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Multiple medications can increase the risk of adverse drug reactions and adverse events in the elderly.Simplification of multiple medications is a systematic process of weighing the benefits and harms of drug use under the supervision of medical personnel, combining the patient's medical condition, current clinical status and personal preferences and tapering or stopping certain drugs while ensuring efficacy.Simplification of multiple prescription drugs can reduce falls, shorten the lengths of hospitalization, and reduce emergency visits for patients.This article gives a brief overview of simplification of multiple prescription drugs for the elderly and introduces the current available tools to do so.
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INTRODUCTION: The importance of breastfeeding is undisputed. It provides benefits to infants, nursing mothers, families, and society as a whole. The World Health Organization encourages a diet of exclusive breastfeeding until six months of age; however, this routine may be unfeasible for many reasons, one of which is the mother's use of medication. OBJECTIVE: To characterize medications used by nursing mothers in terms of risk categories, place of care and medical professionals responsible for the prescription, and the extent of medical advice received by the mothers. METHODS: This is a retrospective, quantitative, and cross-sectional study. The data were collected from Brazil's Family Health Strategies (ESF) program and included information on 161 nursing mothers from 2012 and 2013 and their use of medications while breastfeeding. The data were considered in absolute and relative frequencies and compared to the secondary variables in the study in order to determine whether any associations existed. The chi-square test was applied as part of the analysis. RESULTS: Of the nursing mothers interviewed, 55.9% reported taking medication. The most frequent groups of medications were those affecting the genito-urinary system and sex hormones, endocrine system, followed by systemic and cardiovascular medications. In the ESF program, general practitioners were the medical professionals who most frequently prescribed medication to these women, followed by gynecologists. Of the women who received prescriptions, 64.4% received some type of medical advice. The statistical analysis revealed a positive correlation between risk category and medical specialty (p=0.03), as well as between risk category and place of care (p=0.001). CONCLUSION: The most frequently used drug class was that of contraceptives. All medication classified as contraindicated was found to have been prescribed as part of primary care by general practitioners. Thus, these results reflect the need for more qualified professionals throughout Brazil's public health care network.
INTRODUÇÃO: É inquestionável a importância do aleitamento materno. Seus benefícios abrangem o lactente, a nutriz, a família e a sociedade. A Organização Mundial de Saúde preconiza o aleitamento exclusivo até os seis meses de idade, o qual pode ser comprometido por alguns motivos, dentre eles o uso de medicamentos. OBJETIVO: Caracterizar os medicamentos utilizados por nutrizes, no que se refere a: categorias de risco; locais e responsáveis pela prescrição médica e orientações recebidas. MÉTODO: estudo transversal, retrospectivo, quantitativo. Os dados foram coletados na Estratégia de Saúde da Família (ESF) com 161 nutrizes nos anos de 2012 e 2013, por meio de questionário estruturado, contendo informações sobre o uso de medicamentos durante a lactação. Os dados foram apresentados em frequências absolutas e relativas, e comparados às variáveis selecionadas no estudo para verificação da existência de associação, utilizando-se o Teste do Qui-quadrado. RESULTADOS: 55,9% das entrevistadas referiram uso de medicamentos, predominando os que atuam no Sistema hormonal, seguidos dos de uso sistêmico e cardivascular. O clínico geral foi o que mais prescreveu, seguido do ginecologista, na ESF. 64,4% das entrevistadas receberam algum tipo de orientação. A análise estatística demonstrou associação positiva entre categoria de risco e as variáveis especialidade médica (p=0,03) e local de atendimento (p=0,001). CONCLUSÃO: A classe de medicamento mais utilizada foi a dos anticoncepcionais. Todo medicamento classificado como contra indicado foi prescrito, na Atenção Primária, pelo clínico geral. Sendo assim, destaca-se a necessidade de profissionais qualificados em toda rede de atenção à saúde.
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ABSTRACT This study aimed to identify the legal and normative contours of nurse prescribing of medications in Brazil, showing its history, trends and challenges. It is an exploratory study conducted through desk research of nursing law, the Health Ministry and the health sector norms to address this issue. The steps of a documentary study and the analysis of data contents were followed. The nursing discipline contributed to the legalization of prescription, but not to its legitimacy; this assignment in primary care is consolidated through protocols and legislation, although there is no clear strategy for monitoring by the Health Ministry; there is resistance in some norms within the health sector. We conclude that there is a trend of nurse prescribing of medication, which currently remains only as a legality, and the main challenge is to achieve legitimacy.
RESUMEN Se objetivó identificar contornos legales y normativos de la prescripción de medicinas por enfermeros en Brasil apuntando su historia, tendencias y desafíos. Es un estudio exploratorio, realizado por medio de investigación documental de la legislación de la enfermería, las normas del Ministerio de la Salud y del sector salud que abordan esta cuestión. Se siguieron etapas del estudio documental y el análisis de contenido de los datos. La categoría de enfermería contribuyó para legalización de la prescripción, pero no para su legitimación; en Atención Básica, esa atribución está consolidada por medio de protocolos y legislación, mismo sin estrategia clara de acompañamiento por el Ministerio de Salud; se observa resistencia en algunas normas dentro del sector salud. Se concluye que hay tendencia de la prescripción de medicinas, por enfermeros, permanecer solo en la legalidad y el principal desafío es alcanzar la legitimidad.
RESUMO Objetivou-se identificar os contornos legais e normativos da prescrição de medicamentos por enfermeiros no Brasil apontando sua história, tendências e desafios. Estudo exploratório, realizado por meio de pesquisa documental da legislação da enfermagem, normatizações do Ministério da Saúde e do setor saúde que abordam a questão. Seguiram-se as etapas do estudo documental e a análise de conteúdo dos dados. A categoria da enfermagem contribuiu para a legalização da prescrição, porém não para a sua legitimação; na Atenção Básica, essa atribuição está consolidada por meio de protocolos e legislação, embora sem estratégia clara de acompanhamento pelo Ministério da Saúde; observa-se resistência em algumas normatizações dentro do setor saúde. Conclui-se que há tendência da prescrição de medicamento, por enfermeiros, permanecer apenas na legalidade e o principal desafio é alcançar a legitimidade.
Assuntos
Humanos , Prescrições de Medicamentos , Enfermagem , Legislação de EnfermagemRESUMO
Despite lack of scientific evidence about the safety of some medications, the reported use of medications during pregnancies has increased. This may lead to adverse reproductive outcomes, due to potential risk to the mother and the fetus. In contexts of most developing countries including Ethiopia, it is difficult to elucidate medications use prevalence during pregnancy and their relative contributions to birth defects for several reasons. Institutionbased cross sectional study was conducted in Tertiary care hospital Ethiopia. Current medication use data were collected by reviewing patients' charts in the antenatal care follow up clinic, chronic care (internal medicine) as well as psychiatry clinic and by interviewing pregnant women using semi-structured questionnaire. Medications were classified using the United States Food and Drug Administration pregnancy risk classification system. A total of 339 women were included in the study; of which 187 (55.2%) had used at least one prescription and 162(52.2%) had used over the counter medications during pregnancy. The majority of the medications were antibiotics (42.5%) and analgesics (40.1%). 57(16.8%) and 24(7.1%) of medications were prescribed from category D and X respectively. Out of 187 (55.2%) prescription medications used, 51 (15.0%) were obtained without prescribers order. Majority (70.8%) of the women did not have awareness regarding risks associated with self medication. Prescription medications use was 0.08 times less among women with a co-morbidities (AOR 0.08(.05, 0.13), p=0.001) and 2.5 times higher among women from rural areas (AOR 2.53 (1.15, 5.56); P=0.02). Compared to employed women, over the counter medications use were 1.9 times more among house wife women (AOR1.87 (1.12, 3.09), p= 0.02) and about thrice higher among merchant women (AOR 2.88(1.10, 7.55), p= 0.03). Likewise, presence of medical problems was found to have 60% protective against OTC medications use (AOR 0.40 (.26, 0.64), p=0.01). The overall medications use during pregnancy was found to be high. Medications use without prescribers order was common and potentially harmful medications (category-D and X) use appeared to be higher in all trimesters. The findings of this study argue in favor of prescribing some potentially harmful medications which could have been avoided during pregnancy. Majority of the women lacked awareness about the potential risks associated with medications use in pregnancy without prescribers order.