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6.
Am J Trop Med Hyg ; 103(4): 1630-1634, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32815509

RESUMO

COVID-19 is a global pandemic which has seriously impacted the economy of nations. Access to essential medicines is of utmost importance. This study examined the impacts of the COVID-19 pandemic on the ease of access to essential medicines by end users. A cross-sectional survey using electronic questionnaires was conducted on study participants across the 36 states of Nigeria. They were assessed on sociodemographics, health characteristics, and challenges in accessing essential medicines during the COVID-19 pandemic. Data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS version 20, IBM, Armonk, NY) with overall impact of the pandemic operationalized as < 60.0% or ≥ 60.0% access to essential medicines by respondents as maximal and minimal impact, respectively. The results showed that 35.2% of the respondents managing chronic illnesses had difficulties accessing essential medicines during the COVID-19 lockdown, with 84.0% experiencing deteriorating chronic health conditions in the light of difficulty in accessing their medicines. The proportion of respondents who sourced for orthodox medicines before COVID-19 lockdown (98.4%) was significantly (P < 0.05) higher than that of those who sourced for the same during the lockdown (89.0%). Increase in cost of medicines was observed by 77.7% of participants, with 73.9% of respondents living with chronic illness affirming that their income was negatively affected by the pandemic. The COVID-19 pandemic had minimal impact on consumers' ability to access essential medicines. However, important challenges identified were poor availability of means of transportation, reduced income, and high cost of medicines, as well as fear of contracting the virus.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Medicamentos sob Prescrição/provisão & distribução , Quarentena/psicologia , Adolescente , Adulto , Idoso , Betacoronavirus/patogenicidade , Criança , Pré-Escolar , Resfriado Comum/tratamento farmacológico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Medo/psicologia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Lactente , Malária/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Saúde Pública/ética , Inquéritos e Questionários , Febre Tifoide/tratamento farmacológico
7.
Einstein (Sao Paulo) ; 18: eAO5314, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32785451

RESUMO

Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval - 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.


Assuntos
Uso de Medicamentos/estatística & dados numéricos , Medicamentos Essenciais/uso terapêutico , Gastroenteropatias/tratamento farmacológico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Adulto , Idoso , Brasil , Cidades , Estudos Transversais , Medicamentos Essenciais/provisão & distribução , Feminino , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Preparações Farmacêuticas/provisão & distribução , Medicamentos sob Prescrição/provisão & distribução , Fatores Socioeconômicos , Adulto Jovem
9.
Bull World Health Organ ; 98(6): 413-419, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32514215

RESUMO

Objective: To obtain the perspectives of some small- and medium-sized organizations on the World Health Organization (WHO) prequalification programme for medicines and to ascertain organizations' unmet needs. Methods: We conducted an exploratory, qualitative study in 2018 among 17 representatives of 15 small- and medium-sized Belgian and non-Belgian organizations who purchase medicines for humanitarian, development or public programmes in low- and middle-income countries. We used semi-structured interviews to obtain respondents' views and experiences of using WHO prequalification guidance when procuring medicines. We identified emerging themes and formulated recommendations about the activities of the WHO Prequalification Team. Findings: Most respondents suggested expanding prequalification to essential antibiotics, particularly paediatric formulations; and insulin, antihypertensives and cancer treatments. Respondents were concerned about irregular availability of WHO-prequalified medicines in the marketplace and sometimes high prices of prequalified products. Small organizations, in particular, had difficulties negotiating low-volume purchases. Organizations working in primary health care and hospitals seldom referred to the prequalified lists. Conclusion: We recommend that the WHO-prequalified products be expanded to include essential antibiotics and medicines for noncommunicable diseases. The WHO Prequalification Team could require prequalified manufacturers to make publicly available the details of their authorized distributors and facilitate a process of harmonization of quality assurance policies across all donors. Prequalification of distributors and procurement agencies could help create more transparent and stringent mechanisms. We urge WHO Member States and funders to sustain support for the WHO Prequalification Team, which remains important for the fulfilment of universal health coverage.


Assuntos
Medicamentos Essenciais/provisão & distribução , Saúde Global , Organizações/organização & administração , Medicamentos sob Prescrição/provisão & distribução , Organização Mundial da Saúde/organização & administração , Antibacterianos/provisão & distribução , Humanos , Doenças não Transmissíveis/tratamento farmacológico , Organizações/normas , Pesquisa Qualitativa
10.
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
14.
JAMA Netw Open ; 3(4): e202051, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32242907

RESUMO

Importance: Benzodiazepines, which are associated with safety-related harms for older adults, were not covered when the US Medicare Part D prescription drug benefit began. Coverage was extended to benzodiazepines in 2013. Objective: To examine whether the expansion of benzodiazepine coverage among Medicare Advantage (MA) beneficiaries was associated with increases in fall-related injuries or overdoses among older adults. Design, Setting, and Participants: This ecological study used interrupted time-series with comparison-series analyses of MA claims data from 4 635 312 age-eligible MA beneficiaries and 940 629 commercially insured individuals (comparison group) stratified by age (65-69, 70-74, 75-79, and ≥80 years) to separately compare trends in fall-related injury and overdose before (January 1, 2010, to December 31, 2012) and after (January 1, 2013, to December 31, 2015) coverage expansion for benzodiazepines. Data analysis was performed from September 1, 2018, to August 31, 2019. Exposures: Expansion of benzodiazepine coverage in Medicare Part D in 2013. Main Outcomes and Measures: Monthly rate of fall-related injury and overdose. Results: In 2012 (the year before the policy change), women constituted 57.5% of the MA group and 47.4% of the comparison group. A total of 25.8% of individuals in the MA group were aged 65 to 69 years, and 29.3% were 80 years or older (mean [SD], 75.1 [6.4] years); 56.7% of individuals in the comparison group were aged 65 to 69 years, and 15.1% were 80 years or older (mean [SD] age, 70.9 [6.5] years). In the MA group, 4 635 312 individuals contributed 156 754 749 person-months from 2010 through 2015; in the comparison group, 940 629 individuals contributed 25 104 534 person-months. After coverage of benzodiazepines began, the rate (ie, slope) of fall-related injury among MA beneficiaries increased from before to after coverage among all age groups. Compared with the comparison group, the increase in rate was statistically significant for those 80 years or older (rate changes for the MA vs comparison groups: 0.12 [95% CI, 0.07 to 0.17] vs -0.01 [95% CI, -0.11 to 0.10]; P = .04 for interaction). The overdose trend changed from decreasing to increasing among MA beneficiaries after coverage for all age groups, with a statistically significant increase compared with the comparison group among those aged 65 to 69 years (rate changes for the MA vs comparison groups: 0.23 [95% CI, 0.17 to 0.30] vs 0.02 [95% CI, -0.06 to 0.11]; P < .001 for interaction) and among those 80 years or older (rate changes for the MA vs comparison groups: 0.07 [95% CI, 0.00 to 0.14] vs -0.20 [95% CI, -0.35 to -0.05]; P = .002 for interaction). Results among MA beneficiaries were consistent when stratified by sex and when limited to those prescribed opioids. Conclusions and Relevance: Medicare's expansion of benzodiazepine coverage may have been associated with increases in the rates of overdose among adults ages 65 to 69 years and in the rates of overdose and fall-related injury among those 80 years or older.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Benzodiazepinas/efeitos adversos , Benefícios do Seguro/tendências , Cobertura do Seguro/estatística & dados numéricos , Medicare Part D/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Benzodiazepinas/uso terapêutico , Estudos de Casos e Controles , Overdose de Drogas/epidemiologia , Feminino , Humanos , Benefícios do Seguro/economia , Análise de Séries Temporais Interrompida , Masculino , Medicare Part C , Medicare Part D/economia , Segurança do Paciente , Medicamentos sob Prescrição/efeitos adversos , Medicamentos sob Prescrição/provisão & distribução , Estados Unidos/epidemiologia
16.
Otolaryngol Head Neck Surg ; 162(6): 969-978, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32284006

RESUMO

OBJECTIVE: To evaluate postoperative opiate use and patients' opinions regarding pain management after endoscopic sinus surgery (ESS). STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary referral medical center. SUBJECTS AND METHODS: We prospectively evaluated postoperative opiate utilization in adults undergoing ESS over a 2-year period at an academic medical facility. Exclusion criteria included use of nasal packing, intracranial or orbital procedures, tumor surgery, and any use of endoscopic drills. All patients underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with or without septoplasty. Patients were discharged with 30 oxycodone-acetaminophen (5-325 mg) and a survey assessing pain and narcotic/nonnarcotic use on postoperative days 0 to 7. RESULTS: A total of 64 patients completed surveys. Mean ± SD narcotic use over the 7-day postoperative period was 7.7 ± 7.6 pills. Patients with high narcotic use (>6 pills total) had no differences in demographic or surgical factors from those with low use (≤6 pills) but did report a higher level of postoperative day 1 pain (4.8 ± 1.1 vs 2.0 ± 1.4, P < .001). Narcotic use declined during this period, with <30% of patients requiring narcotics by postoperative day 3. CONCLUSION: Our results support reduced opiate prescription and encouragement of nonnarcotic use after ESS without compromising effective pain management.


Assuntos
Analgésicos Opioides/uso terapêutico , Endoscopia/métodos , Seio Etmoidal/cirurgia , Seio Frontal/cirurgia , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Medicamentos sob Prescrição/provisão & distribução , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/diagnóstico , Estudos Prospectivos
18.
Med J Aust ; 212(7): 321-327, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32200566

RESUMO

OBJECTIVE: To investigate changes in sales to pharmacies of over-the-counter (OTC) and prescription analgesics, cold and flu products, and cough suppressants after the rescheduling of codeine as a prescription only medicine in February 2018. DESIGN: Interrupted time series analysis of sales to pharmacies. SETTING: Pharmaceutical sales to community pharmacies in Australia, March 2015 - March 2019. The period January 2017 (month after rescheduling was announced) to January 2018 (month before rescheduling was implemented) was excluded from the time series analysis. MAIN OUTCOME MEASURES: Monthly pack and tablet sales per 10 000 population of OTC and prescription analgesics, cold and flu products, and cough suppressants. RESULTS: During 2016, 7586 packs and 248 127 tablets of OTC codeine per 10 000 population were sold to pharmacies; in the 14 months after rescheduling, a small level increase in monthly prescription codeine sales was evident (2247 tablets/capsules per 10 000 population; 95% CI, 1231-3264 per 10 000 population). Monthly OTC analgesic sales increased by 258 (95% CI, 151-365) packs per 10 000 population and 37 856 (95% CI, 26 143-49 569) tablet/capsules per 10 000 population. Monthly sales of single ingredient paracetamol (41 415 [95% CI, 31 374-51 456] tablets/capsules per 10 000 population), ibuprofen (1392 [95% CI 916-1868] tablets/capsules per 10 000 population), paracetamol/ibuprofen (1618 tablets [95% CI, 1567-1669] tablets/capsules per 10 000 population), and other paracetamol combinations (233 [95% CI, 112-353] tablets/capsules per 10 000 population) all increased, but not those of prescription analgesic products not containing codeine. Rises for OTC cold/flu products containing the opioid derivative dextromethorphan were small; sales of OTC cough suppressants containing opioid derivatives (dextromethorphan, pholcodine, dihydrocodeine) did not change. CONCLUSIONS: The rescheduling of codeine was followed by increased sales to pharmacies of paracetamol, ibuprofen, and paracetamol combination products. While these products carry no risk of dependence, their inappropriate use is also associated with harms that warrant adverse event monitoring.


Assuntos
Analgésicos Opioides/provisão & distribução , Codeína/provisão & distribução , Comércio/estatística & dados numéricos , Serviços Comunitários de Farmácia/organização & administração , Medicamentos sob Prescrição/provisão & distribução , Austrália , Comércio/tendências , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Análise de Séries Temporais Interrompida , Medicamentos sem Prescrição/provisão & distribução
20.
Annu Rev Pharmacol Toxicol ; 60: 275-289, 2020 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136248

RESUMO

High and rising prescription drug costs have become a preoccupying policy problem in the United States. Notwithstanding broad, bipartisan interest in finding effective policy solutions, several aspects of the drug affordability problem make it an uncommonly difficult one to solve. This article reviews the moral, market, and political factors contributing to the difficulty. Among the moral problems is lack of agreement about how to weigh the fundamental tradeoff involved in regulating drug prices-affordability versus incentives for innovation-and about what constitutes a fair price. Market-related factors include the lack of price transparency and a myriad of perverse incentives in the system through which prescription drugs are supplied to patients. Finally, current policy choices are constrained by past political compromises, and an atmosphere of scandal focusing on egregious instances of price gouging has made rational deliberation about fixes to deeper problems in the system difficult.


Assuntos
Custos de Medicamentos/tendências , Acesso aos Serviços de Saúde/economia , Medicamentos sob Prescrição/economia , Custos e Análise de Custo/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Humanos , Medicamentos sob Prescrição/provisão & distribução , Política Pública , Estados Unidos
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