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Manirakiza A, Gitonga Nyamu D, Maru SM, Bizimana T, Nimpagaritse M. Evaluating drug use patterns among paediatric outpatients in Burundi. J Pharm Policy Pract 2024; 17:2312369. [PMID: 38444527 PMCID: PMC10914302 DOI: 10.1080/20523211.2024.2312369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Background Rational prescribing is key to optimising therapeutic outcomes and avoiding risks associated with irrational use of medicines. Using WHO drug use indicators, this study evaluated drug use patterns among paediatric outpatient encounters at Primary Healthcare Centers (PHCs) in Bujumbura Mairie, Republic of Burundi. Methods Descriptive cross-sectional research assessed paediatric medicine use in 20 PHCs. From 8 February to 7 April 2023, 800 randomly selected paediatric encounters' 2022-year data were retrospectively collected. Data for specific facility indicators were prospectively collected. SPSS 23 was used to analyse data. Results 800 outpatient child encounters were analysed, 48.4% female and 51.6% male. The mean number of medicines per encounter was 2.4(±0.99). The injection rate was 9.9%. Overall, 78.8% of generics and 85.2% of essential medicines were prescribed. Results show drug prescribing differences between private and government PHCs (p < 0.001). All PHCs studied had no standard treatment guidelines (STGs), while 50% had an essential medicine list (EML) and 85% of key medicines were available. Conclusion Poor prescribing practices were found indicating the need for interventions to promote good drug use practices. A large study at a national scale is required to provide a more comprehensive understanding of the overall drug use practices.
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Affiliation(s)
- Audace Manirakiza
- Master of Health Supply Chain Management at the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David Gitonga Nyamu
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, Faculty of Health Sciences, University of Naïrobi, Nairobi, Kenya
| | - Shital Mahindra Maru
- Faculty of Health Sciences, Department of Pharmaceutical Chemistry, Pharmaceutics and Pharmacognosy, University of Naïrobi, Nairobi, Kenya
| | - Thomas Bizimana
- Master of Health Supply Chain Management at the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Ermakov D, Fomina E, Kartashova O. Specific features of rational pharmacotherapy in elderly patients. Eur J Hosp Pharm 2023; 30:322-327. [PMID: 34795002 PMCID: PMC10647877 DOI: 10.1136/ejhpharm-2021-002980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/01/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE It is well-known that finding an optimum medication at the correct dose for elderly patients is challenging for the practitioner. This study aimed to examine the main trends in prescribing medications for elderly patients and their compliance with the principles of rational pharmacotherapy, and to establish the main factors affecting adherence to treatment in these patients. METHODS 956 records of outpatients over 60 years of age were examined. The groups of medications prescribed, the dosage simultaneously prescribed to one patient, the structure of nosologies among elderly patients, and the frequency of side effects were studied. The second stage of the study with 147 patients involved examining the adherence to medications by elderly patients using the Brief Medication Questionnaire. RESULTS A total of 147 patients (79 (53.7%) women and 68 (46.3%) men) aged over 60 years who were taking ≥4 medications for primary and concomitant diseases were surveyed. The phenomenon of polypragmasy is clearly seen when prescribing pharmacotherapy to elderly patients. Thus, 39% of patients were prescribed 2-4 drugs simultaneously, 55.4% were prescribed ≥5 drugs, and only 5.6% were prescribed one type of medication. Consequently, 90.5% of patients did not comply with the prescribed regimen of drugs. The main reasons for low adherence to treatment were: the complexity of the drug regimen (72.1% of cases); the high cost of drugs (63.9%); lack of appropriate knowledge about disease (67.3%); and no understanding of the necessity for drug intake and the pharmacotherapeutic effect in a particular situation (61.9%). CONCLUSION Optimisation of pharmacotherapy for elderly and senile patients requires consideration of functional changes in the body, the peculiarities of the pharmacodynamics and pharmacokinetics of drugs prescribed, the presence of polymorbidity, the prevalence of polypragmasy, and the low adherence to treatment.
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Affiliation(s)
- Dmitriy Ermakov
- Department of Pharmacy, I M Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Elena Fomina
- Department of Nursing Management and Social Work, I M Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Oxana Kartashova
- Department of Оrganizations and Economics of Pharmacy, Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Wynter-Adams DM, Thomas-Brown PG, Williams M, Bromfield L, Bunting-Clarke J. Assessment of rational use of medicines for chronic non-communicable diseases: A cross-sectional design in a public access clinic in Jamaica. J Public Health Res 2022; 11:22799036221126348. [PMID: 36204195 PMCID: PMC9530563 DOI: 10.1177/22799036221126348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Donna-Marie Wynter-Adams
- Caribbean School of Sport Sciences, University of Technology, Jamaica, Kingston, Jamaica
- School of Pharmacy, University of Technology, Jamaica, Kingston, Jamaica
| | | | - Marcia Williams
- School of Pharmacy, University of Technology, Jamaica, Kingston, Jamaica
| | - Lisa Bromfield
- School of Pharmacy, University of Technology, Jamaica, Kingston, Jamaica
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Peixoto RT, Campos MR, Luiza VL, Mendes LV. O farmacêutico na Atenção Primária à Saúde no Brasil: análise comparativa 2014-2017. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O farmacêutico tem importante papel nas unidades de saúde da Atenção Primária à Saúde (APS). No entanto, ainda são escassos no Brasil estudos que abordem a influência do farmacêutico na rede assistencial de saúde. O artigo tem como objetivo verificar em que medida a inserção dos farmacêuticos nas Unidades Básicas de Saúde (UBS) do País está associada à ampliação de aspectos estruturais das farmácias e à disponibilidade de medicamentos. Trata-se de estudo transversal, retrospectivo e analítico, que utilizou dados secundários do 2º (2014) e 3º (2017) ciclos da avaliação externa do Programa de Melhoria de Acesso e da Qualidade da Atenção Básica (PMAQ-AB) e do Cadastro Nacional de Estabelecimentos de Saúde (CNES). Os resultados mostraram importante centralização na dispensação de medicamentos ao longo do 2º e 3ºs ciclos PMAQ-AB. Em contrapartida, identificou-se melhora nos aspectos estruturais nas farmácias das UBS e incremento tanto na disponibilidade média de medicamentos como no total de UBS com disponibilidade de medicamentos ≥80%. Tais avanços foram ainda maiores na existência de farmacêutico cadastrado na UBS. Evidenciou-se a relevância do farmacêutico na APS no Sistema Único de Saúde, uma vez que sua presença potencializa tanto a disponibilidade de medicamentos como também propicia melhores condições estruturais dos serviços de farmácia da APS.
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Peixoto RT, Campos MR, Luiza VL, Mendes LV. The pharmacist in the Brazilian Primary Health Care: a comparative analysis between 2014 and 2017. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213308i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The pharmacist play a vital role in PHC. However, studies addressing how pharmacists influence the health care network are still scarce. We aim to verify to what extent the inclusion of pharmacists in PHC Units (UBS) in the country is associated with the expanded structural aspects of pharmacies and drug availability in Brazil. This cross-sectional, retrospective, and analytical study employed secondary data from cycles 2 (2014) and 3 (2017) of the external evaluation of the Improvement of Access and Quality of Primary Care Program (PMAQ-AB) and the National Register of Health Facilities (CNES) databases. The results showed an essential centralization in drug dispensing over PMAQ-AB cycles 2 and 3. In contrast, we identified an improvement in the structural aspects of the UBS pharmaceutical services and an increase in the mean drug availability and the total UBS with drug availability ≥ 80%. Such advances were even more significant in the presence of registered pharmacists at the UBS. We conclude by stating that the presence of pharmacists in the PHC of the Unified Health System (SUS) enhances drug availability and provides better structural conditions for PHC pharmacy services.
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OUP accepted manuscript. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Garabeli AA, Benetoli A, Halila GC, Machinski I, Tonin FS, Fernandez-Llimos F, Pontarolo R. Mapping community pharmacy services in Brazil: a scoping review. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Dorati CM, Mordujovich Buschiazzo P, Marín GH, Buschiazzo HO, Rojas-Cortés R, Alfonso Arvez MJ, Cardozo JM, Marin D, Hernández de Hernández GI, Maldonado NL, Piva HM, Rego J, Dussault S, Velandia LP, Porrás A, Castro JL. [Indicators of rational prescription of medicines: feasibility of application in institutions in the AmericasIndicadores de prescrição racional de medicamentos: viabilidade de aplicação em instituições das Américas]. Rev Panam Salud Publica 2021; 45:e152. [PMID: 34987559 PMCID: PMC8699123 DOI: 10.26633/rpsp.2021.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Evaluate the feasibility of monitoring the quality of use of medicines in health institutions in countries of the Region of the Americas by means of rational prescription indicators. METHODOLOGY A quantitative study of the use of medicines was conducted during the period 2016-2018. Rational prescription indicators were developed and selected in accordance with international reference values and the best available evidence for: 1) anti-inflammatory drugs: prescription of ibuprofen and/or naproxen as a percentage of all prescribed non-steroidal anti-inflammatory drugs; 2) oral antidiabetics: metformin as a percentage of all prescribed antidiabetics, and metformin and/or sulfonylureas as a percentage of all prescribed antidiabetics; 3) insulins: crystalline insulin and NPH as a percentage of total prescribed insulins; and 4) antihypertensive drugs: angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs-II), and thiazide diuretics as a percentage of all prescribed antihypertensives. The defined daily dose (DDD) per 1 000 inhabitants was used as a measure of consumption per institution. RESULTS Prescription of metformin as a percentage of all antidiabetics was lower than the value of the reference indicator (27.9%-67.6% vs. 88%), while the prescription of metformin and/or a sulfonylurea was comparable with that value (80.9%-97.5% vs. 88%). The values of NPH, crystalline, and NPH/crystalline insulin in relation to all prescribed insulins were variable with respect to the reference indicator (37.1%-100% vs. 75%). Prescription of ibuprofen and naproxen was below the value of the indicator (20%-50% vs. 80%). The percentage of ACE inhibitors, ARBs, and thiazides with respect to all antihypertensives ranged from 65.2%-77.2% to 65%, consistent with the value of the proposed indicator. CONCLUSIONS The feasibility of applying the selected and constructed indicators of rational prescription was demonstrated. These indicators provide useful information for analyzing the quality of prescription in health institutions in countries in the Region and are a useful tool for periodically monitoring it.
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Affiliation(s)
- Cristian Matías Dorati
- Centro Universitario de Farmacología (CUFAR).Universidad Nacional de La PlataLa PlataArgentinaCentro Universitario de Farmacología (CUFAR). Universidad Nacional de La Plata, La Plata, Argentina.
| | - Perla Mordujovich Buschiazzo
- Centro Universitario de Farmacología (CUFAR).Universidad Nacional de La PlataLa PlataArgentinaCentro Universitario de Farmacología (CUFAR). Universidad Nacional de La Plata, La Plata, Argentina.
| | - Gustavo H. Marín
- Centro Universitario de Farmacología (CUFAR).Universidad Nacional de La PlataLa PlataArgentinaCentro Universitario de Farmacología (CUFAR). Universidad Nacional de La Plata, La Plata, Argentina.
| | - Héctor O. Buschiazzo
- Centro Universitario de Farmacología (CUFAR).Universidad Nacional de La PlataLa PlataArgentinaCentro Universitario de Farmacología (CUFAR). Universidad Nacional de La Plata, La Plata, Argentina.
| | - Robin Rojas-Cortés
- Organización Panamericana de la SaludWashington DCEstados Unidos de AméricaOrganización Panamericana de la Salud, Washington DC, Estados Unidos de América.
| | - María José Alfonso Arvez
- Dirección Nacional de Vigilancia SanitariaAsunciónParaguayDirección Nacional de Vigilancia Sanitaria, Asunción, Paraguay.
| | - José M. Cardozo
- Dirección Nacional de Vigilancia SanitariaAsunciónParaguayDirección Nacional de Vigilancia Sanitaria, Asunción, Paraguay.
| | - Danini Marin
- Ministerio de SaludBelmopánBeliceMinisterio de Salud, Belmopán, Belice.
| | - Gilda I. Hernández de Hernández
- Instituto Salvadoreño del Seguro SocialSan SalvadorEl SalvadorInstituto Salvadoreño del Seguro Social, San Salvador, El Salvador.
| | - Noemi Lugo Maldonado
- Secretaría de SaludCiudad de MéxicoMéxicoSecretaría de Salud, Ciudad de México, México.
| | - Hugo Marín Piva
- Caja Costarricense de Seguro SocialSan JoséCosta RicaCaja Costarricense de Seguro Social, San José, Costa Rica.
| | - José Rego
- Hospital Docente Dr. Salvador AllendeLa HabanaCubaHospital Docente Dr. Salvador Allende, La Habana, Cuba.
| | | | | | - Analía Porrás
- Organización Panamericana de la SaludWashington DCEstados Unidos de AméricaOrganización Panamericana de la Salud, Washington DC, Estados Unidos de América.
| | - José Luis Castro
- Organización Panamericana de la SaludWashington DCEstados Unidos de AméricaOrganización Panamericana de la Salud, Washington DC, Estados Unidos de América.
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Galappatthy P, Ranasinghe P, Liyanage CK, Wijayabandara MS, Mythily S, Jayakody RL. WHO/INRUD Core drug use indicators and commonly prescribed medicines: a National Survey from Sri Lanka. BMC Pharmacol Toxicol 2021; 22:67. [PMID: 34711271 PMCID: PMC8555184 DOI: 10.1186/s40360-021-00535-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Identification of internationally comparable indicators of medicines use are important for a country to implement strategies and regulations to improve usage of medicines. Sri Lanka established a new National Medicines Regulatory Authority in 2015 and this survey evaluated the medication use indicators in Sri Lanka, according to the International Network on Rational Use of Drugs (INRUD), prior to its implementation. Methods This descriptive-cross-sectional study was conducted in 80 pharmacies, representing all 25 districts of the country. Three pharmacy categories were included; privately owned pharmacies, ‘Rajya Osusala’ pharmacies operated by the State Pharmaceuticals Corporation (SPC) of Sri Lanka and SPC Franchisee pharmacy outlets. Selection of pharmacies from respective districts were done proportionate to estimated population. Data were collected to identify WHO/INRUD core drug use indicators and the commonly prescribed medicines. Results Total of 2328 prescriptions were included (‘Rajya Osusala 559; SPC Franchise 711; private pharmacies 1058). Altogether 7,255 medicines were prescribed, and the 3 most commonly prescribed medicines were atorvastatin, losartan and metformin. Average number of medicines per encounter was 3.1±1.9 (Median: 3; range 1-12) Highest average number of medicines per encounter was reported in prescriptions received at ‘Rajya Osusala’ pharmacies (3.6±2.2), significantly higher than in other categories of pharmacies (p<0.001). Percentage of medicines prescribed by generic name was only 35.5%, highest at the ‘Rajya Osusala’ pharmacies (40.6%), significantly higher than other categories of pharmacies. The overall percentage of medicines prescribed from essential medicine list (EML) was 68.8%, without any significant variation between different categories of pharmacies. The percentage of medicines actually dispensed and accurately labelled were 92.4 and 98.5% respectively. Conclusions The average number of medicines per encounter was higher than the WHO recommended value but the usage of antibiotic and injectable drugs were within recommended standards. Generic prescribing, was very much lower. The EML prescribing, labelling and percentage dispensed medicines fared much better although lower than the WHO recommended 100% compliance. This island wide study has provided national wide data before the implementation of key changes in regulation of medicines in Sri Lanka and a repeat survey will be useful to identify impact of the new legislations. Supplementary Information The online version contains supplementary material available at 10.1186/s40360-021-00535-5.
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Affiliation(s)
- P Galappatthy
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
| | - P Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka.
| | - C K Liyanage
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
| | - M S Wijayabandara
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
| | - S Mythily
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
| | - R L Jayakody
- Department of Pharmacology, Faculty of Medicine, University of Colombo, No 25, Kynsey Road, Colombo, 08, Sri Lanka
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da Bernardo NLM, Soares L, Leite SN. A Sociotechnical Approach to Analyze Pharmaceutical Policy and Services Management in Primary Health Care in a Brazilian Municipality. PHARMACY 2021; 9:39. [PMID: 33673370 PMCID: PMC8006000 DOI: 10.3390/pharmacy9010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022] Open
Abstract
The decentralization of the Brazilian health system required that municipalities took responsibility for the local Pharmaceutical Policy and Services (PPS) system. This article presents and analyses an innovative experience of diagnosis of municipal PPS as a sociotechnical system. We adopted a multi-methods approach and various data sources. Sociotechnical theory was the framework of the methodology of evaluation and design of systems, analyzing the External System (health system, stakeholders, financing) and Internal System (goals, management, workforce, infrastructure, processes, technology and culture). The "objective" component of the PPS system was identified as the central element. The lack of a unified objective and of a central coordination and unmanaged pharmaceutical services prevented integrated internal planning and planning with other sectors. Stakeholders and documents referred only to technical elements of the system: Infrastructure, technical process, and technology. The social components of the workforce and culture were not mentioned. The organizational culture established was the culture of isolation: "Each one does his own". The pharmacists working in the municipal health system did not know each other. There was no integration strategy between pharmacists and their work processes. Consequently, the municipal PPS had limited scope as a public policy. It had constrained the characteristics of PPS as a complex and open system. Understanding the municipal PPS as a sociotechnical system can push the development of a new level of policy and practice to ensure the population's right to the access to and rational use of medicines.
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Affiliation(s)
- Noemia Liege Maria da Bernardo
- School of Health Sciences, Universidade Federal de Santa Catarina, PPGFAR Universidade do Vale do Itajaí, Itajaí 88300000, Brazil; or
| | - Luciano Soares
- Department of Pharmaceutical Sciences, Universidade Federal de Santa Catarina, Florianópolis 88040000, Brazil;
| | - Silvana Nair Leite
- Department of Pharmaceutical Sciences, Universidade Federal de Santa Catarina, Florianópolis 88040000, Brazil;
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Core Prescribing Indicators and the Most Commonly Prescribed Medicines in a Tertiary Health Care Setting in a Developing Country. Adv Pharmacol Pharm Sci 2021; 2021:6625377. [PMID: 33564747 PMCID: PMC7867447 DOI: 10.1155/2021/6625377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/06/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
Irrational prescribing is common, especially in developing countries. It is important to identify the magnitude of irrational use, to take necessary steps to promote rational prescribing. We identified core prescribing indicators and commonly prescribed medicines at ward settings (IW) and outpatients' clinics (OPC) in a tertiary care hospital in Sri Lanka. A descriptive cross-sectional study was carried out at IW and OPC settings. Prescriptions were obtained from 5 major specialties (Clinical Medicine (CM), Gynaecology and Obstetrics (GO), Paediatrics, Psychiatry, and Surgery). The WHO core prescribing indicators were used to describe the pattern of prescribing, and the most commonly prescribed medicines were identified. A total of 1,318 prescriptions were analyzed. The five most commonly prescribed medicines were paracetamol (31.0%), omeprazole (20.6%), folic acid (18.3%), atorvastatin (16.2%), and salbutamol (15.3%). The average number of medicines per encounter was 4.8 ± 3.6 (IW: 5.7 ± 4; OPC: 3.8 ± 2.8; p < 0.001), with the highest IW (7.8 ± 4.2) and OPC (7.8 ± 2.7) values were from CM, being significantly higher than all other disciplines (p < 0.05). Percentage encounters with an antibiotic or an injection was 26.4% and 30.1%, respectively, with IW being significantly higher than OPC (p < 0.001). Percentage of medicines prescribed by generic name and from the essential medicine list (EML) was 90.1% and 91.1%, respectively, with no significant IW and OPC difference. In conclusion, a high degree of polypharmacy was noted. The use of injectable medicines, prescribing from the EML, and generic name prescribing was satisfactory; however, overall rational prescribing needs further improvement. Further investigation into the degree of rational prescribing associating it with clinical information will be important.
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Lopes LC, Godman B, Bergamaschi CDC, Barberato-Filho S, Silva MT. Editorial: New Horizons in Health-Promoting Technologies: From Development to Rational Use. Front Pharmacol 2020; 11:1180. [PMID: 32848783 PMCID: PMC7424042 DOI: 10.3389/fphar.2020.01180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luciane Cruz Lopes
- Pharmaceutical Science Graduate Course, University of Sorocaba, Sorocaba, Brazil
| | - Brian Godman
- Karolinska University Hospital Huddinge, Karolinska Institutet (KI), Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
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Gonzaga de Andrade Santos TN, Mendonça da Cruz Macieira G, Cardoso Sodré Alves BM, Onozato T, Cunha Cardoso G, Ferreira Nascimento MT, Saquete Martins-Filho PR, Pereira de Lyra D, de Oliveira Filho AD. Prevalence of clinically manifested drug interactions in hospitalized patients: A systematic review and meta-analysis. PLoS One 2020; 15:e0235353. [PMID: 32609783 PMCID: PMC7329110 DOI: 10.1371/journal.pone.0235353] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS This review aims to determine the prevalence of clinically manifested drug-drug interactions (DDIs) in hospitalized patients. METHODS PubMed, Scopus, Embase, Web of Science, and Lilacs databases were used to identify articles published before June 2019 that met specific inclusion criteria. The search strategy was developed using both controlled and uncontrolled vocabulary related to the following domains: "drug interactions," "clinically relevant," and "hospital." In this review, we discuss original observational studies that detected DDIs in the hospital setting, studies that provided enough data to allow us to calculate the prevalence of clinically manifested DDIs, and studies that described the drugs prescribed or provided DDI adverse reaction reports, published in either English, Portuguese, or Spanish. RESULTS From the initial 5,999 articles identified, 10 met the inclusion criteria. The pooled prevalence of clinically manifested DDIs was 9.2% (CI 95% 4.0-19.7). The mean number of medications per patient reported in six studies ranged from 4.0 to 9.0, with an overall average of 5.47 ± 1.77 drugs per patient. The quality of the included studies was moderate. The main methods used to identify clinically manifested DDIs were evaluating medical records and ward visits (n = 7). Micromedex® (27.7%) and Lexi-Comp® (27.7%) online reference databases were commonly used to detect DDIs and none of the studies evaluated used more than one database for this purpose. CONCLUSIONS This systematic review showed that, despite the significant prevalence of potential DDIs reported in the literature, less than one in ten patients were exposed to a clinically manifested drug interaction. The use of causality tools to identify clinically manifested DDIs as well as clinical adoption of DDI lists based on actual adverse outcomes that can be identified through the implementation of real DDI notification systems is recommended to reduce the incidence of alert fatigue, enhance decision-making for DDI prevention or resolution, and, consequently, contribute to patient safety.
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Affiliation(s)
| | - Givalda Mendonça da Cruz Macieira
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Bárbara Manuella Cardoso Sodré Alves
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Thelma Onozato
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Geovanna Cunha Cardoso
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Mônica Thaís Ferreira Nascimento
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Divaldo Pereira de Lyra
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Alfredo Dias de Oliveira Filho
- Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
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Andrade HS, Guimarães EAA, Obreli Neto PR, Pereira ML, Zanetti MOB, Reis TM, Baldoni AO. Conceptual aspects, impact, and state of the art of dependent prescription in Brazil: narrative review. Porto Biomed J 2020; 5:e66. [PMID: 33299947 PMCID: PMC7722403 DOI: 10.1097/j.pbj.0000000000000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/29/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nonmedical prescription is recognized in several countries as an excellent strategy in facing emerging demands that put a strain on the health system. It is a practice carried out by professionals who are not doctors and who, after obtaining specific qualifications and legal authorization, can prescribe medication and curatives. In Brazil, although there is already a legal subsidy for prescription in some professions, it is still an underdeveloped activity with few studies. OBJECTIVE This study aimed to describe the conceptual aspects and state of the art of this type of prescription in Brazil. METHODS It is a narrative review of the literature that included national and international regulations related to the subject, as well as available articles, published in electronic journals in different databases. Key terms used were nonmedical prescription, nursing prescription, and pharmaceutical prescription. RESULTS It was evidenced that nonmedical prescription has ample potential for improving the quality of care and the health conditions of patients. One can highlight as positive results the improvement of work satisfaction and self-confidence of those who have developed this practice; improvement of teamwork reported by other professionals due to the reduction of work overload; greater patient satisfaction in relation to access; and care provided by prescribers. CONCLUSIONS It is understood that there are many challenges for the consolidation of this activity in Brazil and that its success depends on a joint effort of health and educational institutions, health professionals, and patients.
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Affiliation(s)
- Heuler S Andrade
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Eliete A A Guimarães
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Paulo R Obreli Neto
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Mariana L Pereira
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Maria O B Zanetti
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - Tiago M Reis
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
| | - André O Baldoni
- Universidade Federal de São João Del-Rei (UFSJ) - CCO - Divinópolis, Minas Gerais, Brazil
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Garcia MM, Azevedo PS, Mirelman A, Safatle LP, Iunes R, Bennie MC, Godman B, Guerra Junior AA. Funding and Service Organization to Achieve Universal Health Coverage for Medicines: An Economic Evaluation of the Best Investment and Service Organization for the Brazilian Scenario. Front Pharmacol 2020; 11:370. [PMID: 32351382 PMCID: PMC7175689 DOI: 10.3389/fphar.2020.00370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There are many health benefits since 31 years after the foundation of the National Health Service (NHS) in Brazil, especially the increase in life expectancy. However, family-income inequalities, insufficient funding, and suboptimal private sector-public sector collaboration are still areas for improvement. The efforts of Brazil to achieve universal health coverage (UHC) for medicines have resulted in increased public financing of medicines and their availability, reducing avoidable hospitalization and mortality. However, lack of access to medicines still remains. Due to historical reasons, pharmaceutical service organization in developing countries may have important differences from high-income countries. In some cases, developing countries finance and promote medicine access by using the public infrastructure of health care/medical units as dispensing sites and cover all costs of medicines dispensed. In contrast, many high-income countries use private community pharmacies and cover the costs of medicines dispensed plus a fee, which includes all logistic costs. In this study, we will undertake an economic evaluation to understand the funding needs of the Brazilian NHS to reduce inequalities in access to medicines through adopting a pharmaceutical service organization similar to that seen in many high-income countries with hiring/accrediting private pharmacies. METHODS We performed an economic evaluation of a model to provide access to medicines within public funds based on a decision tree model with two alternative scenarios public pharmacies (NHS, state-owned facilities) versus private pharmacies (NHS, agreements). The analysis assumed the perspective of the NHS. We identified the types of resources consumed, the amount, and costs in both scenarios. We also performed a budget impact forecast to estimate the incremental funding required to reduce inequalities in access to essential medicines in Brazil. FINDINGS The model without rebates for medicines estimated an incremental cost of US$3.1 billion in purchasing power parity (PPP) but with an increase in the average availability of medicines from 65% to 90% for citizens across the country irrespective of family income. This amount places the NHS in a very good position to negotiate extensive rebates without the need for external reference pricing for government purchases. Forecast scenarios above 35% rebates place the alternative of hiring private pharmacies as dominant. Higher rebate rates are feasible and may lead to savings of more than US$1.3 billion per year (30%). The impact of incremental funding is related to medicine access improvement of 25% in the second year when paying by dispensing fee. The estimate of the incremental budget in five years would be US$4.8 billion PPP. We have yet to explore the potential reduction in hospital and outpatient costs, as well as in lawsuits, with increased availability with the yearly expenses for these at US$9 billion and US$1.4 billion PPP respectively in 2017. INTERPRETATION The results of the economic evaluation demonstrate potential savings for the NHS and society. Achieving UHC for medicines reduces household expenses with health costs, health litigation, outpatient care, hospitalization, and mortality. An optimal private sector-public sector collaboration model with private community pharmacy accreditation is economically dominant with a feasible medicine price negotiation. The results show the potential to improve access to medicines by 25% for all income classes. This is most beneficial to the poorest families, whose medicines account for 76% of their total health expenses, with potential savings of lives and public resources.
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Affiliation(s)
- Marina Morgado Garcia
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
| | - Pamela Santos Azevedo
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
| | - Andrew Mirelman
- Centre for Health Economics, University of York, York, United Kingdom
| | - Leandro Pinheiro Safatle
- Department of Medicines Market Regulation - Brazilian Health Regulatory Agency (ANVISA), Brasília, Brazil
| | | | - Marion Clark Bennie
- Department of Pharmacoepidemiology, University of Strathclyde, Glasgow, United Kingdom
| | - Brian Godman
- Department of Pharmacoepidemiology, University of Strathclyde, Glasgow, United Kingdom
- Management School, University of Liverpool, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Augusto Afonso Guerra Junior
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
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Minaei H, Peikanpour M, Yousefi N, Peymani P, Peiravian F, Shobeiri N, Karimi Majd Z, Shamsaee J. Country Pharmaceutical Situation on Access, Quality, and Rational Use of Medicines: An Evidence from a middle-income country. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2020; 18:2191-2203. [PMID: 32184884 PMCID: PMC7059036 DOI: 10.22037/ijpr.2019.111636.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evaluation of pharmaceutical systems performance is an essential prerequisite for promoting evidence-based policy-making and improvement in health system performance. This study attempts to evaluate the performance of Iran pharmaceutical system based on the world health organization (WHO)'s indicators, including access, quality, and rational use of medicines. In this cross-sectional descriptive study, inspired by the instructions proposed by WHO, public and private pharmaceutical service-providers were evaluated in three dimensions and 16 indicators. Accordingly, eleven separate checklists were developed and, in terms of translation, face and content validity were certified by pharmaceutical sector's experts. Sampling was randomly carried out in five cities. Depending on the type of indicators, retrospective or prospective approaches was determined for data collection. The data were collected from April to November 2018 and analyzed by SPSS 24. The availability of targeted key medicines in various cities as well as in public and private pharmacies was 97.5% with no significant difference. Although the medicines cost was higher in private sectors than in public ones, they were affordable in both sectors. In quality indicators, public sectors enjoyed a higher level than the private sectors did. The average number of medicines per prescription in public pharmacies was 3.2 and it was 3.4 in private ones. On average, in public sectors 33% and 32% of outpatients received antibiotics and injectable medicines, respectively. Finally, 77% of medicines were prescribed by using their generic names and 25% of prescriptions were in accordance with key medicines list. This study reveals that the availability and affordability of targeted key medicines in Iran are in good condition; however, in terms of rational use of medicines, Iran fails to meet the standard levels.
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Affiliation(s)
- Hossein Minaei
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,H. M. and M. P. contributed equally to this work
| | - Mohammad Peikanpour
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,H. M. and M. P. contributed equally to this work
| | - Nazila Yousefi
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Peymani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Science, Shiraz, Iran
| | - Farzad Peiravian
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nikta Shobeiri
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Karimi Majd
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javad Shamsaee
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Araújo LU, Santos DF, Bodevan EC, Cruz HLD, Souza JD, Silva-Barcellos NM. Patient safety in primary health care and polypharmacy: cross-sectional survey among patients with chronic diseases. Rev Lat Am Enfermagem 2019; 27:e3217. [PMID: 31826159 PMCID: PMC6896818 DOI: 10.1590/1518-8345.3123.3217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 08/08/2019] [Indexed: 01/20/2023] Open
Abstract
Objective: to characterize and determine the polypharmacy prevalence in patients with chronic diseases and to identify the factors associated, in order to improvement of pharmaceutical care focused on patient safety. Methods: cross-sectional study included 558 patients, covered by primary health care, using a household and structured questionnaire. We analyzed the data on polypharmacy and its clinical and socioeconomic factors. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio. Results: the results showed that polypharmacy (consumption of four or more drugs) was of 37.6%. The prevalence ratio analyses identified independent variables associated with polypharmacy: age (3.05), economic strata (0.33), way of medication acquisition through a combination of out-of-pocket and Brazilian public health system (1.44), diabetes and hypertension (2.11), comorbidities (coronary artery disease 2.26) and hospital admission (1.73). In the analyses, inappropriate medication use of the 278 patients (≥ 65 years) was associated with polypharmacy (prevalence ratio 4.04). Conclusion: polypharmacy study becomes an opportunity to guide the strategies for the patient safety to promote the medication without harm in chronic diseases.
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Affiliation(s)
- Lorena Ulhôa Araújo
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Farmácia, Diamantina, Minas Gerais, Brazil
| | - Delba Fonseca Santos
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Farmácia, Diamantina, Minas Gerais, Brazil
| | - Emerson Cotta Bodevan
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Matemática e Estatística, Diamantina, Minas Gerais, Brazil
| | - Hellen Lilliane da Cruz
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Farmácia, Diamantina, Minas Gerais, Brazil
| | - Jacqueline de Souza
- Universidade Federal de Ouro Preto, Escola de Farmácia, Ouro Preto, Minas Gerais, Brazil
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Wogayehu B, Chisha Y, Tekabe B, Adinew A, Asefaw M. A cross sectional comparison of drug use indicators using WHO methodology in primary level hospitals participating in an Auditable Pharmaceutical Transactions and Services program versus non-APTS primary hospitals in Southern Ethiopia. PLoS One 2019; 14:e0223523. [PMID: 31589641 PMCID: PMC6779258 DOI: 10.1371/journal.pone.0223523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Ethiopian pharmaceutical sector has been facing inaccessibility and unaffordability to key essential medicines due to medicines diversion from the public to private health care facilities, lack of transparency, poor inventory management, and poor dispensing workflow. In an effort to improve the pharmaceutical sector, the government of Ethiopia in 2011 introduced Auditable Pharmaceutical Transactions and Services program. This study intended to compare drug use indicators in auditable and non-auditable primary level hospitals. METHODS A cross-sectional comparative study was conducted between January 2018 and December 2018 at primary level hospitals in southern Ethiopia: one with Auditable Pharmaceutical Transactions and Services (APTS) program; another without APTS (Non-APTS).WHO drug use indicators in auditable primary hospitals (n = 10) and similar non-auditable primary hospitals (n = 10) were compared. The prescribing indicators and average cost of medicines were evaluated retrospectively using 1000 prescriptions from each group. Patient care indicators were evaluated prospectively by interviewing and observing 1000 patients from each group. Patient satisfaction was assessed by interviewing 1000 patients from each group. Health care facilities were evaluated through observation. We performed descriptive analysis, t-test, logistic regression, Mann-Whitney U test and linear regression using SPSS version 20.0. RESULTS The mean consultation time in auditable and non-auditable hospitals was found to be 6.5 minutes and 3.46 minutes, respectively. The average dispensing time in auditable and non-auditable hospitals was found to be 6.6 minutes and 1.02 minutes, respectively.The proportion of drugs actually dispensed was 97.59% in APTS facilities and 76.44% in the non-auditable facilities with the lowest value seen in a non-auditable facility (51.65%). The average number of drugs per prescription was 2.32 (±1.26) and 2.84 (±1.17) in auditable and non-auditable facilities, respectively. The level of patient satisfaction on the convenience of pharmacy location, information on contraindications, availability of drugs and amount of time for counseling was significantly higher in the auditable facilities than the non-auditable facilities (p<0.001). CONCLUSIONS This study revealed that patient care indicator values, the level of patient satisfaction on the pharmacy services and health facility indicator values were significantly better in APTS than Non-APTS primary level hospitals. Most of prescribing indicators and labeling practices were not met WHO stated standard in both auditable and non-auditable facilities.This indicates that the auditable programshould include additional strategies to reverse the existing irrational prescribing and inadequate labeling practices.
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Affiliation(s)
- Biruk Wogayehu
- Department of Pharmacy, Arbaminch College of Health Sciences, Arbaminch, Ethiopia
- * E-mail:
| | - Yilma Chisha
- Department of Public Health, Arbaminch University, Arbaminch, Ethiopia
| | - Be’emnetu Tekabe
- Department of Public Health, Arbaminch University, Arbaminch, Ethiopia
| | - Ayalew Adinew
- Pharmacy Service, Federal Ministry of Health, Addis Ababa, Ethiopia
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Abstract
Advances of nanotechnology led to the development of nanoparticulate systems with many advantages due to their unique physicochemical properties. The use of iron-oxide magnetic nanoparticles (IOMNPs) in pharmaceutical areas increased in the last few decades. This article reviews the conceptual information about iron oxides, magnetic nanoparticles, methods of IOMNP synthesis, properties useful for pharmaceutical applications, advantages and disadvantages, strategies for nanoparticle assemblies, and uses in the production of drug delivery, hyperthermia, theranostics, photodynamic therapy, and as an antimicrobial. The encapsulation, coating, or dispersion of IOMNPs with biocompatible material(s) can avoid the aggregation, biodegradation, and alterations from the original state and also enable entrapping the bioactive agent on the particle via adsorption or covalent attachment. IOMNPs show great potential for target drug delivery, improving the therapy as a consequence of a higher drug effect using lower concentrations, thus reducing side effects and toxicity. Different methodologies allow IOMNP synthesis, resulting in different structures, sizes, dispersions, and surface modifications. These advantages support their utilization in pharmaceutical applications, and getting suitable drug release control on the target tissues could be beneficial in several clinical situations, such as infections, inflammations, and cancer. However, more toxicological clinical investigations about IOMNPs are necessary.
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Akerman M, de Freitas O. National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM): evaluation of pharmaceutical services in the primary health care. Rev Saude Publica 2017; 51:1s. [PMID: 29160468 PMCID: PMC5676376 DOI: 10.11606/s1518-8787.201705100supl2ed] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Marco Akerman
- Departamento de Política, Gestão e Saúde. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Osvaldo de Freitas
- Departamento de Ciências Farmacêuticas. Faculdade de Ciências Farmacêuticas. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
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