Fatores associados à não adesão ao tratamento farmacológico em idosos brasileiros: uma revisão sistemática

Abstract

Population aging is a marked and growing fact in most societies, characterizing changes in the morbidity and mortality profile and the age structure, due to an increase in the proportion of elderly. In Brazil, the aging process occurs quickly and poses challenges for public policies and health services. The changes intrinsic to the aging of individuals are associated with alterations in the pharmacokinetics and pharmacodynamics of the drugs. Hence, an accurate process for decision-making is essential to prevent that drug therapy problems become more frequent than the therapeutic benefits. Non-adherence to pharmacotherapy is considered a public health problem. It presents a multifactorial nature, involving the health system, the health policies, the family, the community, the health professionals, and the patients. It has negative impacts on individual and collective health, given the lack of control of diseases and health problems, and the failure to accomplish an essential step for the success of the proposed pharmacotherapy. Due to the attributes that permeate it, primary health care offers a high potential for the proper management of pharmacological treatment and promotion of actions that understand the real needs of individuals, respecting generational, cultural, and social aspects. It configures a privileged point to observe the issues involved in non-adherence. In this context, the study aimed to identify the factors associated with non-adherence to pharmacological treatment in elderly Brazilians assisted by primary health care. This study is a systematic literature review using the methodology recommended by the Cochrane Collaboration. The protocol of this review was registered in PROSPERO. The research carried out comprehended articles published in Portuguese, English, and Spanish from January 2010 to June 2020, accessed in the following databases: SciELO, MEDLINE (via PubMed), LILACS, Embase, and Web of Science. Study selection was performed independently by two reviewers using the Rayyan QCRI selection application. After applying the eligibility criteria, nine studies were included in the systematic review that reveals a high prevalence of non-adherence to pharmacotherapy, with the Morisky-Green Scale (4-items) being the most frequent measurement method. The results point that the main factors related to non-adherence to pharmacotherapy in primary health care are difficulties in medication access, multimorbidities, polypharmacy, the use of potentially inappropriate medications for the elderly, the degree of trust in the health professional and the prescription, beliefs, negative self-perception of health, functional disability, and socioeconomic conditions. The literature recognizes non-adherence to pharmacological treatment as a frequent public health problem in the Brazilian elderly population assisted in primary health care, triggered by several factors, such as memory, cognitive decline, attention, and concentration. The findings reveal the complexity of interactions between the various factors associated with non-adherence and the potential for negative consequences for the control of health conditions. It is noteworthy that most of these factors are subject to intervention at this level of health care in favor of strategies for the rational use of medications and for healthy aging.It is eminent that this study can contribute to directing new strategies and advances in pharmaceutical care as an effective practice model for healthcare for the elderly in Brazilian society.