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1.
Presse Med ; 48(10): e273-e283, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31734048

RESUMO

OBJECTIVES: Self-medication for alleviating pain is very prevalent in most countries. While safe self-medication is supposed to be dependent on both patient's behaviour and pharmacist's counselling, little is known about the context of the delivery of analgesics available without prescription. The primary objective of the study was to define sociodemographic profiles and behaviours of patients seeking non-prescribed analgesics in French community pharmacies. Secondary objectives included the assessment of pharmacist management and identification of risk-associated patients. METHODS: This is a cross-sectional, national and multicentre study, including adults who asked for a prescription-free medication for acute or chronic physical pain. Information was collected through separate patient and healthcare professional (HCP) questionnaires. RESULTS: The analysis was based on 1215 and 1271 patient and HCP questionnaires, respectively, collected from 164 pharmacies. The patient population consisted in women and men (ratio 6:4), mainly (71%) under 60 years old. Headaches, rheumatologic and musculoskeletal pains were the most frequent reasons for getting analgesics, with a median pain intensity of 6 on a scale graded from 0 (no pain) to 10 (intolerable pain). The main reasons guiding self-medication were time saving, a well-known pain and a well-known product. The mean time allocated to delivery was 4.7minutes. Indications, dose and posology were almost systematically addressed by the pharmacy staff, while contra-indications, drug-drug interaction or safety were mentioned in around two-third of cases. The proportion of patients identified at risks due to an inappropriate context of self-medication was 15.5%. DISCUSSION AND CONCLUSIONS: This study shows a great heterogeneity of the population asking for non-prescribed analgesics in French community pharmacies. While pharmacists were able to identify patients at risks, a significant part may have 'slipped through the net'. The results support further studies to better define patient care pathway and optimize pharmacist-led medication.


Assuntos
Dor Aguda/tratamento farmacológico , Analgésicos/uso terapêutico , Dor Crônica/tratamento farmacológico , Medicamentos sem Prescrição/uso terapêutico , Farmacêuticos , Automedicação , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , França , Pesquisas sobre Serviços de Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Farmácias/estatística & dados numéricos , Tamanho da Amostra , Fatores Sexuais , Fatores Socioeconômicos
2.
Med Care ; 57(11): 898-904, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31634269

RESUMO

BACKGROUND: Medication overlap leading to medication excess is a form of therapeutic duplication, itself a type of potentially inappropriate prescribing. OBJECTIVE: To determine the prevalence of potential medication excess in the Veterans Health Administration (VHA) and identify associated medication-level, patient-level, and system-level factors. RESEARCH DESIGN: A retrospective database study. SUBJECTS: All veterans who received ≥1 prescription dispensed by a VHA pharmacy in fiscal year 2014. MEASURES: The primary outcome of "medication excess" was defined for each patient as the number of excess days' worth of medications for all overlap episodes (concurrently dispensed medications with the same name for >10 d). Predictors included medication-level, patient-level, and system-level factors. Multivariable negative binomial regression analyses estimated the rate ratio of each predictor with medication excess. RESULTS: Among 4,687,453 veterans, 64% had ≥1 medication overlap episodes. Patients were prescribed a median of 7 [interquartile range (IQR), 3-12] unique medications, had a median of 2 (IQR, 0-5) overlap episodes, and a median of 27 (IQR, 0-96) days of medication excess. In adjusted regression models, factors associated with greater risk of medication excess included having more comorbidities, multiple prescribers, a combination of filling locations (consolidated mail-order pharmacy vs. local pharmacy), and multiple prescription durations (≥90 d vs. less). CONCLUSIONS: Medication excess was high among VHA users, with nearly two-thirds of patients experiencing at least 1 duplicative medication. As systems such as mail-order pharmacies and 90-day supply are increasingly implemented to reduce costs and improve medication adherence, it is important to recognize the potential for systems-level inefficiencies and potentially inappropriate prescribing.


Assuntos
Farmácias/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Medicamentos sob Prescrição/uso terapêutico , Idoso , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , United States Department of Veterans Affairs
3.
Rev Saude Publica ; 53: 94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644724

RESUMO

OBJECTIVE: To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS: This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS: Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS: Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.


Assuntos
Anti-Hipertensivos/uso terapêutico , Comércio/tendências , Serviços Comunitários de Farmácia/tendências , Medicamentos Genéricos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Programas Nacionais de Saúde/tendências , Brasil , Comércio/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Diabetes Mellitus/tratamento farmacológico , Política de Saúde , Humanos , Hipertensão/tratamento farmacológico , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Programas Nacionais de Saúde/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmácias/tendências , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Estudos Retrospectivos , Fatores de Tempo
4.
MMWR Morb Mortal Wkly Rep ; 68(31): 679-686, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31393863

RESUMO

BACKGROUND: The CDC Guideline for Prescribing Opioids for Chronic Pain recommends considering prescribing naloxone when factors that increase risk for overdose are present (e.g., history of overdose or substance use disorder, opioid dosages ≥50 morphine milligram equivalents per day [high-dose], and concurrent use of benzodiazepines). In light of the high numbers of drug overdose deaths involving opioids, 36% of which in 2017 involved prescription opioids, improving access to naloxone is a public health priority. CDC examined trends and characteristics of naloxone dispensing from retail pharmacies at the national and county levels in the United States. METHODS: CDC analyzed 2012-2018 retail pharmacy data from IQVIA, a health care, data science, and technology company, to assess U.S. naloxone dispensing by U.S. Census region, urban/rural status, prescriber specialty, and recipient characteristics, including age group, sex, out-of-pocket costs, and method of payment. Factors associated with naloxone dispensing at the county level also were examined. RESULTS: The number of naloxone prescriptions dispensed from retail pharmacies increased substantially from 2012 to 2018, including a 106% increase from 2017 to 2018 alone. Nationally, in 2018, one naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. Substantial regional variation in naloxone dispensing was found, including a twenty-fivefold variation across counties, with lowest rates in the most rural counties. A wide variation was also noted by prescriber specialty. Compared with naloxone prescriptions paid for with Medicaid and commercial insurance, a larger percentage of prescriptions paid for with Medicare required out-of-pocket costs. CONCLUSION: Despite substantial increases in naloxone dispensing, the rate of naloxone prescriptions dispensed per high-dose opioid prescription remains low, and overall naloxone dispensing varies substantially across the country. Naloxone distribution is an important component of the public health response to the opioid overdose epidemic. Health care providers can prescribe or dispense naloxone when overdose risk factors are present and counsel patients on how to use it. Efforts to improve naloxone access and distribution work most effectively with efforts to improve opioid prescribing, implement other harm-reduction strategies, promote linkage to medications for opioid use disorder treatment, and enhance public health and public safety partnerships.


Assuntos
Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Farmácias/estatística & dados numéricos , Prescrições/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Overdose de Drogas/mortalidade , Overdose de Drogas/prevenção & controle , Epidemias/prevenção & controle , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
5.
Am J Health Syst Pharm ; 76(Supplement_3): S74-S78, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418772

RESUMO

PURPOSE: The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described. SUMMARY: The use of mail-order pharmacy services continues to increase, as mail-order services offer patient benefits such as reduced copayments and improved clinical outcomes. Prior to undertaking an initiative to improve its mail-order pharmacy services, the University of Utah Health system's pharmacy department offered decentralized mail-order pharmacy services at all of its retail pharmacies, but there was no standardized process for processing mail-order prescriptions or providing phone support to mail-order patients. Centralized mail-order pharmacy services were developed and implemented by creating (1) a standard process for mail-order pharmacy services, (2) a centralized mail-order prescription filling center, and (3) a call center to support mail-order pharmacy services. Implementation of centralized mail-order pharmacy services resulted in an almost 50% reduction in time spent by pharmacy team members on mail-order prescription filling and packaging tasks. Use of a central call center resulted in a decreased call abandonment rate and contributed to a decreased pharmacy workload resulting from an overall reduction in call volume due to an increased rate of first-call issue resolution. CONCLUSION: Establishment of a centralized mail-order pharmacy service along with operational and infrastructure improvements resulted in improved quality and regulatory compliance and enhanced labor efficiency and patient communication.


Assuntos
Implementação de Plano de Saúde , Farmácias/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Serviços Postais , Call Centers/organização & administração , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Farmacêuticos/organização & administração , Farmacêuticos/estatística & dados numéricos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Carga de Trabalho/estatística & dados numéricos
6.
Ethiop J Health Sci ; 29(3): 401-408, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31447509

RESUMO

Background: Frequent stock-out of drugs in the public hospitals causes National Health Insurance Scheme (NHIS) enrollees to purchase most of their medicines out-of-pocket in community pharmacies, thereby imposing financial constraints on them against the main objective of the scheme. The objectives of this study were to determine and compare the level of participation of private retail community pharmacies (PRCPs) in the NHIS of Nigeria and Ghana, to describe their spatial distribution, and to highlight from literature major factors that would influence the participation of these pharmacies in the scheme. Methods: PRCPs data were collected from the Nigerian NHIS active secondary healthcare providers list of 1st July 2017 and the Ghanaian NHIS active providers online list of 2018. PRCPs densities at the national levels were calculated from last published national coverage data for each country. Results: The total number of PRCP accredited by NHIS of both Nigeria and Ghana is 964(639[66.3% versus 325[33.7%]). NHIS accredited PRCPs densities for Nigeria and Ghana were 1 PRCP per 9, 390 enrollees and 1 PRCP per 33, 108 enrollees respectively. Across the Nigerian States, it was noted that Lagos State has the highest proportion (21.4%, n = 137) of community pharmacy participation in the scheme whereas, in Ghan, Greater Accra Region has the highest participation (34.2%, n = 111). Conclusion: This study revealed low participation of PRCPs and skewed spatial distribution between urban and rural areas of both countries, although there was higher participation of these pharmacies in Nigeria due to Nigerian lower NHIS coverage data compared to Ghana.


Assuntos
Medicamentos Essenciais/provisão & distribução , Programas Nacionais de Saúde/organização & administração , Farmácias/organização & administração , Gana , Humanos , Programas Nacionais de Saúde/estatística & dados numéricos , Nigéria , Farmácias/estatística & dados numéricos , Setor Privado/organização & administração , Setor Privado/estatística & dados numéricos
7.
Braz Oral Res ; 33: e076, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31432927

RESUMO

The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.


Assuntos
Analgésicos Opioides/uso terapêutico , Assistência Odontológica/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Acetaminofen/uso terapêutico , Brasil , Codeína/uso terapêutico , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Valores de Referência , Fatores Socioeconômicos , Estatísticas não Paramétricas , Tramadol/uso terapêutico
8.
Med Care ; 57(10): 836-842, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31464843

RESUMO

BACKGROUND: Pharmacy dispensing data are frequently used to identify prevalent medication use as a predictor or covariate in observational research studies. Although several methods have been proposed for using pharmacy dispensing data to identify prevalent medication use, little is known about their comparative performance. OBJECTIVES: The authors sought to compare the performance of different methods for identifying prevalent outpatient medication use. RESEARCH DESIGN: Outpatient pharmacy fill data were compared with medication reconciliation notes denoting prevalent outpatient medication use at the time of hospital admission for a random sample of 207 patients drawn from a national cohort of patients admitted to Veterans Affairs hospitals. Using reconciliation notes as the criterion standard, we determined the test characteristics of 12 pharmacy database algorithms for determining prevalent use of 11 classes of cardiovascular and diabetes medications. RESULTS: The best-performing algorithms included a 180-day fixed look-back period approach (sensitivity, 93%; specificity, 97%; and positive predictive value, 89%) and a medication-on-hand approach with a grace period of 60 days (sensitivity, 91%; specificity, 97%; and positive predictive value, 91%). Algorithms that have been commonly used in previous studies, such as defining prevalent medications to include any medications filled in the prior year or only medications filled in the prior 30 days, performed less well. Algorithm performance was less accurate among patients recently receiving hospital or nursing facility care. CONCLUSION: Pharmacy database algorithms that balance recentness of medication fills with grace periods performed better than more simplistic approaches and should be considered for future studies which examine prevalent chronic medication use.


Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Reconciliação de Medicamentos/métodos , Pacientes Ambulatoriais/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos
9.
Malar J ; 18(1): 260, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362736

RESUMO

BACKGROUND: Despite recent strides made towards reducing the emergence of artemisinin resistance, inappropriate dispensing practices for anti-malarials in both private and public sectors affect treatment outcomes negatively. In Ghana, private retail pharmacies are the most accessible health facilities for managing diseases of common occurrence. However, there is growing concern about the number of patients harmed by dispensing errors in the management of malaria in retail pharmacies. Although considerable work has been done in this area, several questions regarding dispensing practices remain unanswered. This study, therefore, sought to investigate the predictors of appropriate dispensing practices for anti-malarials in community pharmacies in the La Nkwantanang-Madina municipality of Greater Accra, Ghana. METHODS: A cross-sectional analytic study was conducted in sixty-one randomly selected community pharmacies in the La Nkwantanang-Madina. Data from 230 clients and 106 dispensers were analysed. It was checked for internal consistency and completeness then entered and analysed using STATA I/C version 14.0. Frequencies, Chi square tests, and logistic regression analyses were conducted, accounting for clustering. RESULTS AND DISCUSSION: Of the 106 dispensers interviewed, 71.4% were medicine counter assistants. The mean age of dispensers was 30.4 years (SD 8.8). Over 88.0% of clients were advised to complete the full course of their anti-malarials. However, the 8-h loading dose principle for artemether-lumefantrine was not explained to 88.3% of the clients. More than half of the clients (52.2%) were given appropriate dispensing information on anti-malarial use. Most clients (66.1%), were dispensed anti-malarials without malaria tests. Dispensers with more than a 10-years experience were less likely to dispense artemisinin-based combinations appropriately relative to dispensers with less than 2 years experience (AOR = 0.04, 95% CI 0.002-0.802 p-value = 0.036) while pharmacy interns were about 19 times more likely (AOR = 18.5, 95% CI 1.40-245.6 p-value = 0.03) to dispense artemisinin-based combinations appropriately compared to pharmacists. CONCLUSION: Dispensing practices for anti-malarials is unsatisfactory. There is a need to enforce existing legislation with educational programmes directed towards dispensers especially those with more than 10 years experience. Specific adherence to the World Health Organization Test, Treat and Track initiative should be encouraged to ensure effective use of anti-malarials.


Assuntos
Antimaláricos/efeitos adversos , Competência Clínica/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmacêuticos/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Gana , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/estatística & dados numéricos , Adulto Jovem
10.
Reprod Health ; 16(1): 105, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307474

RESUMO

BACKGROUND: Although Nepal legalised abortion in 2002, a significant number of women continue to access unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortion continuing to be a leading contributor to maternal mortality. Despite medical abortion access being solely permitted through government accredited safe abortion services, medical abortion pills are readily available for illegal purchase at pharmacies throughout the country. METHODS: Utilising an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology, underpinned by a health information pyramid conceptual framework, this qualitative exploratory study collected data from in-depth, open-ended interviews. The study explored the medical abortion and sexual and reproductive health experiences of ten women who accessed medical abortion through an accredited safe abortion service, and ten women who accessed unsafe medical abortion through pharmacies. RESULTS: Thematic content analysis revealed emerging themes relating to decision-making processes in accessing safe or unsafe medical abortion; knowledge of safe abortion services; and SRH information access and post-abortion contraceptive counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; reproductive coercion; education; poverty; spousal separation; and women's personal, social and economic empowerment. CONCLUSIONS: While barriers to safe abortion services persist, so will the continued demand for medical abortion provision through pharmacies. Innovated and effective harm reduction implementations combined with access and information expansion strategies offer the potential to increase access to safe medical abortion while decreasing adverse health outcomes for women.


Assuntos
Aborto Induzido/psicologia , Aborto Legal/psicologia , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Saúde Reprodutiva/normas , Aborto Induzido/estatística & dados numéricos , Aborto Legal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Nepal , Gravidez , Pesquisa Qualitativa , Adulto Jovem
11.
Int J Clin Pharm ; 41(4): 913-919, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31161499

RESUMO

Background Medications in which the risk of adverse events exceeds the expectations of clinical benefits are called potentially inappropriate medications (PIMs). To identify the use of PIMs in elderly patients, the most commonly used tool are the Beers criteria, developed for the population of the United States. Recently, a consensus panel of Argentine experts developed the first Latin American tool, called the IFAsPIAM List. Objective The present study aimed to identify PIM prescriptions in elderly outpatients, to estimate the prevalence of PIMs, and to evaluate their possible relation with polypharmacy and gender and age of the patients. Also, we aimed to compare the results obtained by using the Beers criteria and the IFAsPIAM List. Setting Ten community pharmacies of Rosario, Santa Fe, Argentina. Methods A cross-sectional observational study was conducted between February and September 2015. Data were acquired from 56,952 prescriptions prescribed to 2231 patients aged 65 years old or older. To detect the use of PIMs, we used two tools: the Beers criteria and the IFAsPIAM List. Main outcome measure The prevalence of PIM use according to the Beers criteria and the IFAsPIAM List. Results The monthly average of medications dispensed per patient was 4.35 ± 2.18 and 42.27% of the patients presented major polypharmacy. The prevalence of PIMs was 72.75% according to the Beers criteria and 71.13% according to the IFAsPIAM List (Kappa coefficient k = 0.72), and was significantly higher in patients with major polypharmacy, older than 75 years old, and females. The most frequent PIMs prescribed were anxiolytics, analgesics and antipsychotics. Conclusions The IFAsPIAM List is an effective tool to evaluate the prescription of PIMs in the elderly. The results showed a high prevalence of PIMs with a multicausal origin and directly associated with polypharmacy. As clarified by the authors of the IFAsPIAM List, the criteria specified in the list do not substitute the clinical evaluation of each patient.


Assuntos
Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Argentina , Estudos Transversais , Feminino , Humanos , Masculino , Farmácias/estatística & dados numéricos , Polimedicação , Prevalência , Fatores de Risco , Fatores Sexuais
12.
BMC Health Serv Res ; 19(1): 328, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31118096

RESUMO

BACKGROUND: Prescription connects physician, patient and community pharmacy personnel who can help in understanding prescribing pattern. The present study was aimed to get an insight of viewpoints of all members involved in progression of events from prescription to drug purchase, i.e., physician, patient and medical-store personals regarding the prescription pattern in Pakistan. METHODS: Therefore, a cross-sectional study was conducted in four provinces and capital territory (Islamabad) of Pakistan to evaluate the perception of physicians, patients and medical stores/pharmacy personnel of the prescribing trends in Pakistan. RESULTS: Response rate was higher from Punjab and lower in Sindh. Responses of 981 walk-in patients with 393 physicians and 618 medical stores/pharmacies were received and statistically evaluated. The majority of physicians, patients and pharmacists/medical store personnel considered the medicines of multinational manufacturers as more effective. Physicians considered their prescribing cost-effective. However, majority of patients as well as pharmacists/medical store personnel strongly disagreed or disagreed with this notion that physicians prescribe cheap medicines. Furthermore, physicians and patients reported that medicines of local companies were not as effective as the medicines of multinational manufacturers, which were contrary to what pharmacists thought. Majority of physicians disagreed that their prescribing was under the influence of medical stores in their vicinity. The response of most of the patients (40.5%) was in line with that of physicians whereas 32% pharmacist/medical store personnel agreed. Nearly half of the physicians strongly agreed or agreed that patients demand medicines of multinational companies. Contrarily, a majority of patients and medical store personnel denied that patients demand for the medicines of multinational manufacturers. CONCLUSION: The study highlighted that there was a need to develop policy guidelines at the level of Federal Government and Drug Regulatory Authority of Pakistan in connection with prescribing practices to reduce the variation in perception of key stakholders involved in drug use process.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/tendências , Adolescente , Adulto , Idoso , Comportamento do Consumidor , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Percepção , Assistência Farmacêutica/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmacêuticos/psicologia , Médicos/psicologia , Adulto Jovem
13.
J Manag Care Spec Pharm ; 25(6): 688-695, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31134865

RESUMO

BACKGROUND: Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services. While MTM services have been extensively researched, there are few comparisons of CMR versus non-CMR interventions. Given the variability in MTM interventions and lack of a consistent TMR definition in the literature, this study sought to compare CMRs and TMRs that were clearly defined based on Centers for Medicare & Medicaid Services (CMS) criteria. OBJECTIVES: To (a) compare acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services (CMR, TMR, or both) and eligible nonparticipating patients and (b) examine the effect of receiving TMR services on medication adherence. METHODS: This was a retrospective cohort study of patients with Medicare Part D coverage who received MTM services and a 1:1 propensity score-matched control group. Participants had to be eligible for MTM services in 2014 or 2015 based on CMS requirements. CMRs were offered to all MTM-eligible patients, while TMRs were completed based on clinical rules that helped identify medication-related problems (MRPs). The date of MTM intervention, or eligibility for the control group, was considered the index date. Participants had to be continuously enrolled in a Medicare Advantage plan that included prescription drug coverage during the study period and have at least 6 months of data before and after the index date. Medical and pharmacy claims were assessed to examine trend-adjusted inpatient admissions and ED visits from pre-index to post-index date for participants and matched controls. RESULTS: In 2014 and 2015, receipt of TMR interventions was associated with statistically significant reductions in acute inpatient admissions. In 2014, there were 55.2 fewer admits per 1,000 individuals (95% CI = 29-81) and 30.8 fewer admits per 1,000 individuals in 2015 (95% CI = 20-42). Receipt of CMR-only interventions was associated with fewer acute inpatient admissions only when coupled with preidentification of MRPs (36.8 [95% CI = 25-49] fewer admits per 1,000 individuals). In 2015, there were significant reductions in ED visits for participants receiving TMR-only interventions or TMR/CMR interventions (26.1 [95% CI = 11-41] and 12.0 [95% CI = 1-23] fewer ED visits per 1,000 individuals, respectively). In both years, a larger percentage (0.4% for oral diabetes medications; 7.7% for antihypertensives; 3.0% for statins) of MTM participants had greater improvements in medication adherence in the post-index period compared with controls. CONCLUSIONS: Receiving MTM services targeted at resolution of MRPs (TMR or CMR/TMR) resulted in positive reductions in health care utilization and increases in medication adherence. Given the importance of optimal medication utilization, this study highlights the need for additional focus on resolution of MRPs through TMRs and CMRs that can support improved clinical outcomes. DISCLOSURES: No outside funding supported this study. Researchers completed the work as part of their employment with Humana. All authors are or were employees of Humana at the time of the study. There are no other conflicts of interest to disclose. This study was previously presented at AMCP Nexus 2017 on October 16, 2017, in Dallas, TX.


Assuntos
Medicare Part D/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Farmácias/organização & administração , Idoso , Idoso de 80 Anos ou mais , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Medicare Part D/economia , Conduta do Tratamento Medicamentoso/economia , Pessoa de Meia-Idade , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Farmácias/economia , Farmácias/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
14.
BMC Health Serv Res ; 19(1): 217, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953502

RESUMO

BACKGROUND: Delay in healthcare seeking and loss to diagnostic follow-up (LDFU) contribute to substantial increase in tuberculosis (TB) morbidity and mortality. We examined factors, including perceived causes and prior help seeking, contributing to delay and LDFU during referral to a TB clinic among patients with presumptive TB initially seeking help at the pharmacies in Dar es Salaam Tanzania. METHODS: In a TB clinic, a semi-structured interview based on the explanatory model interview catalogue (EMIC) framework for cultural epidemiology was administered to presumptive TB patients enrolled at pharmacies during an intervention study. We assessed delay in seeking care at any medical care provider for a period of ≥3 weeks after the onset of symptoms, LDFU during referral (not reaching the TB clinic), and LDFU for three required TB clinic visits among the presumptive and confirmed TB patients. Logistic regression models were used to assess factors associated with delay and LDFU. RESULTS: Among 136 interviewed patients, 86 (63.2%) were LDFU from pharmacies and TB clinic while 50 (36.8%) were non-LDFU. Out of 136 patients 88 (64.7%) delayed seeking care, of whom 59 (67%) were females. Among the 86 (63.2%) patients in LDFU group, 62 (72.1%) delayed seeking care, while among the 50 (36.8%) non-LDFU, 26 (52.0%) had also delayed seeking care. Prior consultation with a traditional healer (aOR 2.84, 95% CI 1.08-7.40), perceived causes as ingestion (water and food) (aOR 0.38 CI 0.16-0.89), and substance use (smoking and alcohol) (aOR 1.45 CI 0.98-2.14) were all associated with patient delay. Female gender was associated with LDFU (aOR 3.80, 95% CI 1.62-8.87) but not with delay. Other conditions as prior illness and heredity were also associated with LDFU but not delay (aOR 1.48 CI 1.01-2.17). CONCLUSION: Delay and LDFU after referral from the pharmacies were substantial. Notable effects of diagnosis and female gender indicate a need for more attention to women's health to promote timely and sustained TB treatment. Public awareness to counter misconceptions about the causes of TB is needed.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tuberculose/terapia , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Conscientização , Diagnóstico Tardio/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Farmácias/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Distribuição por Sexo , Tanzânia/epidemiologia , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/psicologia , Adulto Jovem
15.
J Headache Pain ; 20(1): 31, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940092

RESUMO

BACKGROUND: Precision medicine may offer new strategies to treat migraine, and access to existing large cohorts may be a key resource to increase statistical power. Treatment response data is not routinely collected for large cohorts; however, such information could be extracted from pharmacy databases. Using a clinical migraine sample with treatment effect data, we assessed whether treatment response can be predicted based on the number of drug purchases. METHODS: A clinical cohort including 1913 migraineurs were interviewed using a semi-structured interview to retrieve treatment response data for acute and prophylactic migraine drugs. The purchase history was obtained from the Danish national pharmacy database. We assessed whether number of purchases at different thresholds could predict the specificity and sensitivity of treatment response. RESULTS: Purchase history of drugs was significantly associated with treatment response. For triptan treatment the specificity and sensitivity were above 80% for individuals with at least ten purchases. For prophylactic treatment (beta-blockers, angiotensin II antagonists or antiepileptic) we observed a sensitivity and specificity above 80% and 50% for individuals purchasing any prophylactic drug at least four times. In the Danish pharmacy database, 73% of the migraine patients have purchased at least ten triptans, while 55-63% have purchased at least one of the four prophylactic drugs. CONCLUSION: Pharmacy databases are a valid source for identification of treatment response. Specifically for migraine drugs, we conclude that ten purchases of triptans or four purchases of prophylactic drugs are sufficient to predict a positive treatment response. Precision medicine may be accelerated with the use of pharmacy databases.


Assuntos
Analgésicos/uso terapêutico , Bases de Dados Factuais/estatística & dados numéricos , Transtornos de Enxaqueca/tratamento farmacológico , Farmácias/estatística & dados numéricos , Medicina de Precisão , Antagonistas Adrenérgicos beta , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/prevenção & controle , Resultado do Tratamento
16.
Asian Pac J Cancer Prev ; 20(4): 991-994, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31030465

RESUMO

Background: One of the main contributors in low survival rate in LMIC is the lack of availability of cancer medications for curative, supportive and palliative care. In many developing countries access to cytotoxic medicine is a major challenge. The information about the availability of essential medicines for pediatric cancer in the country is not known. The main objective of this study was to determine whether the medications used during the treatment of pediatric cancer are available in Armenia. Methods: In summer 2016 we conducted a survey in the 3 main pharmacies in Yerevan, which import pediatric cancer medications to Armenia to evaluate whether medications used during cancer treatment are officially registered and available in the country. In addition, the information on official registration was cross-checked with the Ministry of Health of the Republic of Armenia (MOH). Simultaneously, detailed information about the drugs, on type of produced drug company, doses and price intervals was confined from the price lists of the national drug importer companies. Results: The survey included 64 agents in three classes of medication: anti-neoplastics, anti-microbials, and drugs used in supportive care. All of these medications were included in the recent version of the WHO model list of essential medicines. From 30 anti-neoplastic medications on the essential medicines list 22 (73%) were officially registered in Armenia; from 19 anti-microbial drugs all were registered except caspofungin and from 15 supportive care agents 13 (87%) were registered. From registered anti-neoplastic drugs 18% and from antimicrobial drugs 33% were not available in the drug stores. Conclusion: This study showed that not all the drugs from the SIOP PODC Essential Medication list for pediatric oncology are officially registered and available in Armenia, and effective drug regulation focusing on the childhood cancer care medicine is needed for improving the situation in the country.


Assuntos
Antineoplásicos/provisão & distribução , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde , Neoplasias/tratamento farmacológico , Farmácias/estatística & dados numéricos , Armênia , Criança , Países em Desenvolvimento , Seguimentos , Humanos , Neoplasias/patologia , Prognóstico , Inquéritos e Questionários
17.
BMC Health Serv Res ; 19(1): 186, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30898124

RESUMO

BACKGROUND: Worldwide community pharmacies are shifting their role in the healthcare system from simple medication dispensers to health care providers. High levels of satisfaction with pharmacy services were found in previous studies. This study has two main goals. The primary goal is to describe the levels of satisfaction and knowledge regarding pharmacy services in Portugal. The secondary goal is to explore the perceptions and the utilisation of pharmacy services by the Portuguese. This statement includes exploring the impact of a set of variables on both perceptions and uses of pharmacies in regard to services that are currently offered as well as to new services that may be provided in the future. METHODS: A face-to-face survey of closed-ended questions was applied to a nationwide representative sample of the Portuguese population in September 2015. The sample was weighted based on population distribution across regions, habitat, age and gender. Data analysis comprises descriptive statistics and Multiple Correspondence Analysis to explore different typologies of respondent's orientation toward community pharmacy. RESULTS: A total of 1114 interviews comprised the study. Of the respondents, 36% used the pharmacy as a first resource when seeking to treat a minor ailment, and 54% reported that they use the pharmacy as a first resource when seeking answers about medicines. Of those who visited their pharmacy at least once in the previous year, 94% were either globally satisfied or very satisfied. The level of acknowledgement of pharmacy services' was also high among the Portuguese. Of the participants, 29% considered there could be more services available in pharmacies that are currently provided by other health care facilities. The construction of a typology of orientations towards community pharmacy practice resulted in three outcome groups: "Motivated" (63%), those with a connection to a pharmacy; "Settled" (23%), mainly those who had a pharmacy nearby; and "Demobilised" (14%), those who are weakly tied to a pharmacy. CONCLUSIONS: The vast majority of the Portuguese population has a strong positive attitude towards their community pharmacy, as expressed by the high levels of satisfaction with, and positive evaluation of, the pharmacy's services.


Assuntos
Serviços Comunitários de Farmácia/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços Comunitários de Farmácia/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Percepção , Farmácias/normas , Farmácias/estatística & dados numéricos , Portugal , Opinião Pública , Inquéritos e Questionários , Adulto Jovem
18.
Aust J Prim Health ; 25(2): 118-124, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30721646

RESUMO

Resettled refugees in Australia have been shown to exhibit a high prevalence of limited health literacy and are at greater risk of mismanaging their medication and not being able to access the healthcare services they need. The aim of the current study is to explore the barriers to accessing medicines and pharmacy services in Queensland, Australia, among resettled refugees from Africa; this research was conducted from the perspectives of healthcare professionals and people who help the refugees to resettle in their adopted country (resettlement workers). A 'generic qualitative' approach was used in this study. In-depth interviews were conducted among healthcare professionals (two GPs, nine pharmacists and three nurse practitioners) and resettlement workers. Participants were recruited via a purposive snowball sampling method in the cities of Brisbane and Townsville, Queensland, Australia. Twenty-four in-depth interviews were conducted; 14 with healthcare professionals. Three key themes emerged from the data: (1) Communication Barriers; (2) Navigating the Health System; and (3) Belief Systems and Culture. Perceptions of those 'at the coalface' - healthcare professionals and people who are responsible for assisting refugees to resettle in Australia - provide insight into the language and cultural challenges experienced by resettled refugees from Africa regarding access to the Australian health system, including medicines and pharmacy services.


Assuntos
Assistência à Saúde Culturalmente Competente/métodos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Refugiados/estatística & dados numéricos , África/etnologia , Atitude do Pessoal de Saúde , Austrália , Barreiras de Comunicação , Assistência à Saúde Culturalmente Competente/estatística & dados numéricos , Cultura , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Alfabetização em Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Queensland
19.
Aust J Prim Health ; 25(2): 125-130, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30711018

RESUMO

This cross-sectional study geospatially maps patient access to opioid substitution treatment (OST) pharmacy and medical providers in South Australia (SA), Australia. De-identified data from a total of 2935 public and private OST patients (1092 public cases and 1843 private cases) were included in the study. Geospatial mapping of OST patient locations, their dosing community pharmacy and prescriber was undertaken. The geospatial modelling methods used in this study presents an application whereby information about patient travel patterns to reach OST providers can be used as a tool for treatment service planning.


Assuntos
Mapeamento Geográfico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Estudos Transversais , Humanos , Austrália do Sul
20.
Ann Pharm Fr ; 77(3): 198-204, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30685061

RESUMO

OBJECTIVES: This study aims to: (i) quantify the number of pharmaceutical interventions (PIs) linked to spontaneous requests for the two oral target molecules, ibuprofen and pseudoephedrine (ii) analyse the causes and proposed solutions (iii) quantify the number of registrations in the patient's pharmaceutical record and identify the various causes of non-registration. METHODS: The study was conducted over a 2 weeks' period in the months of February and April 2014 in 482 pharmacies affiliated to the training supervisor associations of 8 French Faculties of Pharmacy. Data regarding spontaneous requests for the target molecules was collected, with due respect to a patient care flow chart at the pharmacy, by incorporating the systematic proposal for registration of the medication in the patient's pharmaceutical record. Each PI was the subject of a notification made with reference to a standardized grid. RESULTS: A total of 12,160 dispensations were made over the two weeks of the study. Overall 815 of them gave rise to an PI (6.7%), justified in almost half of the cases by a contraindication. The alternative proposed by the dispensing pharmacist was accepted in more than 9 out of 10 cases. In half of the cases, the dispensing pharmacist had access to the patient's French healthcare card; more than 2/3 of the dispensations thus led to the registration of the medication in the patient's pharmaceutical record. CONCLUSION: The pairing of the two tools, these being the notification grid and the pharmaceutical record, aims to maximize dispensation security while patients are being guided in their approach to self-medication.


Assuntos
Farmácias/estatística & dados numéricos , Farmacêuticos , Automedicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Broncodilatadores/uso terapêutico , Serviços Comunitários de Farmácia , Feminino , França , Humanos , Ibuprofeno/uso terapêutico , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Pseudoefedrina/uso terapêutico , Encaminhamento e Consulta , Inquéritos e Questionários , Adulto Jovem
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