Health education can save the environment from medicine residues

Castro, Giulia de Souza; Cruz-Cazarim, Estael Luzia Coelho da; Silvério, Marcelo da Silva; Mendonça, Alessandra Ésther de; Cazarim, Maurílio de Souza

doi:10.1590/s2175-97902023e21525

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Pharmaceutical Sciences

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Article • Braz. J. Pharm. Sci. 59 • 2023 • https://doi.org/10.1590/s2175-97902023e21525 copy

Health education can save the environment from medicine residues

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The incorrect disposal of medicines and their environmental impact has been related to the health medicalization and the improper use of medication by society. In this sense, it is very important to know the profile of drug disposal for foster health policies. The aim was to identify the profile of disposal of medicines by the population, including the cost perspective. This is an inquiry descriptive study that began in September 2019. Medicine disposal health education program was carried out over six months in two University pharmacies. A questionnaire for sociodemographic and discarded medicines data collection was applied. Logistic regression analysis for variables association of correct disposal and the chi-square and t-student analysis for comparison between disposal programs were performed for a level of 5% and test power of 80%. Medicines weighed 23.3 kg and 28.5 kg, with the cost variation from US$ 13.5 to US$ 16.1 until the final treatment. The correct disposal was strongly associated with the disposal reason (p=0.013), source of information (p=0.006), prescription (p=0.03), form of use (p=0.01), acquisition source (p=0.001), cost with medication (p=0.0001), education (p=0.028) and age (p=0.05). The correct medicine disposal was associated with important features of the community related to education health.

Keywords:
Pharmaceutical services; Medicalization; Health education; Reverse logistics; Drug utilization; Environmental pollution

Variable	Category	Number (%)	Gross Odds Ratio (IC 95%)	Adjusted Odds Ratio (IC 95%))	Gross P-value	Adjusted p-value
DEPENDENT CATEGORIC VARIABLE
Disposal site
	Correct disposal *	23 (25.84)	-	-	-	-
	Incorrect disposal **	66 (74.16)
INDEPENDENT CATEGORIC VARIABLES
Sex
	Female ^†	63 (70.79)		-	0.72	-
	Male	26 (29.21)	1.2874 (0.3242; 5.1130)
Education
	High School ^†	34 (38.20)		-	0.858	-
	Basic and Fundamental	25 (28.09)	1.5338 (0.2284; 10.2994)
	Higher	30 (33.71)	0.8363 (0.1814; 3.8552)
Acquisition source
	Private ^†	46 (51.69)			0.002	0.001
	*SUS*	20 (22.47)	0.0297 (0.0029; 0.3014)	0.0353 (0.0045; 0.2745)
	Mixed	23 (25.84)	0.1967 (0.0360; 1.0746)	0.2253 (0.0467; 1.0874)
Information source for disposal
	University Pharmacy ^†	67 (75.28)			0.005	0.006
	Social media	4 (4.49)	3.6527 (0.1488; 89.6346)	3.8742 (0.1562; 96.0902)
	Third parties***	7 (7.87)	2.4779 (0.2895; 21.2067)	2.8266 (0.3645; 21.9178)
	Others	11 (12.36)	0.0188 (0.0011; 0.3324)	0.0244 (0.0015; 0.3899 )
Form of use (Continuous use)
	No ^†	43 (48.31)			0.005	0.01
	Yes	35 (39.33)	0.1112 (0.0193; 0.6418)	0.1332 (0.0267; 0.6641)
	Mixed	11 (12.36)	0.0483 (0.0033; 0.7057)	0.0853 (0.0077; 0.9447)
Disposal reason
	Quality / validity ^†	53 (59.55)			0.016	0.013
	Disuse	36 (40.45)	6.6099 (1.2465; 35.0504)	5.99814 (1.3438; 26.6234)
Prescription
	Yes ^†	80 (89.89)			0.041	0.03
	No	9 (10.11)	0.0953 (0.0071; 1.2779)	0.094 (0.0080; 1.1017)
	No	9 (10.11)	0.0953 (0.0071; 1.2779)	0.094 (0.0080; 1.1017)
CONTINUOUS VARIABLES
Age
	-	-	0.9893 (0.9478; 1.0325)	-	> 0.05	-
Number of medicines
	-	-	1.0826 (0.8700; 1.3472)	-	> 0.05	-
Amount of medication (u)
	-	-	1,0009 (0.9930; 1.0089)	-	> 0.05	-
Cost with medication
			0.9927 (0.9865; 0.9990)	0.9943 (0.9902; 0.9983)	0.0001	0.0001

Variable	Category	Number (%)	Gross Odds Ratio (IC 95%)	Adjusted Odds Ratio (IC 95%)	Gross P-value	Adjusted p-value
DEPENDENT CATEGORIC VARIABLE
Disposal site
	Correct disposal *	29 (30.85)	-	-	-	-
	Incorrect disposal **	65 (69.15)
INDEPENDENT CATEGORIC VARIABLES
Sex
	Female ^†	69 (73.40)		-	0.401	-
	Male	25 (26.60)	0.5827 (0.1608; 2.1112)
Education
	Higher^†	64 (68.09)			0.042	0.028
	High school	29 (30.85)	0.1874 (0.0405; 0.8676)	0.1743 (0.0411; 0.7386)
	Basic and Fundamental	1 (1.06)	5.9997 (0.1895; 189.9265)	3.698 (0.1849; 73.9560)
Acquisition source
	Private ^†	76 (80.85)		-	0.914	-
	SUS	6 (6.38)	0.6279 (0.0532; 7.4173)
	Mixed	12 (12.77)	0.8152 (0.1701; 3.9076)
Information source for disposal
	University Pharmacy ^†	51 (54.26)		-	0.471	-
	Social media	12 (12.77)	0.9665 (0.1967; 4.7493)
	Third parties***	8 (8.51)	0.2271 (0.0208; 2.4733)
	Others	23 (24.47)	1.4734 (0.4341; 5.0010)
Form of use (Continuous use)
	No ^†	49 (52.13)			0.116	0.151
	Yes	8 (8.51)	7.3358 (0.9224; 58.3428)	4.8137 (0.8532; 27.1599)
	Mixed	37 (39.36)	2.1874 (0.6705; 7.1362)	1.9468 (0.8532; 27.1599)
Disposal reason
	Disuse ^†	52 (55.32)			0.274	0.193
	Quality / validity	42 (44.68)	0.5413 (0.1769; 1.6558)	0.5125 (0.1840; 1.4279)
Prescription
	Yes ^†	79 (84.04)		-	0.616	-
	No	15 (15.96)	1.4453 (0.3449; 6.0554)
CONTINUOUS VARIABLES
Age
	-	-	0.9451 (0.8945; 0.9985)	0.9561 (0.9118; 1.0026)	0.04	0.05
Number of medicines
	-	-	0.9878 (0.9072; 1.0755)	-	0.78	-
Number of medications
	-	-	0.999 (0.9946; 1.0034)	-	0.64	-
Cost with medication
	-	-	1,0007 (0.9999; 1.0015)	1,0004 (0.9998; 1.0010)	0.08	0.17

ATC	No. of medication (%)	Mean number of drugs per patient (SD)	Total cost	Mean cost per patient (SD)	No. of drug with cost not found
*FU-UFJF*
A	109 (19,53)	1,239 (1,77)	US$ 687,242	US$ 7,809 (18,77)	14
B	9 (1,61)	0,10 (0,37)	US$ 47,402	US$ 0,537 (2,35)	1
C	54 (9,68)	0,61 (1,31)	US$ 648,937	US$ 7,373 (27,68)	-
D	30 (5,38)	0,34 (0,87)	US$ 196,205	US$ 2,229 (6,87)	3
G	12 (2,15)	0,14 (0,41)	US$ 145,101	US$ 1,64 (7,39)	4
H	25 (4,48)	0,28 (0,62)	US$ 91,297	US$ 1,03 (4,67)	-
J	71 (12,72)	0,81 (1,05)	US$ 514,499	US$ 5,84 (12,23)	-
L	-	-	-	-	-
M	48 (8,60)	0,55 (0,95)	US$ 125,471	US$ 1,42 (2,74)	3
N	99 (17,74)	1,13 (1,69)	US$ 875,242	US$ 9,95 (22,29)	-
P	6 (1,08)	0,07 (0,25)	US$ 15,20	US$ 0,17 (0,70)	-
Q	-	-	-	-	6
R	78 (13,98)	0,89 (1,72)	US$ 395,71	US$ 4,35 (12,54)	1
S	17 (3,05)	0,19 (0,52)	US$102,42	US$1,16 (3,47)	1
V	-	-	-	-	-
TOTAL	558	-	US$3.844,72	-	33
*FUUSP-RP*
A	133 (18,65)	1,41 (1,62)	US$1.372,01	US$14,60 (64,70)	23
B	7 (0,98)	0,074 (0,30)	US$34,39	US$0,37 (1,40)	2
C	45 (6,31)	0,48 (0,92)	US$703,28	US$7,48 (24,58)	3
D	96 (13,46)	1,02 (1,80)	US$803,92	US$8,55 (19,44)	13
G	16 (2,24)	0,17 (0,46)	US$163,03	US$1,73 (6,44)	1
H	28 (3,93)	0,30 (0,72)	US$96,69	US$1,03 (3,77)	-
J	47 (6,59)	0,50 (0,92)	US$1.268,97	US$13,50 (82,28)	-
L	6 (0,84)	0,06 (0,35)	US$522,47	US$5,56 (49,62)	-
M	53 (7,43)	0,56 (0,87)	US$155,81	US$1,66 (3,61)	3
N	108 (15,15)	1,15 (1,72)	US$1.431,21	US$15,23 (77,79)	2
P	12 (1,68)	0,13 (0,34)	US$76,65	US$0,82 (3,12)	-
Q	-	-	-	-	21
R	124 (17,39)	1,32 (1,92)	US$686,66	R$7,30 (16,62)	5
S	38 (5,33)	1,52 (1,00)	US$274,69	R$2,92 (6,36)	1
V	-	-	-	-	-
TOTAL	713	-	US$7.589,79	-	-

Class	Quantity of medicine s ( %)	Mean of medication per patient (SD)	Total Medicine number ( %)	Mean of the units of drugs per patient (SD )
FU-UFJF
Phytotherapic	335 (94.90)	3.81 (14.16)	25 (64.10)	0.28 (0.74)
Homeopathic	9 (2.55)	0.10 (0.59)	5 (12.82)	0.06 (0.28)
Cosmetic	9 (2.55)	0.10 (0.76)	9 (23.08)	0.10 (0.76)
*FUUSP-RP*
Phytotherapic	197 (98.5)	2.20 (8.45)	30 (90.90)	0.33 (0.87)
Homeopathic	3 (1.5)	0.02 (0.15)	3 (9.10)	0.02 (0.15)
Cosmetic	-	-	-	-

Variable	Mean (SD)	Median (Q1-Q3)	Minimum - Maximum	Mode (Modal N)	p-value (gross)
FU-UFJF (n = 89)
Age	44,88 (18,38)	49 (23.5-60.5)	16-81	21 (7)	> 0.05
Number of medications *	6,281 (7,187)	4 (2.0-8.0)	1-44	1 (21)	> 0.05
Qtd. of medication (u) **	99,5 (177.6)	43 (8-100.5)	1-1022	3 (6)	> 0.05
Cost with medication (US$)	43,06 (57,96)	20,64 (6.9-46,87)	0,075-303,99	-	0.0001
*FUUSP-RP (n = 94)*
Age	37,53 (14,05)	35 (24-51.25)	18-73		32 (7)	0.04
Number of medicines	6,862 (7,486)	4 (2-8)	140	2 (19)	0.78
Qtd. of medication (u)	91,2 (165,5)	44 (11.8-91)	1-1066	1,4,9 (4)	0.64
Cost with medication(US$)	76,63 (143,38)	36,93 (11,12-72,31)	0,18-786,24	-	0.08

Variable	FU-UFJF	FU USP -RP	Odds Ratio ( IC 95% )	p-value	GL	Chi-Square
CONTINUOUS VARIABLES
Absolute number
	89	94	-	-	-	-
Mean age (SD)
	44,8 (18.4)	37.5 (14.1)	7.12 (2.32; 11.93)	0.004	-	-
Average cost (SD)
	US$ 43,06 (57,96)	US$ 76,63 (143,38)	-	0.041	-	-
CATEGORIC VARIABLES - N (%)
Education
Higher	30 (33.71)	64 (68.09)	-	0.000	2	63.4875
High school	34 (38.20)	29 (30.85)	-
Basic and Fundamental	25 (28.09)	1 (1.06)	-
Acquisition source
Private	46 (51.69)	76 (80.85)	-	0.000	2
SUS	20 (22.47)	6 (6.38)	-			34.5825
Mixed	23 (25.84)	12 (12.77)	-
Information source for disposal
University Pharmacy	67 (75.28)	51 (54.26)	-	0.000	3	33.0522
Social media	4 (4.49)	12 (12.77)	-
Third parties*	7 (7.87)	8 (8.51)	-
Others	11 (12.36)	23 (24.47)	-
Form of use (Continuous use)
No	43 (48.31)	49 (52.13)	-	0.000	2	83,434
Yes	35 (39.33)	8 (8.51)	-
Mixed	11 (12.36)	37 (39.36)	-
Disposal reason
Disuse	36 (40.45)	52 (55.32)	-	0.002	1	9.1795
Quality / validity	53 (59.55)	42 (44.68)	-
Prescription
Yes	80 (89.89)	79 (84.04)	-	0.0052	1	3.7657
No	9 (10.11)	15 (15.96)	-

Universidade de São Paulo, Faculdade de Ciências Farmacêuticas Av. Prof. Lineu Prestes, n. 580, 05508-000 S. Paulo/SP Brasil, Tel.: (55 11) 3091-3824 - São Paulo - SP - Brazil
E-mail: bjps@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Correspondence: M. S. Cazarim. Faculdade de Farmácia. Universidade Federal de Juiz de Fora. Campus Universitário. Rua José Lourenço Kelmer, s/n. 36036-900, São Pedro, Juiz de Fora, MG. E-mail: maurilio.jf@gmail.com.