthequality

oflife.7

Somestudieshavedemonstratedtherelationshipbetween

theprocessofuseofdrugs,morbidityandmortalityrelated

todrugsandasthesemaytriggeradversereactions.Inthese

studies,problemssuchasadversereactions,non-compliance,

overdoseorinadequatetherapyarefactorsthatleadtofailure

oftherapy.Ifthisisnotdetectedandresolved,itcanleadto

death.8–15

Thus,itisnecessarytoevaluatethedrugutilizationin

men-talhealthcareinordertoassessdrugtherapy,detecttherisk

factorsassociatedwiththeuseofmedicationsandpromote

therationaluseofdrugs.Drugutilizationresearcharedeﬁned,

accordingtoWHO,asstudiesonmarketing,distribution,

pre-scription,anduseofdrugsinasociety,withspecialemphasis

ontheresultingmedical,socialandeconomicconsequences.

Thesestudieshaveastheirmainobjectivethepromotionof

therationaluseofdrugs.16,17

In recent years, literature has highlighted the

involve-mentofthepharmacistinprogramstooptimizetheeffects

of medications, through monitoring the use of drugs. The

applicationofrationalcriteriacanensuregreatercompliance

withtherapy,effectivenessandsafetyofmedicationsusedby

patients.18–20

Aim

of

study

Thepresentstudyaimedtoevaluatetheuseofmedications

bypatientsinaprimarymentalhealthservicelocatedinacity

attheNortheastofBrazil.

Methods

Weconducted,inanunprecedentedwayinSergipestate,a

(3)

typeIpsychosocialcarecenter(CAPS)‘ValterCorreia’inSão

Cristovão,Sergipe,Brazil.AllpatientsregisteredintheCAPS

(and/ortheirinformal/familycaregivers)wereincludedinthe

study.

CAPS type I is a unit for own psychosocial care with

therapeuticworkshopsand otherformsofcareand

opera-tionalcapacitytoprovidehealthcarecoveragetoapopulation

between20,000and 70,000inhabitants,workingundertwo

shifts,developingdailyactivitiesinmentalhealth.21

Data was collected from patient medical records, such

associodemographics,clinicalcharacteristicsand

pharmaco-logicaltreatments.Sociodemographicdataincludedpatient

gender,age,educationalstatus,occupationalactivity,beneﬁts

orpensions,incomeandmaritalstatus.Diagnoses

(accord-ingtotheICD-10 internationalclassiﬁcationofmentaland

behavioraldisorders)22 and thepatient’s psychiatric

admis-sionhistoryweretheclinicalcharacteristicsobtained.Details

ofallpsychiatricprescribedmedicationswerealsocollected,

including dose, frequency, administrationroutes and

ther-apeutic indications. Drugswere classiﬁed accordingto the

anatomicaltherapeuticchemical(ATC)classiﬁcationsystem

andthedeﬁneddailydose(DDD).TheATC/DDDsystemisa

widelyusedtoolforexchangingandcomparingdataondrug

consumptionatinternational,nationalorlocallevels.23

Inaddition,personalinterviewswereperformed(appliedto

thepatientsand/ortheirinformal/familycaregivers)and

col-lectiveinterviews(appliedtogroupsofpatientsand/ortheir

informal/familycaregivers),inordertocompareinformations

registered on records, collect the missing data on records,

identifyfeaturesontheuseofmedicationsandcharacterize

theperceptionofpatients abouttheirhealthproblemsand

theirtreatments.Theinterviewswereconductedbya

gradu-atestudentinpharmacy,previouslytrained.

TheprotocolswereapprovedbytheEthicsCommitteeon

HumanResearchattheFederalUniversityofSergipe.Patients

participatinginthestudywereinformedabouteverystepand

agreedtoparticipateinthesurveythroughatermofinformed

consent.

The programs EPI-INFO (version 3.5.1-obtained from

www.cdc.gov/EpiInfo)andExcel(Microsoft®₎_were_used_to

sta-tisticalanalysis.ThestudyprotocolwasapprovedbytheEthics

CommitteeofFederalUniversityofSergipe.

Duringthedevelopmentofthisstudy,itwas ministered

lectures,homevisits,workshopsandmeetingsforpatients,

informal/familycaregivers,andforthemultidisciplinaryteam

of the CAPS. The themes approached the rational use of

medications,mentaldisorder, psychopharmacology,

medic-inal plants, hygiene, handicraft, culture, integration, social

inclusion,ﬁrst aid and use ofalcohol, tobacco and others

drugs.

Results

101registeredpatientsweredistributedinintensive(13.86%),

semi-intensive(52.48%)andnon-intensive(33.66%)regimeat

CAPSValterCorreia.Thoseregimesaredeﬁnedbytheir

clini-calconditions,basedonclinicalcareandtherapyofpatients.

According to their needs, patients belonging to intensive

regimerequire dailycarebyaspecialized multidisciplinary

Table1–Sociodemographicsdataofpatientsattendedat

CAPSValterCorreia(n=101).

Variables AF(RF%)* Gender Male 59(58.40) Female 42 (41.60) Educationalstatus Analphabet 52(51.50)

Uncompletedprimaryschool 36(35.60) Primaryschool 1(0.99) Uncompletedsecondaryschool 8(7.90) Secondaryschool 4(3.96) Occupationalactivity None 91(90.10) Housemaid 1(0.99) Homemaker 4(3.96) Bricklayer 2(1.98) Fishman 3(2.97) Beneﬁt/pensions Receive 51(50.50) Noreceive 50(49.50) Income(monthly) Noincome 50(49.50) 1minimumwage($28,736) 49(48.50) 2minimumwage($57,471) 1(0.99) 3minimumwage($86,207) 1(0.99) Maritalstatus Single 77(76.20)

Marriedorlivingasmarried 17(16.80)

Divorced 2 (1.98)

Widowed 5(4.95)

∗ _AF_–_Absolute_frequency,_RF%_–_Relative_frequency_in_percentage.

team (up to 25 days/month), patients belonging to

semi-intensiveregimerequirefrequentcare(upto12days/month)

andpatientsbelongingtonon-intensiveregimerequireless

frequentattendance(upto3daysofthemonth).

The mean age of patients was 42.18±12.01-years-old,

medianof42years.Table1describesthedistributionofother

importantsocio-demographicparameters.

Schizophrenia was the most prevalent mental disorder

(31.53%).Thementaldisorderproﬁlepresentedbythepatients

attendedontheCAPS,accordingwiththeinternational

clas-siﬁcation of mental and behavioral disorders (ICD-10)22 _is

describedinTable2.

Somepatientspresentedotherdiseasesassociatedto

men-taldisorders,suchasarterialhypertension(18.81%),diabetes

mellitus(10.9%),gastritis(10.9%),asthma(4.0%),othersheart

problems(7.9%)andhypothyroidism(2.2%).

Regarding to the pharmacotherapeutic proﬁle, Table 3

exhibits the therapeutic classes of psychiatric drugs used

by patients attended at CAPS. Table 4 describes the

the-rapeutic classes of non-psychiatricdrugs used by patients

attendedatCAPS,accordingtotheWHO-ATC/DDD

method-ology.Thepsychiatricdrugclassmostfrequentlyprescribed

wasantipsychotics(44.8%)andthenon-psychiatricdrugclass

mostprevalentwasangiotensin-convertingenzymeinhibitors

(4)

Table2–MentaldisordersdiagnosedatCAPSpatients

accordingtoICD-10(n=101).

ICD Mentaldisorders AF(RF%)a

F06 Othermentaldisordersdue tobraindamageanddysfunction andtophysicaldisease

5(4.50)

F10 Mentalandbehaviouraldisorders duetouseofalcohol

20 (18.02) F20 Schizophrenia 35(31.53) F21 Schizotypaldisorder 3(2.70) F25 Schizoaffectivedisorders 3(2.70) F29 Unspeciﬁednonorganicpsychosis 8(7.21) F31 Bipolaraffectivedisorder 7(6.31) F32 Depressiveepisode 1(0.90) F71 Moderatementalretardation 9(8.11) F72 Severementalretardation 4(3.60)

G40 Epilepsy 4(3.60)

Others 12(10.81)

Total 111(100)b

a _AF_{– Absolute}_frequency,_RF%_{– Relative}_frequency_in_percentage. b _It_is_observed_that_some_patients_have_more_than_one_mental

disorder.

Table3–Therapeuticclassesofpsychotropicdrugsused

bypatientsattendedatCAPSValterCorreia,accordingto

ATCclassiﬁcation.

ATC Therapeuticclass AF(RF%)*

N03A ANTIEPILEPTICS 26(9.63) N03AA Barbituratesandderivatives 12 (4.44) N03AB Hydantoinderivatives 2(0.74) N03AE Benzodiazepinederivatives 8(2.96) N03AF Carboxamidederivatives 16(5.93) N04A ANTICHOLINERGICAGENTS 18(6.67) N04AA Tertiaryamines 18(6.67) N05A ANTIPSYCHOTICS 121(44.81) N05AA Phenothiazineswithaliphatic

side-chain

46(17.04) N05AC Phenothiazineswithpiperidine

structure

6(2.22) N05AD Butyrophenonederivatives 65(24.07)

N05AN Lithium 2(0.74)

N05AX Otherantipsychotics 2(0.74) N05B ANXIOLYTICS 22(8.15) N05BA Benzodiazepinederivatives 22(8.15) N06A ANTIDEPRESSANTS 23(8.52) N06AA Non-selectivemonoamine

reuptakeinhibitors

16(5.93) N06AB Selectiveserotoninreuptake

inhibitors

7(2.59) R06A ANTIHISTAMINESFORSYSTEMIC

USE

43(15.93) R06AD Phenothiazinederivatives 43(15.93) V03A ALLOTHERTHERAPEUTIC

PRODUCTS

5(1.85) V03AA Drugsfortreatmentofchronic

alcoholism

5(1.85)

Total 219(100)

Table4–Therapeuticclassesofnon-psychotropicdrugs

usedbypatientsattendedatCAPSValterCorreia,

accordingtoATCclassiﬁcation.

ATC Therapeuticclass AF(RF%)*

A02B Drugsfortreatmentofpepticulcer 3(7.89) A04A Antiemeticsandantinauseants 2(5.26) A06A Laxatives 2(5.26) A07D Antipropulsives 1(2.63) A10B Oralbloodglucoseloweringdrugs 1(2.63) B03A Ironpreparations 1(2.63) B03B VitaminB12andfolicacid 2(5.26) C01D Vasodilatorsusedincardiac

diseases

1(2.63) C02A Antiadrenergicagents,centrally

acting

1(2.63) C03A Low-ceilingdiuretics,thiazides 1(2.63) C03C High-ceilingdiuretics 1(2.63) C07A Betablockingagents 3(7.89) C09A Aceinhibitors,plain 6(15.79) C09C AngiotensinIIantagonists,plain 1(2.63) G03A Hormonalcontraceptives

forsystemicuse

1(2.63) G03G Gonadotropinsandother

ovulationstimulants

1(2.63) G04B Otherurologicals,incl.

antispasmodics

1(2.63) H02A Corticosteroidsforsystemicuse,

plain

1(2.63) M03A Musclerelaxants,peripherally

actingagents

3(7.89) R03A Adrenergics,inhalants 1 (2.63) R03C Adrenergicsforsystemicuse 1(2.63) R03D Otheranti-asthmaticsforsystemic

use

1(2.63) R05C Expectorants,excl.combinations

withcoughsuppressants

1(2.63) R06A Antihistaminesforsystemicuse 1(2.63)

Total 38(100)

The average number of medications (psychotropic and

non-psychotropic) usedbypatientswas3.11±1.41

medica-tions/patients,median3(Table5).

Table 6 shows the percentage ofdrug interactions

pre-sented bypacientsoftheCAPS,according tothedegreeof

severity.

With respecttoconsumptionof otherssubstances, it is

observedinTable7theproﬁleofusealcohol,tobacco,illicit

drugsandteas.

Discussion

TheCAPSisanopenandcommunityserviceofmentalhealth

ontheuniﬁedhealthsystem(SUS)inBrazil.Itsmainobjective

istoestablishareferenceplacetotreatmentforpeoplewith

mentaldisorders,whoneedanintensivecarerelatedtotheir

severityand/orpersistencedemand.5

101registeredpatientsatCAPS‘ValterCorreia’were

dis-tributed in intensive (13.86%), semi-intensive (52.48%) and

non-intensive (33.66%) regime.Theaverageage ofpatients

(5)

Table5–Meannumberofmedications(psychotropic

andnon-psychotropic)usedbypatientsattendedat

CAPSValterCorreia,accordingtotheagegroup.

Agegroup(years) Averageamountof

medicationsused/patient 20–24 2.33±1.21 25–29 3.89±1.17 30–34 2.82±1.01 35–39 2.62±0.96 40–44 2.91±1.20 45–49 2.70±1.42 50–54 3.88±1.96 55–59 3.50±0.71 60–64 3.00±0.71 65–69 3.00±0.00 70–74 3.00±0.00 75–80 5.50±0.00

Valuesareexpressedasmean±standarddeviation.

Table6–Druginteractions(drug–drug)presentedby

patientsattendedatCAPSValterCorreia,classiﬁedby

degreedseverity. Typeofinteraction AF(RF%)* Light 4(3.01%) Moderate 72(54.13%) Several 39(29.32%) Contraindicated 18(13.54%) Totaly 133(100%)

∗ _AF_{– Absolute}_frequency,_RF%_–_Relative_frequency_in_percentage.

Table7–Consumeofalcohol,tobacco,coffee,illicitdrugs

andteabypatientsattendedatCAPSValterCorreia.

Substances Consume AF(RF%)* Alcohol <2cups/week 1(0.99) >6cups/week 18(17.82) 2–6cups/week 4(3.96) Sporadically 1(0.99) Donotconsume 76(75.25) Tryingtostop 1(0.99) Tobacco <1wallet/day 15(14.85) >1wallet/day 23(22.77) Doesnotconsume 63(62.38) Coffee <2cup/day 17(16.83) >6cups/day 8(7.92) 2–6cups/day 20(19.80) Sporadically 36 (35.64) Historyofdependence 5(4.95) Donotconsume 14(13.86) Tryingtostop 1(0.99) Illicit drugs >6times/week 1(0.99) 2–6times/week 1(0.99) Sporadically 2(1.98) Historyofdependence 2(1.98) Donotconsume 95(94.06) Tea <2cups/day 10(9.90) >2cups/day 9(8.91) Sporadically 46(45.54) Donotconsume 36(35.64)

∗ _AF_–_Absolute_frequence,_RF%_–_Relative_frequency_in_percentage.

otherstudies,whichclaimthatmentaldisordersaffectpeople

ofallages,withtheprevalenceon30–49years.24,25_The

pres-enceofmentaldisorderatthisagegroupinﬂuencestheway

oflife,interruptingproductivityasaresultofdisabilitycaused

bydisease.24

ItisobservedinTable1thatthe CAPSconsistedmainly

ofmalepatients(58.50%),whichdiffersfromothersstudies

thatindicatetheprevalenceoffemales.24,26

Mostpatientsweresingle(76.20%),childless(54.50%),

illit-erate(51.50%),withoutoccupation(90.10%),withoutbeneﬁts

(49.50%)andwithoutmonthlyincome(49.50%).Theseresults

suggestthatthepresenceofmentaldisordercaninﬂuencethe

culturalbackgroundofpeopleandthechancetoattendschool

islow,whichcanmakeitdifﬁculttoenteratuniversityand

gainagoodjob.AccordingtoOMS(2001)2_,_ﬁve_from_ten_causes

ofinabilityontheworldarementaldisorder.

Regardingtothenosologicalproﬁles,Table2revealsthat

therearepatientswithmorethanonetypeofmentaldisorder

andthatschizophreniaisthemostprevalentmentaldisorder

(31.53%).

Schizophreniaisoneofthemostseriousneuropsychiatric

diseasesandaffectsabout1%ofworldpopulation.Currently,

thereisnospeciﬁcpreventionforthisdisease.Neurolepticor

antipsychoticdrugsareusedastheprimarytreatmentforall

stagesofthedisease.27

Depressive episodes are common mental disorders on

Brazilianpopulation,28–31 _but_we_found_in_only_0.90%_of_our

CAPSpatients.Thisdifferenceshouldbecausedduetothe

introduction of a newmodel ofpsychiatric care, which is

still suffering transition in Brazil. Part of the population,

who suffers from moodand anxiety disorders, isprobably

under-diagnozed. Another part, even receiving the correct

medicaldiagnosis,choosestoreceiveambulatorytreatment

withoutresorttotheCAPS,whichcouldbeinconsequenceof

stigmasfear.

Consumption of alcohol and others drugs is an

impor-tant cause of disorder. Mental behavioral disorders due

the consumptionofalcoholwere foundin18.02%,due the

consumptionofmultipledrugsandotherspsychoactive

sub-stancesin0.90%andduetotheuseofcocainein0.90%.Those

patientsshouldbeindicatedforanADtypeofCAPS.

Thepsychiatricdrugclassmostfrequentlyprescribedwas

antipsychotics (44.8%), described in Table 3.

Angiotensin-convertingenzymeinhibitors(ACEI)werethemostprevalent

non-psychiatric drug class (15.8%) (Table 4). Those results

are in consistence with the most prevalent diseases,

schizophreniaforantipsychoticsandhypertensionforACEI

medications.

There iscurrently avery large numberof antipsychotic

medications,with differentproﬁleofsideeffects, but with

similarpotencywhenuseinequivalentdoses.However,there

areindividualdifferencesonefﬁcacy,toleranceandcost.

Par-ticularcontextshouldbeusedtochoosetheadequatedrug.

Theaveragenumberofmedicationsusedbypatientswas

3.11±1.41medications/patients.Thelargestconsumptionof

medicationswasfoundinthe75–80yearsgroup,5.5

medica-tionsforpatient(Table5).Thesedataareinwiththeliterature.

Elderlypopulationismarkedbyahigherfrequencyofchronic

degenerative diseases. It has greater demand for health

(6)

populationtogreatriskswiththepracticeofpolypharmacy

andadverseeffectsofmedications.32

Inregardtodruginteractions,33–35_3.0%_mild,_54.1%

mod-erate,29.3%severeand13.5%contraindicated(Table6).Those

results demonstrate the need to evaluate possible

inter-ventions,sincedruginteractions may,amongother things,

increase undesired medications effects, lead to ineffective

therapyandendangerthelifeofpatient.36–39

ItisobservedinTable7that24.75%ofpatientsconsumed

alcohol,37.62% tobacco, 86.14%caffeine, 5.94%illicitdrugs

and64.36%tea.Itisnecessaryafurtherdetailedstudy,since

thesesubstancescaninteractwithseveralmedications.

Themedicationshaveanimportantroleinthehealth

sys-tem,theycansavelivesorremovethesignsandsymptoms

ofnumerousdiseases.40_However,_the_drugs_may_increase_the

costsofhealthcareifusedimproperly.41_According_to_WHO

data,hospitalsspend15%–20%oftheirbudgetstodealwith

thecomplicationscausedbymisuseofmedications.42

In this context, pharmacists are professionals who can

activelyparticipateinthemultidisciplinaryteam,makethe

managementofpharmacotherapy,assesstheuseof

medica-tions,provideguidelines andperformpharmacotherapeutic

monitoringofpatients,whichcontributetotherationaluseof

medicationsandimprovethequalityoflifeofpatients.43

Conclusion

Our resultsrevealed the need formonitoring the

pharma-cotherapyofpatientswithmentalandbehavioraldisordersto

encouragetherationaluseofmedications.Thismonitoringis

necessary,sincethesepatientsarepolymedicated,haveother

comorbidities,andusedrugsthatcauseadverseeffects,which

compromisethe adherence oftreatment and consequently

theirqualityoflife.

Conﬂicts

of

interest

Theauthorshavenoconﬂictsofinteresttodeclare.

Acknowledgments

Wewouldlike tothankthe Fundac¸ãodeApoio àPesquisa

eà Inovac¸ãoTecnológica do Estadode Sergipe/FAPITEC-SE

andNational CouncilofTechnologicalandScientiﬁc

Devel-opment(ConselhoNacionaldeDesenvolvimentoCientíﬁcoe

Tecnológico/CNPq/Brazil)forthefellowshipsupport.

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