Pharmacy World & Science

, Volume 32, Issue 6, pp 744–751 | Cite as

Association between drug prescribing and quality of life in primary care

  • Samanta E. FröhlichEmail author
  • Anamaria V. Zaccolo
  • Sabrina L. C. da Silva
  • Sotero S. Mengue
Research Article


Objective To evaluate quality of life among patients of Family Health Strategy Units and how it relates to the prescribing complexity and to the number of psychotropic medications prescribed, including adjustments for sociodemographic characteristics. Setting Family Health Strategy Units in a municipality in the Brazilian state of Rio Grande do Sul. Method Cross-sectional study using face-to-face interviews and prescribing analysis among users of Family Health Strategy Units. Patients were recruited by consecutive sampling. Multiple linear regression models were fitted to the different domains of quality of life in the WHOQOL-Bref questionnaire. The response rate for the patients who completed the interview was 97%. The prescribed medication data and sociodemographic characteristics of the sample were included as covariates. Prescribing complexity was analyzed by means of the Medication Regimen Complexity Index. The assumptions in the estimated models were tested and the models were validated. Main outcome measure Quality of life among patients of Family Health Strategy Units. Results At total, 336 patients answered the questionnaire. Through multiple linear regression, it was observed that higher prescribing complexity was associated with significantly low scores in the physical (−2.01, 95% CI = −2.89 to −1.35) and overall (−1.93, 95% CI = −2.81 to −0.99) quality of life domains. Greater amounts of psychotropic medications prescribed were associated with significantly low scores in the physical (−1.02, 95% CI = −1.29 to −0.56), psychological (−2.52, 95% CI = −3.15 to −1.65) and overall (−0.97, 95% CI = −2.06 to −0.33) domains of the interviewees’ quality of life. The estimated models were adjusted for the sociodemographic characteristics of the sample and presented good predictive capacity. Conclusions The evaluated aspects of the prescribed medication (complexity and presence of psychotropic medications) were associated with low scores in the physical, psychological and overall quality of life domains. This may be an intrinsic characteristic of the interviewed patients, like having the quality of life at such a low level before starting the treatment, that the medication could not improve it to normal levels. Also, it can be a demonstration of the ineffectiveness of these treatments within primary health care.


Brazil Prescribing complexity Multiple linear regression Primary care Psychotropic medications Quality of life 



Samanta E. Fröhlich received assistance from the National Counsel of Technological and Scientific Development in the form of a bursary to help to fund the studies for a master’s degree in Pharmaceutical Sciences.

Conflicts of Interest

The authors do not have any conflict of interest to declare.


  1. 1.
    The WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28(3):551–8.CrossRefGoogle Scholar
  2. 2.
    Verdugo MA, Schalock RL, Keith KD, et al. Quality of life and its measurement: important principles and guidelines. J Intellect Disabil Res. 2005;49(Pt 10):707–17.CrossRefPubMedGoogle Scholar
  3. 3.
    Universidade Federal do Rio Grande do Sul. Psiquiatria (home Page on the Internet). WHOQOL ABREVIADO—Versão em Português. Programa de Saúde Mental. Organização Mundial da Saúde. Assessed 2006 Sep 14. Available from:
  4. 4.
    Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann. 1983;6(3–4):185–210.CrossRefPubMedGoogle Scholar
  5. 5.
    Berlim MT, Fleck MP. “Quality of life”: a brand new concept for research and practice in psychiatry. Rev Bras Psiquiatr. 2003;25(4):249–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Andersen M. Is it possible to measure prescribing quality using only prescription data? Basic Clin Pharmacol Toxicol. 2006;98(3):314–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Azpiazu GM, Cruz JA, Villagrasa FJR, et al. Quality of life in noninstitutionalized persons older than 65 years in two health care districts in Madrid. Aten Primaria. 2003;31(5):285–92.CrossRefGoogle Scholar
  8. 8.
    Franic DM, Jiang JZ. Potentially inappropriate drug use and health-related quality of life in the elderly. Pharmacotherapy. 2006;26(6):768–78.CrossRefPubMedGoogle Scholar
  9. 9.
    Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug-related events and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med. 2001;38(6):666–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Juurlink DN, Mamdani M, Kopp A, Laupacis A, Redelmeier DA. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA. 2003;289(13):1652–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Manasse HR Jr. Medication use in an imperfect world: drug misadventuring as an issue of public policy, Part 1. Am J Hosp Pharm. 1989;46(5):929–44.PubMedGoogle Scholar
  12. 12.
    Okano GJ, Malone DC, Billups SJ, Carter BL, Sintek CD, Covey D, et al. Reduced quality of life in veterans at risk for drug-related problems. Pharmacotherapy. 2001;21(9):1123–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511–44.CrossRefPubMedGoogle Scholar
  14. 14.
    Rost K, Nutting P, Smith J, Coyne JC, Cooper-Patrick L, Rubenstein L. The role of competing demands in the treatment provided primary care patients with major depression. Arch Fam Med. 2000;9(2):150–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Roy-Byrne PP, Katon W, Cowley DS, Russo J. A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care. Arch Gen Psychiatry. 2001;58(9):869–76.CrossRefPubMedGoogle Scholar
  16. 16.
    Gorman JM. Treatment of generalized anxiety disorder. J Clin Psychiatry. 2002;63(Suppl 8):17–23.PubMedGoogle Scholar
  17. 17.
    Stein MB, Sherbourne CD, Craske MG, Means-Christensen A, Bystritsky A, Katon W, et al. Quality of care for primary care patients with anxiety disorders. Am J Psychiatry. 2004;161(12):2230–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Ministério da Saúde (home Page on the Internet). Departamento de Atenção Básica. Saúde da Família. Assessed 2006 Jan 23. Available from:
  19. 19.
    Prefeitura Municipal de Santa Cruz do Sul (home Page on the Internet). Secretaria Municipal da Saúde. Plano Municipal de Saúde. Assessed 2009 May 22. Available from:
  20. 20.
    Programa das Nações Unidas para o Desenvolvimento (home Page on the Internet). Atlas do Desenvolvimento Humano no Brasil. Assessed 2009 May 15. Available from:
  21. 21.
    Fleck MP, Louzada S, Xavier M, et al. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev Saude Publica. 2000;34(2):178–83.CrossRefPubMedGoogle Scholar
  22. 22.
    George J, Phun YT, Bailey MJ, et al. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38(9):1369–76.CrossRefPubMedGoogle Scholar
  23. 23.
    Melchiors AC, Correr CJ, Fernández-Llimos F. Translation and validation into Portuguese language of the medication regimen complexity index. Arq Bras Cardiol. 2007;89(4):210–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Korolkovas A, França FFAC. Dicionário terapêutico Guanabara. 16 ed. Rio de Janeiro: Guanabara Koogan; 2009/2010.Google Scholar
  25. 25.
    World Health Organization (homepage on the Internet). Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical classification system with Defined Daily Doses (ATC/DDD Index), 2006. Assessed 2006 Jul 4. Available from:
  26. 26.
    Galdas PM, Cheater F, Marshall P. Men and health help-seeking behavior: literature review. J Adv Nurs. 2005;49(6):616–23.CrossRefPubMedGoogle Scholar
  27. 27.
    Bayliss EA, Bayliss MS, Ware JEJ, et al. Predicting declines in physical function in persons with multiple chronic medical conditions: what we can learn from the medical problem list. Health Qual Life Outcomes. 2004;2:47.CrossRefPubMedGoogle Scholar
  28. 28.
    Fortin M, Bravo G, Hudon C, et al. Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res. 2006;15(1):83–91.CrossRefPubMedGoogle Scholar
  29. 29.
    Gijsen R, Hoeymans N, Schellevis FG, et al. Causes and consequences of co morbidity: a review. J Clin Epidemiol. 2001;54(7):661–74.CrossRefPubMedGoogle Scholar
  30. 30.
    Preskorn SH, Silkey B, Shah R, et al. Complexity of medication use in the Veterans Affairs healthcare system: Part I: Outpatient use in relation to age and number of prescribers. J Psychiatr Pract. 2005;11(1):5–15.CrossRefPubMedGoogle Scholar
  31. 31.
    Verbrugge LM, Lepkowski JM, Imanaka Y. Co morbidity and its impact on disability. Milbank Q. 1989;67(3–4):450–84.CrossRefPubMedGoogle Scholar
  32. 32.
    Oldridge NB, Stump TE, Nothwehr FK, et al. Prevalence and outcomes of co morbid metabolic and cardiovascular conditions in middle- and older-age adults. J Clin Epidemiol. 2001;54(9):928–34.CrossRefPubMedGoogle Scholar
  33. 33.
    Conn VS, Taylor SG, Kelley S. Medication regimen complexity and adherence among older adults. Image J Nurs Sch. 1991;23(4):231–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Johnson M, Griffiths R, Piper M, et al. Risk factors for an untoward medication event among elders in community-based nursing caseloads in Australia. Public Health Nurs. 2005;22(1):36–44.CrossRefPubMedGoogle Scholar
  35. 35.
    Ruo B, Rumsfeld JS, Hlatky MA, et al. Depressive symptoms and health-related quality of life: the Heart and Soul Study. JAMA. 2003;290(2):215–21.CrossRefPubMedGoogle Scholar
  36. 36.
    Gorman JM. Gender differences in depression and response to psychotropic medication. Gend Med. 2006;3(2):93–109.CrossRefPubMedGoogle Scholar
  37. 37.
    Spitzer RL, Kroenke K, Linzer M, et al. Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA. 1995;274(19):1511–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Fleck MP, Lima AF, Louzada S, et al. Association of depressive symptoms and social functioning in primary care service, Brazil. Rev Saude Publica. 2002;36(4):431–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Sampogna F, Picardi A, Chren MM, et al. Association between poorer quality of life and psychiatric morbidity in patients with different dermatological conditions. Psychosom Med. 2004;66(4):620–4.CrossRefPubMedGoogle Scholar
  40. 40.
    Norholm V, Bech P. Quality of life in schizophrenic patients: association with depressive symptoms. Nord J Psychiatry. 2006;60(1):32–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA. 1992;267(11):1478–83.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Samanta E. Fröhlich
    • 1
    • 2
    Email author
  • Anamaria V. Zaccolo
    • 1
  • Sabrina L. C. da Silva
    • 1
  • Sotero S. Mengue
    • 1
    • 3
  1. 1.Department of Epidemiology ProgramFederal University of Rio Grande do SulPorto AlegreBrazil
  2. 2.Porto AlegreBrazil
  3. 3.Department of Pharmaceutical SciencesFederal University of Rio Grande do SulPorto AlegreBrazil

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