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1.
Medicine (Baltimore) ; 100(4): e24083, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530202

RESUMO

BACKGROUND: Migraine is a chronic paroxysmal incapacitating neurological disorder, which endangers the health of human worldwide ranking as the third most prevalent medical condition. There are no comprehensive estimates of treatments for migraine. We will conduct this systematic review and Bayesian network meta-analysis (NMA) to synthesis quantitative and comparative evidence on the efficacy and tolerability of all the known pharmacological and non-pharmacological interventions for migraine. METHOD: We will perform the systematic electronic search of the literature utilizing MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing & Allied Health (CINAHL), and PsycINFO. We will only include randomized controlled trials (RCTs) of high quality which appraise the efficacy or safety of any potential pharmacological or non-pharmacological interventions in the treatment of patients with migraine. The traditional pairwise meta-analyses will be performed to anticipate the heterogeneities and publication bias and the NMA will be conducted within a Bayesian hierarchical model framework to obtain estimates for all valuable treatments for migraine. The entire heterogeneity will be quantified by Q statistic and I2 index. Other analyses included sensitivity analyses, meta-regression, and subgroup analyses will also be conducted. The whole process will be conducted using in R-3.6.0 software. RESULTS: This study will obtain the efficacy and tolerability of all potential treatments for migraine, aiming at providing consolidated evidence to help make the best choice of interventions. The results will be published in a peer-reviewed journal. DISCUSSION: This Bayesian network meta-analysis may be the first attempt to quantitatively synthesize the efficacy and tolerability of all potential treatments for migraine. And this method can ensure us to fully utilize both the direct and indirect evidence as well as gain the comparative estimates displayed in the derived hierarchies. Besides, we have registered this protocol on the international prospective register of systematic review (PROSPERO) (CRD42020157278).


Assuntos
Terapias Complementares/métodos , Transtornos de Enxaqueca/terapia , Preparações de Plantas/uso terapêutico , Medicamentos sob Prescrição/uso terapêutico , Teorema de Bayes , Doença Crônica , Terapias Complementares/efeitos adversos , Humanos , Transtornos de Enxaqueca/reabilitação , Transtornos de Enxaqueca/cirurgia , Metanálise em Rede , Preparações de Plantas/administração & dosagem , Preparações de Plantas/efeitos adversos , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
2.
Pediatr Crit Care Med ; 21(7): 607-619, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32420720

RESUMO

OBJECTIVE: In the midst of the severe acute respiratory syndrome coronavirus 2 pandemic, which causes coronavirus disease 2019, there is a recognized need to expand critical care services and beds beyond the traditional boundaries. There is considerable concern that widespread infection will result in a surge of critically ill patients that will overwhelm our present adult ICU capacity. In this setting, one proposal to add "surge capacity" has been the use of PICU beds and physicians to care for these critically ill adults. DESIGN: Narrative review/perspective. SETTING: Not applicable. PATIENTS: Not applicable. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The virus's high infectivity and prolonged asymptomatic shedding have resulted in an exponential growth in the number of cases in the United States within the past weeks with many (up to 6%) developing acute respiratory distress syndrome mandating critical care services. Coronavirus disease 2019 critical illness appears to be primarily occurring in adults. Although pediatric intensivists are well versed in the care of acute respiratory distress syndrome from viral pneumonia, the care of differing aged adult populations presents some unique challenges. In this statement, a team of adult and pediatric-trained critical care physicians provides guidance on common "adult" issues that may be encountered in the care of these patients and how they can best be managed in a PICU. CONCLUSIONS: This concise scientific statement includes references to the most recent and relevant guidelines and clinical trials that shape management decisions. The intention is to assist PICUs and intensivists in rapidly preparing for care of adult coronavirus disease 2019 patients should the need arise.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Unidades de Terapia Intensiva Pediátrica/organização & administração , Pediatras/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Capacidade de Resposta ante Emergências/organização & administração , Suporte Vital Cardíaco Avançado/instrumentação , Betacoronavirus , Competência Clínica , Comorbidade , Estado Terminal/terapia , Equipamentos e Provisões Hospitalares , Humanos , Unidades de Terapia Intensiva Pediátrica/normas , Pandemias , Posicionamento do Paciente/normas , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/provisão & distribução , Encaminhamento e Consulta/organização & administração , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Estados Unidos/epidemiologia
4.
Am J Med ; 133(6): 675-678, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32145207

RESUMO

In 2019, the US Food and Drug Administration (FDA) approved 48 novel drugs. Thirty of the 48 (62.5%) novel drug approvals were reviewed and approved through an expedited review pathway while 20 of the 48 (41.7%) were approved for treatment of a rare disease. This review includes a summary of the novel drugs approved by the FDA in 2019.


Assuntos
Aprovação de Drogas , Medicamentos sob Prescrição/uso terapêutico , Humanos , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/efeitos adversos , Estados Unidos , United States Food and Drug Administration
5.
Cutis ; 105(1): E24-E28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32074163

RESUMO

The relationship between physicians and pharmaceutical companies has caused the medical community to question the degree to which pharmaceutical interactions and incentives can influence physicians' prescribing habits. Our study aimed to analyze whether a change in institutional policy that restricted the availability of in-office samples for patients resulted in any measurable change in the prescribing habits of faculty physicians in the Department of Dermatology and Cutaneous Surgery at the University of South Florida (USF)(Tampa, Florida). Medical records were retrospectively reviewed for common dermatology diagnoses-acne vulgaris, atopic dermatitis, onychomycosis, psoriasis, and rosacea-before and after the pharmaceutical policy changes, and the prescribed medications were recorded. These medications were then categorized as brand name, generic, and over-the-counter (OTC). Statistical analysis using a mixed effects ordinal logistic regression model accounting for baseline patient characteristics was conducted to determine if a difference in prescribing habits occurred.


Assuntos
Dermatologistas/estatística & dados numéricos , Prescrições de Medicamentos/economia , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição/administração & dosagem , Dermatologia/estatística & dados numéricos , Indústria Farmacêutica/organização & administração , Florida , Humanos , Visita a Consultório Médico , Medicamentos sob Prescrição/economia , Estudos Retrospectivos
6.
J Am Acad Orthop Surg ; 28(20): e917-e922, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32091422

RESUMO

INTRODUCTION: Opioids remain the most prescribed medication after total hip arthroplasty (THA) despite the potential for abuse and adverse effects. Given the high rates of opioid abuse and potential adverse effects, the reporting of controlled substances is now mandatory in many statewide databases. This study aimed to use a mandatory statewide database to analyze opioid prescription patterns in postoperative THA patients and identify independent risk factors for those patients who need a second prescription and/or require prolonged use (>6 months). METHODS: We retrospectively reviewed a consecutive series of 619 primary THAs. Demographic and comorbidity information were collected for all patients. Narcotic prescription data (converted to morphine milligram equivalents) as well as prescription data for sedatives, benzodiazepines, and stimulants were collected from the State's Controlled Substance Monitoring websites 6 months before and 9 months after the index procedure. Bivariate and multivariate analyses were done for second prescription and continued use. RESULTS: Of the 619 patients who underwent THA, 34.9% (216/619) used preoperative opioids, 36.2% (224/619) filled a second opioid prescription, and 10.5% (65/619) had continued use past 6 months. Patients with preoperative opioids were at an approximately 4-fold increased odds of requiring a second script and 12 times odds of continued opioid use. In the multivariate analysis, independent risk factors for requiring a second prescription, in descending order of magnitude, included the use of any sedative or sleep aid prescription and preoperative narcotic use. Independent risk factors for continued narcotic use longer than 6 months after THA included preoperative narcotic use and increased length of stay. DISCUSSION: Several risk factors and their relative weight have been identified for continued narcotic consumption after THA. It is important for surgeons to consider these predisposing factors preoperatively during the informed consent process and for managing postoperative pain expectations.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Artroplastia de Quadril , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Programas de Monitoramento de Prescrição de Medicamentos , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Artroplastia do Joelho , Feminino , Humanos , Consentimento Livre e Esclarecido , Masculino , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/etiologia
7.
Geriatr Gerontol Int ; 20(4): 304-311, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32048453

RESUMO

AIM: To determine the patterns of concomitant drug use for chronic diseases and examine the risk factors of polypharmacy in older outpatients. METHODS: Data were extracted from an anonymized health insurance claims database of a public insurance program for older adults in Tokyo, Japan. We analyzed individuals aged ≥75 years who had visited an outpatient clinic, and were regularly prescribed orally administered drugs for chronic diseases for ≥14 days between May and August 2014. The prescription patterns for 16 main drug types were studied using exploratory factor analysis, and the risk factors of polypharmacy, defined as the concomitant prescription of five or more drugs, were identified using multivariate logistic regression models. RESULTS: A total of 1 094 199 outpatients were analyzed (mean age 81.8 years, 38.4% men). We identified five prescription patterns that explained almost 40% of all observed variance: edema/heart failure/atrial fibrillation-related drugs, insomnia/anxiety-related drugs, pain-related drugs, lifestyle disease-related drugs and dementia-related drugs. The significant risk factors of polypharmacy included men, octogenarians and nonagenarians, higher number of medical institutions visited, use of physician home visits, and hospitalization during the study period. The main drug types most strongly associated with polypharmacy were analgesics, diuretics and antidiabetics. CONCLUSIONS: Polypharmacy was found to be prevalent in older outpatients aged ≥75 years in Tokyo. These findings might provide useful evidence that can contribute to the development of practical countermeasures against adverse events associated with polypharmacy in clinical practice. Geriatr Gerontol Int 2020; 20: 304-311.


Assuntos
Polimedicação , Padrões de Prática Médica/estatística & dados numéricos , Medicamentos sob Prescrição/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/tratamento farmacológico , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Fatores de Risco , Tóquio
8.
Med Care ; 58(6): 504-510, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32011425

RESUMO

BACKGROUND: The 2010 Patient Protection and Affordable Care Act reformed the individual and small group health insurance markets and established a risk adjustment program to create a level playing field for competition. A new set of predictive models for measuring enrollee risk across plans was developed for the Patient Protection and Affordable Care Act-reformed markets, referred to as the Department of Health and Human Services Hierarchical Condition Category (HHS-HCC) models. Beginning in 2018, selected prescription drug classes were added to the models as risk markers. OBJECTIVE: We describe the motivations, concerns, methodology, and results of adding prescription drug utilization to the HHS-HCC models. METHODS: Separate HHS-HCC models are estimated by enrollee age and plan actuarial value. We defined and added 10 prescription drug classes, called RXCs, to the HHS-HCC adult models. RESULTS: Using selected RXCs alongside demographic and diagnostic indicators yielded modest overall improvement in HHS-HCC models' predictive power. Also, adding RXCs captures the higher costs of enrollees taking certain expensive pharmaceuticals and allows imputation of diagnoses for enrollees utilizing a drug but lacking the associated diagnosis. CONCLUSIONS: Including selected drugs in risk adjustment improved the models' predictive power. In addition, inclusion of selected drugs may discourage insurers from using formulary and drug benefit design to avoid enrollment of patients taking high-cost drugs, such as for HIV, multiple sclerosis, and rheumatoid arthritis, and improve access for enrollees taking these drugs. Adding RXCs also may improve plan risk measurement for plans with less complete diagnosis reporting.


Assuntos
Modelos Estatísticos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Medicamentos sob Prescrição/administração & dosagem , Risco Ajustado/métodos , Uso de Medicamentos/economia , Humanos , Medição de Risco , Fatores Socioeconômicos
9.
Ann Pharmacother ; 54(7): 625-632, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31896276

RESUMO

Background: Chronic kidney disease (CKD) affects up to 18% of those over the age of 65 years. Potentially inappropriate medication prescribing in people with CKD is common. Objectives: Develop a pragmatic list of medications used in primary care that required dose adjustment or avoidance in people with CKD, using a modified Delphi panel approach, followed by a consensus workshop. Methods: We conducted a comprehensive literature search to identify potential medications. A group of 17 experts participated in a 3-round modified Delphi panel to identify medications for inclusion. A subsequent consensus workshop of 8 experts reviewed this list to prioritize medications for the development of point-of-care knowledge translation materials for primary care. Results: After a comprehensive literature review, 59 medications were included for consideration by the Delphi panel, with a further 10 medications added after the initial round. On completion of the 3 Delphi rounds, 66 unique medications remained, 63 requiring dose adjustment and 16 medications requiring avoidance in one or more estimated glomerular filtration rate categories. The consensus workshop prioritized this list further to 24 medications that must be dose-adjusted or avoided, including baclofen, metformin, and digoxin, as well as the newer SGLT2 inhibitor agents. Conclusion and Relevance: We have developed a concise list of 24 medications commonly used in primary care that should be dose-adjusted or avoided in people with CKD to reduce harm. This list incorporates new and frequently prescribed medications and will inform an updated, easy to access source for primary care providers.


Assuntos
Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Medicamentos sob Prescrição/administração & dosagem , Atenção Primária à Saúde/métodos , Insuficiência Renal Crônica/tratamento farmacológico , Consenso , Técnica Delfos , Feminino , Humanos , Medicamentos sob Prescrição/efeitos adversos , Medicamentos sob Prescrição/uso terapêutico
11.
Clin Pharmacol Ther ; 107(3): 530-540, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31544241

RESUMO

The objective of this study was to analyze information on pediatric use in Korean drug product labels and compare it with that in US Food and Drug Administration (FDA) labeling information. Prescription information on pediatric use contained in the commonly used drugs' product labels approved by Korean government was compared with that approved by the FDA. Among the top 50 commonly prescribed drugs, 20 drugs were deemed to have insufficient prescribing information in Korean drug labels. Pediatric prescribing information regarding indication, approved age, formulations, and safety was insufficient in Korean drug labels compared with those in the FDA. Most important, the adverse events frequently reported in Korean children were not sufficiently presented in drug labels. In conclusion, this study highlights the urgent need for the Korean regulatory agency to encourage and accelerate research and development to increase the extent of pediatric prescribing information to be added to drug labels to promote appropriate drug prescribing for children.


Assuntos
Rotulagem de Medicamentos/legislação & jurisprudência , Padrões de Prática Médica/normas , Medicamentos sob Prescrição/administração & dosagem , Criança , Desenvolvimento de Medicamentos/legislação & jurisprudência , Humanos , Medicamentos sob Prescrição/efeitos adversos , República da Coreia , Estados Unidos , United States Food and Drug Administration
12.
Curr Med Res Opin ; 36(1): 161-168, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31433680

RESUMO

Objective: Determine healthcare resource utilization (HCRU) and costs associated with fatigue and stiffness among patients with rheumatoid arthritis (RA).Methods: A retrospective claims analysis compared RA patients with fatigue or stiffness to matched RA control patients with neither. Claims from a large US commercial insurance database identified new cases of stiffness/fatigue among newly diagnosed patients. Study patients had ≥2 medical claims for RA ≥45 days apart, continuous insurance coverage ≥12 months before RA index (baseline period) and ≥12 months after fatigue/stiffness index (follow-up period). Controls had no diagnosis of fatigue or stiffness ≥12 months before index. Cases had ≥1 claim of fatigue/stiffness after RA index; the first such claim was the index date. Multivariate logistic regressions, adjusting for baseline demographics, comorbidities, medication use and HCRU, were used to predict the propensity of having a fatigue/stiffness diagnosis. Controls were propensity-score matched to cases. Generalized linear models estimated all-cause and RA-specific costs associated with resource use as well as prescription drugs, adjusting for any unbalanced covariates after propensity-score matching.Results: Approximately 32% of newly diagnosed RA patients suffer from fatigue/stiffness. Matched cohorts were analyzed: fatigue vs. control; stiffness vs. control; fatigue and stiffness vs. control. After RA diagnosis, hospitalizations increased: 83% for fatigue, 117% for stiffness and 148% for both; total office visits increased 63%, 113% and 135%, respectively. Greater HCRU yielded significantly greater (all p < .001) per-patient-per-year hospitalization costs vs. matched controls: fatigue ($2554 vs. $1293); stiffness ($2792 vs. $892); fatigue and stiffness ($3322 vs. $1033). Per-patient-per-year costs of office visits increased significantly (all p < .001) vs. matched controls: fatigue ($1373 vs. $908); stiffness ($1580 vs. $761); fatigue and stiffness ($1989 vs. $921).Conclusions: RA patients with fatigue and/or stiffness report more HCRU and incur significantly higher medical costs than RA patients without them.


Assuntos
Artrite Reumatoide/fisiopatologia , Efeitos Psicossociais da Doença , Fadiga/etiologia , Custos de Cuidados de Saúde , Artrite Reumatoide/tratamento farmacológico , Comorbidade , Bases de Dados Factuais , Feminino , Recursos em Saúde , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Medicamentos sob Prescrição/administração & dosagem , Estudos Retrospectivos
14.
Pan Afr Med J ; 37: 127, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33425160

RESUMO

Introduction: vaso-occlusive crises (VOCs) are the primary reason for admission and hospitalization in children with sickle cell disease and most often they require home care before arriving to consultation. The purpose of this study was to describe home-based therapy for children with sickle cell disease admitted with VOCs. Methods: we conducted a descriptive and analytical cross-sectional study, in the pediatric emergencies at the Mother and Child Centre of the Chantal Biya Foundation (CBF) over a 4-month period from February to May 2018. Consecutive sampling was used. All patients with sickle cell disease presenting with VOCs were included in the study. Results: one hundred and fifty-two patients were enrolled. The most represented age group was 5- 10 years. Eighty-two patients (54%) presented more than 24 hours after the onset of the crises and 70 (46%) in the first 24 hours; 80% (n=122) of our sample had received analgesic treatment at home. Escalation of therapy was found in 31.2% of cases. The use of prescription medications (75.4%, n=92) was dominant as the 1st recourse. The dosage for analgesics was not correct in 67% of cases (overdose in 70% of cases). The correct dosage of home-based analgesics was administered in only 33% of patients. Conclusion: this study shows that home-based management of VOCs is inadequate. Measures must be taken to ensure that all patients with sickle cell disease can effectively manage minor to moderate VOCs at home.


Assuntos
Analgésicos/administração & dosagem , Anemia Falciforme/tratamento farmacológico , Overdose de Drogas/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Anemia Falciforme/complicações , Criança , Pré-Escolar , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Humanos , Lactente , Masculino , Medicamentos sob Prescrição/administração & dosagem
15.
Value Health ; 22(11): 1266-1274, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31708063

RESUMO

BACKGROUND: In 2012, Medicare incorporated medication adherence targeting oral antidiabetic medications, renin-angiotensin system (RAS) antagonists, and statins as highly weighted components in its Star Ratings Program. In the same year, health plans began receiving quality bonus payments for higher star ratings. OBJECTIVE: We aimed to assess how these policy changes affected adherence to targeted and other chronic disease medications in the United States. METHODS: We performed interrupted time series analyses to assess monthly changes in medication adherence from 2010 to 2016 using health plans' Medicare claims submitted to a large pharmacy benefits manager. We conducted 2 sets of analyses. The first examined whether policy changes affected adherence to the 3 targeted therapy classes, and the second assessed the association between policy changes and adherence to 5 chronic disease classes not targeted by star ratings. For the second analysis, we further compared adherence between members who concomitantly used and did not use targeted medications. RESULTS: For star-ratings analyses, we studied 240 811 members on oral antidiabetic medications, 500 958 on RAS antagonists, and 471 135 on statins. Adherence for all star rating-targeted and nontargeted medications increased after 2012 (P < .001). Oral antidiabetic, statin, and RAS antagonist adherence was, respectively, 11.2%, 3.7%, and 8.1% higher than adherence without policy changes (P < .001). Nontargeted antihypertensive and antihyperlipidemic adherence trends were higher among those concomitantly on star rating-targeted medications compared with those who were not (P < .001). CONCLUSIONS: As policy makers strive to identify optimal quality measures for improving healthcare delivery, it is important to consider that incentives can promote improved performance in both targeted measures and related outcomes.


Assuntos
Medicare Part D/organização & administração , Adesão à Medicação/estatística & dados numéricos , Medicamentos sob Prescrição/administração & dosagem , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Acidente Nuclear de Chernobyl , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipoglicemiantes/administração & dosagem , Análise de Séries Temporais Interrompida , Masculino , Medicare Part D/economia , Motivação , Indicadores de Qualidade em Assistência à Saúde , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos
16.
Addict Sci Clin Pract ; 14(1): 41, 2019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718716

RESUMO

BACKGROUND: Dependence to prescription and over-the-counter (OTC) drugs represents an increasing public health and clinical problem both in England and internationally. However, relatively little is known about those affected, particularly in relation to their management at drug dependence treatment centres. This study aimed to explore the views and experiences of health care professionals (HCPs) working in formal drug treatment services in relation to supporting clients with prescription and OTC drug dependence. METHODS: An exploratory, qualitative design was used involving semi-structured telephone interviews. 15 staff were recruited using purposive sampling to represent a variety of different professional roles, funding (NHS, charity and local government) and geographical locations across England. Transcribed interviews were analysed using Braun and Clarke's six stage thematic analysis. RESULTS: Current services were considered to be inappropriate for the treatment of OTC and prescription drug dependence, which was perceived to be a significantly under-recognised issue affecting a range of individuals but particularly those taking opioid analgesics. Negativity around current treatment services involved concerns that these were more suited for illicit drug users and this was exacerbated by a lack of specific resources, funding and commissioning. There was a perceived variation in service provision in different areas and a further concern about the lack of formal treatment guidelines and care pathways. Participants felt there to be stigma for affected clients in both the diagnosis of OTC or prescription drug dependence and also attendance at drug treatment centres which adversely impacted service engagement. Suggested service improvements included commissioning new specific services in general practices and pain management clinics, developing national guidelines and care pathways to ensure equal access to treatment and increasing awareness amongst the public and HCPs. CONCLUSIONS: This study reveals considerable negativity and concern about current treatment services for prescription and OTC drug dependence in England from the perspective of those working in such services. Policy and practice improvement are suggested to improve outcomes for this neglected group in relation to increasing funding, guidelines and awareness.


Assuntos
Atitude do Pessoal de Saúde , Medicamentos sem Prescrição/administração & dosagem , Medicamentos sob Prescrição/administração & dosagem , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Analgésicos Opioides/administração & dosagem , Procedimentos Clínicos/normas , Inglaterra/epidemiologia , Feminino , Financiamento Governamental , Acesso aos Serviços de Saúde/normas , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto/normas , Pesquisa Qualitativa , Estigma Social , Medicina Estatal , Centros de Tratamento de Abuso de Substâncias/economia , Centros de Tratamento de Abuso de Substâncias/normas
17.
PLoS One ; 14(11): e0224315, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693707

RESUMO

Preventive treatments for dementia are warranted. Here we show that utilization of certain combinations of prescription medications and supplements correlates with reduced rates of cognitive decline. More than 1,900 FDA-approved agents and supplements were collapsed into 53 mechanism-based groups and traced in electronic medical records (EMRs) for >50,000 patients. These mechanistic groups were aligned with the data presented in more than 300 clinical trials, then regression model was built to fit the signals from EMRs to clinical trial performance. While EMR signals of each single agents correlated with clinical performance relatively weakly, the signals produced by combinations of active compounds were highly correlated with the clinical trial performance (R = 0.93, p = 3.8 x10^-8). Higher ranking pharmacological modalities were traced in patient profiles as their combinations, producing protective complexity estimates reflecting degrees of exposure to beneficial polypharmacy. For each age strata, the higher was the protective complexity score, the lower was the prevalence of dementia, with maximized life-long effects for the highest regression score /diversity compositions. The connection was less strong in individuals already diagnosed with cognitive impairment. Confounder analysis confirmed an independent effect of protective complexity in multivariate context. A sub-cohort with lifelong odds of dementia decreased > 5-folds was identified; this sub-cohort should be studied in further details, including controlled clinical trials. In short, our study systematically explored combinatorial preventive treatment regimens for age-associated multi-morbidity, with an emphasis on neurodegeneration, and provided extensive evidence for their feasibility.


Assuntos
Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Suplementos Nutricionais , Polimedicação , Medicamentos sob Prescrição/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Cognição/efeitos dos fármacos , Cognição/fisiologia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/prevenção & controle , Fatores de Confusão Epidemiológicos , Bases de Dados Factuais/estatística & dados numéricos , Demência/fisiopatologia , Demência/prevenção & controle , Progressão da Doença , Registros Eletrônicos de Saúde/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Ciênc. Saúde Colet ; 24(11): 4335-4344, nov. 2019. tab
Artigo em Português | LILACS | ID: biblio-1039517

RESUMO

Resumo O objetivo do presente estudo foi caracterizar as interações medicamentosas potenciais (IMP) e avaliar os fatores associados à sua ocorrência em adultos e idosos assistidos pelo Programa Médico de Família de Niterói, Rio de Janeiro. Trata-se de um subestudo do ESTUDO DIGITALIS, que incluiu indivíduos cadastrados no Programa Médico de Família de Niterói (45-99 anos). Foram analisados 341 indivíduos com prescrição de dois ou mais medicamentos. A classificação das IMP seguiu o MICROMEDEX®. Houve 113 interações diferentes. Do total de indivíduos, 63,6% apresentaram pelo menos uma IMP. As variáveis com maior chance de IMP foram: menor escolaridade; renda inferior a R$800,00; ausência de plano de saúde; diagnóstico de hipertensão, diabetes, infarto agudo do miocárdio; e uso de 5 ou mais medicamentos prescritos. Após ajuste, as variáveis diagnóstico anterior de hipertensão e diabetes e uso de 5 ou mais medicamentos prescritos permaneceram significativas estatisticamente. É importante uma gestão cautelosa do tratamento na atenção básica com monitoramento das IMP, especialmente em pacientes mais susceptíveis.


Abstract The objective of the present study was to characterize the potential drug interactions (PDI), estimating the factors associated to their occurrence in adults and the elderly assisted by the Programa Médico de Família de Niterói, Rio de Janeiro. This is a sub-study of STUDY DIGITALIS, which included individuals enrolled in the Niteroi Family Medical Program (45-99 years). In this study, 341 individuals with a prescription of two or more drugs were analyzed. The classification of PDI followed MICROMEDEX. There were 113 different interactions. Of the total number of individuals, 63.6% had at least one PDI. The variables with higher probability of PDI were: lower level of schooling; income less than R$800.00; absence of health plan; previous diagnosis of hypertension and diabetes; use of 5 or more medications prescribed. After adjustment, the variables previous diagnosis of hypertension and diabetes and use of 5 or more prescription drugs remained statistically significant. Careful management of primary care treatment with monitoring is important in patients with PDI, especially in patients who are more susceptible.


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Atenção Primária à Saúde , Interações Medicamentosas , Medicamentos sob Prescrição/administração & dosagem , Brasil , Fatores de Risco , Diabetes Mellitus/epidemiologia , Escolaridade , Medicamentos sob Prescrição/efeitos adversos , Hipertensão/epidemiologia , Renda , Pessoa de Meia-Idade
20.
Int J Drug Policy ; 74: 170-173, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31622949

RESUMO

PURPOSE: In February 2018, Australia up-scheduled the 'weak' opioid codeine to a prescription only medication. This study aimed to analyse the change in prescribing trends for codeine and other commonly prescribed opioids in Australia following this policy change to determine if removal of over-the-counter codeine resulted in an increase in opioid prescribing. METHODS: Data was obtained through the Australian Government Department of Human Services statistics website, and contained monthly data about subsidised national prescription numbers for codeine, oxycodone, oxycodone-naloxone, tapentadol, tramadol, morphine, and fentanyl, from January 2016 to December 2018. Segmented linear regression accounting for autocorrelation was used to assess the effect of codeine rescheduling on the supply trends of these opioids. RESULTS: Rescheduling codeine to remove over-the-counter (non-prescription) supply does not appear to have had an immediate effect on the prescription rates of codeine, and there is no significant change in these rates in the months following. Analysis of data showed decreasing trends for codeine and most other schedule 8 prescription opioids, with no increase in any prescribed opioids associated with codeine up scheduling. CONCLUSIONS: Despite concerns, substitution of over-the-counter codeine with higher strength prescribed codeine has not been observed at a population level, nor has a shift to other prescribed opioids occurred. Overall, opioid prescribing in Australia has been decreasing since 2016, both for strong and weak opioids.


Assuntos
Analgésicos Opioides/administração & dosagem , Codeína/administração & dosagem , Medicamentos sem Prescrição/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos , Analgésicos Opioides/classificação , Austrália , Codeína/classificação , Humanos , Medicamentos sem Prescrição/provisão & distribução , Medicamentos sob Prescrição/administração & dosagem , Estudos Retrospectivos
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