High prevalence of off-label and unlicensed paediatric prescribing in a hospital in Indonesia during the period Aug.-Oct. 2014.

BACKGROUND: Data on off-label and unlicensed prescribing in children in Indonesia is limited. The aims of this study were to determine the prevalence of off-label and unlicensed prescribing for paediatric patients in a public hospital, Indonesia. METHOD: A retrospective cross-sectional study of 200 randomly selected paediatric patients admitted to hospital between August and October 2014, collected patient details and all drugs prescribed. Licensed drugs were classified as off-label if there was a non-compliance with the Product Information for age, weight, indication, dose, frequency and route of administration, if there was a contraindication, special precautions or not recommended for children. Unlicensed drugs were those not approved for use in Indonesia. The main outcome was the prevalence of off-label or unlicensed prescribing to infants, children and adolescents and the impact of age group on off-label prescribing. RESULTS: A total of 200 patients received 1961 medicines of which 1807/1961 (92.1%) were licensed and 154/1961 (7.9%) were unlicensed. There were 1403/1961 (71.5%) drugs prescribed off-label. More than half of the total drugs (n = 1066; 54.4%) were administered parenterally. Every patient was prescribed at least one off-label drug. Indication (n = 810; 34.6%) was the most common reason for off-label prescribing. Ranitidine was the most frequent drug prescribed off label. Darplex® (dihydroartemisinin and piperaquine), although manufactured in Indonesia, was unlicensed. There was a significant difference between age group and off-label prescribing in that children were prescribed significantly less off-label drugs (p<0.0003). CONCLUSION: This study revealed a high prevalence of off-label and unlicensed drug use in paediatric patients in this hospital, exposing them to drug treatments or regimens that had not been approved by regulatory authorities. The high incidence of invasive parenteral prescribing is of concern for paediatric patients. Incentives are needed to encourage specific drug evaluation in paediatric populations.

'I just need an opiate refill to get me through the weekend'.

In this article, we discuss the ethical dimensions for the prescribing behaviours of opioids for a chronic pain patient, a scenario commonly witnessed by many physicians. The opioid epidemic in the USA and Canada is well known, existing since the late 1990s, and individuals are suffering and dying as a result of the easy availability of prescription opioids. More recently, this problem has been seen outside of North America affecting individuals at similar rates in Australia and Europe. We argue that physicians are also confronted with an ethical crisis where a capitalist-consumerist society is contributing to this opioid crisis in which societal, legal and business interests push physicians to overprescribe opioids. Individual physicians often find themselves unequipped and unsupported in attempts to curb the prescribing of opioid medications and balance competing goals of alleviating pain against the judicious use of pain medications. Physicians, individually and as a community, must reclaim the ethical mantle of our profession, through a more nuanced understanding of autonomy and beneficence. Furthermore, physicians and the medical community at large have a fiduciary duty to patients and society to play a more active role in curbing the widespread distribution of opioids in our communities.

Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008-2016.

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.

Patterns and predictors of off-label prescription of psychiatric drugs.

Off-label prescribing of psychiatric drugs is common, despite lacking strong scientific evidence of efficacy and potentially increasing risk for adverse events. The goal of this study was to characterize prevalence of off-label prescriptions of psychiatric drugs and examine patient and clinician predictors of off-label use. This manuscript presents a retrospective, cross-sectional study using data from the 2012 and 2013 National Ambulatory Medical Care Surveys (NAMCS). The study examined all adult outpatient visits to psychiatric practices for chronic care management with a single listed visit diagnosis in which at least one psychiatric drug was prescribed. The main outcome measure was off-label prescribing of at least one psychiatric drug, defined as prescription for a condition for which it has not been approved for use by the FDA. Among our sample representative of 1.85 billion outpatient visits, 18.5 million (1.3%) visits were to psychiatrists for chronic care management in which at least one psychiatric drug was prescribed. Overall, the rate of off-label use was 12.9% (95% CI: 12.2-15.7). The most common off-label uses were for manic-depressive psychosis treated with citalopram and primary insomnia treated with trazodone. Several patient and clinician characteristics were positively associated with off-label prescribing, including seeing a psychiatrist (OR: 1.06, 95% CI, 1.01-1.12; p = 0.03) instead of another type of clinician, the office visit taking place in the Western region of the country (OR: 1.09, 95% CI, 1.01-1.17; p = 0.02), and the patient having 3 or more chronic conditions (OR: 1.12, 95% CI, 1.02-1.14; p = 0.003). In contrast, having Medicare coverage (OR: 0.93, 95% CI, 0.84-0.97; p = 0.04) and receiving payment assistance from a medical charity (OR: 0.91, 95% CI, 0.88-0.96; p = 0.03) instead of private insurance were negatively associated with off-label prescribing. These results suggest that certain classes of psychiatric medications are being commonly prescribed to treat conditions for which they have not been determined by the FDA to be clinically efficacious and/or safe.

Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System.

Data are needed from outpatient settings to better inform antimicrobial stewardship. In this study, a random sample of outpatient antibiotic prescriptions by primary care providers (PCPs) at our health care system was reviewed and compared to consensus guidelines. Over 12 months, 3,880 acute antibiotic prescriptions were written by 76 PCPs caring for 40,734 patients (median panel, 600 patients; range, 33 to 1,547). PCPs ordered a median of 84 antibiotic prescriptions per 1,000 patients per year. Azithromycin (25.8%), amoxicillin-clavulanate (13.3%), doxycycline (12.4%), amoxicillin (11%), fluoroquinolones (11%), and trimethoprim-sulfamethoxazole (10.6%) were prescribed most commonly. Medical records corresponding to 300 prescriptions from 59 PCPs were analyzed in depth. The most common indications for these prescriptions were acute respiratory tract infection (28.3%), urinary tract infection (23%), skin and soft tissue infection (15.7%), and chronic obstructive pulmonary disease (COPD) exacerbation (6.3%). In 5.7% of cases, no reason for the prescription was listed. No antibiotic was indicated in 49.7% of cases. In 12.3% of cases, an antibiotic was indicated, but the prescribed agent was guideline discordant. In another 14% of cases, a guideline-concordant antibiotic was given for a guideline-discordant duration. Therefore, 76% of reviewed prescriptions were inappropriate. Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately. A non-face-to-face encounter prompted 34% of prescriptions. The condition for which an antibiotic was prescribed was not listed in primary or secondary diagnosis codes in 54.5% of clinic visits. In conclusion, there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.

Errors in Antibiotic Therapy: Study with Dentist's Prescriptions in a Large Brazilian City

Objective: To evaluate errors in dental prescriptions of antibiotics for therapeutic purpose. Material and Methods: This was a descriptive study using a random and calculated sample of 366 prescriptions (July1 2011 to June 30 2012), from a total of 31 105 dental prescriptions, was surveyed in an important drugstore chain in a large Brazilian city. Data was validated by double entry in Epi-data (EpiData Assoc, Odense M, Denmark) and then analysed in SPSS (version 19.0, Chicago, IL, USA). Statistical analyses included the calculation of proportions with a 95% confidence interval (CI). Results: We identified 272 prescriptions for therapeutic purpose. Prescription errors involved spelling of the antibiotic name, dose, dosing intervals and duration of treatment. A total of 116 prescriptions (42.6%; 95% CI 36.9%-48.6%) were considered to be totally correct with regard to the generic name, dose, dosing interval and duration of the antibiotic therapy. Most of the antibiotics prescribed by dentists showed errors related to the name, dose, intervals and duration of treatment. Conclusion: These errors may compromise the effectiveness of drug therapy, contribute to microbial resistance and increase the risk of adverse events and costs of treatment.

La agresividad terapéutica y la oncología líquida / Therapeutic aggressiveness and liquid oncology

Los criterios de agresividad terapéutica publicados hace una década proporcionan un juicio de calidad y son una referencia en la atención de pacientes con cáncer avanzado, pero su utilización no está generalizada en la evaluación de los Servicios de Oncología. En este trabajo analizamos la agresividad terapéutica, según los criterios estándar, en 1.001 pacientes con cáncer avanzado fallecidos en el Complejo Hospitalario Universitario de Santiago de Compostela, entre los años 2010 y 2013. Los resultados parecen demostrar que la agresividad terapéutica al final de la vida en nuestro medio hospitalario está presente con más frecuencia de lo recomendado, ya que el 25% de los pacientes cumple al menos un criterio de agresividad. Este resultado podría explicarse por la presencia de una Oncología líquida que no prioriza al paciente como sujeto moral del encuentro clínico. Los cuidados se dirigen a la atención de las necesidades y deben estar articulados en modelos centrados en la comunicación y en la dignidad. Su aplicación mediante la Planificación Anticipada de los Cuidados, la consideración de los valores y preferencias del paciente y la Limitación del Esfuerzo Terapéutico, son formas de disminuir esta agresividad y mejorar la práctica clínica al final de la vida. Necesitamos plantear actitudes sinérgicas y proactivas, sumando lo mejor de la investigación oncológica con el mejor cuidado y atención clínica en beneficio del ser humano, sujeto moral y finalidad última de la Medicina

Aggressiveness criteria proposed in the scientific literature a decade ago provide a quality judgment and are a reference in the care of patients with advanced cancer, but their use is not generalized in the evaluation of Oncology Services. In this paper we analyze the therapeutic aggressiveness, according to standard criteria, in 1.001 patients with advanced cancer who died in our Institution between 2010 and 2013. The results seem to show that aggressiveness at the end of life is present more frequently than experts recommend. About 25% of patients fulfill at least one criterion of aggressiveness. This result could be explained by a liquid Oncology which does not prioritize the patient as a moral subject in the clinical appointment. Medical care is oriented to necessities and must be articulated in a model focused on dignity and communication. Its implementation through Advanced Care Planning, consideration of patient’s values and preferences, and Limitation of therapeutic effort are ways to reduce aggressiveness and improve clinical practice at the end of life. We need to encourage synergic and proactive attitudes, adding the best of cancer research with the best clinical care for the benefit of human being, moral subject and main goal of Medicine

Prescripción potencialmente inadecuada en pacientes mayores grandes polimedicados según criterios «STOPP» / Potentially inappropriate prescription according to the "STOPP" Criteria in heavily polymedicated elderly patients

Introducción. La adecuación en la prescripción terapéutica es especialmente relevante en pacientes mayores. El objetivo de este trabajo es analizar la prescripción potencialmente inadecuada (PPI) en pacientes ancianos grandes polimedicados según criterios del Screening Tool of Older Person's Prescriptions (STOPP). Pacientes y métodos. Estudio descriptivo transversal realizado en el centro de salud Siero-Sariego (Asturias), en el que participaron todos los pacientes mayores de 64 años adscritos al centro, grandes polimedicados (consumo ≥10 fármacos durante 6 meses). Se revisaron los 65 criterios del Screening Tool of Older Person's Prescriptions en la historia clínica electrónica de atención primaria. Se recogieron variables sociodemográficas, fármacos prescritos y patologías crónicas. Se calculó el índice de Charlson. Se realizaron distribuciones de frecuencias de cada criterio y se exploraron causas relacionadas con la PPI a través de tablas de contingencia, correlación de Spearman y regresión lineal. Resultados. Trescientos cuarenta y nueve grandes polimedicados (prevalencia: 6,4 [IC 95% : 5,76-7,08]), media: 79 años (DE : 3,7), 62,2% mujeres, 14% institucionalizados. Media de fármacos: 11,5 (DE : 1,7). Patologías más frecuentes: hipertensión arterial (64%), diabetes (46%) y patología osteoarticular (41%). El 72,9% de los polimedicados tenía al menos una PPI. Media: 1,32 (DE : 1,2). Criterios del Screening Tool of Older Person's Prescriptions más incumplidos: duplicidad terapéutica (25,2%), uso de benzodiacepinas de vida media larga (15,8%) y uso inadecuado de aspirina (10,9%). Se encontró asociación entre presentar alguna PPI y el número de fármacos dispensados (OR = 1,22 [IC 95% : 1,04-1,43]) y de forma inversa al índice de Charlson (OR = 0,76 [IC 95% : 0,65-0,89]). Conclusiones. La PPI es frecuente en grandes polimedicados. Debe prestarse especial atención al uso de fármacos psicotropos, implicados en un volumen importante de PPI (AU)

Introduction. Appropriate prescribing is especially relevant in elderly people. The objective of this study is to analyse the potentially inappropriate prescription (PIP) in heavily polymedicated elderly patients according to the criteria Screening Tool of Older Person's Prescriptions. Patients and methods. A descriptive cross-sectional study was conducted in Primary Care on patients assigned to the Siero-Sariego (Asturias) Health Centre, who were over 64 years old and heavily polymedicated (consumption >10 drugs for six months). The 65 Screening Tool of Older Person's Prescriptions criteria were reviewed in the electronic Primary Care patient records, collecting sociodemographic variables, prescribed medications, and chronic diseases. Frequency distributions were made for each criterion, and causes related to PIP were explored using contingency tables, the Spearman correlation coefficient, and logistic regression. Results. A total of 349 polymedicated elderly patients were analysed with a prevalence of 6.4 (95% CI : 5.76-7.08), a mean age of 79.2 years (SD : 3.7), 62.2% were female, 14% institutionalised, a Charlson index of 2.9. The mean of number of drugs was 11.5 (SD : 1.7), and the most frequent pathologies were high blood pressure (64%), diabetes (46%), and osteoarticular diseases (41%). There was at least one PIP in 72.9% of heavily polymedicated elderly patients [(Mean: 1.32 (SD : 1.2)]. The Screening Tool of Older Person's Prescriptions criteria least complied with were: therapeutic duplication (25.2%), use of long-acting benzodiazepines (15.8%), and inappropriate use of aspirin (10.9%). An association was found between having any inappropriate prescription and the number of medications prescribed (OR = 1.22 [95% CI : 1.04-1.43]) and inversely to the Charlson index (OR = 0.76 [95% CI : 0.65-0.89]). Conclusions. PIP is common in heavily polymedicated elderly patients. Special attention must be paid to the use of psychotropic drugs, which are implicated in a high volume of PIP (AU)

Perfil de prescripción y adecuación del tratamiento con antiinflamatorios no esteroideos en el paciente diabético / Profile of prescription and adequacy of treatment with non-steroidal anti-inflammatory drugs in diabetic patients

Objetivo. Cuantificar, describir el perfil de prescripción y valorar la adecuación del tratamiento con antiinflamatorios no esteroideos (AINE) en la población diabética de una zona básica de salud. Material y métodos. Estudio descriptivo, transversal, dirigido a una población diana de 2.795 pacientes diagnosticados de diabetes mellitus. Los datos se obtuvieron de la historia clínica informatizada de una muestra de 380 individuos. La adecuación del tratamiento se valoró siguiendo las recomendaciones propuestas por las sociedades españolas de Reumatología, Cardiología y Gastroenterología. Resultados. Se prescribieron AINE al 28,9% de los pacientes. Los más utilizados fueron ibuprofeno, naproxeno y dexketoprofeno con una dosis diaria definida por habitante y día de 35,3; 17,2 y 13,2, respectivamente. Se recetaron menos AINE en pacientes con antecedentes de enfermedad renal crónica y con riesgo cardiovascular alto, mientras que en aquellos con riesgo gastrointestinal elevado se utilizaron más frecuentemente. La prescripción se consideró adecuada en el 46,5% de los pacientes diabéticos. Las causas principales de uso inadecuado fueron: la prescripción de AINE cuando deberían ser evitados (25,2%) y la utilización de otros AINE cuando el que estaba indicado era naproxeno (20,6%). Conclusiones. Prescribimos mayoritariamente los AINE con menor riesgo cardiovascular. El tratamiento es inadecuado en más de la mitad de los pacientes. Deberíamos evitar su prescripción cuando el riesgo cardiovascular y sobre todo el riesgo gastrointestinal del paciente así lo aconseje, y no utilizar otros AINE cuando el indicado es naproxeno (AU)

Objective. The aim of this study was to quantify and describe the prescription profile, as well as to assess the adequacy of treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in the diabetic population of a health district. Material and methods. This is a descriptive, cross-sectional study aimed at a target population of 2,795 diabetic patients. Data were collected from the computerised clinical records of a sample of 380 individuals. The adequacy of treatment was assessed using the recommendations proposed by the Spanish societies of Rheumatology, Cardiology and Gastroenterology. Results. More than one-quarter (28%) of the diabetic patients received treatment with NSAIDs. The most commonly used ones were ibuprofen, naproxen, and dexketoprofen, with a defined daily dose per 1,000 inhabitants per day of 35.3, 17.2, and 13.2, respectively. In patients with a history of chronic kidney disease and cardiovascular high risk, fewer NSAIDs were prescribed, while they were used most frequently in patients with a risk for gastrointestinal adverse events. The prescription was considered adequate in 46.5% of diabetic patients. The main causes of inappropriate use were the inadequate prescription of NSAIDs (25.2%), and the use of any NSAID other than naproxen (20.6%). Conclusions. The most prescribed NSAIDs were those showing a low cardiovascular risk profile. Treatment with NSAIDs was inadequate in more than half of the patients. Risk factors for cardiovascular, and especially gastrointestinal, events must be considered in order to avoid its use when not indicated, as well as the use of any NSAIDs other than naproxen (AU)

III Premios de Investigación en Atención Primaria / No disponible

No disponible

Conciliación de la medicación en farmacia comunitaria / Reconciliation of the medication in community pharmacy

Introducción: La conciliación del tratamiento farmacológico consiste en revisar y registrar de forma completa y precisa la medicación habitual de un paciente, con objeto de conseguir la seguridad del mismo en cuanto al uso de los medicamentos. El objetivo principal de este estudio es cuantificar las discrepancias de conciliación producidas como consecuencia de la transición sanitaria del paciente entre los distintos niveles asistenciales. Métodos: Estudio piloto descriptivo multicéntrico desarrollado con 29 pacientes en seis farmacias comunitarias onubenses durante tres meses. Se estudia el tratamiento farmacológico del paciente comparando su tratamiento habitual con el nuevo tratamiento instaurado. Para la toma de decisiones se emplean la Base de Datos de Medicamentos y Productos Sanitarios, el método Dáder en seguimiento farmacoterapéutico y los criterios Stopp-Start en pacientes mayores de 65 años. Resultados: En un 37,9% de los pacientes estudiados se encontraron discrepancias en la medicación, principalmente en pacientes que proceden del hospital (36,4% tras alta hospitalaria y 45,5% tras visita al especialista). Las discrepancias mayoritarias tras la conciliación se detectan en la patología cardiovascular, seguida en menor medida por la patología renal. En un 36,4% de los casos el tipo de error observado ha sido la duplicidad de tratamiento farmacológico para una misma patología y en un 27,3% de los pacientes se detectaron enfermedades que no estaban siendo tratadas. Asimismo, se observaron pautas erróneas en el tratamiento (18,2%) y dosis erróneas de administración (9,1%). Un 81,8 % de los pacientes fue derivado al médico. Conclusión: Las discrepancias en el tratamiento farmacológico de un paciente tras el cambio de nivel asistencial son muy elevadas. Dado que el farmacéutico comunitario es el último profesional sanitario en contacto con el paciente antes de la administración del medicamento, su intervención permite detectar estas discrepancias, disminuyendo la morbilidad asociada a las mismas y contribuyendo a garantizar la continuidad asistencial (AU)

Introduction: Proper usage of medicines is the main objective of the medication reconciliation. It consists of a method to review systematically the patient medicine intakes to guarantee their safety. Objectives: This paper aims to demonstrate the correlation between failure in treatment reconciliation and patient changes in the different care levels. Methods: A multisite descriptive pilot study was developed in six pharmacies from Huelva for three months. Twenty nine patients’ ordinary pharmacological treatments were compared to new prescribed treatments. BOT PLUS medicine database, Dader method and Stopp-Start criteria were used in the decision making process to analyze data. Results: A 37.9% patients show discrepancies in their pharmacological treatments, mainly those who come from a hospital discharge (36.4%) and those who come from specialists (45.5%). Heart disease patients showed the highest discrepancies, followed by kidney disease patients. Discrepancies were due to double prescription for the same pathology (36.4%) and non treatment diseases detection (27.3%). Additionally, mistakes in treatment (18.2%) and mistakes in dosage prescription (9.1%) were observed. As a consequence, 81.8% were sent back to receive medical attention. Discussion: As a summary, discrepancies in pharmacological treatments are found to be very high when patients change care levels. Pharmacist role to avoid these discrepancies is key, since they are the last sanitary professional in contact with the patient before medicines intake (AU)

Un modelo de deprescripción prudente / A prudent deprescription model

La estructura terapéutica de los sistemas sanitarios descansa en gran medida sobre la prescripción, lo que genera una tendencia mantenida a sumar fármacos en la historia clínica del paciente. Por el lado contrario, destaca una ausencia significativa de estímulos sobre los profesionales para la reevaluación de prescripciones y la retirada de aquellas con un balance riesgo/beneficio negativo o neutro, lo que supone una desviación de recursos sanitarios hacia el mantenimiento de tratamientos inútiles, cuando no dañinos. La deprescripción, como la retirada meditada de medicación que complementa una prescripción prudente, está dirigida a frenar esta desviación injusta de recursos hacia prescripciones no beneficentes, cuando no maleficentes (AU)

The therapeutic structure of health systems relies heavily on medical prescription, which generates a marked tendency to add drugs to a patient's medical history. There is an absence of incentives for professionals to reassess prescriptions and withdraw those with a negative or neutral risk/benefit. This can create a deviation of medical resources to the maintenance of useless or even harmful treatments. Deprescribing, a process of thoughtful medication withdrawal that complements moderate prescribing, is aimed to stop this unfair deviation of resources towards non-beneficial, if not maleficent, prescription (AU)

Deprescribing psychotropic medications in aged care facilities: the potential role of family members.

There is widespread concern in Australia and internationally at the high prevalence of psychotropic medication use in residential aged care facilities. It is difficult for nurses and general practitioners in aged care facilities to cease new residents' psychotropic medications when they often have no information about why residents were started on the treatment, when and by whom and with what result. Most existing interventions have had a limited and temporary effect and there is a need to test different strategies to overcome the structural and practical barriers to psychotropic medication cessation or deprescribing. In this chapter, we review the literature regarding psychotropic medication deprescribing in aged care facilities and present the protocol of a novel study that will examine the potential role of family members in facilitating deprescribing. This project will help determine if family members can contribute information that will prove useful to clinicians and thereby overcome one of the barriers to deprescribing medications whose harmful effects often outweigh their benefits. We wish to understand the knowledge and attitudes of family members regarding the prescribing and deprescribing of psychotropic medications to newly admitted residents of aged care facilities with a view to developing and testing a range of clinical interventions that will result in better, safer prescribing practices.

[A prudent deprescription model]. / Un modelo de deprescripción prudente.

The therapeutic structure of health systems relies heavily on medical prescription, which generates a marked tendency to add drugs to a patient's medical history. There is an absence of incentives for professionals to reassess prescriptions and withdraw those with a negative or neutral risk/benefit. This can create a deviation of medical resources to the maintenance of useless or even harmful treatments. Deprescribing, a process of thoughtful medication withdrawal that complements moderate prescribing, is aimed to stop this unfair deviation of resources towards non-beneficial, if not maleficent, prescription.

Errores de prescripción como barrera para la Atención Farmacéutica en establecimientos de salud públicos: Experiencia Perú / Prescription errors as a barrier to pharmaceutical care in public health facilities: Experience Peru

Objetivos: Evaluar la calidad de llenado de las recetas médicas en los establecimientos públicos de salud del distrito de Independencia, departamento de Lima como barrera para brindar atención farmacéutica a los pacientes. Material y métodos: Estudio de diseño transversal, se emplearon recetas atendidas en las farmacias ambulatorias de todos los establecimientos de salud del distrito de Independencia (11). En el mes de noviembre 2013 se seleccionaron aleatoriamente, de cada uno de los 11 establecimientos, 384 recetas atendidas en el mes de octubre de 2013. Resultados: Se tomó de modo aleatorizado 384 recetas de cada uno de los 11 establecimientos de salud, haciendo un total de 4224 recetas. El 24% de recetas consignaban el dato del peso del paciente (IC: 22,76%-25,30%); el 34,2% mencionaba el diagnóstico (IC: 32,80%-35,62%); el 93,7% tenían descrito los medicamentos expresados en DCI (IC: 93,00-94,41%). Asimismo, solo el 11,3% consignaban la vía de administración (IC: 10,40%-12,28%) y el 41,4% señalaban la frecuencia (IC: 39,94%- 42,88%). La duración del tratamiento estuvo ausente en 32% de las recetas evaluadas (IC: 66,62%-69,41%) y solo el 5,7% tuvieron la fecha de vencimiento (IC: 5,00%-6,41%). Estos errores son barreras para la atención farmacéutica ya que dificulta la detección de problemas relacionados con medicamentos y asimismo limita la información que se pueda brindar al paciente sobre el uso de sus medicamentos. Conclusión: Se necesita de estrategias innovadoras para mejorar la prescripción de modo que no sea una barrera para poder detectar, resolver y prevenir la aparición de problemas relacionados a los medicamentos

Objectives: to evaluate the quality of prescriptions' filling in Independencia’s District public health facilities in the department of Lima as a barrier to provide pharmaceutical care to patients. Materials and methods: It was carried out a cross-sectional study with prescriptions from the outpatients pharmacies of all the Independencia’s District health facilities (11). During the month of November 2013, 384 prescriptions that have been assisted in October were randomly selected of each of the health facilities. Results: 384 prescriptions were randomly selected of each of the 11 health facilities which represented a whole of 4224 prescriptions. 24% of the prescriptions recorded the patient’s weight (IC: 22,76%-25,30%); 34,2% included the diagnosis (IC: 32,80%- 35,62%); 93,7% included drugs expressed in INN (IC: 93,00-94,41%). Furthermore, only 11,3 mentioned the route of administration (IC: 10,40%-12,28%) and 41,4 pointed out the frequency (IC: 39,94%-42,88%). The length of treatment was missing in 32% of the evaluated prescriptions (IC: 66,62%-69,41%) and only 5,7 included the expiration date (IC: 5,00%-6,41%). These errors are barriers for the pharmaceutical care due to the fact that they make difficult the detection of problems related to drugs; on the other hand, they limit the information that can be given to a patient about the use of his/her drugs. Conclusion: Innovative strategies are needed in order to improve prescriptions so that they are not a barrier any more for the detection, solution and prevention of problems related to drugs

Correlates of inappropriate prescribing of antibiotics to patients with malaria in Uganda.

BACKGROUND: In many rural areas of Uganda, febrile patients presenting to health facilities are prescribed both antimalarials and antibiotics, contributing to the overuse of antibiotics. We identified the prevalence and correlates of inappropriate antibiotic management of patients with confirmed malaria. METHODS: We utilized individual outpatient data from 36 health centers from January to September 2011. We identified patients who were prescribed antibiotics without an appropriate clinical indication, as well as patients who were not prescribed antibiotics when treatment was clinically indicated. Multivariate logistic regression models were used to identify clinical and operational factors associated with inappropriate case management. FINDINGS: Of the 45,591 patients with parasitological diagnosis of malaria, 40,870 (90%) did not have a clinical indication for antibiotic treatment. Within this group, 17,152 (42%) were inappropriately prescribed antibiotics. The odds of inappropriate prescribing were higher if the patient was less than five years old (aOR 1.96, 95% CI 1.75-2.19) and if the health provider had the fewest years of training (aOR 1.86, 95% CI 1.05-3.29). The odds of inappropriate prescribing were lower if patients had emergency triage status (aOR 0.75, 95% CI 0.59-0.96) or were HIV positive (aOR 0.31, 95% CI 0.20-0.45). Of the 4,721 (10%) patients with clinical indications for antibiotic treatment, 521 (11%) were inappropriately not prescribed antibiotics. Clinical officers were less likely than medical officers to inappropriately withhold antibiotics (aOR 0.54, 95% CI 0.29-0.98). CONCLUSION: Over 40% of the antibiotic treatment in malaria positive patients is prescribed despite a lack of documented clinical indication. In addition, over 10% of patients with malaria and a clinical indication for antibiotics do not receive them. These findings should inform facility-level trainings and interventions to optimize patient care and slow trends of rising antibiotic resistance.

Prescripción inapropiada de fármacos en personas mayores atendidas en un centro de Atención Primaria según los criterios STOPP-START / Inappropriate prescribing of drugs in older people attending primary care health centres: Detection using STOPP-START criteria

Objetivo. Conocer la prevalencia y características de prescripción inapropiada (PI) de los fármacos en los pacientes mayores de 65 años atendidos por un Equipo de Atención Primaria (EAP), utilizando los criterios STOPP-START. Material y método. Estudio transversal de muestra representativa de pacientes mayores de 65 años con historia activa en 2010, atendidos en 13 consultorios urbanos (muestreo sistemático aleatorizado; prevalencia esperada de PI del 40%; precisión: 5%; nivel de confianza: 95%). Se revisó la prescripción en las historias durante 2010, valorando los criterios STOPP-START. Resultados. Se seleccionaron 363 pacientes (56,7% mujeres); con una edad media de 75,2 años (DE: 7,02). Las enfermedades más frecuentes fueron cardiovascular (76,9%) y osteoarticular (57,6%), y el promedio de fármacos en prescripción crónica fue de 4,9 (DE: 3,32). Se detectó PI en 170 pacientes (46,8%, IC 95%: 41,7-52,0%), 42% en varones (IC 95%: 34,3-49,8%) y 46,6% en mujeres (IC 95%: 39,8-53,4%), sin diferencias entre sexos (p = 0,386) y con una mayor prevalencia si hay polimedicación o comorbilidad (p < 0,001). En cuanto al tipo de PI se cumplían criterios STOPP en 131 pacientes (36,1%, IC 95%: 31,1-41,0%) y START en 73 (20,1%, IC 95%: 16-24,2%), sin diferencias entre sexos (p = 0,623 para STOPP; p = 0,678 para START). Las PI STOPP más frecuentes se observan en indicadores del sistema musculoesquelético (50 pacientes: 38,2%, IC 95%: 29,8-46,5%) y las START en indicadores de endocrinología (38 pacientes: 52,1%, IC 95%: 40,0-63,9%). Conclusiones. La herramienta STOPP-START permite detectar y sistematizar la aplicación de criterios de PI en un porcentaje elevado de pacientes mayores atendidos por un EAP, pudiendo promover estrategias de mejora de la prescripción (AU)

ObjectiveTo determine the prevalence and characteristics of inappropriate prescribing of drugs (IP) in patients >65 years-old evaluated by a primary care team (PCT), using the STOPP-START criteria.Material and methodCross-sectional sample of patients older than 65 years-old with active clinical history in 2010, and who were attended in 13 urban clinics (systematic random sampling, expected IP prevalence of 40%, precision: 5% confidence level: 95%). Requirement was reviewed clinical histories in 2010, using the STOPP-START criteria.ResultsA total of 363 patients were selected (56.7% women), mean age 75.2 years (SD: 7.02). The most frequent diseases were cardiovascular (76.9%) and osteoarticular (57.6%) diseases, and the average number of prescription drugs was 4.9 (SD: 3.32). IP was detected in 170 patients (46.8%; 95% CI: 41.7-52.0%), 42% in men (95% CI: 34.3-49.8%) and 46.6% in women (95% CI: 39.8-53.4%), with no differences between sexes (P=.386), with a higher prevalence if polypharmacy or comorbidity were present (P<.001). The STOPP criteria were met in 131 patients (36.1%; 95% CI: 31.1-41.0%), and START criteria in 73 (20.1%; 95% CI: 16-24.2%), with no difference between sexes (P=.623 for STOPP, and P=.678 for START). The most frequent STOPP criteria were observed in the musculoskeletal system (50 patients, 38.2%; 95% CI: 29.8-46.5%) and START endocrinology indicators (38 patients, 52.1%; 95% CI: 40.0-63.9%).ConclusionsThe STOPP-START tool detected and systematised IP in a high percentage of elderly patients treated by a PCT, and can promote improvement in prescribing strategies (AU)