RESUMO
Background: Rational use of medicines (RUM) offers a cost-saving strategy to maximize therapeutic outcomes. The aims of this study were to assess RUM for chronic non-communicable diseases (NCDs) using the World Health Organization's (WHO) prescribing indicators in a public access facility and to evaluate the alignment of the use of drugs with therapeutic recommendations/guidelines. Design and methods: In this retrospective cross-sectional study, prescriptions of adult patients containing at least one drug for chronic NCDs, filled between January and July 2019 were reviewed using the WHO prescribing indicators for RUM. Data were analyzed and expressed as descriptive statistics. Associations were determined using chi-square tests, correlations using Pearson's correlation and medians compared using Mann-Whitney U test. For all analyses, significance was determined at p < 0.05. Results: Of the 571 prescriptions reviewed, most were for female, elderly patients with mean age of 69 years, predominantly with hypertension and/or diabetes. Polypharmacy was noted for 53.6% of prescriptions, primarily in elderly patients (p < 0.001), with the median number of five drugs prescribed and three dispensed. Of the drugs prescribed, 76.6% used generic prescribing, 63.3% were dispensed as written and 3.9% were antibiotics prescribed mainly for asthmatic patients (χ2 = 74.9, p < 0.001). Drugs prescribed for NCDs were aligned to therapeutic guidelines, but a significantly higher proportion of diabetes medications, (metformin and gliclazide), and cardiovascular medications (enalapril and losartan), were not dispensed as written (χ2 = 40.0, p = 0.007). Conclusion: This research indicates that there is positive alignment with recommended therapeutic guidelines, however, based on WHO prescribing factors, strategies to improve RUM in this setting are highly recommended.
RESUMO
Os estudos sobre utilização de medicamentos são úteis aos gestores dos sistemas de saúde, uma vez que comparam o funcionamento entre os serviços, identificam problemas de funcionamento destes e propõem medidas de intervenção que promovam o uso racional dos medicamentos. Neste estudo buscou-se caracterizar o uso de medicamentos em uma Unidade de Saúde da Família em Salvador-Bahia. Foi realizado um estudo descritivo de corte transversal mediante uma análise retrospectiva das prescrições dos meses de agosto e setembro de 2010. Utilizou-se como referencial os indicadores de uso de medicamentos preconizados pela Organização Mundial da Saúde (OMS). Foram analisadas 1230 receitas com 2408 medicamentos prescritos. Evidenciou-se que o maior percentual dos pacientes atendidos foi do sexo feminino (77%). As classes de medicamentos mais frequentes foram: anti-hipertensivos (28%), antimicrobianos tópicos (12%) e contraceptivos (11%). O medicamento mais prescrito foi a hidroclorotiazida presente em 20,2% das receitas. O percentual dos medicamentos prescritos segundo o nome genérico foi de 72%, sendo que 11% prescrito mediante sigla ou abreviação. Foi encontrado um percentual elevado de prescrições que continham medicamentos injetáveis, sendo que 87,9% destes eram contraceptivos hormonais. O número médio de medicamentos por receita foi de 2,0. Os indicadores apresentaram bons índices quando comparados com os estabelecidos pela OMS, porém, alguns achados sinalizam a necessidade do estabelecimento de educação permanente junto aos profissionais prescritores.
Studies on use of medicines are useful for managers of health systems for comparing the operation between services, and also identifying problems in the functioning of these, proposing measures and assessing the impact of an intervention. This study sought to characterize the use of drugs in a Family Health Unit in Salvador, Bahia. This was a cross-sectional study, conducting a retrospective analysis of prescriptions for the months of August and September of 2010, using as a methodological basis drug use indicators established by WHO. In this study, 1230 revenues were analyzed, being prescribed 2408 drugs in the mentioned period. Of the total patients enrolled, 77% were female. The most common drug classes were: antihypertensives 28%, topical antimicrobial agents 12%, and contraceptives 11%. The most drug prescribed was the hydrochlorothiazide with 20.2% of the revenues. The percentage of drugs prescribed under the generic name was 72% and 11% prescribed under the acronym or abbreviation. About 21% of the prescriptions contained injectable drugs, and 87.9% of these were hormonal contraceptives. The average number of drugs per prescription was 2.0. The indicators presented good rates when compared with those established by WHO, however, some findings suggest the need to establish a continuing education with the prescribers.