Study on the risk and countermeasure of prescription drugs sold online by drug retail enterprises / 中国药房

OBJECTIVE To analyze the risks of prescription drugs sold online by drug retail enterprises， and to provide countermeasures and suggestions for risk prevention and control of prescription drugs sold online. METHODS The risk hierarchy structure model of prescription drugs sold online by drug retail enterprises was constructed by using analytic hierarchy process. Multiple rounds of risk research and judgment were carried out on 123 pairs of evaluation indicators by using Delphi expert survey method. The normalized weight calculation and consistency test of risk judgment matrix were carried out to perform fuzzy quantitative research. RESULTS The risk of prescription dispensing and review （6.48%）， the risk of drug first and prescription later （5.48%）， the risk of rational drug use guidance （4.99%）， the risk of buying drugs by abnormal channel （4.97%）， the risk of “first diagnosis， non-chronic disease and non-common disease” （4.43%）， and the quality and safety risk of returned drugs （4.34%） and the application risk of regulatory technology （4.06%） were high risks； the overall risk of drug retail enterprises （chain） selling prescription drugs online was 38.67%， and the overall risk of drug retail enterprises （individual） selling prescription drugs online was 61.33%， with a difference of 22.66% between them. CONCLUSIONS There were 7 high-risk indicators for prescription drugs sold online by drug retail enterprises. Among them， the risk of prescription dispensing and review， the risk of drug first and prescription later， and the risk of rational drug use guidance are the top three high-risk points. The risk of prescription drugs sold online by drug retail enterprises （individual） is higher than that of drug retail enterprises （chain）. It is recommended that regulatory authorities focus on and regulate the prescription drugs sold online by drug retail enterprises （individual）， and encourage drug retail enterprises （chain） to establish a systematic online sales process for prescription drugs； for high-risk points of prescription drugs sold online， it is recommended that regulatory authorities and drug retail enterprises focus on it and take effective risk prevention and control measures to ensure the safe use of prescription drugs by the general public.

Prevalence of the Consumption of Tranquilizers without a Medical Prescription and Associated Factors in School-Based Adolescents in Colombia / Prevalencia del consumo de tranquilizantes sin prescripción médica y factores asociados en adolescentes escolarizados de Colombia / Prevalência do uso de tranquilizantes sem prescrição médica e fatores associados em adolescentes em idade escolar na Colômbia

Introduction: Non-prescription tranquilizers are a specific group of benzodiazepines, used as drugs that act on the central nervous system and have an extensive effect in patients with anxiety disorders and problems in sleep stages. Objective: To determine the prevalence of the year and month of consumption of tranquilizers without a medical prescription and the associated factors, in adolescents in school in Colombia. Methods: It is a cross-sec-tional study with an analytical scope. The universe of the study consisted of 3,243,377 students, from grades 7 to 11 (aged between 12 and 18 years), the valid surveys were 80,018. The adolescent who declared having used tranquilizers during the last 30 days and the last 12 months was considered a consumer. All variables were self-re-ported by adolescents. Results: The prevalence of tranquilizer use without medical prescription was 1.02% and 1.97% (month and year, respectively). Adolescents who presented disciplinary problems are the most predisposed to use during the last month with an OR 2.79 (95% CI: 2.20­3.53) and last year an OR of 2.77 (95 % CI: 2.34­3.27). Conclusions: There is a higher prevalence of the consumption of tranquilizers without medical prescription in women between 14 and 17 years of age, from mixed schools and it is associated with academic and disciplinary performance problems, in the last year. In addition, as age increases, the consumption of substances without a medical prescription increases

Introducción: Los tranquilizantes sin prescripción médica son un grupo específico de benzodiacepinas, usados como medicamentos que actúan sobre el sistema nervioso central y cuentan con un extenso efecto en pacientes con trastornos de ansiedad y problemas en las etapas del sueño. Objetivo: Determinar la prevalencia de año y mes de consumo de tranquilizantes sin prescripción médica y los factores asociados en adolescentes escolarizados de Colombia. Métodos: Estudio transversal con alcance analítico. El universo del estudio estuvo constituido por 3 243 377 estudiantes de los gados 7.º a 11.º (con edades entre 12 y 18 años). Las encuestas válidas fueron 80 018. Se consideró consumidor al adolescente que declaró haber consumido tranquilizantes durante los últimos 30 días y los últimos 12 meses. Todas las variables fueron autorreportadas por los adolescentes. Resultados: La prevalencia de consumo de tranquilizantes sin prescripción médica fue del 1,02 % y del 1,97 % (mes y año, respectivamente). Los adolescentes que presentaron problemas disciplinarios son los más predispuestos al consumo durante el último mes con un OR de 2,79 (IC95 %: 2,20-3,53) y último año un OR de 2,77 (IC95 %: 2,34-3,27). Conclusiones: Existe mayor prevalencia de consumo de tranquilizantes sin prescripción médica en mujeres entre los 14 y los 17 años, de colegios mixtos, y se encuentra asociada con problemas de rendimiento académico y disciplinarios, en el último año. Además, a medida que aumenta la edad, se incrementa el consumo de sustancias sin prescripción médica

Introdução: Os tranquilizantes isentos de prescrição são um grupo específico de benzodiazepínicos, usados como medicamentos que atuam no sistema nervoso central e têm um efeito extenso em pa-cientes com transtornos de ansiedade e problemas no estágio do sono. Objetivo: Determinar a prevalência anual e mensal do uso de tranquilizantes sem prescrição médica e os fatores associados em adolescentes em idade escolar na Colômbia. Métodos: Estudo transversal com escopo analítico. O universo do estudo consistiu em 3243377 alunos da 7ª à 11ª série (com idades entre 12 e 18 anos). Foram realizadas 80018 pesquisas válidas. Um adolescente foi considerado usuário, o qual relatou ter usado tranquilizantes nos últimos 30 dias e nos últimos 12 meses. Todas as variáveis foram autorrelatadas pelos adolescentes. Resultados: A prevalência do uso de tranquilizantes sem prescrição médica foi de 1,02% e 1,97% (mês e ano, respectivamente). Os adolescentes com problemas disciplinares apresentaram maior pro-babilidade de uso no último mês, com um OR de 2,79 (IC95%: 2,20-3,53) e no último ano, com um OR de 2,77 (IC95%: 2,34-3,27). Conclusões: Há uma maior prevalência de uso de tranquilizantes sem prescrição médica em mulheres de 14 a 17 anos, de escolas mistas, e isso está associado a problemas de desempenho acadêmico e disciplinar no último ano. Além disso, com o aumento da idade, aumenta o uso de substâncias sem prescrição médica.

Análise da automedicação pediátrica em pacientes atendidos em hospital de alta complexidade / Analysis of pediatric self-medication in patients treated at a highcomplexity hospital

A automedicação pediátrica ocorre quando pais ou responsáveis usam medicamentos sem prescrição para tratar doenças ou sintomas reconhecidos nas crianças. Analisar o perfil da automedicação pediátrica em um hospital de alta complexidade no interior do Ceará. Trata-se de um estudo transversal baseado na técnica de entrevista, realizado com 135 pais/responsáveis de crianças com idade entre 0 a 12 anos que procuraram atendimento hospitalar entre novembro de 2020 e março de 2021. Observou-se uma prevalência de automedicação de 60%. Quanto à frequência, 43,2% dos entrevistados relataram realizar às vezes. Destes, a maioria era: mãe (94,3%; p<0,0001), com 17 a 27 anos (48,6%; p<0,0001) e renda familiar de menos de 1 salário mínimo (57,1%; p=0,020); 59,3% apontaram como motivo considerar o problema de saúde simples. A principal causa da automedicação foi a febre e os medicamentos mais utilizados foram analgésicos e antipiréticos. A predominância da automedicação pediátrica pelas mães deve-se à experiência com seus outros filhos. Além disso, as condições socioeconômicas influenciaram as práticas errôneas da automedicação, pois as famílias que não possuem recursos para a consulta e compra dos fármacos acabam optando pela autoadministração. O uso indiscriminado de medicações deve ser reprimido, pois, a depender da dose, consequências graves podem ocorrer às crianças. Destaca-se a importância da equipe multiprofissional de saúde durante uma consulta pediátrica, com médicos, enfermeiros e farmacêuticos repassando aos pais informações a respeito dos medicamentos, seus benefícios e riscos, desestimulando a prática nesta faixa populacional e reduzindo os erros de medicação.

Pediatric self-medication occurs when parents or guardians use over-the-counter medications to treat recognized illnesses or symptoms in children. To analyze the profile of pediatric self-medication in a high-complexity hospital in the interior of Ceará. This is a cross-sectional study based on the interview technique, carried out with 135 parents/guardians of children aged 0 to 12 years old who sought hospital care between November 2020 and March 2021. There was a prevalence of self-medication of 60%. As for frequency, 43.2% of respondents reported doing it sometimes. Of these, the majority were: mothers (94.3%; p<0.0001); aged 17 to 27 years old (48.6%; p<0.0001); family income of less than 1 minimum wage (57.1 %; p=0.020); and 59.3% indicated that their reason for medicating was that they considered the health problem as simple. The main cause of self-medication was fever, and the most used drugs were analgesics and antipyretics. The predominance of pediatric self-medication by mothers is due to their experience with their other children. In addition, socioeconomic conditions influenced the erroneous practices of self-medication, as families that do not have the resources to consult and purchase drugs end up opting for self-administration. The indiscriminate use of medications must be repressed, because, depending on the dose, serious consequences can occur to children. The importance of a multidisciplinary health team during a pediatric consultation is highlighted, with doctors, nurses, and pharmacists providing parents with information about medication, their benefits and risks, discouraging the practice in this population group and reducing medication errors.

Consumption of drugs for Alzheimer's disease on the Brazilian private market / Consumo de medicamentos para doença de Alzheimer no mercado privado brasileiro

ABSTRACT OBJECTIVE To analyze the consumption of drugs for Alzheimer's disease on the Brazilian private market and its geographical distribution from 2014 to 2020. METHODS National data from the Brazilian National System of Controlled Product Management were used, regarding sales of donepezil, galantamine, rivastigmine, and memantine from January 2014 to December 2020. Sales data were used as a proxy for drug consumption and expressed as defined daily dose/1,000 inhabitants/year at national, regional, federative unit and microregion levels. RESULTS Drug consumption went from 5,000 defined daily doses/1,000 inhabitants, in 2014, to more than 16,000/1,000 inhabitants, in 2020, and all federative units showed positive variation. The Brazilian Northeast had the highest cumulative consumption in the period but displayed microregional disparities while the North region had the lowest consumption. Donepezil and memantine were the most consumed drugs, with the highest growth in consumption from 2014 to 2020. CONCLUSION The consumption of medicines indicated to treat Alzheimer's disease tripled in Brazil between 2014 and 2020, which may relate to the increase in the prevalence of the disease in the country, greater access to health services, and inappropriate use. This challenges managers and healthcare providers due to population aging and the increased prevalence of chronic-degenerative diseases.

RESUMO OBJETIVO Analisar o consumo de medicamentos para a doença de Alzheimer no mercado privado brasileiro e sua distribuição geográfica entre os anos de 2014 e 2020. MÉTODOS Foram utilizados dados do Sistema Nacional de Gerenciamento de Produtos Controlados relativos às vendas de donepezila, galantamina, rivastigmina e memantina, entre janeiro de 2014 a dezembro de 2020, em todo o território nacional. Os dados de venda foram utilizados como proxy para o consumo dos medicamentos, avaliado em dose diária definida (DDD)/1.000 habitantes/ano em nível nacional, regional, por unidade federativa e microrregião. RESULTADOS O consumo dos medicamentos passou de 5.000 DDD/1.000 habitantes em 2014 para mais de 16.000 DDD/1.000 habitantes em 2020, e todas as unidades de federação apresentaram variação positiva. A região Nordeste apresentou o maior consumo acumulado no período, porém exibiu disparidades microrregionais. A região Norte apresentou o menor consumo. Os medicamentos mais consumidos foram donepezila e memantina, os quais também apresentaram maior crescimento do consumo no intervalo de tempo entre os anos de 2014 e 2020. CONCLUSÃO O consumo de medicamentos para o tratamento da doença de Alzheimer triplicou no Brasil entre os anos de 2014 e 2020, o que pode estar relacionado ao aumento da prevalência da doença no país e/ou maior acesso a serviços de saúde, assim como estar ligado, também, à utilização inapropriada destes medicamentos. Este é um desafio para gestores e profissionais de saúde num cenário de envelhecimento populacional e aumento da prevalência de doenças crônico-degenerativas.

Prescripción de clonazepam tabletas en el municipio Santa Clara

Introducción: Las benzodiazepinas son medicamentos utilizados para el tratamiento de la ansiedad y los trastornos del sueño, así como relajantes musculares y anticonvulsivantes. A pesar de que no se aconseja su uso para tratamientos prolongados, algunos pacientes lo utilizan de forma continuada lo cual se asocia con la dependencia física y síntomas de abstinencia moderada a severa. El clonazepam es uno de las benzodiazepinas con propiedades ansiolíticas y antiepilépticas. Objetivo: Determinar el aumento en la prescripción del medicamento clonazepam de 1mg tabletas en el municipio Santa Clara. Métodos: Se realizó una investigación observacional, retrospectiva, descriptiva y transversal, que se correspondió con un estudio de uso de medicamentos, del tipo prescripción-indicación del medicamento clonazepam de 1mg tabletas, durante el período junio 2021 a junio 2023. El universo lo conformaron 5 819 pacientes que constituían la totalidad de los pacientes de tipo ambulatorio con dicha prescripción al final del estudio. Resultados: En cuanto al sexo, al final del estudio, la distribución mostró un predominio del sexo femenino. Se evidenció un incremento de un 198 % de los pacientes y predominó el grupo de edades de más de 59 años (55,3 %). Conclusiones: Existe una alta tendencia en el uso del clonazepam, sobre todo en personas de la tercera edad, las cuales son las más susceptibles a la aparición de efectos indeseables con consecuencias lamentables.

Introduction: Benzodiazepines are drugs used for anxiety and sleep disorders, as well as muscle relaxants and anticonvulsive. Despite being discouraged in prolonged treatments, some patients have chronic use, which is associated with the development of physical dependence, manifested in moderate to severe withdrawal symptoms. Clonazepam is one such benzodiazepine which has antiepileptic as well as anxiolytic properties. Objective: To determine the increase in prescription of clonazepam 1mg tablets in Santa Clara municipality. Methods: An observational, retrospective, descriptive and cross-sectional investigation was carried out, which corresponded with a medications use study, of prescription-indication type. It was conducted aimed at assessing the prescription of the medication clonazepam 1mg tablets during the period from June 2021 to June 2023. The universe was built by 5819 patients which constituted the totality of ambulatory patients with such prescription at the end of the study. Results: Regarding sex, at the end of the study, the distribution showed a predominance of the female sex. It was evidenced an increase of 198 % of patients and a predominance of patients over 59 years of age (55.33 %). Conclusions: The results showed a high trend in the use of clonazepam, mainly in elderly patients, which are the most susceptible to the appearance of undesirable effects and unfortunate consequences.

Características das prescrições de metilfenidato em ambulatório de neuropediatria / Characteristics of methylphenidate prescriptions in a pediatric neurology outpatient clinic

RESUMO O metilfenidato não é disponibilizado pelo Sistema Único de Saúde (SUS), pois não faz parte da Relação Nacional de Medicamentos Essenciais. Todavia, o metilfenidato 10 mg é disponibilizado pela rede pública em Maringá-PR de acordo com a Política da Assistência Farmacêutica do município. Objetivou-se analisar as características das prescrições médicas de metilfenidato para crianças em ambulatório de neuropediatria vinculado ao SUS no município. Estudo transversal observacional retrospectivo de caráter quantitativo, realizado por meio da coleta de dados dos prontuários cadastrados no Sistema Gestor da rede pública de saúde do município, pelo ambulatório de neuropediatria na Unidade Básica de Saúde, Zona 7, entre janeiro de 2017 e novembro de 2019. Analisaram-se os dados por frequência relativa e absoluta. Emitiram-se 339 prescrições pelo neuropediatra responsável do ambulatório para 107 pacientes de 6 a 11 anos. Notou-se distribuição geográfica desigual das crianças atendidas conforme bairro da cidade, o que denota influência socioeconômica na prescrição de medicamentos. Ressaltam-se picos de prescrições coincidindo com o período do ano letivo escolar. Concluiu-se que o acompanhamento especializado adequado é premissa para o tratamento, não dispensando a rede longitudinal de assistência. Ademais, evidencia-se o impacto das condições socioeconômicas, tanto na prescrição como na aquisição do medicamento.

ABSTRACT Methylphenidate is not available through the Unified Health System (SUS), as it is not part of the National List of Essential Medicines. However, methylphenidate 10 mg is available through the public system in Maringá-PR, according to the Pharmaceutical Assistance Policy of the municipality. Retrospective cross-sectional observational study of a quantitative character occurred through the collection of data from the medical records registered in the Management System of the public health network in Maringá-PR, Brazil, by the neuropediatric outpatient clinic in the Basic Health Unit, between January 2017 and November 2019. Data were analyzed by relative and absolute frequency. 339 prescriptions were issued by the responsible neuropediatrician for 107 patients aged 6 to 11 years. There was an uneven geographic distribution of the number of children attended according to the neighborhood of the city, which points to a socioeconomic influence on the medication prescription. It is worth noting peaks of prescriptions coinciding with the period of the school year, following to a national trend. It was concluded that adequate specialized monitoring is a premise for better treatment, not dispensing the longitudinal assistance network. The impact of socioeconomic conditions is significant in the prescription and purchase of the medication.

Automedicación en dirigentes estatales en la Delegación Provincial de la Agricultura en Cienfuegos

Introducción: El consumo desmedido de medicamentos o polifarmacia constituye una problemática de salud a escala mundial. El uso prolongado de estos fármacos supera en riesgos o efectos adversos a los beneficios que pudieran aportar, solo apreciables ante situaciones de necesidad evidente. Objetivo: Caracterizar la automedicación en dirigentes estatales en la Delegación Provincial de la Agricultura en Cienfuegos. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo de corte trasversal con dirigentes referente a la automedicación en la Delegación Provincial de la Agricultura en Cienfuegos. El universo se conformó por 23 personas. Se utilizaron las variables edad, sexo, cumplimiento del tratamiento médico, medicamento consumido con y sin prescripción. Se utilizó la estadística descriptiva. Resultados: Predominó el sexo masculino (14 personas; 60,86 %). Se destacó el grupo etario 40-59 con 11 personas (54,80 %). Los inhibidores de la enzima convertidora de angiotensina son los medicamentos de mayor consumo bajo indicación médica (8 personas; 34,78 %). 11 casos cumplieron con el tratamiento (73,33 %). El dolor resultó el síntomas más frecuente (19 personas; 82,60 %). Los antinflamatorios no esteroideos se consumen más sin indicación médica (17 casos; 80,95 %). Conclusiones: la automedicación se caracterizó por ser una práctica cotidiana que se realiza de manera consciente; aun cuando se desconozca sus complicaciones posteriores. El consumo de medicamento sin autorizo del facultativo responde al tipo de lesión o padecimiento a tratar; donde no existe distinción entre ambos sexos.

Introduction: the excessive consumption of drugs or polypharmacy constitutes a health problem on a global scale. Prolonged use of these drugs outweighs the risks or adverse effects that they could provide (only appreciable in situations of obvious need). Objective: to characterize self-medication in state leaders in the Provincial Delegation of Agriculture of Cienfuegos. Methods: an observational, descriptive, retrospective cross-sectional study was carried out with leaders regarding self-medication in the Provincial Delegation of Agriculture of Cienfuegos. The universe was made up of 23 people. The variables age, sex, compliance with medical treatment, medication consumed with and without a prescription were used. It used the descriptive statistic. Results: male sex predominated (14 people; 60.86 %). The age group 40-59 stood out with 11 people (54.80 %). Angiotensin converting enzyme inhibitors are the most widely used drugs under medical indication (8 people; 34.78 %). 11 cases complied with the treatment (73,33 %). Pain was the most frequent symptom (19 people; 82.60 %). Non-steroidal anti-inflammatory drugs are consumed more without medical indication (17 cases; 80.95 %). Conclusions: self-medication is a daily practice that is carried out consciously; even if its subsequent complications are unknown. The consumption of medication without the authorization of the physician responds to the type of injury or condition to be treated; where there is no distinction between both sexes.

The process of deprescribing in older adults: a methodological protocol / Processo de desprescrição em idosos: protocolo metodológico

Objective: To report, by means of a methodological protocol, the process of deprescribing implemented in a geriatric psychiatry outpatient clinic of a teaching hospital. Methods: The topic of interest was comprehensively reviewed in the scientific literature. Instruments and tools necessary to develop the protocol were selected, including the Treatment Adherence Measure, Beers criteria, the EURO-FORTA List, the Brazilian Consensus on Potentially Inappropriate Medications for Older Persons, Drugs.com, and deprescribing algorithms. Results: The protocol consists of the following steps: 1) Review: Assess older patients' physical and behavioral status and family context and list all medications used; 2) Analyze: Review patients' drug therapy; 3) Act: Initiate deprescribing (if indicated); 4) Adjust: Discuss patients' expectations, beliefs, and preferences and adjust the prescription to their real possibilities; 5) Monitor: Identify responses to treatment, assess adherence to the deprescribing process, and detect return of symptoms or worsening of the underlying disease. Conclusions: Health care professionals need to work together to provide comprehensive care for older persons. The inclusion of deprescribing in more research groups focused on the geriatric population will increase attention to the safety of pharmacological treatment for older patients.

Objetivo: Relatar como ocorre o processo de desprescrição em um ambulatório de Psiquiatria Geriátrica de um hospital universitário, por meio de um protocolo metodológico. Metodologia: O assunto foi revisado na literatura científica e foram selecionados instrumentos e ferramentas necessários para desenvolver o protocolo, incluindo a Medida de Adesão aos Tratamentos, o Critério de Beers, a Lista Fit for the Aged (EURO-FORTA), o Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos, Drugs.com e algoritmos de desprescrição. Resultados: O protocolo elaborado é composto das seguintes etapas: 1) revisar: avaliar o estado físico e comportamental e o contexto familiar do idoso e listar todos os medicamentos utilizados; 2) analisar: revisar a farmacoterapia do paciente; 3) agir: iniciar a desprescrição (se tiver indicação); 4) ajustar: pactuar expectativas, crenças e preferências do paciente, adaptando a prescrição às suas reais possibilidades; 5) monitorar: verificar as respostas ao tratamento, avaliar a adesão à desprescrição, detectar ressurgimento dos sintomas ou agravamento da doença de base. Conclusões: Os profissionais da saúde precisam trabalhar em conjunto para proporcionar atenção completa ao idoso. A inserção da desprescrição em mais grupos de pesquisa com o foco na população geriátrica possibilitará maior atenção à segurança dos tratamentos farmacológicos dos pacientes.

Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil

ABSTRACT BACKGROUND: Physician and patient-related characteristics can influence prescription of medications to older patients within primary healthcare. Use of Brazilian criteria may indicate the real prevalence of prescription of potentially inappropriate medications to this population. OBJECTIVES: To evaluate prescription of potentially inappropriate medications to older patients within primary care and identify patient-related and prescribing physician-related factors. DESIGN AND SETTING: This cross-sectional study was conducted in 22 public primary care facilities in Brazil, among older people (≥ 60 years) who were waiting for medical consultations. METHODS: Interviews were conducted before and after the medical consultations. If the patient received a medical prescription at the consultation, all the drugs prescribed and the physician's medical council registration number were recorded. Prevalence ratios were estimated to ascertain the magnitude of prescription of potentially inappropriate medications, along with patient and physician-related factors associated with such prescription. RESULTS: In total, 417 older patients were included; 45.3% had received ≥ 1 potentially inappropriate medication, and 86.8% out of 53 physicians involved had prescribed ≥ 1 potentially inappropriate medication. The strongest patient-related factor associated with higher prevalence of prescription of potentially inappropriate medications was polypharmacy. Among physician-related factors, the number of patients attended, number of prescriptions and length of medical practice < 10 years were positively associated with prescription of potentially inappropriate medications. CONCLUSIONS: High prevalence of prescription of potentially inappropriate medications was observed. Physician-related characteristics can influence prescription of medications to older people within primary healthcare. This suggests that there is a need for interventions among all physicians, especially younger physicians.

Cost-effectiveness of drug-management of hypertension among patients in selected secondary facilities in Nigeria: Empirical evidence for rational prescription choices / Costo-efectividad del manejo farmacológico de la hipertensión en pacientes de entidades de segundo nivel seleccionados en Nigeria: evidencia empírica para elecciones racionales de formulación

Abstract Background: The financial burden of managing hypertension in developing countries, where most of healthcare is funded out-of-pocket, is huge and poor patients cannot sustainably afford it. This is a challenge for most people, especially in sub-Saharan Africa with poor health indices, and this informed the investigation of the cost-effectiveness of anti-hypertensive drugs. Methodology: This was essentially a before-and-after study without control, in which blood pressure was assessed after commencing treatment with anti-hypertensive drugs among hypertensive patients. A systematic sampling technique was employed to recruit 320 participants from new patients attending cardiology clinic and admitted into the wards in four secondary health facilities offering specialized medical services in Nigeria. Results: The median cost of drug treatment of hypertension per week was N977.50; this cost was much lower for monotherapy than combined therapy. Similarly, the median costs of treatment per decrease in systolic and diastolic blood pressures were higher with combined therapy than monotherapy. The median cost of treatment per decrease in systolic blood pressure was higher than diastolic pressure. Diuretics had the most cost per decrease in diastolic blood pressure, while ACEI had the highest costs per decrease in systolic blood pressure and the highest cost per week. The lowest cost per week was recorded for beta-blockers, which also had the lowest cost per decrease in diastolic blood pressure and similar to the average cost per unit decrease in systolic blood pressure for centrally acting drugs. Conclusion: There was a significant improvement in blood pressure three months following the start of anti-hypertensive drugs. Beta-blockers appeared most cost-effective while diuretics as well as ACE inhibitors were the least. Monotherapy costs less per week, but it could not be proved from this study that it was more cost-effective than combined therapy.

Resumen Antecedentes: la carga financiera del manejo de la hipertensión en países en vías de desarrollo, donde la mayoría de la atención en salud es financiada por cuenta propia, es enorme, y los pacientes de escasos recursos no lo pueden costear de manera sostenible. Este es el reto para la mayoría de las personas, especialmente en África subsahariana que tiene indicadores de salud pobres, y esto fundamentó la investigación de la costo-efectividad de las drogas antihipertensivas. Metodología: esencialmente un estudio antes-después, sin control, en el cual se evaluó la tensión arterial luego de iniciar tratamiento con antihipertensivos en pacientes hipertensos. Se empleó una técnica de muestreo sistemático para reclutar 320 participantes de entre los pacientes nuevos atendidos en consulta de cardiología y hospitalizados en cuatro entidades de salud de segundo nivel en Nigeria. Resultados: el costo medio semanal del tratamiento farmacológico de la hipertensión fue de N977.50; este costo fue mucho menor para la monoterapia que para la terapia combinada. Asimismo, el costo medio de tratamiento por reducción en las cifras de tensión arterial sistólica y diastólica fue mayor con la terapia combinada que con la monoterapia. El costo medio de tratamiento por reducción en la tensión arterial sistólica fue mayor que para la tensión diastólica. Los diuréticos tuvieron el mayor costo por reducción en tensión arterial diastólica, mientras que los IECA tuvieron el mayor costo por reducción en tensión arterial sistólica y el costo más alto por semana. El costo más bajo por semana se registró para los beta-bloqueadores, los cuales también tuvieron el menor costo por reducción en la tensión arterial diastólica y un costo similar al promedio por unidad de reducción en la tensión arterial sistólica para los medicamentos de acción central. Conclusión: hubo una mejoría significativa en la tensión arterial luego de tres meses del inicio de drogas antihipertensivas. Los beta-bloqueadores parecieron ser los más costo-efectivos, mientras que los diuréticos e inhibidores de ECA fueron los menos costo-efectivos. La monoterapia costó menos por semana pero no se pudo comprobar con este estudio que fuera más costo-efectivo que la terapia combinada.

Avaliação do Seguimento de 1 Ano dos Pacientes Incluídos no Registro da Prática Clínica em Pacientes de Alto Risco Cardiovascular (REACT) / Evaluation of 1-Year Follow-up of Patients Included in the Registry of Clinical Practice in Patients at High Cardiovascular Risk (REACT)

Resumo Fundamento Na prática clínica, há evidências de falhas na prescrição de terapias baseadas em evidências para pacientes de alto risco cardiovascular. Entretanto, no Brasil, ainda são insuficientes os dados sobre a evolução ao longo de 1 ano desses pacientes. Objetivos Descrição no acompanhamento de 12 meses da utilização de terapias baseadas em evidência e da ocorrência de desfechos cardiovasculares maiores e seus principais preditores em um registro brasileiro multicêntrico de pacientes de alto risco cardiovascular. Métodos Estudo observacional prospectivo que documentou a prática clínica ambulatorial de indivíduos acima de 45 anos e de alto risco cardiovascular tanto em prevenção primária como secundária. Os pacientes foram seguidos por 1 ano e avaliou-se a prescrição de terapias baseadas em evidência e a ocorrência de eventos cardiovasculares maiores (infarto agudo do miocárdio [IAM], acidente vascular cerebral [AVC], parada cardíaca e mortalidade por causa cardiovascular). Valores de p < 0,05 foram considerados estatisticamente significantes. Resultados De julho de 2010 até agosto de 2014, 5.076 indivíduos foram incluídos em 48 centros, sendo 91% dos 4.975 pacientes elegíveis acompanhados em centros de cardiologia e 68,6% em prevenção secundária. Em 1 ano, o uso concomitante de antiplaquetários, estatinas e inibidores da enzima conversora de angiotensina (IECA) reduziu de 28,3% para 24,2% (valor de p < 0,001). A taxa de eventos cardiovasculares maiores foi de 5,46%, e os preditores identificados foram: idade, pacientes em prevenção secundária e nefropatia diabética. Conclusões Neste grande registro nacional de pacientes de alto risco cardiovascular, foram identificados preditores de risco semelhantes aos registros internacionais, porém a adesão da prescrição médica a terapias baseadas em evidência esteve abaixo dos dados da literatura internacional e apresentou piora significativa em 1 ano. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background In clinical practice, there is evidence of failure to prescribe evidence-based therapies for patients at high cardiovascular risk. However, in Brazil, data on 1-year outcomes of these patients remain insufficient. Objectives To describe the use of evidence-based therapies and the occurrence of major cardiovascular outcomes and their major predictors in a 12-month follow-up of a Brazilian multicenter registry of patients at high cardiovascular risk. Methods This prospective observational study documented the outpatient clinical practice of managing patients over 45 years of age and of high cardiovascular risk in both primary and secondary prevention. Patients were followed-up for 1 year, and the prescription of evidence-based therapies and the occurrence of major cardiovascular events (myocardial infarction, stroke, cardiac arrest, and cardiovascular death) were assessed. P-values < 0.05 were considered statistically significant. Results From July 2010 to August 2014, a total of 5076 individuals were enrolled in 48 centers, 91% of the 4975 eligible patients were followed-up in cardiology centers, and 68.6% were in secondary prevention. At 1 year, the concomitant use of antiplatelet agents, statins, and angiotensin-converting enzyme inhibitors reduced from 28.3% to 24.2% (p < 0.001). Major cardiovascular event rate was 5.46%, and the identified predictors were age, patients in secondary prevention, and diabetic nephropathy. Conclusions In this large national registry of patients at high cardiovascular risk, risk predictors similar to those of international registries were identified, but medical prescription adherence to evidence-based therapies was inferior and significantly worsened at 1 year. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Potentially inappropriate prescribing in older adults in Mexico / Prescripción potencialmente inapropiada en adultos mayores en México

ABSTRACT OBJECTIVE To identify and quantify potentially inappropriate prescribing (prescripción potencialmente inapropiada, PPI) and other drug prescribing problems in public health care services in a population-based study at the three existing levels of complexity in Mexico. METHODS Descriptive analysis of the Study on Satisfaction of Users of the Social Protection System in Health 2014-2016, prescription and drug supply section, to obtain the prevalence of PPI in older adults (≥ 65 years), based on Beers, STOPP, Prescrire and BSP listings using AM (older adults) prescription indicators, one for each listing. RESULTS Most older adults (67%) were prescribed at least one medication, with a mean of 2.7 medications per prescription. The PPI prevalence was 74% according to the BSP criteria, 67% according to the STOPP listing, 59% with the Beer criteria, and 20% with Prescrire. The most frequent PPI prescriptions were NSAIDs, vasodilators and sulfonylureas. CONCLUSIONS The use of PPIs in AM is high in Mexico. The higher prevalence found in this study may reflect the use of a source with population representativeness. The partial use and adaptations of the criteria make difficult comparing the studies; however, the STOPP criteria are the ones with the highest prevalence, as they cover a greater number of drugs and their use is more common in the first level of care.

RESUMEN OBJETIVO Identificar y cuantificar la prescripción potencialmente inapropiada (PPI) y otros problemas en la prescripción de medicamentos en los servicios públicos de atención médica en un estudio poblacional en los tres niveles de complejidad existentes en México. MÉTODOS Análisis descriptivo del Estudio de Satisfacción de Usuarios del Sistema de Protección Social en Salud 2014-2016, sección de prescripción y surtimiento de medicamentos, para obtener la prevalencia de PPI en adultos mayores (≥ 65 años) con base en listados Beers, STOPP, Prescrire y BSP mediante indicadores de prescripción en AM, uno por cada listado. RESULTADOS Al 67% de los AM se les prescribió al menos un medicamento, con una media de 2.7 medicamentos por receta. La prevalencia de PPI fue del 74% según los criterios BSP, del 67% según el listado STOPP, del 59% con los criterios Beer y del 20% con Prescrire. Las prescripciones PPI más frecuentes fueron los AINES, vasodilatadores y las sulfonilureas. CONCLUSIONES El uso de PPI en AM es alto en México. La mayor prevalencia encontrada en este estudio puede ser reflejo de la utilización de una fuente con representatividad poblacional. La utilización parcial y adaptaciones de los criterios dificultan la comparabilidad entre estudios, sin embargo, los criterios STOPP son los que más altas prevalencias han presentado debido a que abarca un mayor número de medicamentos y su uso más habitual en el primer nivel de atención.

Under pressure: non-medical use of prescription drugs among undergraduate students / Sob pressão: uso não médico de medicamento prescrito entre estudantes de graduação

ABSTRACT Objective To measure lifetime, last-year and last-month prevalence of Non-Medical Use of Prescription Drugs (NMUPD) as well as the characteristics associated to last-month NMUPD among undergraduate students of a university in southern Brazil. Methods This was a cross-sectional study, with a sample that was selected through a clustered systematic sampling strategy. Multivariate analysis was conducted with Poisson regression according to a four-level hierarchical model of analysis. Fieldwork was conducted in 2015, and 1,423 students participated. Results Lifetime, last-year and last-month prevalence of NMUPD were 25.2%, 13.1% and 8.5%, respectively. Anxiolytics and barbiturates were the most prevalent. Variables independently associated were being female, having a family income lower than one or higher than six Brazilian minimum wages, being enrolled in a health sciences-related undergraduate course, and having reported lifetime NMUPD by a friend. Conclusions Based on these results, we suggest the development of prevention and promotion activities on this theme for students and professors, especially among those from health sciences-related courses. These interventions should focus on harmful effects of NMUPD, psychosocial coping strategies and socially established gender roles.

RESUMO Objetivo Medir a prevalência do Uso Não Médico de Medicamento Prescrito (UNMMP) na vida, no último ano e no último mês, bem como as características associadas ao UNMMP no último mês entre estudantes de graduação de uma universidade no sul do Brasil. Métodos O estudo teve delineamento transversal com amostragem aleatória sistemática por conglomerados. A análise multivariável foi conduzida por meio de regressão de Poisson com ajuste robusto da variância seguindo um modelo hierárquico de análise de quatro níveis. O estudo foi conduzido em 2015 e 1.423 estudantes participaram. Resultados As prevalências de UNMMP na vida, no último ano e no último mês foram de 25,2%, 13,1% e 8,5%, respectivamente. Ansiolíticos e barbitúricos foram os mais prevalentes. As variáveis associadas foram ser do sexo feminino, ter uma renda família menor que um ou maior que seis salários-mínimos, estar em um curso da área da saúde e ter algum amigo que já fez UNMMP. Conclusões A partir desses resultados, sugere-se o desenvolvimento de atividades de prevenção e promoção sobre este tema, especialmente para os alunos e professores dos cursos da área da saúde. Essas intervenções podem ser sobre efeitos adversos desse tipo de uso, bem como sobre estratégias psicossociais de enfrentamento e papéis de gênero socialmente estabelecidos.

Análise de prescrições de antimicrobianos na Atenção Primária à Saúde / Análisis de prescripciones antimicrobianas en Atención Primaria de Salud / Analysis of antimicrobial prescriptions in Primary Healthcare

RESUMO Objetivo Avaliar receitas com prescrição de antimicrobianos retidas nas unidades de saúde da Atenção Primária de uma capital da região Nordeste do Brasil. Método Estudo avaliativo, analítico. Foram utilizadas as informações da central de distribuição de medicamentos essenciais e as receitas com prescrição de antimicrobianos. Resultados Foram analisadas 2.232 receitas, nas quais o metronidazol (250 mg) foi prescrito em 28% das receitas avaliadas, a forma farmacêutica "comprimido" em 30,7% e a forma de administração "oral" em 78,2%. Nas receitas prescritas por enfermeiros, 80,7% destinavam-se para usuários com infecção sexualmente transmissível. Com exceção da forma farmacêutica, somente 34,7% das receitas estavam em concordância com as recomendações do protocolo de Enfermagem. Há, ainda, inexistência de informações sobre a concentração (43,7%), a posologia (39,9%) e o tempo de tratamento (36,8%). Conclusão As receitas com prescrição de antimicrobianos avaliadas não seguem com precisão as orientações da Resolução nº 20/2011, e nem do protocolo de Enfermagem instituído.

RESUMEN Objetivo Evaluar recetas con prescripción de antimicrobianas retenidas en las unidades de salud de la atención primaria de una capital de la región Nordeste de Brasil. Método Estudio evaluativo, analítico. Fueron utilizadas las informaciones de la central de distribución de los medicamentos esenciales y las recetas con prescripción de los antimicrobianos. Resultados Fueron analizadas 2.232 recetas, en las cuales lo metronidazol (250 mg) fue prescrito en 28% de las recetas evaluadas, la forma farmacéutica "comprimido" en 30,7% y la forma de administración por vía oral en 78,2%. En las recetas prescritas por los enfermeros, 80,7% eran para usuarios con infección sexualmente transmisibles. Con excepción de la forma farmacéutica, solo 34,7% de las recetas estaban en concordancia con las recomendaciones de lo protocolo de Enfermería. Todavía hay inexistencia de informaciones acerca de la concentración (43,7%), la posología (39,9%) y el tiempo del tratamiento (36,8%). Conclusión Las recetas con prescripción de antimicrobianos evaluadas no siguen con precisión ni las orientaciones de la resolución nº 20/2011, ni del protocolo de Enfermería instituido.

ABSTRACT Objective To evaluate prescription receipts for antimicrobial prescriptions prescribed in primary healthcare units in a capital city in the Northeast region of Brazil. Method An evaluative, analytical study. Information from the central distribution of essential medicines and the receipts of antimicrobial prescriptions were used. Results There were 2,232 prescription receipts analyzed, in which metronidazole (250 mg) was prescribed in 28% of the evaluated prescription receipts, the "pill" pharmaceutical form in 30.7%, and the "oral" administration form in 78.2%. In the prescriptions prescribed by nurses, 80.7% were intended for users with sexually transmitted infections. With the exception of the pharmaceutical form, only 34.7% of the prescriptions were in accordance with the Nursing protocol recommendations. There is still no information on the concentration (43.7%), the dosage (39.9%) and the treatment time (36.8%). Conclusion The evaluated receipts of antimicrobial prescriptions do not accurately follow the guidelines of Resolution No. 20/2011, nor of the instituted Nursing protocol.

Use of Medicines by Infants with Microcephaly Caused by Congenital Zika Virus Infection and Implications to Oral Health

Abstract Objective: To analyze the use of continued-use medications by Brazilian children with microcephaly caused by Congenital Zika Virus Infection. Material and Methods: Cross-sectional study with 76 children of both genders. Information on age, use of continued-use medications, number and type of drugs used was collected. Data were analyzed using descriptive statistics. Results: Continued-use medications were used by 89.4% of the children, anticonvulsants / antiepileptics (88.1%), and those indicated for behavioral disorders (27.1%) were the most frequent. Sodium saccharin, sucrose, and sorbitol are the most common sugars in the composition of these drugs. Conclusion: The use of medicines is high, predominantly anticonvulsants and antiepileptics, which contain sugars in their composition. These drugs can lead to irreversible dental problems, such as tooth decay if proper oral hygiene is not present. Therefore, parents/guardians should be advised about adopting healthy oral hygiene habits after the administration of these drugs.

A prescrição de medicação psicotrópica e o conhecimento da portaria regulatória brasileira por cirurgiões-dentistas / The prescription of psychotropic medication and the knowledge of brazilian regulatory legislation by dental surgeons

Resumo Introdução O uso de psicotrópicos por cirurgiões-dentistas é permitido por lei no Brasil para casos clínicos específicos. São poucos os estudos sobre a sua utilização na odontologia. Objetivo Este estudo investigou a prescrição de psicotrópicos por cirurgiões-dentistas inscritos no Conselho Regional de Minas Gerais e seu conhecimento sobre a Portaria 344/1998. Método Foram enviados aos 15.250 cirurgiões-dentistas um questionário eletrônico com 13 questões abordando a prescrição de psicotrópicos, e foram respondidos 969 questionários. Foram estudados: o tempo de formado, tipo de instituição de graduação, tipo de pós-graduação, medicamentos mais prescritos, conhecimento sobre a Portaria 344/1998 e público mais frequente que recebe a prescrição. Resultados 257 profissionais prescrevem psicotrópicos e 223 conhecem a legislação. Um preocupante percentual de profissionais que prescreve esses medicamentos não conhece o teor da Portaria 344/1998. Os analgésicos opioides são os medicamentos mais prescritos. Os especialistas são os que mais prescrevem psicotrópicos (p=0,015), e aqueles que prescrevem ansiolíticos conhecem a legislação com maior frequência (p=0,003). Os cirurgiões bucomaxilofaciais (p=0,02) e os especialistas em distúrbios da articulação temporomandibular (0,03) são os que mais conhecem a legislação e prescrevem medicação psicotrópica. A dor forte e o medo são as duas principais razões para a prescrição. Conclusão Ser especialista e conhecer a Portaria 344/1998 são fatores associados à prescrição de psicotrópicos entre cirurgiões-dentistas.

Abstract Background The use of psychotropics by dental surgeons is permitted by law in Brazil for specific clinical cases. There are few studies on its use in dentistry. Objective This study investigated the prescription of psychotropics drugs by dentists enrolled in the Regional Council of Minas Gerais and their knowledge about regulatory ordinance 344/1998. Method An electronic questionnaire with 13 questions addressing the prescription of psychotropic drugs was sent to 15250 dental surgeons and 969 questionnaires were answered. It was considered the time of graduation, type of undergraduate institution, type of postgraduate course, more frequent prescribed medication, knowledge about ordinance 344/1998 and more frequent public that receives the prescription. Results Two hundred and fifty-seven professionals prescribe psychotropic drugs and 223 know the law, and a worrying percentage of professionals who prescribe these drugs does not know the content of the Ordinance 344/1998. Opioid analgesics are the most prescribed psychotropic medications. Specialists are the ones who prescribe psychotropic drugs (p=0.015) and those professionals who prescribe anxiolytics know the legislation more frequently (p=0.003). The maxillofacial surgeons (p=0.02) and experts in disorders of the temporomandibular jaw joint (0.03) are the ones who know the law and prescribe psychotropic medication. Strong pain and fear are the two main reasons for prescribing psychotropic drugs. Conclusion Being a specialist and knowing the ordinance 344/1998 are factors associated with the prescription of psychotropic medications among dentists.

A self-medicating scale and questionnaire based drug use survey and the effect of educational intervention among healthcare professional students

Background: Due to an array of reasons like easy accessibility and awareness about the available drugs, self-medication has steeply increased the already existent drug misuse. As the health professional students are exposed to all the information of drugs, it would be worthwhile to survey if this knowledge is misused to self-medicate. The present study was aimed at determining the impact of educational intervention on the prevalent attitudes and pattern of self-medication among medical, dental and nursing students as they constitute a vulnerable group for such practices.Methods: A total of 360 health professional students participated in the study. A validated questionnaire and self-medication scale (SMS) were used for the survey, before and after the educational workshop.Results: Of the 360 students 70% were females. 93.89% reported practicing self-medication, which reduced to 78.63% after the educational workshops. Average number of self-medication encounters before the workshop was 4.03±0.30. Analgesics were most commonly used. The modified SMS scores were significantly reduced (p<0.0001) after interventional workshops indicating that the enhanced knowledge, increased the reluctance to self-medicate and make students think twice before self-medicating so as to reduce such harmful, casual drug use habits. Educational workshops statistically (p<0.0001) enhanced the participants knowledge of ADRs, OTC drugs, expiry date, package inserts etc. 77.78% nursing students were habituated to at least one drug which was significantly higher (?2=20.45, p<0.0001) than that of medical and dental students taken together.Conclusions: Educational intervention reduces the evil of self-medication and enhances safe drug use habits among healthcare professional students.

Análise de prescrições irregulares em uma rede de farmácias do Recife / Analysis of irregular prescriptions in a pharmacy of Recife

A prescrição é um "documento" essencial que visa à adesão farmacoterapêutica por meio da tradução completa de informações fundamentais sobre a terapia a ser seguida pelo paciente. Ela deve ser escrita de forma legível, à tinta e ao vernáculo, e conter todas as informações sobre o medicamento. Além disso, características referentes ao prescritor e ao paciente são indispensáveis, pois garantem a confiabilidade e a rastreabilidade da receita perante a Vigilância Sanitária e asseguram o uso racional de medicamentos. Atualmente, o número de prescrições ilegíveis é alto e esse fator contribui para o aparecimento de efeitos adversos, tóxicos e até letais, dependendo do caso. O presente estudo teve como objetivos avaliar as prescrições que apresentaram ilegibilidade, bem como sua origem, sua classificação e os principais erros de preenchimento. O projeto foi submetido e aprovado pelo Comitê de Ética. Realizou-se a pesquisa em um dos estabelecimentos da Rede de Farmácias Pague Menos®, durante o mês de junho de 2015, sendo analisadas 200 receitas consideradas ilegíveis. Das receitas analisadas, 43 (22%) não possibilitaram a dispensação do medicamento. Constatou-se, também, que a maioria das receitas veio de estabelecimentos públicos (60%) e que 74% era de controle especial. Além disso, observou-se a ausência de informações importantes no receituário, como duração do tratamento, posologia e data. Desse modo, essas características comprovam que a ilegibilidade é uma prática recorrente, que impossibilita uma dispensação segura de medicamentos nos estabelecimentos de saúde e, consequentemente, comprova a grande importância da padronização no preenchimento de receitas para que haja uma eficácia no tratamento.

The prescription is an essential "document" that aims to pharmacotherapeutic adherence through the complete translation of key information about the therapy to be followed by the patient. As such, it must be written legibly in ink and vernacular, and contain all the medicine information. In addition, features of the prescriber and the patient are indispensable, as they ensure the reliability and traceability of the recipe before the Health Surveillance, and ensure the rational use of medicines. Currently, the number of illegible prescriptions is high and this factor contributes to the appearance of side effects, toxic and even lethal damage, depending on the case. This study aimed to evaluate the prescriptions that presented illegibility, as well as their origin, their classification and their main filling errors. The project was approved by the Ethics Committee. The survey was conducted in one of the establishments of pharmacies PagueMenos® Network, during the month of June 2015, which analyzed 200 recipes considered unreadable. Of the recipes analyzed, 43 (22%) did not allow the dispensing of the drug. It was also found that most recipes were coming from public institutions (60%) and that 74% were prescriptions of Special Control. Furthermore, there is the absence of significant information on prescriptions, as duration of treatment, dosage, date. Thus, these features prove that illegibility is a recurring practice that prevents a safe drugs dispensing in health facilities and proves the importance of standardization of recipes allowing treatment effectiveness.

Study on Policies of Online Prescri ption Drug Sales Based on SWO T Analysis / 中国药房

OBJECTIVE： To provide reference and basis for our country to formulate policies for online prescription drug sales. METHODS： SWOT analysis was adopted to analyze the Strengths （S）， Weaknesses （W）， opportunities （O）， threats （T） and other factors of prescription drug online sale so as to put forward policy reform suggestions. RESULTS & CONCLUSIONS： The online prescription drug sales had the advantages of better drug availability， improving cost affordability， promote information disclosure and break the monopoly， caught up with the country to vigorously promote the “Internet+” era opportunities. But online prescription drug sales also had disadvantages and threats such as inappropriate management mode， incomplete credit system and inadequate supervision. Conditional release of online prescription drug sales would be favorable to the internal and external environment and the overall development situation. It is suggested that under the condition of improving the ability of intelligent supervision， promote the adjustment of online prescription drug policy， allow Internet e-commerce to carry out prescription drug dispensing by prescription， and orderly release online prescription drug sales.

A national study on the use of opioid analgesics in dentistry

Abstract The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.