Red blood cell prescription and recognition of transfusion reactions by pediatricians / Prescrição de hemácias e reconhecimento de reações transfusionais por pediatras

ABSTRACT Objective To assess the level of knowledge of emergency pediatricians on red blood cell transfusions and their reactions. Methods Written survey with emergency pediatricians from a pediatric hospital. Results Less than 20% of pediatricians showed appropriate knowledge on prescribing red blood cells and recognition of transfusion reactions. There was no significant statistical regarding time since graduation and blood transfusion classes in undergraduate studies or during medical residency. Conclusion Pediatricians have insufficient knowledge about red blood cell transfusions and recognition of transfusion reactions.

RESUMO Objetivo Avaliar o conhecimento de pediatras emergencistas sobre transfusão de concentrados de hemácias e reações transfusionais. Métodos Aplicação de formulário para pediatras emergencistas de um hospital pediátrico. Resultados Menos de 20% dos participantes demonstraram conhecimento adequado sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais. Não houve diferença estatística significativa quando avaliados o tempo de formação profissional e o fato de ter recebido aula de hemoterapia na graduação ou na residência médica. Conclusão Os pediatras têm conhecimento insuficiente sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais.

Prescription of red cell concentrates by emergency physicians

SUMMARY OBJECTIVE To evaluate the adequacy of the prescription of red cell concentrates by emergency physicians. METHODS A cross-sectional study based on the survey of transfusion requests records completed by emergency physicians, from May/2018 to April/2019, in an emergency hospital. Adequacy in the indication, volume, and subtype (filtered, irradiated, and washed) of prescribed erythrocytes were evaluated. To compare the qualitative data, we used the χ2 test. The significance level adopted was 5%. RESULTS One thousand and twenty-two transfusions were evaluated. The indication, volume, and subtypes were correct in 72.7%, 45.9%, and 81.6% respectively. Transfusion in symptomatic patients presented superior adequacy when compared to asymptomatic individuals with significant statistical difference (indication: 79,6% vs 67.2%, p <0.001; Volume: 63.5% vs 31.7%, p <0.001; subtype: 85.3% vs 78.7%, p 0.006). Among clinical situations, there were more errors in sepsis (39.7%) and pneumonia (36.3%). More than half of the prescriptions presented excessive volume, raising the risk of circulatory overload, observing that the mean age was 60.6 years. The specific analysis of the prescribed subtypes showed adequacy of 17.9% in the filtered, 1.7% in the irradiated, and none in the washed. Thirty transfusions should have been filtered, but the prescriber did not request the subtype. CONCLUSION One hypothesis for the observed inaccuracies is inadequate medical training on the subject, both in undergraduate and medical residency, associated with a lack of continuing education on transfusion protocols. The transfusion Committee received the results of this study with a proposal for continuing education measures on transfusion hemotherapy.

RESUMO OBJETIVO Avaliar a adequação da prescrição de concentrados de hemácias por médicos emergencistas. MÉTODOS Estudo transversal por levantamento de fichas de requisição de transfusões preenchidas por médicos emergencistas, no período de maio de 2018 a abril de 2019, em um hospital de emergências. Foram avaliadas as adequações na indicação, volume e subtipo (filtradas, irradiadas e lavadas) de hemácias prescritas. Para comparação dos dados qualitativos, utilizamos o teste de χ2. O nível de significância adotado foi de 5%. RESULTADOS Foram avaliadas 1.022 transfusões. A indicação, o volume e os subtipos estavam corretos em 72,7%, 45,9% e 81,6%, respectivamente. A transfusão prescrita em pacientes sintomáticos apresentou adequação superior quando comparada aos assintomáticos, com diferença estatística significativa (indicação: 79,6% vs 67,2% - p<0,001; volume: 63,5% vs 31,7% - p<0,001; subtipo: 85,3% vs 78,7% - p 0,006). Entre as situações clínicas, ocorreram mais erros na sepse (39,7%) e pneumonia (36,3%). Mais da metade das prescrições apresentavam volume excessivo, elevando o risco de sobrecarga circulatória, observando-se que a média da idade foi 60,6 anos. A análise específica dos subtipos prescritos apresentou adequação de 17,9% nas filtradas, 1,7% nas irradiadas e nenhuma das lavadas. Trinta transfusões deveriam ter sido filtradas, porém o prescritor não solicitou o subtipo. CONCLUSÃO Uma hipótese para as incorreções observadas é a formação médica inadequada sobre o assunto, tanto na graduação como na residência médica, associada à falta de atualização nos protocolos transfusionais. O comitê transfusional recebeu os resultados deste estudo com proposta de medidas de educação permanente sobre hemoterapia transfusional.

Erros de prescrição em uma farmácia básica do distrito federal / Errores de prescripción en una farmacia básica del distrito federal / Prescription errors in a basic pharmacy of the federal district

RESUMO Objetivo: Analisar prescrições eletrônicas e manuais quanto à ocorrência de polifarmácia e tipos potenciais de erros de medicação no contexto da atenção primária. Material e método: Estudo de caráter descritivo, transversal e retrospectivo, baseado na avaliação de prescrições manuais e eletrônicas arquivadas na farmácia da Unidade Básica de Saúde do Distrito Federal de Brasília (DF). Foram incluídas as segundas vias das prescrições para as doenças crônicas não transmissíveis. Resultados: 1500 prescrições foram analisadas. Apontaram a não totalidade dos critérios de avaliação proposto neste estudo, dentre eles: ilegibilidade (35,5%), abreviaturas (97,7%), forma farmacêutica (57,6%), concentração (32,4%). A polifarmácia foi identificada em 46% dos usuários e estava diretamente relacionada à idade do usuário. Conclusão: As prescrições apresentaram incompletude de informações em relação ao que estabelece a legislação, são necessárias estratégias que busquem melhorar a promoção de saúde na atenção básica, como trabalhos de educação permanente e que visem sensibilizar os prescritores e demais atores envolvidos neste processo sobre o ato de prescrever medicamentos.

ABSTRACT Objective: To analyze electronic and manual prescriptions regarding the occurrence of polypharmacy and potential types of medication errors in the context of primary care. Material and method: A descriptive, cross-sectional and retrospective study based on the evaluation of prescriptions filed at the pharmacy of a Basic Health Unit of the Federal District of Brazil. Copies of prescriptions for chronic non-communicable diseases were included. Results: 1500 prescriptions were analyzed according to evaluation criteria, such as illegibility (35.5 %), abbreviations (97.7%), dosage form (57.6%), and concentration (32.4%). Polypharmacy was identified in 46% of users and it was directly related to the age of the user. Conclusion: Prescriptions presented incomplete information regarding current legislation. Strategies that seek to improve health promotion in primary care, such as permanent education and more awareness from prescribers and other actors involved in the process of prescribing medications, are required.

RESUMEN Objetivo: Analizar prescripciones electrónicas y manuales en cuanto a la ocurrencia de polifarmacia y tipos potenciales de errores de medicación en el contexto de la atención primaria. Material y método: Estudio de carácter descriptivo, transversal y retrospectivo, basado en la evaluación de prescripciones manuales y electrónicas archivadas en la farmacia de la Unidad Básica de Salud (UBS) del Distrito Federal (Brasil). Se incluyeron los duplicados de las prescripciones para las enfermedades crónicas no transmisibles. Resultados: Se analizaron 1.500 prescripciones considerando la no totalidad de los criterios de evaluación propuestos en este estudio, entre ellos: ilegibilidad (35,5%), abreviaturas (97,7%), forma farmacéutica (57,6%), concentración (32,4%). Se identificó polifarmacia en el 46% de los usuarios y que estaba directamente relacionada a la edad del usuario. Conclusión: Las prescripciones presentaron información incompleta en relación a lo establecido por la legislación. Se requieren estrategias que busquen mejorar la promoción de salud en la atención básica, como educación permanente y sensibilización de los prescriptores y demás actores involucrados en el acto de prescribir medicamentos.

Interações entre nutrientes e fármacos prescritos para idosos com síndrome coronariana aguda / Food-drug interactions in prescriptions for elderly with acute coronary syndrome

Introdução: As interações entre fármacos e nutrientes acarretam reações adversas e/ou ineficácia da farmacoterapia, além de provocar prejuízos no estado nutricional, sobretudo em idosos. Objetivo: Descrever a taxa de interações potenciais teóricas entre nutrientes da dieta e fármacos prescritos para idosos hospitalizados por Síndrome Coronariana Aguda em um hospital de ensino. Material e Métodos: Trata-se de um estudo transversal com delineamento descritivo e abordagem qualitativa que analisou 607 prescrições no período entre abril e julho de 2016, utilizando-se as bases de dados informatizadas Micromedex e Drugs.com. Resultados: Foram identificadas 4.313 interações distribuídas em 61 tipos entre os fármacos prescritos e nutrientes. Conclusão: Verifica-se alta taxa de interações entre fármacos e nutrientes nas prescrições para idosos com Síndrome Coronariana Aguda. Apesar do fato de que alguns nutrientes não são rotineiramente consumidos, é fundamental a revisão da prescrição e dos componentes da dieta pelo farmacêutico para evitar problemas relacionados às interações.

Introduction: Food-drug interactions result in adverse reactions and/or ineffectiveness of pharmacotherapy. Furthermore, these interactions cause nutritional losses, especially in elderly people. Objective: Describe the rate of potential theoretical interactions between nutrients of dietary and drugs prescribed for elderly people hospitalized with Acute Coronary Syndrome in a teaching hospital. Material and Methods: This isa transversal, descriptive study using a qualitative approach. We analyzed 607 prescriptions from April to July 2016. We used databases such as Micromedex and Drugs.com.Results: Weidentified 4,313 interactions, which were distributed in 61 types between the prescribed drugs and food. Conclusion: There is a high rate of food-drug interactions in the prescriptions for the elderly people with Acute Coronary Syndrome. Despite the fact that some nutrients are not routinely consumed, it is very important the revision of the prescription and diet components by the pharmacist to avoid problems related to interactions.

Análise da prevalência dos pacientes que necessitam de óculos em um Hospital Oftalmológico em Goiânia, Goiás, Brasil. Projeto Olhar Brasil / Analysis of the prevalence of patients in need eyeglasses in Ophthalmologic Hospital in Goiânia, Goiás, Brazil: Projeto Olhar Brasil

Resumo Objetivo: Avaliar o projeto Olhar Brasil sob um olhar crítico, examinando a prevalência dos pacientes encaminhados para consulta oftalmológica, pós-triagem, que realmente apresentem vícios de refração não corrigidos. Métodos: Revisão de prontuários entre Março de 2014 e Agosto de 2016, totalizando 339 pacientes entre 6 e 18 anos de idade, sendo 5 pré-escolares (2 - 6 anos e 11 meses), 124 escolares (2 - 6 anos e 11 meses) e 210 adolescentes (10-20 anos) entre os quais 156 do sexo masculino e 183 do feminino , em um hospital oftalmológico em Goiânia, Goiás, Brasil. Resultados: No total dos 339 pacientes examinados 143 (42,1 %) necessitaram de correção e 196 (57,8%) não. Entre os 156 pacientes do sexo masculino 74 (47,4%) apresentaram necessidade de uso de óculos contra 82 (52,5%) que não precisaram, em relação ao sexo feminino os números foram de 69 (37,7%) que tiveram alteração ao exame e 114 (62,2%) que não apresentaram alterações refrativas. Em relação a faixa etária, os adolescentes, escolares, e pré-escolares apresentaram em números absolutos e porcentagem respectivamente 102 (48,5%), 40 (32,2%) e 2 (40%) de indicação de lentes corretivas. Conclusão: O projeto Olhar Brasil tem importância relevante para sociedade em geral, com diminuição da evasão escolar, melhor rendimento escolar e consequentemente da qualidade de vida dos beneficiários, embora necessite melhor treinamento e aperfeiçoamento dos profissionais da Atenção Básica em Saúde, professores do ensino fundamental e os alfabetizadores que são responsáveis pela triagem.

Abstract Objective: Measure the "Projeto Olhar Brasil" under a critic point of view, examining the prevalence of patients referred for ophthalmological appointment, post-screening, that show refractive errors uncorrected. Methods: Review of records between March 2014 and August 2016, in totality of 339 patients between 6 and 18 years old, 5 preschools (2 - 6 years and 11 months) 124 school (7 - 9 years and 11 months) and 210 teenagers (10 - 20 years old). There were 156 males and 183 females, in an Ophthalmologic Hospital in Goiânia, Goiás, Brazil. Results: In total of 339 patients examined, 143 (42.1%) needed optical correction against 196 (57.8%) that not benefiting from the same. There were 74 (47.4%) males patients who required the use of eyeglasses, against 69 (37.7%) of females gender who obtained eyes test alterations. In relation to age, the teenagers, school and preschool showed in absolute numbers and percentage respectively 102 (48.5%), 40 (32.2%) and 2 (40%) indications of corrective lenses. Conclusion: The "Projeto Olhar Brasil" has great importance for society in general reducing the loss of students in school, improving school performance and consequently the quality of life of the beneficiaries, although it needs better training and improvement of professionals in primary health care, elementary school teachers and educators that are responsible for screening.

Attempts to Reduce the Progression of Myopia and Spectacle Prescriptions during Childhood: A Survey of Eye Specialists

PURPOSE: To determine methods tried in clinical trials to reduce the progression of myopia in children, and spectacle prescribing patterns of hospital ophthalmologists. METHODS: A multi-sectioned survey composed of Likert items relating to the methods of reducing myopia progression (orthokeratology lenses [O-K lenses], undercorrected glasses, and topical atropine) and the patterns of prescribing spectacles for children (including two cases involving a 5-year-old girl and an 8-year-old boy) were distributed to members of the Korean Ophthalmological Society, and the collected data was statistically analyzed. RESULTS: A total of 78 out of 130 ophthalmologists returned the survey. On a scale of 1 to 5, the mean rates of whether the ophthalmologists think O-K lenses arrest myopia progression, and whether they recommend their patients to wear O-K lenses if indicative, were 3.06 and 2.75, respectively. Moreover, the mean rates of whether they consider that wearing glasses which are undercorrected would slow down the progression of the myopia, or if they think topical atropine helps in arresting myopia progression in children, were 2.34 and 1.27, respectively. In response to the case studies, the majority of practitioners preferred to prescribe the full amount found in cycloplegic refraction to pediatric patients with myopia. CONCLUSIONS: Ophthalmologists in clinical practice encouraged children to wear O-K lenses more than undercorrected glasses as a way to retard myopia progression. However, the application of atropine is rarely tried in clinical trials. In managing pediatric patients with myopia (case specific), the majority of the practitioners chose to prescribe glasses with full cycloplegic correction.

Access to medicines by ambulatory health service users in Mexico: an analysis of the national health surveys 1994 to 2006 / Acceso a medicamentos para los usuarios del primer nivel de los servicios de salud: análisis de las encuestas nacionales de salud 1994, 2000 y 2006

OBJECTIVE: To analyse the medicines prescription, prescription filling, payment expenditure for medicines by ambulatory health service users (HSU) in 2006, and to evaluate its evolution in the last 12 years. MATERIAL AND METHODS: Using data from the National Health Surveys in 2006 three binary logistic regression models were constructed to identify the variables associated with the prescription rate, prescription filling and payment for medicines in 2006. The results of access to medicines were compared to the ones from previous National Health Services from 1994 and 2000. RESULTS: The type of health service provider was found to be the most important predictors of access to medicines. Although the proportion of HSU obtaining a prescription and paying for drugs has broadly stayed the same as in 1994, the percentage of HSU paying for their prescribed medicines decreased from 70 percent in 1994 to 42 percent at Ministry of Health institutions in 2006. CONCLUSION: The progress in prescription and population access to medicines has been uneven across health service providers.

OBJETIVO: Analizar la prescripción médica, surtimiento de recetas y gasto en medicamentos que tienen los usuarios del primer nivel de los servicios de salud (UPNS) en 2006 y evaluar su evolución en los últimos 12 años. MATERIAL Y MÉTODOS: Utilizando los datos de la Encuesta Nacional de Salud de 2006 se construyeron tres modelos de regresión logística para identificar los factores asociados con la prescripción, el surtimiento de medicamentos y el pago por medicamentos recetados. Se compararon los resultados del acceso a medicamentos con los de encuestas anteriores de 1994 y 2000. RESULTADOS: La variable más relevante para el acceso a medicamentos fue el tipo de institución donde se prestó atención. Aunque al nivel global la proporción de los UPNS que obtuvieron una prescripción y que pagaron por los medicamentos más o menos se mantuvo estable, el porcentaje de los UPNS que pagaron por los medicamentos en las instituciones de la Secretaría de Salud disminuyó de 70 a 42 por ciento entre 1994 y 2006. CONCLUSIÓN: El mejoramiento del acceso a medicamentos para usuarios de los servicios de salud ha sido desigual a través de las instituciones.

Qual é o tipo de fototerapia mais comumente indicada no tratamento da psoríase?: UVB banda estreita e PUVA: comportamento da prescrição / What is the most common phototherapy prescription for psoriasis: NB-UVB or PUVA? Prescription behavior

FUNDAMENTOS: Formas moderada e grave de psoríase requerem fototerapia e/ou medicações sistêmicas. Tanto UVB banda estreita quanto fototerapia UVA com psoralênicos (PUVA) podem ser utilizadas no tratamento dessas formas de psoríase, sendo comprovada a efetividade de ambas as terapias. OBJETIVOS: Avaliar as indicações de dois tipos de fototerapia no tratamento da psoríase refratária à terapia tópica: UVB banda estreita e PUVA. MÉTODOS: Entre janeiro de 2006 e dezembro de 2007, os pacientes encaminhados a dois serviços de fototerapia foram incluídos neste estudo. Dados sobre os casos e tipos de prescrição foram coletados de maneira retrospectiva. RESULTADOS: Dentre os 67 pacientes estudados, 51 (76 por cento) foram tratados com UVB banda estreita. As razões para sua indicação foram presença de psoríase em gotas (22 por cento), presença de finas placas (15 por cento), uso de drogas fotossensibilizantes (15 por cento), idade abaixo de 20 anos (9 por cento), fototipo I (9 por cento) e doença hepática (6 por cento). Os 16 (24 por cento) restantes foram tratados com PUVA. A principal indicação dessa terapia foi gravidade da doença (15 por cento), seguida de fototipo IV (9 por cento). CONCLUSÕES: As prescrições de UVB banda estreita excederam as de PUVA devido ao menor número de contraindicações, menor possibilidade de efeitos colaterais, e ainda por ser uma opção mais prática.

BACKGROUND: Moderate and severe forms of psoriasis require phototherapy and / or systemic medications. Both UVA and UVB can be used to treat cases of moderate and severe psoriasis, and the effectiveness of both has been proven. OBJECTIVE: to access the prescription behavior relating to two types of phototherapy for treating psoriasis refractory to topical treatment: narrowband UVB (NB-UVB) or psoralen plus UVA phototherapy (PUVA). METHODS: Between January 2006 and December 2007, patients referred to two phototherapy services were included in this study. Data on the cases and on the type of prescription were collected retrospectively. RESULTS: Among the 67 studied patients, 51 (76 percent) were treated with narrowband UVB. The reasons for the indication were the presence of the guttate type of psoriasis (22 percent), the presence of thin plaques (15 percent), the use of drugs that affected photosensitivity (15 percent), age less than 20 years (9 percent), skin type I (9 percent), and liver disease (6 percent). The remaining 16 (24 percent) were treated with PUVA. The main indication for this therapy was the severity of the disease (15 percent), followed by the presence of skin type IV (9 percent). CONCLUSIONS: Prescriptions of narrowband UVB exceeded those of PUVA because of fewer contraindications and fewer possible side effects, and because it was a more practical option.

Antimicrobial prescription patterns for common acute infections in some rural & urban health facilities of India.

BACKGROUND & OBJECTIVES: Irrational use of antimicrobials is a key factor behind rapidly spreading antimicrobial resistance in microorganisms. This study was undertaken to determine the rate and pattern of antimicrobial prescribing in patients with uncomplicated acute respiratory infections, fever and diarrhoea attending a few rural and urban health settings. METHODS: The study was done in primary and secondary health care facilities of public/government and private settings at four sites in India. Patients with fever, cough, diarrhoea or ear, nose or throat infections of < 7 days were included. Pregnant women, lactating mothers, infants, seriously ill patients and patients with bloody diarrhoea or purulent nasal or ear discharge were excluded. RESULTS: Overall antimicrobial prescription rate was 69.4 per cent (95% CI 67.1, 71.7). Wide variation was observed (Thiruvananthapuram 47.6%, Lucknow 81.8%, Chennai 73.1% and Vellore 76.5%). Physicians practicing in rural and public/government settings prescribed antimicrobials more frequently than those in urban and private settings (83.8, 81.9, 68.3 and 68.2% respectively). Antimicrobials were more frequently prescribed for patients presenting with fever. Highest rate was noticed for children aged between 6 and 18 yr. Patients of the high-income group received antimicrobials more frequently (72.7%). In both public/ government and private settings, for patients who purchased medicines, the rate was higher (82.4 and 68.9% respectively), vs. those receiving free medicines (70.2 and 46.2% respectively). Two third of all antimicrobials prescribed were penicillins and co-trimoxazole, and > 40 per cent of prescriptions from private sector were quinolones and cephalosporins. INTERPRETATION & CONCLUSIONS: Our findings showed that prescription of antimicrobials for acute respiratory infections and diarrhoea was extremely common and warrants interventional strategies.

Lente de contato em crianças: aspectos epidemiológicos / Contact lens in children: epidemiological aspects

OBJETIVO: Traçar o perfil epidemiológico de crianças encaminhadas para adaptação de lente de contato. MÉTODOS: Foi realizado estudo retrospectivo de pacientes registrados no Setor de lente de contato da Universidade Federal de São Paulo. Os pacientes com até 12 anos de idade foram avaliados quanto ao sexo, idade, diagnóstico, indicação e tipo de lente de contato testada na primeira consulta. RESULTADOS: Dos 73 prontuários avaliados, 34 (46,6 por cento) pertenciam a crianças do sexo masculino e 39 (53,4 por cento) a crianças do sexo feminino. A idade variou de 2 a 12 com média de 10,2 e desvio-padrão de 2,42 anos. O diagnóstico mais encontrado foi afacia em 16 (21,9 por cento) crianças, seguido de ceratocone em 14 (19,1 por cento), leucoma em 11 (15 por cento), anisometropia em 10 (13,7 por cento), ametropia em 9 (12,3 por cento), astigmatismo irregular em 7 (9,5 por cento) e ectopia lentis em 4 (5,4 por cento). Uma criança era alta míope (1,3 por cento) e outra emétrope (1,3 por cento) que possuía desejo de usar lente de contato estética. Em relação às indicações, 52 (71,2 por cento) pacientes tinham indicação médica, 9 (12,3 por cento) indicação óptica e 12 (16,4 por cento) indicação cosmética. Foram testadas lentes em 103 olhos sendo as mais testadas a rígida gás permeável esférica em 43 (41,7 por cento), a gelatinosa esférica em 41 (39,8 por cento) e a gelatinosa cosmética em 11 (10,6 por cento). CONCLUSÃO: O perfil epidemiológico dos usuários de lente de contato nessa faixa etária tem como diagnóstico mais prevalente a afacia, a indicação mais freqüente a de ordem médica e a lente mais testada a rígida gás permeável esférica.

PURPOSE: To describe the epidemiology of children submitted to contact lens fit. METHODS: Retrospective study of 73 children that had been submitted to contact lens fit at the "Universidade Federal de São Paulo". This study analyzed sex distribution, age, diagnosis, indications and contact lens fitted at first examination. RESULTS: 34 children (46.6 percent) were male and 39 (53.4 percent) female, aged between 2 and 12 years with mean of 10.2 and standard deviation of 2.42. The most common diagnosis was aphakia, in 16 (21.9 percent) cases. Keratoconus was present in 14 (19.1 percent), leucoma in 11 (15 percent), anisometropia in 10 (13.7 percent), refractive errors in 9 (12.3 percent), irregular astigmatism in 7 (9.5 percent), ectopia lentis in 4 (5.4 percent), high myopia in one case (1.3 percent) and one child (1.3 percent) had no ocular pathology, just wishing to change eye color. 52 (71.2 percent) had medical indication, 9 (12.3 percent) had optical indication and 12 (16.4 percent) had cosmetic indication. Contact lenses were fitted in 103 eyes, the most tested lens was rigid gas permeable in 43 (41.7 percent), soft lens in 41 (39.8 percent) and cosmetic soft lens in 11 (10.6 percent). CONCLUSION: Aphakia was the most common diagnosis among children in use of contact lens. The incidence of medical indication was higher than the others and the most tested lens was the rigid gas permeable one.

Evaluación de un programa de educación médica continua para la atención primaria en la prescripción de hipoglucémicos / An evaluation of a continuing medical education program for primary care services in the hypoglycemic agent’s prescription in diabetes mellitus type 2

OBJETIVO: Evaluar el efecto en la prescripción de hipoglucémicos de un programa de educación médica continua en unidades de medicina familiar (UMF). MATERIAL Y MÉTODOS: Se realizó un estudio observacional que comparó dos grupos (con y sin programa) con dos cortes transversales (antes y después). La unidad de análisis fue la consulta. El periodo de análisis comprendió seis meses anteriores y seis posteriores a la institución del programa. La principal variable de resultado fue la prescripción adecuada, evaluada mediante dos criterios: elección e indicación correctas. El análisis incluyó modelos de regresión logística, se aplicó la técnica de dobles diferencias y se ajustó por variables relativas al paciente, la consulta y la UMF; las más relevantes fueron sexo, obesidad, otras afecciones, número de consultas, número de medicamentos, tamaño de la clínica, grupo y etapa. RESULTADOS: Se obtuvo un incremento atribuible al programa de 0.6 por ciento en la probabilidad de prescripción adecuada y de 11 por ciento en la elección correcta en pacientes obesos.

OBJECTIVE: To evaluate the impact of a continuing medical education program on family doctors to improve prescription of hypoglycemic drugs. MATERIAL AND METHODS: An observational study was conducted with two groups of comparison (with-without program) and before-after periods. The unit of analysis was the visit. The period of evaluation comprised six months before and six after implementing the program. The outcome variable was the appropriateness of prescription that was based upon two criteria: appropriate selection and proper indication of the drug. Logistic regression models and the double differences technique were used to analyze the information. Models were adjusted by independent variables related with the patient, the visit and the PCC, the more relevant ones were: sex, obesity, conditions other than diabetes, number of visits in the analyzed period, number of drugs prescribed, size of the PCC and period. RESULTS: the program increases 0.6 percent the probability of appropriate prescription and 11 percent the probability of appropriate choice of the hypoglycemic drug in obese patients.

Surtimiento de recetas a los afiliados al Seguro Popular de Salud de México / Dispensing prescriptions to persons affiliated with Popular Health Insurance in Mexico

OBJETIVO: Medir y comparar el porcentaje de recetas surtidas completamente a los usuarios de servicios ambulatorios y de los hospitales generales de los Servicios Estatales de Salud de México (SESA) afiliados y no afiliados al Seguro Popular de Salud (SPS) según condición de aseguramiento, además de medir la satisfacción de los usuarios de los SESA con el acceso a los medicamentos. MATERIAL Y MÉTODOS: La información del estudio procede de cuatro encuestas de unidades ambulatorias y hospitalarias de los SESA que contaron con muestras probabilísticas de representatividad estatal. Las muestras de las unidades ambulatorias se seleccionaron mediante estratificación por nivel de atención y por condición de pertenencia a la red de servicios del SPS. RESULTADOS: Los hallazgos indican que el porcentaje de recetas completamente surtidas ha mejorado en las unidades ambulatorias de los SESA, sobre todo en aquellas que ofrecen servicios a los afiliados al SPS y que alcanzan porcentajes de casi 90 por ciento. Estos porcentajes, sin embargo, siguen siendo inferiores a los de las unidades ambulatorias de las instituciones de seguridad social. Los porcentajes de recetas surtidas en las unidades hospitalarias de los SESA también han mejorado, pero siguen siendo relativamente bajos. En casi todas las entidades federativas, conforme se ha incrementado el porcentaje de surtimiento completo de recetas, ha aumentado la satisfacción de los usuarios con el acceso a los medicamentos. CONCLUSIONES: En 2006, más de 50 por ciento de las entidades federativas presentaron altos niveles de surtimiento completo de recetas entre los afiliados al SPS (>90 por ciento). El mayor problema en este sentido se encuentra en los hospitales, ya que sólo 44 por ciento de los usuarios que recibieron una prescripción en los hospitales de los SESA en 2006 obtuvieron el surtimiento completo de sus recetas. Este hallazgo obliga a revisar la política de medicamentos del SPS, que ha privilegiado...

OBJECTIVE: Measure and compare the percentage of prescriptions fully dispensed to persons with and without Popular Health Insurance (SPS in Spanish) who use ambulatory and general hospital services associated with the Mexico State Health Services (SESA in Spanish), and taking into account insurance status. SESA user satisfaction was also measured with respect to access to medication. MATERIAL AND METHODS: Information for the study was taken from four surveys of SESA ambulatory and hospital units that included probabilistic samples with state representativity. Samples of ambulatory units were selected by stratification according to level of care and association to the SPS service network. RESULTS: The findings indicate that the percentage of prescriptions fully dispensed in SESA ambulatory units has improved, reaching approximately 90 percent, especially among those units offering services to persons affiliated with SPS. Nevertheless, these percentages continue to be lower than those of ambulatory units associated with social security institutions. Percentages of prescriptions fully dispensed have also improved in SESA hospital units, but continue to be relatively low. In nearly all states, as the percentage of prescriptions fully dispensed has increased, user satisfaction with access to medication has also improved. CONCLUSIONS: In 2006 more than 50 percent of the states had high levels of fully dispensed prescriptions among persons with SPS (>90 percent). The more significant problem exists among hospitals, since only 44 percent of users who received a prescription in SESA hospitals in 2006 had their prescriptions fully dispensed. This finding requires a review of SPS medication policies, which have favored highly prescribed low-cost medications at ambulatory services at the expense of higher cost and more therapeutically effective medications for hospital care, the latter having a greater impact on household budgets.

Medicines in Mexico, 1990-2004: systematic review of research on access and use: [review] / Medicamentos en México, 1990-2004: revisión de investigación sobre acceso y uso: [revisión]

OBJECTIVE: To review original research studies published between 1990 and 2004 on the access and use of medicines in Mexico to assess the knowledge base for reforming Mexico's pharmaceutical policy. MATERIAL AND METHODS: A literature review using electronic databases was conducted of original studies published in the last 15 years about access and use of medicines in Mexico. In addition, a manual search of six relevant journals was performed. Excluded were publications on herbal, complementary and alternative medicines. RESULTS: Were identified 108 original articles as being relevant, out of 2289 titles reviewed, highlighting four policy-related problems: irrational prescribing, harmful self-medication, inequitable access, and frequent drug stock shortage in public health centers. CONCLUSIONS: This review identified two priorities for Mexico's pharmaceutical policy and strategies: tackling the irrational use of medicines and the inadequate access of medicines. These are critical priorities for a new national pharmaceutical policy.

OBJETIVO: Revisar estudios de investigaciones originales publicados sobre el acceso y uso de los medicamentos en México de 1990 a 2004, con el fin de evaluar el conocimiento que existe para reformar la política farmacéutica nacional. MATERIAL Y MÉTODOS: Se condujo una revisión de la literatura sobre estudios originales publicados entre 1990 y 2004 sobre el acceso y uso de medicamentos en México. Además, se revisaron manualmente seis revistas relevantes. Se excluyeron publicaciones sobre herbolaria, medicamentos tradicionales y alternativos. RESULTADOS: Se revisaron 2 289 artículos e identificaron 108 como relevantes que destacan cuatro problemas importantes relacionados con las políticas farmacéuticas: prescripción inadecuada, automedicación dañina, acceso inequitativo y desabasto de medicamentos en servicios públicos de salud. CONCLUSIONES: Esta revisión identificó dos prioridades críticas para el desarrollo de una nueva política farmacéutica en México: actuar sobre el uso irracional de medicamentos y sobre el acceso inadecuado a medicamentos.

Does indication sheet reduce unnecessary urethral catheterization?

The study on the effect of indication sheet on the decision of doctors in ordering urethral catheterization was done in thirteen hospitals randomly selected from all regions of Thailand. 16,959 patients in medical and surgical wards were included between April and May 1989. The rates of urethral catheterization did not change by the influence of indication sheet. However, urethral catheterization without proper indications was reduced from 27.0 per cent in the control group to 14.3 per cent in the experiment group. The indication sheet was accepted in 96.5 per cent of the occasions when doctors prescribed urethral catheterization. The indication sheet changed the doctors' decision and hence reversed the order in 3 events (0.8%). It is concluded that indication sheet was well accepted by doctors and could reduce urethral catheterization without proper indications.