Inclusion of Potentially Inappropriate Medicines for the Older Adults in the Brazilian Consensus in Accordance with International Criteria.

AIM: The use of potentially inappropriate medications (PIM) can impair the safety and effectiveness of pharmacotherapy in the older adults. Thus, several countries have lists and criteria to indicate these drugs, in order to promote the safety of prescription and the rational use of drugs in geriatric practice. OBJECTIVE: This study sought to contribute to the inclusion of PIM for the older adults in the Brazilian criterion (BCPIM/2016) - current list used in Brazil and reference in Latin American countries - through expert approval, comparing convergences with international AGS lists BEERS/2019, STOPP/START/2015, PRISCUS/2010 and EU (7)-PIM List/2015. METHODS: This is a critical analysis of potentially inappropriate medications for use in the older adults present in the list of Brazilian criteria, together with their absence of some drugs that are on international lists (BEERS/2019; Priscus/2010; Stopp/Start/2015; EU7-PIM list/2015). This study was subdivided in 6 stages: selection of national criteria, classification of drugs according to Anatomic Therapeutic Chemical, comparison between BCPIM/2016 with international lists, selection of drugs not included in the Brazilian list, selection of experts for evaluation and suggestions about drugs not included in the Brazilian list and the synthesis of the analysis carried out by the specialists. RESULTS: We cataloged 66 drugs marketed in Brazil that are on international lists, but not in the Brazilian consensus, of which 24 were validated by experts as necessary for inclusion in this consensus, considering the risks and benefits in health care for the older adults. However, the lists have divergences and similarities between them. We observed that eight drugs were common to all criteria studied, mainly related to the nervous system. CONCLUSION: The results suggest the need for periodic validation of PIM against research clinics, new drugs and the inclusion of this agenda by the Ministry of Health in the revision of the National List of Essential Drugs and other Clinical Protocols and Therapeutic Prescription Guidelines for the older adults.

Dispensing of psychotropic drugs in the Brazilian capital city before and during the COVID-19 pandemic (2018-2020).

Objective: Evaluate the data on the psychotropic drugs dispensed by private community pharmacies before and during the SARS-CoV-2 pandemic. Methods: This cross-sectional study compared the quarterly and annual consumption of psychotropic drugs per Defined Daily Dose per 1000 inhabitants-day (DHD). Interrupted time series were also constructed to expose changes in the consumption pattern in the periods before and after March 2020. Results: Among the 20 most consumed psychoactive drugs, 12 were antidepressants, for example, escitalopram (DHD 7.996 and 10.626; p < 0.001), and sertraline (DHD 6.321 and 8.484; p < 0.001), in addition to the hypnotic zolpidem (DHD 6.202 and 8.526; p < 0.001). The time series reveals (R 2 value) a variation in drug dispensing, in DHD values, during the pandemic. Conclusion: Despite the higher variance, a significant increase is clearly seen in the consumption trends of psychoactive drugs, particularly antidepressants, consistent with the pandemic's influence on the general population's mental health.

Social participation in the health technology incorporation process into Unified Health System.

OBJECTIVE: To describe the current process of social participation in the incorporation of health technologies in Brazil, within the context of the Unified Health System (SUS). METHODS: A descriptive study was conducted based on the analysis of official records of the actions of the National Committee for Health Technology Incorporation into Unified Health System and its website, from the beginning of its activities in January 2012 until December 2017. RESULTS: The findings indicate that, in Brazil, there are legal instruments related to social participation in health, including the health technology assessment (HTA) field. However, its implementation is relatively recent and has been carried out gradually. In addition to the legal instruments (National Health Council representative, public consultation and public hearing forecast), other information and transparency strategies have been shown to be allied to social participation in the incorporation of health technologies. However, activities such as legally provided public hearings have not yet been carried out. CONCLUSIONS: Several actions to foster social participation were developed over the analyzed period, but they need to be evaluated in order to maintain or improve them. In addition, there is a need for more qualified social participation in the various existing spaces, including those prescribed by law.

Characterization of the selection of medicines for the Brazilian primary health care.

OBJECTIVE: To characterize the process of selection of medicines for primary health care in the Brazilian regions. METHODS: This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. RESULTS: The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. CONCLUSIONS: As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.

Characterization of the selection of medicines for the Brazilian primary health care / Caracterização da seleção de medicamentos para a atenção primária no Brasil

ABSTRACT OBJECTIVE To characterize the process of selection of medicines for primary health care in the Brazilian regions. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. RESULTS The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. CONCLUSIONS As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.

RESUMO OBJETIVO Caracterizar o processo de seleção de medicamentos na atenção primária à saúde, nas regiões brasileiras. MÉTODOS Artigo integrante da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços 2015, um estudo transversal que envolveu o levantamento de informações numa amostra de municípios das cinco regiões do Brasil. Os dados utilizados foram coletados por meio de entrevistas com os responsáveis pela assistência farmacêutica (n = 506), profissionais que realizam a dispensação de medicamentos (n = 1.139) e médicos (n = 1.558). Para avaliar a diferença entre as proporções foi adotado o teste do qui-quadrado para amostras complexas. As diferenças entre as médias foram analisadas em modelos lineares generalizados, com teste F com correção de Bonferroni para comparações múltiplas. Foram significativas as análises com valores de p ≤ 0,05. RESULTADOS Os responsáveis da assistência farmacêutica relataram não haver Comissão de Farmácia e Terapêutica formalmente constituída (12,5%). Eles afirmaram possuir uma Lista de Medicamentos Essenciais (85,3%) atualizada (80,4%), e serem participantes deste processo (88,2%). Contudo, na percepção dos entrevistados a Lista atende apenas parcialmente (70,1%) as demandas de saúde. Dos profissionais que realizam a dispensação de medicamentos entrevistados, apenas 16,6% eram farmacêuticos, mesmo assim, 47,8% referiram conhecer os procedimentos para mudança da lista. Na perspectiva da maior parte desses profissionais (70,9%), a lista atende as demandas de saúde do município. Dentre os médicos apenas 27,2% declararam ter conhecimento dos procedimentos para mudança da lista, mas 76,5% teriam alguma reivindicação de alteração. A maior parte reporta que baseia suas reivindicações em experiências clínicas (80,0%); para 13,0% deles, a lista atende às demandas de saúde. CONCLUSÕES Por tratar-se da primeira pesquisa nacional de caracterização do processo de seleção de medicamentos no âmbito da atenção primária à saúde, traz dados inéditos para a avaliação das políticas relacionadas com medicamentos no Brasil.

Adverse drug reactions among patients admitted with infectious diseases at a Brazilian hospital.

INTRODUCTION:: Despite the therapeutic benefits of drugs, adverse drug reactions (ADRs) occur. Method: We assessed a series of suspected ADRs identified from notifications and intensive monitoring of inpatients from March 2013 to March 2014. RESULTS:: Skin reactions predominated (31%). Systemic anti-infective agents were implicated in 16 (72%) reactions. Fifteen (68%) ADRs were classified as possible. The implicated drug was not correctly identified by the healthcare team in 12 cases. CONCLUSIONS:: Some reactions were not correctly attributed to the causative drug(s), suggesting that the use of a validated evaluation method can promote successful identification of causal links between ADRs and drugs.

Adverse drug reactions among patients admitted with infectious diseases at a Brazilian hospital

Abstract INTRODUCTION: Despite the therapeutic benefits of drugs, adverse drug reactions (ADRs) occur. Method: We assessed a series of suspected ADRs identified from notifications and intensive monitoring of inpatients from March 2013 to March 2014. RESULTS: Skin reactions predominated (31%). Systemic anti-infective agents were implicated in 16 (72%) reactions. Fifteen (68%) ADRs were classified as possible. The implicated drug was not correctly identified by the healthcare team in 12 cases. CONCLUSIONS: Some reactions were not correctly attributed to the causative drug(s), suggesting that the use of a validated evaluation method can promote successful identification of causal links between ADRs and drugs.

Seguimento das diretrizes terapêuticas e adesão à farmacoterapia no tratamento da asma / Compliance with guidelines and adherence to pharmacotherapy in the treatment of asthma

Verificar o seguimento das diretrizes terapêuticas e a adesão Farmacoterapêutica em ambulatório de hospital público terciário do DistritoFederal, Brasil.

To investigate compliance with therapeutic guidelines and adherence to pharmacotherapy in an outpatient unit of a tertiary public hospital in theFederal District of Brazil.

Infodemiologia: uma abordagem epidemiológica da informação / Infodemiology: an epidemiological approach to information

A Internet tornou-se instrumento importante para a busca de informações sobre todas as áreas de conhecimento, incluindo a da saúde. Os profissionais de saúde utilizam a rede mundial de computadores para atualizar seus conhecimentos e fazer pesquisas, visando à resolução de casos clínicos. O público, em geral, também usa a Internet para obter mais conhecimentos sobre uma doença específica. Contudo, por ser um território livre, em que qualquer pessoa pode escrever e publicar conteúdo, a Internet não se constitui numa fonte completamente segura para pesquisas na área da saúde, requerendo cuidado e muito discernimento na leitura do que é disponibilizado. Considerando os sítios da Internet como uma população sujeita à análise, pode-se estudar uma amostra e medir a ocorrência de alguns aspectos selecionados que podem ser indicadores de qualidade. O presente artigo mostra o contexto atual da rede mundial de computadores como uma fonte de informação sobre saúde e os riscos a ela relacionados, além de apresentar uma nova disciplina que estuda seus determinantes e a distribuição de sua freqüência: a infodemiologia, epidemiologia da informação.

Centro de Informação sobre Medicamentos: caracterização do serviço e estudo da opinião dos usuários / Center of Information on Medications: characterization of the service and study of the users' opinion

(...) O objetivo deste trabalho é caracterizar a estrutura e o processo deste Centro,analisar os seus resultados e estudar a opinião dos usuários sobre o serviço. Para tanto, foi utilizado um desenho descritivo de corte transversal, abordando aspectos do trabalho desenvolvido pelo Cebrim: estrutura, processo e resultados e, utilizando a técnica de entrevista, foi realizado um inquérito analítico de opinião dos usuários sobre os serviços de informação reativa prestados pelo Cebrim. Segundo os parâmetros estabelecidos pela literatura especializada, pôde-se concluir que o Cebrim dispõe de estrutura adequada para o funcionamento de um CIM. O número de solicitações atendidas por mês (81), no período deste estudo, de novembro de 2000 a outubro de 2001, foi 30 por cento superior ao apresentado pela maioria dos centros que fazem parte do Sistema Brasileiro de Informação sobre Medicamentos - SISMED. A porcentagem de solicitações de informação respondidas em 24 horas (44 por cento) foi menor do que o estabelecido na literatura, mas este fato pode estar relacionado com a alta proporção de respostas dadas por escrito (61,5 por cento). A proporção de solicitações envolvendo paciente foi considerada muito baixa (34,5 por cento). Isto pode ser atribuído à incipiente formação e atuação clínica do farmacêutico, o profissional que mais utilizou os serviços prestados pelo Cebrim (66 por cento ). No período do estudo de opinião dos usuários, de 1º. de agosto a 31 de outubro de 2001, 89.5 por cento dos solicitantes consideraram que as respostas foram dadas a tempo, 87,9 por cento claras e objetivas e 86.5 por cento completas. Em 99,2 por cento dos casos, eles pretendem utilizar, novamente, este serviço. (...) Pôde-se concluir que a iniciativa do CFF e da OPAS, na implantação do Cebrim, é válida e de grande utilidade no fornecimento de informação objetiva, atualizada, oportuna e sem viés sobre medicamentos, que, além de constituir um instrumento de auxílio aos profissionais de saúde no cuidado ao paciente, possui papel relevante na promoção do uso racional dos medicamentos. A divulgação desse tipo de serviço a outras categorias de profissionais da saúde é estratégica no processo que visa aumentar a efetividade da terapia medicamentosa no cuidado ao paciente. Os resultados desse trabalho permitem recomendar o desenvolvimento de um programa permanente de garantia de qualidade dos serviços prestados pelo Cebrim.

Sistema Brasileiro de Informaçäo sobre Medicamentos - SISMED / The Brazilian Drug Information System - SISMED

Foram descritas as atividades do farmacêutico especiaista em informaçäo sobre medicamentos (IM) e caracterizados os Centros de Informaçäo sobre Medicamentos (CIMs), deixando claro o que näo säo e o que säo - mitos e fatos. Foram apresentadas as definiçöes de IM e de CIMs e apresentadas as atividades usuais dos Centros, destacando a informaçäo passiva como atividade fundamental. Foi apresentado o Sistema Brasileiro de Informaçäo sobre Medicamentos (SISMED), uma rede de CIMs integrados através de um Protocolo de Cooperaçäo que estabelece os requisitos mínimos para o funcionamento dos CIMs e os mecanismos de cooperaçäo entre os Centros participantes. As estratégias para a formaçäo do SISMED foram a capacitaçäo de recursos humanos e encontros dos responsáveis pelos CIMs. O treinamento de recursos humanos através de quatro cursos, deu suporte à implantaçäo rápida de CIMs pelo Brasil, preenchendo importante lacuna, e consolidando definitivamente esta atividae no país, dentro dos preceitos adotados mundialmente. Os encontros periódicos dos que trabalham nos CIMs fortaleceram os Centros, e conseqüentemente, o SISMED.