Consumo de medicamentos em adultos do Brasil e da região metropolitana de Manaus

Abstract

Introduction: The appropriate use of drugs is associated with a reduction in morbidity and mortality among users. The evaluation of the pattern of consumption of these products in the population makes it possible to know the medicines most used, to evaluate the population profile, forms of access, socioeconomic aspects and the main related diseases, these information are instruments for the elaboration of educational measures and improvement of the public policies of Health care of the population. Objective: To evaluate the prevalence of adult drug use in Brazil and the Metropolitan Region of Manaus Methods: Two parallel studies were carried out. The first estimated the consumption of drugs in Brazil, through a systematic review with meta-analysis of drug use studies. The MEDLINE and Embase databases were searched through other sources as of January 2017. Two independent reviewers selected the studies and the counselor was consulted in case of divergences. The academic extracted the data and assessed the methodological quality of the included studies, steps that were reviewed by the counselor. Prevalence of consumption were combined in meta-analyzes of random effects and heterogeneity was measured by I². The second research refers to a cross-sectional population-based study conducted in the Metropolitan Region of Manaus to estimate the consumption of medications by adults. Survey participants reported on social, economic and demographic data, health status, and drug use in the last 15 days. The survey was conducted in three stages (census tract, household and resident). The drugs were classified according to the Anatomical Therapeutic and Chemical Classification (ATC). The approaches were carried out by interviewers experienced in quantitative research, who received specific training for the research. In the descriptive analysis we evaluated all the variables that characterize the sample and the statistical analysis weighted the complex sampling design in all the calculations. The Poisson regression was performed with robust variance to obtain the prevalence ratios (RR) adjusted by the variables with statistical significance of p≤0.10 in the bivariate analysis. Results: In the systematic review we identified 4,005 publications, of which 14 were included in the study. The majority of the studies (12/14) measured the consumption in the last 15 days, finding prevalence of consumption of 49.1% (95% CI: 48.5-49.6%, I² = 100%). The recall period explains part of the heterogeneity found (R² = 23%, p = 0.048), but the subgroup analysis did not allow finding more homogeneous results. In the cross-sectional study, the prevalence of drug use was 29% (95% CI: 28-31%) in the last 15 days and 15% (CI 95%: 14-17%) on the day of the interview. Analgesics (18%), renin-angiotensin system agents (13%), anti-inflammatories and antirheumatic products (12%) were more consumed according to ATC and the most commonly consumed drugs included dipyrone (13%), losartan (7%) and diclofenac (5%). Medical prescription was the main inducer of consumption (80%), obtained mainly by purchase in drugstore (46.4%) and by the Unified Health System (39,6%). Conclusion: Although inconsistencies between the studies limit the findings, it was possible to observe in the systematic review that approximately half of Brazilian adults use drugs. The prevalence of consumption in the Metropolitan Region of Manaus occurs in less than a third of the population. To ensure the rational use of these technologies at the national and regional levels, pharmaceutical care actions should be promoted.