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Sep 2, 2017 - Divinópolis, Brazil to describe the profile of medication use among people enrolled in the Health Support Service for. People with Stoma - Level ...
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A Cross-sectional, Descriptive Study of Medication Use Among Persons With a Gastrointestinal Stoma

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Bianca Augusta Pereira de Paula, RPh; Geisa Cristina da Silva Alves, MSc; Álvaro Percínio; Mariana Linhares Pereira, PhD; Juliano Teixeira Moraes, PhD; and Cristina Sanches, PhD

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Abstract

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Research on the use of medications in people with intestinal stomas is lacking, creating gaps in knowledge of pharmacoepidemiology in these patients. A cross-sectional, descriptive study was conducted over a period of 4 months in Divinópolis, Brazil to describe the profile of medication use among people enrolled in the Health Support Service for People with Stoma - Level II (SSPS II) of a municipality in the state of Minas Gerais, Brazil. All patients from SSPS II with a colostomy or ileostomy were invited by phone to participate; those with incomplete registration data and/or who were 5 medications (polypharmacy). Low and medium level adherence with prescriptions was noted (37.7%); 39.6% reported receiving no guidance on the use of the medication associated with their condition. Improper storage was observed in 33.9% of participants. In this population, persons with a stoma had complex pharmacotherapy, a high rate of polypharmacy, and deficiency in guidance on the use of medication. Further research into determining whether investments in both inclusion of a pharmacist on the team and more pharmacoepidemiological studies would improve patient care and medication safety in patients with a stoma is warranted.

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Keywords: observational study, colostomy, ileostomy, pharmacoepidemiology, patient safety Index: Ostomy Wound Management 2017;63(9):24–31

doi: 10.25270/owm.2017.09.2431

Potential Conflicts of Interest: none disclosed

Ms. Pereira de Paula is a clinical pharmacist; Ms. da Silva Alves is a nurse; Mr. Percinio is a medical student; and Dr. Pereira, Dr. Moraes, and Dr. Sanches are adjunct professors, Federal University of São João Del Rei, Bairro Chanadour, Divinópolis, Brazil. Please address correspondence to: Geisa Cristina da Silva Alves, Federal University of São João Del Rei – Rua Sebastião Gonçalves Coelho, 400 – Bairro Chanadour, Divinópolis, Brazil; email: [email protected]. 24

OSTOMY WOUND MANAGEMENT® SEPTEMBER 2017

www.o-wm.com

MEDICATIONS IN OSTOMATES

Ostomy Wound Management 2017;63(9):24–31

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Key Points • The authors conducted a cross-sectional study to describe the profile and use of medication among persons with an intestinal stoma. • Most (49) of the 59 participants had a colostomy and were >60 years of age; 89.9% of participants were prescribed medications for an average of 2.3 health conditions. • Polypharmacy (>5 medications) was common, as was improper/unsafe medication storage; only 5 participants (15.62%) reported receiving good guidance on medication indications, usage, and storage. • The results of this study suggest that the inclusion of a pharmacist on the health care professional team for stoma patients should be considered and that additional studies might provide more needed details about pharmacotherapy in persons with a gastrointestinal stoma.

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n intestinal stoma is precipitated by or related to various underlying diseases, including agenesis and anorectal atresia, neoplasia, colorectal trauma, diverticular disease, inflammatory bowel disease, and fistulas.1 In Brazil, colorectal cancer is the leading reason for stoma creation2; surgical resection of the affected site and creation of a permanent colostomy are considered the most effective approaches.3 Having a stoma typically does not involve the use of specific medications, but underlying or concomittant disease may require treatment involving medication.4-6 The major consequence of extensive bowel resection is the loss of absorptive area; this may result in malabsorption of macro- and micronutrients, electrolytes, and water, which may interfere with the absorption of medications. Most macronutrient absorption occurs in the first 100 cm to 150 cm of the proximal intestines and specific micronutrients are absorbed in certain areas of the small intestine. Therefore, the length of the remaining intestine is a determining prognostic factor for ostomy patients.7 Absorption processes are related to the permeation of compounds through the biological membranes and are influenced by the physiochemical characteristics of both the large and small intestines. Thus, the anatomical and physiological parameters of the gastrointestinal tract drastically affect the speed and extent of oral drug absorption. For example, although the highest amount of absorption occurs in the duodenum and the proximal part of the jejunum, acidic drugs also are absorbed in the stomach, because the acidic pH hinders their dissociation, promoting their passive diffusion through the lipophilic portion of the membrane bilayer. An in vitro study8 has shown that commonly used drugs such as popranolol, acetaminophen, morphine, and hidrochlorothiazide drugs are absorbed mainly in the first part of the intestine. Pharmacoepidemiology aims to study and describe the use of medication and its effect in a given population. It is extremely important to know the medication usage profile of the population in order to develop strategies aimed at optimal medication use.5 Pharmacoepidemiological data for ostomy patients are scarce. According to a descriptive study by Barbosa et al5 and an integrative review study by Luz et al,2 medication, nutrient, and electrolyte absorption among this population may be compromised,2,5 so gastroresistant medications and prolonged release of pharmaceutical substances can be affected by a decrease of the intestinal portion, leading to a reduction of the absorbed drug concentration and possible ineffectiveness of treatment.5,9,10 Knowing the profile of medication use in these patients is essential to understanding the frequency and distribution of medication use (prescribed and over-the-counter) in this population and in consequently ensuring its effectiveness and correct use. The purpose of this cross-sectional study was to describe the medication profile of persons with an intestinal stoma.

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Methods Data were collected after institutional approvals authorized the research; permission from the Brazilian Ethics Committee was obtained through opinion no. 862,133 (CAAE: 37653514.4.0000.5545). The study respected the ethical precepts determined by the Brazilian ethical criteria in agreement with the Declaration of Helsinki. All participants in the study signed the Free and Informed Consent Term Form and anonymity was ensured. The cross-sectional study was conducted at the Health Support Service for People with Stoma - Level II (SSPS II) of a municipality in the state of Minas Gerais, Brazil. This type of service encompasses a multidisciplinary team including a physician, nurse, social worker, psychologist, and nutritionist. This team provides specialized and interdisciplinary assistance to people with a stoma, including instruction in the care and use of ostomy collection devices, prevention and treatment of stoma complications, health care professional training, and ostomy supplies and adjuvant equipment.11 All patients from SSPS II were eligible for the study. A total of 98 persons with a colostomy or ileostomy who were registered with the service were invited by phone call to participate via the local public health service. For sampling purposes, a 95% confidence interval, an error of 5%, and hypothetical population frequency of 90% were considered, with a sample of 59 ostomy patients being calculated (49 patients with colostomy and 10 patients with ileostomy). Persons with incomplete registration data,