Política de medicamentos de alto costo en un hospital público pediátrico: Análisis de utilización y costos / High-cost medication policy at a public pediatric hospital: utilization and cost analysis

Objetivos. Analizar el circuito de utilización de los medicamentos de alto costo (MAC) y los resultados clínicos obtenidos en un hospital de pediatría público de alta complejidad de Argentina y presentar una estrategia de selección replicable para otras instituciones de similares características de la región. Métodos: Estudio prospectivo, descriptivo, aleatorizado, conducido en el Hospital de Pediatría Juan P. Garrahan de la Ciudad Autónoma de Buenos Aires en el período entre el 1 de setiembre de 2018 y el 31 de marzo de 2019. Se evaluaron dos unidades de estudio, la unidad paciente y la unidad MAC. Resultados: Los MAC consumen 7.921.200 dólares estadounidenses (USD) anuales y representan el 41% del costo de los medicamentos del hospital de alta complejidad. El 50% del costo de los MAC estuvo representado por la gammaglobulina (medicamento utilizado en diferentes enfermedades). Los pacientes proceden de toda la Argentina y otros países y un 44% tiene cobertura de salud. Los diagnósticos para los que se prescribieron MAC con mayor frecuencia fueron los relacionados con patología oncológica (leucemia linfoide aguda, leucemia mieloblástica aguda). El 54% de los pacientes presentó mejoría atribuible directamente a la administración de los MAC, 39% no presentó cambios y el 7% empeoró. Conclusiones: La efectividad en los resultados clínicos y el análisis de los circuitos de aprobación indican que, además de la aprobación por las entidades nacional e internacionales, la evaluación responsable por parte de las instituciones efectoras, mediante la discusión interdisciplinaria basada en la mejor evidencia, contribuye a optimizar la utilización de los MAC y la seguridad de los pacientes (AU)

Objectives. To analyze the utilization circuit of high-cost medications (HCM) and the clinical results obtained in a tertiarycare public pediatric hospital in Argentina and to present a selection strategy that may be disseminated to other institutions of similar characteristics in the region. Methods: A prospective, descriptive, randomized study was conducted at Hospital de Pediatría Juan P. Garrahan in Buenos Aires between September 1, 2018 and March 31, 2019. Two study units were evaluated, the patient and the HCM. Results: HCMs account for 7,921,200 US dollars (USD) per year and represent 41% of the cost of drugs in this tertiary-care hospital. Gamma globulin (a drug used for different diseases) accounted for 50% of the cost of HCMs. Patients came from Argentina and other countries and 44% had a health insurance. Cancer (acute lymphoid leukemia, acute myeloblastic leukemia) was the diagnosis for which HCMs were most frequently prescribed. Fifty-four percent of patients showed improvement directly attributable to the administration of HCMs, 39% showed no change, and 7% worsened. Conclusions: The effectiveness in clinical outcomes and the analysis of approval circuits show that, in addition to approval by national and international entities, responsible evaluation by the effector institutions through interdisciplinary discussion based on the best evidence contributes to optimizing the use of HCMs and patient safety (AU)

Análise das solicitações de medicamentos não padronizados de um hospital universitário terciário / Analysis of requests for non-standard medicines from a tertiary university hospital

Introdução: O uso extensivo de medicamentos não padronizados causa aumento de custos em saúde, além de potencial redução de segurança e uso racional de medicamentos. A Comissão de Farmácia e Terapêutica orienta a prescrição de medicamentos, por meio da avaliação e seleção de medicamentos a serem incluídos no formulário de medicamentos padronizados, com base nas melhores evidências científicas disponíveis e no perfil dos pacientes locais, promovendo o uso racional de medicamentos. O objetivo deste trabalho foi analisar as solicitações de fornecimento de medicamentos não padronizados na instituição. Métodos: Trata-se de um estudo observacional e descritivo onde foram analisadas as solicitações de medicamentos não padronizados realizadas entre fevereiro de 2016 e dezembro de 2021, identificando os medicamentos envolvidos e seus respectivos custos. Resultados: Foram realizadas 203 solicitações no período, sendo 174 incluídas no estudo. Os medicamentos que tiveram mais solicitações foram o rituximabe (41), a imunoglobulina humana (31), o sucralfato (23), a nitazoxanida (12) e o eltrombopague (7). As solicitações com maior custo foram as de imunoglobulina humana (US$ 799,702.38), rituximabe (US$ 717,320.26), eltrombopague (US$ 281,062.50), ruxolitinibe (US$ 167,867.46) e bortezomibe (US$ 149,033.52). As principais clínicas que solicitaram medicamentos não padronizado foram a neurologia (47), a hematologia (30), as moléstias infecciosas e parasitárias (17), e a anestesiologia (12). As solicitações de maior custo foram realizadas pela neurologia (US$ 145,519.08), hematologia (US$ 120,980.25), transplante de medula óssea (US$ 51,635.11) e dermatologia (US$ 44,813.40). Conclusão: O estudo demonstrou que há um fluxo estruturado de solicitação de medicamentos não padronizados na instituição, sendo uma importante ferramenta de gerenciamento dessas solicitações, evitando a aquisição desnecessária de itens que não compõem o elenco terapêutico do hospital.

Introduction: Widespread use of non-formulary drugs (NFD) increases cost and may reduce safety and rational use of medicines. The Pharmacy and Therapeutics Committee provides guidance on drug prescription by evaluating and selecting medications to be included in a hospital's formulary based on best scientific evidence available and local patients' profile, promoting rational use of medicines. The objective of this study was to assess non-formulary drugs prescriptions at a tertiary hospital. Methods: This was a retrospective study. NFD prescribed and its associated costs were assessed through NFD request forms received from February 2016 to December 2021. Results: A total of 203 NFD request forms were received, from which 174 were included in this study. The most frequently prescribed NFD included rituximab (n = 41), immunoglobulin (31), sucralfate (23), nitazoxanide (12), and eltrombopag (7), with the highest costs being with immunoglobulin (US$ 799,702.38), rituximab (US$ 717,320.26), eltrombopag (US$ 281,062.50), ruxolitinib (US$ 167,867.46), and bortezomib (US$ 149,033.52). The most frequent requesting specialties were neurology (n = 47), hematology (30), infectious disease (17) and anesthesiology (12), and highest costs requests were from neurology (US$ 145,519.08), hematology (US$ 120,980.25), bone marrow transplant unit (US$ 51,635.11), and dermatology (US$ 44,813.40). Conclusion: This study showed that a structured request flow for NFD prescription is a critical procedure in order to better manage drug prescription within the hospital, promoting rational use of medicines and preventing unnecessary spending with drugs for which the clinical indication may be covered by a drug already in the hospital's formulary.

Long-Term Care medicines formularies: any reasons for pharmacists' concern?

Abstract This study aimed to characterize and compare medicines formularies (MFs) used in Long-Term Care (LTC) facilities in Portugal, and to identify the prevalence of Potentially Inappropriate Medicines (PIMs). A systematic contact with LTC facilities was undertaken in December 2021. MFs were systematized according to the Anatomical Therapeutical Chemical classification system (ATC), followed by descriptive content analysis. A structured comparison between MFs developed by public organizations and private LTC facilities was performed. After duplicate removal and exclusion of medicines not for systemic use, two explicit criteria - the Algorithm of medication review in frail older people and the EU(7)-PIM list - were employed for PIMs identification. Five MFs were obtained and assessed. The three MFs developed by private institutions covered 23% of the national LTC facilities and approximately 34% of the national total of beds. Heterogeneity was particularly high for the Alimentary tract and metabolism, Blood and blood-forming organs, Musculoskeletal system, and Respiratory system ATC groups. A PIM prevalence of 29,4% was identified. Medicines distribution between the MFs suggests the need to develop national guidelines towards harmonizing medicines usage in LTC. The prevalence of PIMs found highlights the importance of a particular optimized use of this health technology in aged sub-populations

Análisis del cumplimiento del plan de consumo de los medicamentos de alto costo. Matanzas. 2012-2017 / Analysis of the fulfillment of the consumption plan of high cost medications. Matanzas. 2012 - 2017

RESUMEN Introducción: los medicamentos de alto costo son medicamentos nuevos, altamente específicos y utilizados en condiciones clínicas complejas, como el tratamiento de algunos tipos de cáncer; enfermedades que comprometen el sistema inmunológico, enfermedades inflamatorias o infecciosas. Objetivo: determinar cumplimiento del plan de consumo de los medicamentos de alto costo en la provincia de Matanzas, en el quinquenio 2012-2017. Materiales y métodos: estudio descriptivo, observacional de seguimiento sobre el cumplimiento del plan de consumo de los medicamentos de alto costo, en la población matancera del año 2012 al 2017. Se analizó el universo de medicamentos incluidos en esta categoría, a partir de la base de datos de suministro de medicamentos que emplea la Empresa Comercializadora de Medicamentos. Se identificaron las variables estudiadas. Resultados: en todo el período de estudio se observó un incremento creciente de los medicamentos de alto costo, en el 88,9 % de ellos el consumo ha estado por encima de la planificación realizada por la provincia. Los costos se incrementaron en un 233 % y además en las prescripciones realizadas de estos productos, se encontraron problemas como escaques vacíos, antibióticos sin impresión diagnóstica y omisión de la forma de presentación del medicamento y/o dosis indicada. Conclusiones: el consumo de muchos medicamentos de alto costo fue mayor que la planificación realizada en la provincia de Matanzas, durante el período analizado. Implicó un incremento significativo del presupuesto destinado a estos fines y se detectaron dificultades en el cumplimiento de lo establecido en las prescripciones de dichos medicamentos (AU).

ABSTRACT Introduction: high cost medications (HCM) are new highly specific medications and used in complex clinical conditions as in treatment of some types of cancer, diseases that compromise the immunological system, inflammatory or infections disorders. Objective: to determine the fulfillment of the consumption plan of high-cost medications in the province of Matanzas in the period 2012-2017. Materials and methods: a descriptive, observational, follow up study on the fulfillment of the consumption plan of high-cost medication by the population of Matanzas2012 year to 2017. The universe of drugs included in this category was analyzed on the bases of the drug-supplying database used by the Drug Commercializing Enterprise (ENCOMED in Spanish). The studied variables were identified. Results: it was observed a growing increase of high-cost drugs use during all the period; in 88.9 % of them the consumption has been above the planning made in the province. The costs increased in 233 %, and besides that in the prescriptions made of these drugs there were found problems like empty boxes, antibiotics without diagnostic impression and omissions of the drug presentation forms and/or the prescribed doses. Conclusions: the consumption of many high-cost drugs was higher than the planning made in the province of Matanzas for the analyzed period. It implied a significant increase of the budget destined for these aims and difficulties were found in the fulfillment of the terms for prescribing these drugs (AU).

Valoración de los comités farmacoterapéuticos en policlínicos / Assessment of Therapeutic Drug Committees at Polyclinics

Introducción: El uso inadecuado de los medicamentos provoca falta de eficacia terapéutica, aparición de reacciones adversas prevenibles y aumento del gasto sanitario. Objetivos: Valorar la composición y el funcionamiento de los comités farmacoterapéuticos de los policlínicos del municipio Boyeros e identificar factores que pueden afectar su funcionamiento. Métodos: Estudio descriptivo, transversal. El universo estuvo constituido por los siete comités farmacoterapéuticos del municipio; se exploraron variables como cargo y profesión de los presidentes y secretarios, miembros permanentes, cantidad de actas de reunión, funciones que realizan, productos de su gestión; esta información se obtuvo por entrevista al presidente del comité y por la revisión de las actas de reuniones efectuadas en el año. Además, se realizó un grupo focal con los presidentes y secretarios de los comités farmacoterapéuticos, entre otros integrantes, cuyos criterios se agruparon según su frecuencia.m Resultados: Predominó la composición inadecuada (71,5 por ciento); todos los presidentes eran médicos, un secretario era enfermera de profesión; existió poca participación de Pediatría (71,4 por ciento), Ginecoobstetricia (42,9 por ciento), Medicina General Integral (28,5 por ciento). El funcionamiento se valoró mal (57,1 por ciento) y regular (42,9 por ciento); sólo 42,9 por ciento tenía entre 9 y 12 actas de reuniones. Se identificó poca percepción de los directores de la importancia del comité, falta de capacitación de sus integrantes y la necesidad de que un profesional asuma esa actividad como única tarea en la institución. Conclusiones: Se identificó que la composición y el funcionamiento de los comités farmacoterapéuticos en el municipio Boyeros no fueron adecuados, lo que también fue reconocido por sus miembros(AU)

Introducción: El uso inadecuado de los medicamentos provoca falta de eficacia terapéutica, aparición de reacciones adversas prevenibles y aumento del gasto sanitario. Objetivos: Valorar la composición y el funcionamiento de los comités farmacoterapéuticos de los policlínicos del municipio Boyeros e identificar factores que pueden afectar su funcionamiento. Métodos: Estudio descriptivo, transversal. El universo estuvo constituido por los siete comités farmacoterapéuticos del municipio; se exploraron variables como cargo y profesión de los presidentes y secretarios, miembros permanentes, cantidad de actas de reunión, funciones que realizan, productos de su gestión; esta información se obtuvo por entrevista al presidente del comité y por la revisión de las actas de reuniones efectuadas en el año. Además, se realizó un grupo focal con los presidentes y secretarios de los comités farmacoterapéuticos, entre otros integrantes, cuyos criterios se agruparon según su frecuencia. Resultados: Predominó la composición inadecuada (71,5 percent); todos los presidentes eran médicos, un secretario era enfermera de profesión; existió poca participación de Pediatría (71,4 percent), Ginecoobstetricia (42,9 percent), Medicina General Integral (28,5 percent). El funcionamiento se valoró mal (57,1 percent) y regular (42,9 percent); sólo 42,9 percent tenía entre 9 y 12 actas de reuniones. Se identificó poca percepción de los directores de la importancia del comité, falta de capacitación de sus integrantes y la necesidad de que un profesional asuma esa actividad como única tarea en la institución. Conclusiones: Se identificó que la composición y el funcionamiento de los comités farmacoterapéuticos en el municipio Boyeros no fueron adecuados, lo que también fue reconocido por sus miembros(AU)

Composición y funcionamiento del comité farmacoterapéutico en policlínicos de La Habana / Composition and functioning of the drug therapy commission in polyclinics located in Havana

Introducción: no se ha evaluado y se sospecha un inadecuado funcionamiento de los comités farmacoterapéuticos en los policlínicos de La Habana. Objetivos: evaluar la composición y el funcionamiento del comité farmacoterapéutico y determinar el nivel de conocimiento de sus presidentes en la metodología de trabajo. Métodos: estudio observacional descriptivo y transversal en 62 policlínicos seleccionados por muestreo simple aleatorio. Se exploraron variables como existencia del comité farmacoterapéutico, cargo y profesión de los presidentes y secretarios, miembros permanentes, cantidad de actas de reunión, funciones que realizan, productos de su gestión, conocimientos. La información se obtuvo mediante un cuestionario aplicado a los presidentes de los comités y de las actas de reuniones realizadas durante el 2009. Resultados: se comprobó la existencia del comité farmacoterapéutico en el 98,4 por ciento de los policlínicos. Predominó una composición inadecuada (43,5 por ciento), solo el 53,2 por ciento estaban presididos por el director, 29 por ciento tenían como secretario al responsable de medicamentos del policlínico y había poca participación de ginecoobstetricia (61,4 por ciento) y pediatría (58,1 por ciento). El funcionamiento fue regular en el 37,7 por ciento; 65,6 por ciento tenían entre 9 y 12 actas de reuniones, no analizaban sistemáticamente la farmacovigilancia (34,4 por ciento) ni la promoción del uso racional de los medicamentos (80,3 por ciento). El 89,4 por ciento de los presidentes carecía de conocimientos suficientes. Conclusiones: la estructura y el funcionamiento deficiente observado en los comités farmacoterapéuticos indican que no se reconoce su importancia por los directivos sanitarios para lograr la calidad de la asistencia médica que se brinda(AU)

Introduction: the evaluation of the drug therapy commissions' work in polyclinics located in Havana has not been made, but it is suspected that their functioning is not adequate. Objetives: to evaluate the composition and functioning of the drug therapy commissions and to determine the level of knowledge of their presidents on work methodology. Methods: observational, descriptive and cross-sectional study of 62 polyclinics which were selected through simple random sampling. The variables were existence of a drug therapy commission, position and profession of the presidents and secretaries, permanent members, number of meeting reports, functions, management results and knowledge. Data was taken from questionnaires to the commission presidents and from the meeting reports during 2009. Results: it was confirmed that 98.4 percent of polyclinics had drug therapy commissions. Their composition was not adequate in 43.5 percent of the sample; just 53.2 percent were led by the director, 29 percent had the position of secretary performed by the person in charge of drug issues in the polyclinics and the participation of gynecobstetricians (61.4 percent) and pediatricians (58.1 percent) was low. The functioning of the commissions was rated as regular in 37.7 percent of the sample; 65.6 percent had kept 9 to 12 reports; they analyzed neither the drug surveillance issues on a systematic basis (34.4 percent) nor the promotion of rational drug use (80.3). It was also observed that 89.4 percent of the commission presidents lacked adequate knowledge. Conclusions: the deficient structure and functioning of the drug therapy commissions show that health managers ignore the importance of this work to attain higher quality in medical assistance(AU)

The medicine selection process in four large university hospitals in Brazil: Does the DTC have a role?

Knowledge about evidence-based medicine selection and the role of the Drug and Therapeutics Committee (DTC) is an important topic in the literature but is scarcely discussed in Brazil. Our objective, using a qualitative design, was to analyze the medicine selection process performed in four large university hospitals in the state of Rio de Janeiro. Information was collected from documents, interviews with key informants and direct observations. Two dimensions were analyzed: the structural and organizational aspects of the selection process and the criteria and methods used in medicine selection. The findings showed that the DTC was active in two hospitals. The structure for decision-making was weak. DTC members had little experience in evidence-based selection, and their everyday functions did not influence their participation in DTC activities. The methods used to evaluate evidence were inadequate. The uncritical adoption of new medicines in these complex hospital facilities may be hampering pharmaceutical services, with consequences for the entire health system. Although the qualitative approach considerably limits the extent to which the results can be extrapolated, we believe that our findings may be relevant to other university hospitals in the country.

A produção de conhecimento sobre a seleção de medicamentos baseada em evidências e executada por Comissões de Farmácia e Terapêutica é ainda escassa no Brasil, apesar da ampla discussão sobre o tema em países desenvolvidos. Este estudo buscou conhecer e analisar os aspectos relacionados à seleção de medicamentos em quatro hospitais universitários de grande porte no Rio de Janeiro, por meio de abordagem qualitativa. Entrevistas, observação direta e análise documental instrumentaram a coleta de dados qualitativos e quantitativos. A análise considerou duas dimensões: (i) estrutura e organização para o processo de seleção e (ii) critérios e métodos utilizados para avaliação. Apenas dois hospitais possuíam Comissão de Farmácia e Terapêutica (CFT) ativa. A estrutura para a tomada de decisão era deficiente e os membros das Comissões apontaram pouca experiência e disponibilidade para a atividade. Os métodos de avaliação e critérios observados indicaram um processo de seleção acrítico nestes hospitais, comprometendo a assistência farmacêutica e potencialmente prejudicando o sistema de saúde. Apesar da metodologia qualitativa não permitir a extrapolação de resultados, é possível que este cenário seja parecido com o de outros hospitais universitários brasileiros.

Indicadores da seleção de medicamentos em sistemas de saúde: uma revisão integrativa / Indicators for drug selection in health systems: an integrative review

OBJETIVO: Obter um painel dos principais indicadores utilizados para a seleção de medicamentos por meio da realização de uma revisão integrativa da literatura. MÉTODOS: Após elaborar um protocolo de revisão, foram realizadas buscas nas bases LILACS, MEDLINE, Embase e SciELO. Foram utilizados os descritores "indicadores", "critérios", "seleção de medicamentos", "comitê de farmácia e terapêutica" e "formulário de medicamentos", com suas variações em inglês e espanhol. Foram selecionados e revisados 16 artigos originais publicados entre janeiro de 1996 e março de 2012 para compor um painel de indicadores. RESULTADOS: Foram identificados 45 indicadores quantitativos e qualitativos. Esses indicadores foram agrupados de acordo com semelhanças conceituais em três categorias: 1) avaliação da estrutura da comissão de farmácia e terapêutica; 2) avaliação dos processos gerais de seleção de medicamentos; e 3) avaliação dos resultados da seleção de medicamentos. CONCLUSÕES: Os indicadores avaliados demonstram relativa uniformidade nos padrões estabelecidos para a seleção de medicamentos. O grupo de indicadores estabelecidos neste estudo deve servir como referência para fomento e consolidação dessa atividade nos serviços de saúde pública.

OBJECTIVE: To produce a panel of the main drug selection indicators by performing an integrative literature review. METHODS: After the elaboration of a review protocol, searches were conducted in LILACS, MEDLINE, Embase, and SciELO databases. The following search terms were used: "indicators"; "criteria"; "drug selection"; "pharmacy and therapeutics committee"; and "medication form"; with the applicable variations in English and Spanish. Sixteen original articles published between January 1996 and March 2012 were retrieved and reviewed to compose a panel of indicators. RESULTS: Forty-five quantitative and qualitative indicators were identified. These indicators were grouped according to conceptual similarities in three categories: 1) assessment of pharmacy and therapeutics committee structure; 2) evaluation of the general processes of drug selection; and 3) evaluation of the results of drug selection. CONCLUSIONS: The indicators identified reveal relative uniformity in the established patterns for drug selection. The group of indicators established in this study should serve as reference for the development and consolidation of drug selection in public health services.

Propuesta metodológica para el funcionamiento de los Comités Farmacoterapéuticos en la Atención Primaria de Salud / Methodological proposal for the operation of Pharmacotherapy Committees in Primary Health Care

La OMS ha intensificado sus esfuerzos por promover y alcanzar un uso racional del medicamento para contribuir al bienestar del individuo y de la sociedad. El comité farmacoterapéutico es un foro para la mejora de la prestación de servicios de salud, es también un instrumento para fomentar un uso más eficaz y racional de los medicamentos. En Cuba se ha comprobado que existen problemas de uso irracional, lo que hace pensar que los comités farmacoterapéuticos no están funcionando según lo establecido. Objetivo: brindar una metodología a las instituciones de la Atención Primaria de Salud para el correcto funcionamiento del comité farmacoterapéutico. Método: se realizó una revisión exhaustiva de la literatura científica sobre los aspectos relacionados con cada apartado, se designó a un grupo multidisciplinario de profesionales expertos, procedentes de las áreas de Atención Primaria de Salud y Farmacoepidemiología con experiencia en el tema. El texto final estuvo sometido a comentarios y sugerencias, las recomendaciones fueron consensuadas por todo el grupo redactor. Resultados: se obtuvo un documento dirigido a los profesionales prescriptores y todos aquellos que realizan las tareas específicas de mejora de uso de medicamentos en las instituciones correspondientes a la Atención Primaria de Salud y a los gestores sanitarios que deben fomentarlas. La aplicación del mismo traerá como consecuencia beneficios médicos, económicos y sociales, una vez implantada la estrategia que estimulen e impulsen la actividad de dichos comité y así lograr un uso eficiente y racional de los medicamentos. Conclusiones: la metodología aportada por este documento hará que los CFT funcionen como foros de discusión para un uso adecuado, racional y seguro de los medicamentos...

The World Health Organization (WHO) has intensified its efforts to promote and achieve a rational use of medications to contribute to the individual and social welfare. The Pharmacotherapy Committee is a forum for improving health care services and is also considered an instrument to foster a more efficient and rational use of medication. In Cuba, it has been proven that there is an irrational use of medications, what makes us think that the Pharmacotherapy Committees are not functioning in accordance with the established. Objective: to provide a methodology to Primary Health Care institutions for the correct operation of the Pharmacotherapy Committee. Method: we conducted a detailed review of the scientific literature about the aspects related to each section and designed a multidisciplinary group of professional experts from Primary Health Care areas and Pharmacoepidemiology with experience on the topic. The final text was submitted to comments and suggestions and the recommendations were agreed by the consensus among the whole editor group. Results: we obtained a document which was directed to all professional prescribers and those that perform specific tasks for the improvement of the use of medications in Primary Health Care institutions as well as the sanitary managers that should encourage them. The application of this document will result in medical, economic and social benefits once the strategy has been implemented. These benefits should stimulate and promote the activities of such committees to achieve an efficient and rational use of medications. Conclusions: the methodology provided by this document will make the Pharmacotherapy Committees function as discussion forums for a safe, rational and adequate use of medications...

Impacto de un programa de control de la calidad de la prescripción de antibióticos en un hospital de La Habana, Cuba / Impact of a quality control program on antibiotic prescription in a hospital in Havana, Cuba

Objetivo. Demostrar la eficacia de un programa de control de la calidad de la prescripción de antibióticos en el Hospital Docente Clínico Quirúrgico Joaquín Albarrán de La Habana, Cuba.Métodos. Estudio de intervención realizado en el período del 1 de mayo de 2008 a 31 de marzo de 2011, que incluyó la evaluación de la calidad de la prescripción y la retroalimentaciónde la información, actividades educativas, funcionamiento de un comité de antibióticos y la elaboración de protocolos de uso de antimicrobianos. Se construyó un gráfico aritméticosimple de la serie temporal y se compararon los valores absolutos de las proporciones de la serie entre sí. Para comprobar la existencia de tendencia en la serie se ajustó a un modelo deregresión lineal simple. Resultados. Se evaluaron las prescripciones de antibióticos de 2 941 pacientes, en las que se observó una serie irregular, con proporción de uso inadecuado entre 48,4% y 30,7% en los primeros tres meses analizados. Se encontró que el valor tomado por la pendiente de regresión, aunque se encontraba cercano a cero, era negativo y significativamente diferente de cero (b =–0,29; P = 0,02). Conclusiones. El programa de control de antibióticos mejoró la calidad de la prescripcióna los pacientes hospitalizados.

Objective. Demonstrate the efficacy of a quality control program on antibioticprescription in Joaquín Albarrán Hospital in Havana, Cuba. Methods. An interventional study was conducted from 1 May 2008 to 31 March 2011. The study included evaluation of prescription quality, information feedback, educational activities, the operations of an antibiotic committee, and the preparation of protocols on antimicrobial drug use. A simple arithmetic graph of the time series was constructed, and the absolute values of the series percentages were compared. Inorder to verify the existence of a series trend, a simple linear regression model was applied. Results. Antibiotic prescription was evaluated in 2 941 patients. An irregular series was observed, with inappropriate use in 30.7%–48.4% of these patients in the first three months analyzed. The value of the regression slope was close to zero, although it was negative and significantly different from zero (b = –0.29; P = 0.02). Conclusions. The antibiotic control program improved the quality of prescribing for hospital patients.

Vivenciando a seleção de medicamentos em hospital de ensino / Experiencing drug selection in a teaching hospital

A seleção de medicamentos essenciais orienta a utilização eficaz, segura e racional de medicamentos. O texto descreve e discute o processo e os resultados alcançados pelo trabalho da Comissão de Farmácia e Terapêutica do Instituto Fernandes Figueira no momento de revisão de sua lista de medicamentos, ressaltando as implicações para a gestão, para a clínica e para a formação médica e da equipe multidisciplinar. Os dados trabalhados foram resgatados de documentos produzidos pelo grupo entre abril de 2005 e março de 2008. Foram trabalhados três grupos de medicamentos. Os achados apontam diminuição mínima de 44 por cento no quantitativo de itens. O processo envolveu grande número de profissionais de diferentes categorias e setores do hospital. Embora demorada e complexa, estima-se que a revisão da lista de medicamentos tenha despertado todos para a necessidade de repensar a utilização do arsenal terapêutico, contribuindo para uma formação mais centrada no paradigma da evidência científica e favorecendo a adesão aos produtos finais.

Essential drug selection guides the efficacious, safe, and rational use of medicines. This article describes and discusses the process and results achieved in the work of the Pharmacy and Therapeutics Committee of the Fernandes Figueira Institute in Rio de Janeiro, Brazil, in the revision of its drug list, highlighting the implications for management, clinical practice, and medical and multidisciplinary team training. The data were retrieved from documents produced by the group from April 2005 to March 2008. Three drug groups were analyzed. The findings point to a decrease of at least 44 percent in the amount of items. The process involved a large number of staff members from different professions and departments in the hospital. Although long and complex, it is estimated that the revision of the drug list awakened the entire staff to the need for rethinking the use of the therapeutic armamentarium, contributing to training based on the scientific evidence paradigm and favoring adherence to the drugs on the final list.

role of pharmacoeconomics in formulary decision making in different hospitals in Riyadh, Saudi Arabia

To assess the trend of using pharmacoeconomic information by Pharmacy and Therapeutics [P and T] committees when making formulary decisions. A cross-sectional study conducted in 2007, using structured survey questionnaires which were distributed to members of the P and T committees in 11 different hospitals in Riyadh, Saudi Arabia. A total of 100 survey questionnaires were sent to head of pharmacy departments of 11 different hospitals in Riyadh, Saudi Arabia. Out of these, 48 questionnaires were completed and returned. Of the total respondents participated in the study, 64.58% were medical doctors and 16.66% were pharmacists and 75% of the respondents said they have applied pharmacoeconomic evaluations in their decision making process. More than 80% of the respondents perceived that they had a fair knowledge of pharmacoeconomics. Approximately 80% of respondents expressed some degree of agreement that pharmacoeconomics should be applied as a decision making tool. The majority of decision-makers [95%] expressed the interest in attending workshops on pharmacoeconomics. The study showed that pharmacoeconomics can play an important role in the P and T committee formulary decisions. However, more education to health care professionals and to hospital administrators should be conducted to facilitate the use of such a tool. Also, hospitals should recruit health care professionals with pharmacoeconomic expertise to manage limited health resources in the best way available

Describen la experiencia cubana en el uso racional de medicamentos en pediatría / Improving children´s medicines: cuban experience of rational drug therapy

La legislación europea y norteamericana debería mejorar la información sobre la que se basa la medicina para realizar prescripciones a los niños. La utilización de fármacos en relación con esos datos se denomina uso racional de medicamentos. En muchos hospitales se establecieron Comités Fármaco-Terapéuticos para intentar mejorar la utilización de medicamentos. Se ilustra la tarea de un Comité Fármaco-Terapéutico en un hospital pediátrico de Camagüey, Cuba, para destacar lo que es posible lograr. El uso inapropiado de antibióticos es uno de los mayores problemas, tanto en el hospital como en la poblacion. El control de la utilización de antibióticos junto con la creación de protocolos y la educación puede resultar en una terapia con antibióticos más racional. Los antibióticos son sólo un ejemplo de un grupo de medicamentos cuya prescripción puede mejorarse. Los Comités Fármaco-Terapéuticos pueden desempeñar un papel fundamental para asegurar que los niños reciban medicamentos de forma segura en las condiciones apropiadas.

Preparación de mezclas intravenosas citostáticas: experiencia de un año de trabajo del Servicio Farmacéutico del Instituto Nacional de Oncología y Radiobiología / Preparation of intravenous cytostatic mixtures: one-year work experience at the Pharmaceutical Service of the Nacional Institute of Oncology and Radiobiology

Desde octubre de 2006 a septiembre de 2007, fecha en que el Servicio Farmacéutico del Instituto Nacional de Oncología y Radiobiología comenzó a elaborar las mezclas intravenosas citostáticas, se obtuvieron resultados que se decidieron analizar. Se seleccionaron indicadores como: número de errores de medicación detectados y/o evitados, consumo de citostáticos, tratamientos recuperados por la elaboración centralizada y la aplicación de las Buenas Prácticas de Elaboración y Farmacia, y los resultados se compararon con igual etapa de años anteriores. Se apreció que con la presencia del farmacéutico en el equipo de quimioterapia oncológica se recuperaron tratamientos tan costosos como el docetaxel 80 mg, paclitaxel 300 mg y trastuzomab 150 mg bulbos. En ese orden y potencialmente se pudieron beneficiar 121 pacientes, fundamentalmente de cáncer de mama; se minimizó el consumo de citostáticos como la vincristina 1 mg y la bleomicina 15 mg bulbos; con la aplicación del control técnico y económico, se evidenció un incremento en el uso de presentaciones de la ciclofosfamida de 200 mg y el cisplatino de 10 mg bulbos Además, se detectaron y evitaron el 1,3 por ciento de errores de medicación en la prescripción, valor aún elevado. Se concluye que la presencia del farmacéutico mejora la calidad del servicio hospitalario que atiende a pacientes oncológicos y se propone la incorporación de este personal en otros centros hospitalarios del país, ya que favorece el incremento en la aplicación de las Buenas Prácticas de Elaboración y se contribuye a minimizar la ocurrencia de errores de medicación.

From October 2006 to September 2007, which marked the beginning of the preparation of intravenous cytostatic mixtures by the Pharmaceutical Service of the National Institute of Oncology and Radiobiology, a number of results were achieved and then considered for analysis in this paper. The selected indicators included the number of detected and/or avoided medication errors, cytostatics consumption, therapies recovered through centralized preparation and the implementation of Good Practices of Preparation and Pharmacy. The results were compared with those of similar periods of time in previous years. It was observed that the involvement of the pharmacist in the oncological chemotherapy team contributed to recovering costly therapies such as 80mg Docetaxel, 300mg Paclitaxel and 150mg Transtuzomab ampules. One hundred and twenty one patients could potentially benefit from these therapies, mainly those suffering breast cancer. The consumption of cytostatic drugs such as 1 mg Vincristine and 15mg Bleomycin ampules decreased; the application of technical and economic control evidenced an increased use of 200 mg Cyclophosphamide and 10mg Cisplatine ampules. Besides, 1,3 percent medication errors in prescription was detected and avoided, although this is still a high figure. It was concluded that the involvement of a pharmacist in the medical team improves the quality of service in those hospitals that care for oncological patients. It was suggested that a pharmacist should be incorporated into the medical teams of other hospital centers throughout the country since this encourages the implementation of Good Practices of Preparation and contributes to minimizing medication errors.