Caracterização da prescrição de medicamentos por enfermeiros nos protocolos de Atenção Primária à Saúde / Characterization of medication prescription by nurses in Primary Health Care protocols / Caracterización de los medicamentos recetados por los enfermeros en los protocolos de Atención Primaria de Salud

Objetivo: caracterizar o modelo de prescrição de medicamentos por enfermeiros nos Protocolos de Atenção Primária à Saúde no Brasil. Método: realizou-se análise documental etnometodológica de 10 protocolos clínicos publicados entre 2002 e 2011 pelo Ministério da Saúde. A coleta ocorreu de agosto a dezembro de 2011. O projeto foi aprovado pelo Comitê de Ética em Pesquisa sob número do CAAE 2813.0.000.133-10. Resultados: não há exigência de pré-requisitos na maioria dos protocolos; há possibilidade de diagnóstico pelo enfermeiro na gravidez, nutrição infantil e doenças sexualmente transmissíveis; observou-se variados graus de autonomia; amplo grupo de medicamentos prescritos por enfermeiros. Conclusão: no Brasil, confirma-se uma prática prescritiva sem requisitos, diversidade de orientações induzindo à multiplicidade de ações que pode afetar a qualidade da prescrição.

Objective: to characterize the model for medication prescription by nurses in Primary Health Care Protocols in Brazil. Method: 10 clinical protocols published between 2002 and 2011 by the Health Ministry were subjected to ethno-methodological document analysis. Data were collected from August to December 2011. The project was approved by the research ethics committee (CAAE No. 2813.0.000.133-10). Results: there are no prerequisites in most protocols; nursing diagnosis is possible in pregnancy, child nutrition and sexually transmitted diseases; varying degrees of autonomy were observed; and a broad group of drugs were prescribed by nurses. Conclusion: In Brazil, this confirms a practice of prescribing without requirements and with a diversity of guidelines, inducing a multiplicity of actions, which may impair the quality of prescribing.

Objetivo: caracterizar el modelo de prescripción de fármacos por enfermeros en los Protocolos de Atención Primaria a la Salud en Brasil. Método: Se realizó Análisis Documental etnometodológico de 10 protocolos clínicos publicados entre 2002 y 2011 por el Ministerio de la Salud. La colecta ocurrió de agosto a diciembre de 2011. El proyecto fue aprobado por el Comité Ético de Investigación bajo el número CAAE 2813.0.000.133-10. Resultados: no hay exigencia de prerrequisitos en la mayoría de los protocolos; hay posibilidad de diagnóstico por el enfermero en embarazo, nutrición infantil y enfermedades sexualmente contagiosas; se observó variados grados de autonomía; amplio grupo de fármacos prescritos por enfermeros. Conclusión: en Brasil se confirma una práctica prescriptiva sin requisitos, diversidad de orientaciones induciendo a multiplicidad de acciones que puede afectar la cualidad de la prescripción.

Evaluación de la prescripción de medicamentos en consultas de Gastroenterología / Evaluation of drug prescription in Gastroenterology outpatient departments

Se realizó un estudio descriptivo y transversal, de tipo farmacoepidemiológico, de 426 pacientes atendidos en las consultas de Gastroenterología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" y del Policlínico Docente "Ramón López Peña" de Santiago de Cuba, de mayo del 2011 a igual mes del 2012, quienes consumían medicamentos bajo indicación facultativa (o se automedicaban), con vistas a evaluar dichas prescripciones. En la serie, el grupo farmacológico más prescrito fue el de los antiácidos, con un mayor consumo del Alusil® y el Silogel®, y entre las prescripciones inadecuadas predominaron las asociaciones medicamentosas para la cimetidina y la metoclopramida, así como la incorrecta individualización al recetar el Alusil®; de igual manera, la polimedicación resultó el factor más relacionado con la prescripción inadecuada.

A descriptive and cross-sectional study of pharmacoepidemiological type of 426 patients assisted in the Gastroenterology Department from "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital and in "Ramón López Peña" Teaching Polyclinic in Santiago de Cuba was carried out from May, 2011 to same month of 2012, who consumed drugs prescribed by doctors (or they self-medicated), with the aim of evaluating these prescriptions. In the series, the most prescribed pharmacological group was that of antacids, with a higher consumption of Alusil® and Silogel®, and among the inadequate prescriptions the medicamentous associations for cimetidina and metoclopramida, as well as the incorrect individualization when prescribing Alusil® prevailed; likewise, polymedication was the most related factor with inadequate prescription.

Calidad de prescripción de medicamentos en adultos mayores. EsSalud-2011

Objetivo: Evaluar la calidad de prescripción de medicamentos en adultos mayores, en el Hospital Nacional Almanzor Aguinaga Asenjo, en el periodo mayo-junio 2011. Material y Métodos: Descriptivo, Trasversal analítico. Población constituida por las prescripciones farmacológicas de los pacientes atendidos por consulta externa y/o hospitalización del servicio de Geriatría del Hospital Nacional Almanzor Aguinaga Asenjo. Se analizó los datos obtenidos por medio del software estadístico SPSS v 17.0, la calidad de prescripción de medicamentos se determinó utilizando la metodología del instrumento ACOVE modificado por Higashi y col. en el año 2004, el cual consta de 4 ejes, de los cuales para nuestro estudio se utilizó solo: 1) uso adecuado de medicamentos y 2) evitar medicación inadecuada. Resultados: La evaluación de la calidad de prescripción, mostró que los indicadores del eje 1 (uso de adecuado de medicamentos) presento 88% de cumplimiento y del eje 2 (evitar medicación inadecuada) fue del 66%. Conclusiones: La calidad de prescripción de medicamentos en adultos mayores, presenta porcentajes altos (>50%) de nivel adecuado de cumplimiento en la mayoría de los 26 indicadores de los Ejes 1 y 2, de la Metodología ACOVE (AssessingCare of Vulnerable Elder).(AU)

Objective: To evaluate the quality of drug prescription to elderly people at the Almanzor Aguinaga Asenjo National Hospital, during May ­ June, 2011. Material and Methods:Descriptive, Cross-sectional analytical. Population was constituted by the pharmacologic prescriptions of external consultation or hospitalized patients of the Geriatric service of the Almanzor Aguinaga Asenjo National Hospital. Obtained data was analyzed using the statistical software SPSS v17.0, the quality of drug prescription was determined using the instrument 'ACOVE', modified by Higashi and col., in the year 2004, which consists of 4 axis, from which we only used: 1) suitable usage of drugs and 2) avoiding unsuitable medication. Results: The evaluation of the prescription quality showed that the indicators of the axle 1 (use of adequate of medications) had 88 % of fulfillment and of the axle 2 (avoiding unsuitable medication) had 66 %. Conclusions: The quality of drug prescription in senior citizens presented high percentages (50 %) of an adequate level of fulfillment in most of the 26 indicators of the Axles 1 and 2 of the ACOVE (AssessingCare Vulnerable of Elder) Methodology.(AU)

Organización del abasto de medicamentos en los servicios estatales de salud: potenciales consecuencias de la mezcla público-privada / Organization of the drug supply chain in state health services: potential consequences of the public-private mix.

OBJETIVO. Evaluar las consecuencias de la subrogación privada sobre el proceso general de abasto y el surtimiento completo de recetas en los servicios estatales de salud. MATERIAL Y MÉTODOS. La investigación se realizó utilizando técnicas cuantitativas y cualitativas en 13 entidades federativas. La información se recolectó mediante entrevistas y observación directa. Las entrevistas se aplicaron a personal de los servicios estatales de salud relacionados con la cadena de abasto de medicamentos y a usuarios de los servicios de atención. La aproximación cuantitativa examinó, en una muestra por conveniencia de usuarios, el porcentaje de recetas completas surtidas. RESULTADOS. Las entidades que han optado por el modelo tercerizado en su totalidad y lo controlan adecuadamente han incrementado el suministro de medicamentos entre sus usuarios y garantizado el abasto en las unidades de atención a su cargo. Otras entidades con modelo tercerizado tienen múltiples problemas: compra directa de medicamentos no incluidos en el cuadro básico, incumplimiento de proveedores y escasez de insumos en los laboratorios que proveen a la empresa. Como principales inconvenientes de todos los modelos se identificaron la subordinación de los criterios médicos a los criterios administrativos; la insuficiente planeación basada en las necesidades locales de atención; la heterogeneidad de los procedimientos; el conocimiento insuficiente de la normatividad y la falta de regulación. CONCLUSIÓN. Los resultados indican que la incorporación de proveedores privados en la cadena de abasto de medicamentos podría no ser la solución para abatir el desabasto que padecen los servicios de salud, especialmente a escala hospitalaria. El cambio hacia modelos subrogados (tercerizados) se ha desarrollado sin incorporar mecanismos de evaluación, y las consecuencias que esta transición puede acarrear sobre los sistemas estatales de salud deben ser investigadas con mayor profundidad.

OBJECTIVE. To assess the consequences of private outsourcing on the overall supply and filling of prescriptions in state health services. MATERIAL AND METHODS. The research was conducted using quantitative and qualitative techniques in 13 states. The information was collected through interviews and direct observation. The interviews were carried on staff of state health services related to the drug supply chain and users of health services. The quantitative approach examined the percentage of stocked full recipes in a sample of users. RESULTS States that have opted for the fully outsourced model, and properly monitored this choice, have increased the supply of drugs to their users and guaranteed the supply in the care units in charge. Other states with the outsourced model have multiple problems: direct purchase of drugs not included in the basic drugs catalogue, failure of suppliers and shortage of supplies in the laboratories that provide the company. The main disadvantages identified in all models were: the subordination of the medical criteria to administrative criteria, insufficient planning based on local care needs, heterogeneous procedures, insufficient knowledge of regulations and lack of normativity. CONCLUSION. The results indicate that the incorporation of private providers in the drug supply chain may not be the solution to bring down the shortage faced by health services, especially at the hospital level. The shift to outsourcing models has developed without incorporating evaluation mechanisms and the consequences that this transition can have on state health systems must be investigated more deeply.

Medicamentos del tipo indicación-prescripción en pacientes con insuficiencia cardíaca / Medications of the type indication-prescription in patients with heart failure

Se realizó una investigación enmarcada en los estudios de utilización de medicamentos del tipo indicación-prescripción, que incluyó a 50 pacientes con insuficiencia cardíaca, ingresados en el Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba durante el 2006, con vista a evaluar la individualización del tratamiento, el esquema terapéutico y las combinaciones medicamentosas. Se emplearon diuréticos, digitálicos e inhibidores de la enzima convertidora de angiotensina, entre los cuales predominaron la furosemida, la digoxina y el captopril, cuya indicación se consideró inadecuada, fundamentalmente por incumplimiento del estándar establecido

An investigation comprised in the studies of the type indication-prescription drugs use, that included 50 patients with heart failure, admitted at Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba during the 2006 was carried out, aimed at evaluating the individualization of treatment, the therapeutic scheme and the drug combinations . Diuretics, digitalics and inhibitors of the angiotensin converting enzyme were used, among which there were furosemide, digoxin and captopril prevailed, and their indication was considered inadequate, mainly due to the unfulfillment of the established standard

Características do uso de benzodiazepínicos por mulheres que buscavam tratamento na atenção primária / Characteristics of the use of benzodiazepines by women seeking treatment in primary care

INTRODUÇÃO: Benzodiazepínicos são medicamentos psicotrópicos de prescrição restrita utilizados para crises agudas de ansiedade, insônia e convulsões. Sua utilização é muitas vezes inadequada. O objetivo deste trabalho é identificar o perfil da usuária de benzodiazepínicos na atenção primária e as características de sua utilização. MÉTODO: Foram entrevistadas todas as pacientes maiores de 18 anos em espera para atendimento em uma unidade básica de saúde de Sorocaba (SP) em 2008. RESULTADOS: Foi encontrada utilização de benzodiazepínicos por 13,14 por cento das frequentadoras da unidade básica de saúde, sendo maior em mulheres de 50 a 69 anos, em relacionamento estável e analfabetas. O uso encontrado foi principalmente por insônia (48,14 por cento), de medicamentos de longa meia-vida, crônico (mais de 6 meses, 89,14 por cento), com prescrição inicial principalmente pelo clínico geral (47,82 por cento), com alta taxa de tentativas de interrupção (91,3 por cento) infrutíferas (69,05 por cento). DISCUSSÃO: A utilização é 3,3 vezes maior do que a descrita na literatura para mulheres de perfil semelhante, com prescrições em geral inadequadas, independentemente do prescritor inicial (especialista ou não). CONCLUSÃO: O uso é crônico em mulheres mais idosas, de menor escolaridade, de relacionamento estável, por motivos corretos, porém de tempo de tratamento inadequado.

INTRODUCTION: Benzodiazepines are psychotropic drugs whose prescription is indicated for acute crises of anxiety, insomnia and convulsions. Its use is most of the times inadequate. This study aimed at identifying the profile of the female benzodiazepine user at primary care and the characteristics of use. METHODS: All patients over 18 years old were questioned about their benzodiazepine use at a primary care unit from Sorocaba, Brazil, in the year of 2008. RESULTS: Benzodiazepines were used by 13.14 percent, mainly by older women (50-69 years old), in a stable relationship and illiterate. The use was mainly due to insomnia (48.14 percent), of longer half-life drugs, chronic (over 6 months, 89.14 percent), with first prescription by the general practitioner (47.82 percent) and high rates of interruption (91.3 percent) failures (69.05 percent). DISCUSSION: The use is 3.3 times higher than described in the literature for women of similar profiles, with generally inadequate prescriptions, independently of the first prescriber (specialist or not). CONCLUSION: Use is chronic, mainly by older women, with lower educational level and who are in a stable relationship, for correct reasons, but for inadequate time of treatment.

Off-label drug use in a pediatric intensive care unit.

Objective. To determine the extent and nature of off-label drug use in children admitted to a Pediatric Intensive Care Unit (PICU) Methods. This prospective exploratory study was conducted in a tertiary care hospital in a metropolitan city in India after obtaining clearance from the institutional ethics committee. Subjects admitted in PICU from February-August 2006 were enrolled in the study. In addition to the demographic data and diagnosis, details of drugs prescribed (name, dose and route and frequency of administration) were obtained from hospital records. British National Formulary 2005 was used to determine if the prescriptions were off-label and if so, they were categorized as off-label for age, indication, dosage or frequency and route of administration. Descriptive statistics was used to determine the proportion of off-label drug use. Fischer’s exact test was used to determine if there was significant difference (P<0.05) in off-label use between patients with multiple system affection and those with single system affection and between those requiring artificial ventilatory support and those not requiring it. Results. Three hundred subjects received 2237 analyzable prescriptions. Of these 1579 (70.58%) prescriptions were offlabel in nature. Off-label drug use was prevalent in all age-groups and in all systemic afflictions. The proportion of off-label drug use was not influenced by severity of illness, as judged by involvement of multiple systems or need for ventilatory support. The list of off-label drugs used included old as well as new molecules. Most commonly used drugs in PICU were also the most common off-label drugs. Conclusion. Off-label drug use is highly prevalent in PICU settings.

Prescrição medicamentosa em odontopediatria / Drugs prescription in pediatric dentistry

A inadequada prescrição de medicamentos na clínica odontológica pediátrica deve-se, principalmente, ao escasso conhecimento dos cirurgiões-dentistas a respeito da farmacologia e da terapêutica. A falta de informação adequada do cirurgião-dentista acerca de indicação, formas de administração, posologia e efeitos adversos dos medicamentos em crianças pode, muitas vezes, excluí-las dos benefícios de certos fármacos que são reconhecidamente úteis em pacientes adultos. Este estudo tem como objetivo revisar a literatura, abordando de maneira simples, a farmacodinâmica e a farmacocinética dos principais medicamentos utilizados na Odontopediatria, além de orientar o cirurgião-dentista acerca de como obter sucesso no tratamento farmacológico. Concluiu-se que, para se obter tal sucesso, a responsabilidade com o esquema terapêutico deve envolver cirurgião-dentista, pais e criança.

The inadequate drugs prescription in the daily pediatric dentistry clinic is normally close related to the dentists deficiency concerning to the pharmacological and therapeutical basic mechanisms. The lack of a correct information about drugs indications, ways of administrations, dosages and side effects in pediatric group leads to exclude them of the real benefits of those medicines admittedly useful in adults patients. The aim of this paper was to review the literature, elucidating, in a simple manner, the pharmacodynamical and the pharmacokinetic basis of the main pediatric medicines, besides of guiding the dentist to achieved a safely pharmacological success during the routine treatments. It was concluded that, in order to obtain high-quality results, not only the dentist, but also parents and children must be involved in the treatment.

PRESCRIPTION PATTERNS OF ANTIMALARIAL DRUGS AMONG MEDICAL PRACTITIONERS IN OSOGBO METROPOLIS. SOUTH-WEST NIGERIA

<B>Objective:</B> In view of the increased prevalence of chloroquine resistance and the recent WHO malaria drug policy recommendation to use a combination of therapies especially artemisinin-based combination therapies (ACTs) in Africa, we tried to assess the prescription pattern and level of knowledge in the use of antimalarial drugs including ACTs among medical practitioners in Osogbo metropolis, southwest Nigeria, an endemic area of <I>Plasmodium falciparum</I> infection. <B>Method:</B> Questionnaires were sent to every medical practitioner working in all the health facilities in the metropolis, namely, a teaching hospital, general hospital, mission hospital, comprehensive health centre and 20 privately owned health facilities. Of the total of 100 questionnaires sent out, 96 were completed and returned while the remaining 4 were not returned. The questionnaires were self-administered. <B>Result:</B> Sixty-seven percent of the respondents work in the teaching hospital, while the remaining 33% either work in the general hospital or in private medical practice. 82.4% prescribed chloroquine despite the widespread resistance, indicating that this remains the most prescribed antimalarial drug. 45.7% apply the dosage regimen correctly (Χ2 P<0.005); 66.7% prefer the use of chloroquine injection; 85.6% give chlorpheniramine with chloroquine because of pruritus; 14.4% give it because of its synergistic and reversal mechanism. Other commonly prescribed drugs include sulphadoxine-pyrimethamine (71.1%), halofantrine (53.6%), amodiaquine and quinine (51.1%), mefloquine (20.6%), artemisinin or ACTs (18.6%) and co-trimoxazole (17.5%). Of these, the dosage regimen was applied correctly for: sulphadoxine-pyrimethamine (30.9%), halofantrine (12.8%), amodiaquine (3.2%), co-trimoxazole (2.1%), ACTs, quinine and artemisinin monotherapy (1.1%). About 40% of practitioners prefer the use of combination therapy in the future. <B>Conclusion:</B> There is an obvious paucity of knowledge on the prescription of antimalarial drugs. The proportion of practitioners anticipating the use of combination therapy in the future indicates that with continued medical education the use of combination therapies especially ACTs will be accepted easily.