[Demand for dispensing of medicines without medical prescription]. / Demanda de medicamentos de prescripción sin receta médica.

OBJECTIVES: To study the request for drugs and their dispensing without the necessary prescription form. DESIGN: Cross-sectional, observational study. SETTING: Volunteer community pharmacies in Spain. MAIN MEASUREMENTS: Percentages of request and dispensation of drugs without prescription. Reasons given by people requesting the medicines and pharmacists' reasons for dispensing them. RESULTS: 11.1% of prescription drugs were requested without a prescription form: 69.7% of these requests were for chronic medication or acute treatment and 20% were for self-medication. The drugs without prescription form were dispensed in 10.8% and refused in 0.3% of cases. The reasons given by pharmacists for dispensing without the compulsory prescription form were: "drugs recommended by a doctor" (33.3%), "advance on prescriptions" (24.1%), and "the pharmacist knew the patient's pharmaco-therapeutic record" (17.5%). CONCLUSIONS: Dispensing drugs without the necessary prescription form is a very frequent practice (10.8%) and is not restricted to any particular drug therapy group. Doctors, dentists, nurses, pharmacists, patients and health service management must all assume their share of responsibility if this problem is to be solved. The system of prescription and dispensing of chronic medicine (repeat prescription in long-term treatment) needs to be improved and strengthened.

Demanda de medicamentos de prescripción sin receta médica / Demand for dispensing of medicines without medical prescription

Objetivo. Estudiar la demanda y la dispensación de medicamentos de prescripción sin la correspondiente receta. Diseño. Estudio observacional, transversal. Emplazamiento. Farmacias comunitarias voluntarias de España. Mediciones principales. Porcentajes de demanda y dispensación de medicamentos de prescripción sin la receta; razones alegadas por los usuarios para la demanda; motivos del farmacéutico para dispensar. Resultados. De los medicamentos que necesitan receta, el 11,1% se solicitó sin ella, correspondiéndose en el 69,7% de los casos con tratamiento crónico o tratamiento médico urgente. El 20% fue automedicación. Se dispensaron sin receta el 10,8% y se negó el 0,3%. Los motivos alegados por el farmacéutico para dispensar sin la receta obligatoria fueron: recomendado por un médico (33,3%), adelantos de recetas (24,1%) y conocimiento previo de la historia farmacoterapéutica del paciente en el 17,5%. Conclusiones. La dispensación de medicamentos que precisan receta sin cumplir este requisito es un hecho frecuente (10,8%) en las farmacias españolas. Afecta a todos los grupos terapéuticos y no es característica de un grupo de pacientes determinados. Para resolver este problema es necesario que todos los implicados (médicos, odontólogos, personal de enfermería, farmacéuticos, pacientes y la propia administración) asuman su parte de responsabilidad. Se debe mejorar y potenciar el sistema de prescripción y dispensación de los medicamentos crónicos (prescripción repetida en tratamientos de larga duración)

Objectives. To study the request for drugs and their dispensing without the necessary prescription form. Design. Cross-sectional, observational study. Setting. Volunteer community pharmacies in Spain. Main measurements. Percentages of request and dispensation of drugs without prescription. Reasons given by people requesting the medicines and pharmacists' reasons for dispensing them. Results. 11.1% of prescription drugs were requested without a prescription form: 69.7% of these requests were for chronic medication or acute treatment and 20% were for self-medication. The drugs without prescription form were dispensed in 10.8% and refused in 0.3% of cases. The reasons given by pharmacists for dispensing without the compulsory prescription form were: "drugs recommended by a doctor" (33.3%), "advance on prescriptions" (24.1%), and "the pharmacist knew the patient's pharmaco-therapeutic record" (17.5%). Conclusions. Dispensing drugs without the necessary prescription form is a very frequent practice (10.8%) and is not restricted to any particular drug therapy group. Doctors, dentists, nurses, pharmacists, patients and health service management must all assume their share of responsibility if this problem is to be solved. The system of prescription and dispensing of chronic medicine (repeat prescription in long-term treatment) needs to be improved and strengthened

Oliguria y elevación de la creatinfosfocinasa secundaria a citalopram / Oliguria and rise in creatine phosphokinase as a side-effect of cytalopram

No disponible

[Management of vaccinations and prophylaxis of international travellers from community pharmacy (VINTAF study)]. / Seguimiento desde la farmacia comunitaria de la vacunación y la quimioprofilaxis de los viajeros internacionales. Estudio VINTAF.

OBJECTIVES: To improve and evaluate the travel advice by community pharmacists. DESIGN: Cross-sectional and prospective study. SETTING: Community pharmacies from Asturias, Barcelona, Madrid and Valencia. PARTICIPANTS: 483 travellers to high health risk countries who visit the community pharmacies and were agreed with the aims of the study. METHOD: Community pharmacists gave information regarding immunization and prophylaxis about travel-related disease according to the destination, type and duration of travel and other features of the tourist (age, taking medicines, diseases, etc.). MAIN MEASUREMENTS: Destination, adherence to the prophylaxis and vaccinations recommended, adverse effects and diseases the tourists have in the travel and one month after they are back. RESULTS: Only 6.3% of the travellers were effective vaccinated and took prophylaxis (all vaccines and prophylaxis according to the destination). 36.2% of the travellers experienced an illness while abroad. The commonest disease were travellers' diarrhoea (15.7%). The pharmacists were the only source of information about sunscreens, repellents, and other sanitary goods. CONCLUSIONS: The community pharmacists can give accurate information regarding immunization and prophylaxis about international travels. It is necessary to improve the communication between family physician, the tropical travel clinic and community pharmacists in order to improving compliance. It is necessary keep the bureaucratic barriers away to get this kind of drugs. The international tourists still travel without the necessary vaccines and prophylaxis to the high health risk areas.

Seguimiento desde la farmacia comunitaria de la vacunación y la quimioprofilaxis de los viajeros internacionales. Estudio VINTAF / Management of vaccinations and prophylaxis of international travellers from community pharmacy (VINTAF study)

Objetivos. Mejorar la captación de viajeros a zonas de riesgo sanitario por los farmacéuticos comunitarios y evaluar dicha actuación sanitaria. Diseño. Estudio observacional prospectivo. Emplazamiento. Farmacias comunitarias de Asturias, Barcelona, Madrid y Valencia. Participantes. Un total de 483 viajeros a zonas de riesgo que iban a las farmacias participantes y que dieron su consentimiento verbal para participar en el estudio. Intervenciones. Asesoramiento por parte de los farmacéuticos comunitarios a los viajeros sobre las vacunas, la quimioprofilaxis y el botiquín de viaje necesarios según el destino, la duración y las características de los viajeros (medicación concomitante, embarazo, comorbilidades, edad, etc.).Mediciones principales. Destino y duración del viaje, cumplimiento de vacunas y/o quimioprofilaxis recomendadas, reacciones adversas a ellas. Problemas de salud durante el viaje y al mes del regreso. Resultados. El 6,3 por ciento de los viajeros estaba protegido correctamente (todas las vacunas y quimioprofilaxis que necesitaban). El 36,2 por ciento de los viajeros tuvieron algún problema de salud durante el viaje, siendo la diarrea el más frecuente (15,7 por ciento). El botiquín de viaje fue recomendado sobre todo por el farmacéutico comunitario (89-95 por ciento).Conclusiones. Los farmacéuticos convenientemente formados están capacitados para asesorar a los viajeros sobre las vacunas, la quimioprofilaxis y el botiquín de viaje necesarios. Hay que mejorar la coordinación con los departamentos de medicina exterior y los médicos de familia correspondientes. Conviene disminuir las trabas burocráticas (visado de inspección) para la obtención de estos medicamentos. Los viajeros internacionales aún no van correctamente vacunados a las zonas de riesgo sanitario (AU)

¿Adolescentes o menores de edad? / Adolescents or under-age?

No disponible

Problemas acuciantes en atención primaria / Pressing problems in Primary Care

No disponible

[Drug substitutions in the pharmacy offices of the Community of Madrid]. / Sustituciones de medicamentos en oficinas de farmacia de la Comunidad de Madrid.

OBJECTIVES: To evaluate the stock failure and substitutions of drugs in community pharmacies. DESIGN: A descriptive cross-sectional study. SETTING: Community pharmacies in Madrid. PARTICIPANTS: Nine pharmacies which voluntarily accepted to work in this study. The data were collected during four months in a year. MEASUREMENTS AND MAIN RESULTS: The total stock failure was 1.72%. New pharmaceuticals correspond with 10.73% of all stock failure. The pharmacists substituted the 31.04% of the total stock failure. Antibiotics and chemotherapeutics were the drugs most substituted with 46.98% of all substitutions. Patients accepted to substitute 78.39% of the proposals of the pharmacists. CONCLUSIONS: High percentage of the stock failure belongs to new brand pharmaceuticals. In this study there were few substitutions (0.53%) of the total dispensings. The drugs most substituted were antibiotics and chemotherapeutics. Substitutions depend on pharmacists' wishes and on patients' approval.

[Continuity and longitudinal aspects of care in general practice in four European countries]. / Continuidad y longitudinalidad en medicina general en cuatro países Europeos.

BACKGROUND: The objective of the study was to compare continuity and longitudinality of care in general practice in four European countries with a public salary model. METHODS: Descriptive and prospective study. 63 general practitioners/family physicians working in public health centers registered all encounters (direct and indirect) over a period of one week in Spain, Finland, Portugal and Sweden. RESULTS: 92% of the contacts were office encounters: 75% were direct (face to face), the average number of encounters per doctor, per week was 103. The principal problem was chronic in 42% of cases and acute in 31%. The physician has previous knowledge of the principal problem in 63% of the encounters and previous knowledge of concurrent problems in 79%. In 66% of cases the doctor has previous knowledge of the patient relatives. CONCLUSIONS: The level of continuity and longitudinality is variable; from high to low: Portugal, Spain, Sweden and Finland. In Spain the duration of the encounter is short and repeated prescription are infrequent. In Portugal there are waitings lists which implies low accessibility for acute problems. In Finland general practitioners have no patients lists and the care is des-personalized. In Sweden there are waiting lists and high use of telephone encounters.

[Evaluation of computerized medical records]. / Evaluación de historias clínicas informatizadas.

BACKGROUND: A wide and expensive supply of electronic medical records obliged us to evaluate them before selecting one. In this study a questionnaire was used to evaluate computerized medical records. MATERIAL AND METHODS: Descriptive and prospective study with personal interviews in which a questionnaire was used, that had been previously published. RESULTS: The 12 questionnaires were completed in 99%. The greatest difficulty for answering the questions was the medical terminology. Four of the twelve computer programs were designed for hospitals, another 4 were designed for health centers and the rest were designed for both hospitals and health centers. The preventive and social data and annex were the more scarce of the elements (47%). Postsells services (100%), the ICE-9-CM classification (75%) and medicals data (51%) were the more frequent elements. CONCLUSIONS: In Spain there are few medical records regulated, and computerized designers do not have a standard model. The sellers of medical record softwares don't have knowledge of medical terminology. Medical record software programs are not designed for specific health settings (health centers or hospitals).

[Consultations with third parties in general medicine]. / Consultas por terceras personas en medicina general.

OBJECTIVE: To quantify and describe consultations carried out with third parties in General Medicine. DESIGN: Prospective and descriptive study. SETTING: Three General Medical consulting rooms in INSALUD's Health Area IV, Madrid. PARTICIPANTS: All those consultations carried out with third parties from 15 February 1993 until 200 cases per doctor had been reached. INTERVENTION AND MAIN RESULTS: The data of the patient, the third party and the meeting were recorded for a total of 603 consultations using a third party. These consultations made up 18% of the total number at the three consulting rooms. According to the criterion of the doctor involved, more than half of these consultations were not clinically justified. People attended fundamentally to obtain prescriptions (76%), notes for short periods of time off work (9.6%) and referral to specialists (8.9%). The third party was usually a woman (62%) and spouse or mother of the patient (45 and 28%, respectively). CONCLUSIONS: In the three General Medical consulting rooms studied, which were organized on the traditional model, third-party consultations are common and clinically unjustified in more than half the instances. These consultations are due fundamentally to difficulties of access to Primary Care services. Increasing the General Practitioner's availability for on-demand consultations could lessen this high incidence of third-party consultations.

[Primary care research: the content of articles published in scientific journals]. / Investigación en atención primaria: contenido de los artículos publicados en revistas científicas.

OBJECTIVE: The quantifying, by subject area, of research published in scientific journals on primary health care, in five different cultural/geographic areas. DESIGN: Descriptive study. SETTING: Scientific journals on primary health care. PARTICIPANTS: Original articles published in 1991 in the following journals on primary health care (general practice): Atención Primaria, Canadian Family Physician, Family Practice, Journal of Family Practice and Scandinavian Journal of Primary Health Care. INTERVENTIONS AND MAIN RESULTS: The classification adopted here was that used in the research into primary health care by the Canadian Association of Family Physicians. The five journals between them published 263 original articles. Articles on organisation and provision of health services constituted 42% of the total; next in frequency were articles on epidemiology (18%) and on psychosocial concerns. Methodological studies and research into training and professional kills represent a scarce 6% and 8% respectively. CONCLUSIONS: The most commonly occurring subject in primary health care research is research on services. In the future it would be desirable to develop other areas (the clinical and psycho-social areas, methodology, and training).