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1.
BMJ ; 368: l6968, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996352

RESUMO

OBJECTIVE: To examine the distribution and patterns of opioid prescribing in the United States. DESIGN: Retrospective, observational study. SETTING: National private insurer covering all 50 US states and Washington DC. PARTICIPANTS: An annual average of 669 495 providers prescribing 8.9 million opioid prescriptions to 3.9 million patients from 2003 through 2017. MAIN OUTCOME MEASURES: Standardized doses of opioids in morphine milligram equivalents (MMEs) and number of opioid prescriptions. RESULTS: In 2017, the top 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions. In absolute terms, the top 1% of providers prescribed an average of 748 000 MMEs-nearly 1000 times more than the middle 1%. At least half of all providers in the top 1% in one year were also in the top 1% in adjacent years. More than two fifths of all prescriptions written by the top 1% of providers were for more than 50 MMEs a day and over four fifths were for longer than seven days. In contrast, prescriptions written by the bottom 99% of providers were below these thresholds, with 86% of prescriptions for less than 50 MMEs a day and 71% for fewer than seven days. Providers prescribing high amounts of opioids and patients receiving high amounts of opioids persisted over time, with over half of both appearing in adjacent years. CONCLUSIONS: Most prescriptions written by the majority of providers are under the recommended thresholds, suggesting that most US providers are careful in their prescribing. Interventions focusing on this group of providers are unlikely to effect beneficial change and could induce unnecessary burden. A large proportion of providers have established relationships with their patients over multiple years. Interventions to reduce inappropriate opioid prescribing should be focused on improving patient care, management of patients with complex pain, and reducing comorbidities rather than seeking to enforce a threshold for prescribing.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrição Inadequada/prevenção & controle , Administração dos Cuidados ao Paciente/normas , Médicos , Padrões de Prática Médica , Adulto , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Médicos/classificação , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Medicamentos sob Prescrição/uso terapêutico , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos/epidemiologia
3.
J Surg Res ; 245: 107-114, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415931

RESUMO

BACKGROUND: To help control opioid overprescription, we conducted a large institutional, 3-site initiative to provide discharge prescribing guidelines for different procedures. Our aim is to refine institutional guidelines for parathyroidectomy. METHODS: Patients undergoing parathyroidectomy completed a 28-question survey about opioid consumption. Discharge opioid prescription amounts were converted into morphine milligram equivalents (MMEs) and reported as median and interquartile range (IQR). Consumption was dichotomized into top quartile MME users (Q4) versus standard users (Q1, Q3). Univariate analysis compared opioid consumption. RESULTS: A total of 91 patients were included; 90% were opioid-naive. While the median prescribed was 75 (IQR 75, 150) MME, the median consumed was 0 (IQR 0, 20). Top users reported higher pain scores [median (IQR): 2 (2, 4)] compared to standard users [1 (0, 3), P = 0.01]. However, there was no difference in opioid consumption between unilateral neck exploration, bilateral exploration, or thyroidectomy and parathyroidectomy, P = 0.11. There was no difference in opioid consumption by age, sex, or BMI (all P > 0.05). Of those receiving a prescription, 94.6% had left-over opioids at the time of survey, resulting in 82% of prescribed opioids being unused. CONCLUSIONS: Over half of patients undergoing parathyroidectomy did not consume any opioid, and very few needed more than 2 d of opioid. Moreover, most patients did not dispose the unused opioids, which put these pills at risk of diversion and misuse. Surgical approach did not change consumption, illustrating that these guidelines are applicable to thyroidectomy given the similarity between techniques. We recommend prescribing nonopioid analgesics for patients undergoing parathyroidectomy.


Assuntos
Analgésicos não Entorpecentes/efeitos adversos , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Paratireoidectomia/efeitos adversos , Padrões de Prática Médica/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /prevenção & controle , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Guias de Prática Clínica como Assunto , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Estudos Retrospectivos , Tireoidectomia/efeitos adversos
5.
Rev Chilena Infectol ; 36(3): 253-264, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859743

RESUMO

BACKGROUND: Nowadays about half of antibiotic prescriptions are inadequate, increasing bacterial resistance. Both cephalosporins and fluoroquinolones are associated with this phenomenon: increase of ß-lactamase producing bacteria and Clostridioides difficile infections, which is why regulatory agencies seek to rationalize their use. AIM: To evaluate the effect of use recommendations on the proportion of inadequate prescriptions of ceftriaxone and fluoroquinolones. METHODS: A prospective and interventional study was developed, comparing the quality and quantity of use of ceftriaxone and fluoroquinolones before and after the implementation of use recommendations for treatments of infectious diseases acquired at the community. The outcomes were: proportion of inadequate prescriptions and defined daily dose (DDD). Data were analyzed using the Chi-square test, Fisher's correction and Student's test. RESULTS: A total of 206 patients were evaluated, a 35% decrease in inadequate prescriptions, a decline in the consumption of ceftriaxone and levofloxacin, and a significant increase in the use of ampicillin/ sulbactam was observed. CONCLUSIONS: The implementation of use recommendations based on scientific evidence and local susceptibility allowed to reduce the proportion of inadequate prescriptions and to reduce de consumption of ceftriaxone and fluoroquinolones.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos/normas , Ceftriaxona/administração & dosagem , Prescrições de Medicamentos/normas , Fluoroquinolonas/administração & dosagem , Hospitais Universitários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Uso de Medicamentos/normas , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Prescrição Inadequada/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
6.
Am Surg ; 85(10): 1198-1203, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657324

RESUMO

Overdose of opioids is the number one cause of accidental death in the United States, and surgeons are overprescribing these medications. The aim of this study was to assess the feasibility of implementing postoperative opioid prescribing guidelines for general surgery procedures at a public hospital, where patients have lower socioeconomic status, public insurance, and limited access to care. We implemented a quality improvement project, which included in-service training for surgical staff and distribution of standardized guidelines. An infographic for patients was created to facilitate education on postoperative pain management. Pre- and postintervention opioid prescriptions and emergency room visits were compared for patients undergoing common general surgery procedures (inguinal hernia repair, appendectomy, and laparoscopic cholecystectomy). The median number of narcotic pills prescribed significantly decreased from 30 (n = 64) to 15 (n = 63) after the intervention (P < 0.0001). Morphine milligram equivalents decreased from a median [range] of 150 [20,600] to 90 [5,300] (P < 0.0001). The percentage of patients with postoperative pain-related emergency department visits remained low (1.6%). Standardization of postoperative opioid prescription practices was successfully implemented at a public hospital without an increase in the number of emergency room visits for pain.


Assuntos
Analgésicos Opioides/uso terapêutico , Manejo da Dor/normas , Dor Pós-Operatória/tratamento farmacológico , Melhoria de Qualidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Prescrições de Medicamentos/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Herniorrafia/efeitos adversos , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Adulto Jovem
7.
BMC Res Notes ; 12(1): 592, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533806

RESUMO

OBJECTIVE: To investigate medications prescribed for pregnant women and their potential teratogenicity risk in Kemisse General Hospital. RESULT: A total of 263 medical records of pregnant women were reviewed, of which 234 pregnant women were prescribed with a total of 430 prescription drugs. The average numbers of drugs per pregnant women was found to be 1.84. Most pregnant women 166 (63.2%) were in the third trimester and more than half of them (51.3%) were multigravida. The maximum number of drugs were prescribed in the second trimester 162 (37.67%) followed by third trimester 143 (33.26%). Supplemental drugs were the most widely used medications 297 (69.07%) and followed by 82 (19.1%) drugs from category B; 54 (12.6%) drugs from category C; and the rest 7 (1.6%) drugs from category D. There was no any drug from category X. Moreover, approximately one third of the pregnant women encountered with drugs from category B, C and D. However, there were no FDA category C and D drugs prescribed in first trimester.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Hospitais Gerais , Cuidado Pré-Natal/estatística & dados numéricos , Medicamentos sob Prescrição/administração & dosagem , Adolescente , Adulto , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Prescrições de Medicamentos/normas , Etiópia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Medicamentos sob Prescrição/efeitos adversos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Teratogênese/efeitos dos fármacos , Adulto Jovem
9.
Diabetes Res Clin Pract ; 157: 107833, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31476347

RESUMO

AIM: The clinical andon board (CAB) is a novel electronic surveillance and communication system, which alerts providers to and prompts treatment of dysglycemia. This investigation was designed to determine the CAB's effectiveness in supporting adherence to standardized evidence-based protocols, as well as improving glycemic control. METHODS: This study was a retrospective pre/post analysis of insulin orders and blood glucose values. We used a Student's t-test for continuous variables and Chi2 for all other variables. This study included patients 18 years or older admitted to the hospital medical service as an inpatient with a length of stay greater than 24 h and less than 90 days. We used Pearson's correlation coefficient to evaluate the relationship between CAB and blood glucose. RESULTS: The rate of compliance in prescribing basal insulin for patient with diabetes increased from 56% to 77% (p < 0.001). Similarly, compliance rates for prescribing correctional insulin in patients without diabetes increased from 15% to 37% (p < 0.001). Performance on the CAB was linearly related to blood glucose (p = 0.004), and there was a small statistically (not clinically) significant improvement in mean blood glucose values. CONCLUSION: This approach is effective in alerting and engaging providers to prescribe insulin in a standardized manner with potential to improve glycemic control.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Prescrições de Medicamentos/normas , Insulina/uso terapêutico , Idoso , Algoritmos , Feminino , Humanos , Insulina/farmacologia , Masculino , Estudos Retrospectivos
11.
J Manag Care Spec Pharm ; 25(10): 1064-1072, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556825

RESUMO

BACKGROUND: It is challenging to detect long-term opioid therapy (LTOT) using administrative data, as refill gaps can disrupt opioid utilization episodes. Previous studies have used various methods to define LTOT and allowable refill gaps with little supporting evidence. OBJECTIVE: To describe the effect of allowable refill gaps on detecting LTOT among a cohort of patients with arthritis awaiting total knee arthroplasty (TKA) using 3 different methods. METHODS: A retrospective analysis of multicenter population-based data between January 1, 2012, and December 31, 2016, identified patients prescribed opioids before TKA in Alberta, Canada. We described 3 methods to detect LTOT based on a (1) fixed number of days between prescriptions; (2) fraction of the preceding prescription length; and (3) combination method that selected whichever refill gap was greatest. We then compared the number of patients classified as long-term opioid users by varying the number of days between prescriptions from 1-90 days (fixed method) or 0.04-3.2 times the duration (fraction method) for each method and refill gap. RESULTS: Of the 14,252 patients included in our cohort, 4,393 patients (31%) had an opioid prescription within 180 days before TKA. Detection of LTOT varied from 4.4% to 14.6% (fixed method), 4.2% to 13.2% (fraction method), and 4.5% to 15.1% (mixed method) as refill gaps varied from minimum to maximum. As refills gaps increased, the dose and duration of opioids in the utilization episode decreased for all 3 methods. CONCLUSIONS: The allowable refill gap between opioid prescriptions can influence the estimated rate of LTOT when using administrative pharmaceutical dispensing data. Definitional parameters should be carefully considered when using administrative data to define consistent opioid use. DISCLOSURES: This work was supported by the Department of Surgery's Clinical Research Grant at the University of Alberta (RES0039945). The authors have no potential conflicts of interest.


Assuntos
Analgésicos Opioides/uso terapêutico , Artralgia/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Osteoartrite do Joelho/complicações , Idoso , Artralgia/etiologia , Artroplastia do Joelho , Bases de Dados Factuais/estatística & dados numéricos , Prescrições de Medicamentos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Tempo
12.
Am J Health Syst Pharm ; 76(18): 1403-1412, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31505561

RESUMO

PURPOSE: Millions of Americans who undergo surgical procedures receive opioid prescriptions as they return home. While some derive great benefit from these medicines, others experience adverse events, convert to chronic opioid use, or have unused medicines that serve as a reservoir for potential nonmedical use. Our aim was to investigate concepts and methods relevant to optimal opioid prescribing and pain treatment in the perioperative period. METHODS: We reviewed existing literature for trials on factors that influence opioid prescribing and optimization of pain treatment for surgical procedures and generated a conceptual framework to guide future quality, safety, and research efforts. RESULTS: Opioid prescribing and pain treatment after discharge from surgery broadly consist of 3 key interacting perspectives, including those of the patient, the perioperative team, and, serving in an essential role for all patients, the pharmacist. Systems-based factors, ranging from the organizational environment's ability to provide multimodal analgesia and participation in enhanced recovery after surgery programs to other healthcare system and macro-level trends, shape these interactions and influence opioid-related safety outcomes. CONCLUSIONS: The severity and persistence of the opioid crisis underscore the urgent need for interventions to improve postoperative prescription opioid use in the United States. Such interventions are likely to be most effective, with the fewest unintended consequences, if based on sound evidence and built on multidisciplinary efforts that include pharmacists, nurses, surgeons, anesthesiologists, and the patient. Future studies have the potential to identify the optimal amount to prescribe, improve patient-focused safety and quality outcomes, and help curb the oversupply of opioids that contributes to the most pressing public health crisis of our time.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/normas , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , /normas , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Conduta do Tratamento Medicamentoso/organização & administração , Conduta do Tratamento Medicamentoso/normas , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor/normas , Dor Pós-Operatória/etiologia , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Alta do Paciente , Segurança do Paciente , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Farmacêuticos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Estados Unidos/epidemiologia
13.
Clin Drug Investig ; 39(11): 1077-1092, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31399894

RESUMO

BACKGROUND AND OBJECTIVES: In Japan, polypharmacy reduction policy, which reduces the reimbursement of medical cost, was introduced to address unnecessary psychotropic polypharmacy. The rule was applied to the prescriptions of three or more anxiolytics or three or more hypnotics in the policy introduced in 2012. The prescriptions of four or more antidepressants or four or more antipsychotics were added to the rule in the policy revised in 2014. Furthermore, the prescriptions of three or more drugs of anxiolytics, hypnotics, antidepressants, or antipsychotics were subject to the reduction criteria of the policy revision in 2016. Benzodiazepine receptor agonists (BZs) are classified both into anxiolytics and hypnotics, and the reduction rule was not applied to the category of BZs before April 2018. This study aimed to examine the effect of the policy on the prescriptions of four drug categories as well as BZs from the point of view of the number of drugs and doses. METHODS: This was a retrospective observational study using a large-scale Japanese health insurance claims database. Patients who were prescribed at least one psychotropic drug (anxiolytic, hypnotic, antidepressant, or antipsychotic) during the study period (from April 2011 to March 2017) were selected. Segmented regression analysis was used to analyze the proportions of patients with three or more or four or more drugs as well as patients above clinically recommended doses, and the means of the average daily doses by drug category. RESULTS: A total of 312,167 patients were identified as a study population. The proportions of patients with three or more drugs in anxiolytics, hypnotics, antidepressants, and antipsychotics significantly decreased after the introduction or revisions of the policy, but not BZs. The proportions of patients with three or more drugs in March 2017 were 0.9%, 2.0%, 1.2%, 2.4%, and 8.9% in anxiolytics, hypnotics, antidepressants, antipsychotics, and BZs, respectively. The effect of the policy in reducing the proportions of patients above clinically recommended doses was identified in antipsychotics after the revision in 2016, but not identified in the sum of anxiolytics and hypnotics as well as BZs after the revision in 2014, and antidepressants after the revision in 2016. The proportions of monotherapy were increased from April 2011 to March 2017 only for antidepressants (76.9% → 80.8%) and antipsychotics (79.8% → 82.1%), and not changed or decreased for anxiolytics (85.2% → 85.7%), hypnotics (78.6% → 77.6%), sum of anxiolytics and hypnotics (68.1% → 65.7%), BZs (68.0% → 67.3%), and sum of psychotropic drugs (52.1% → 49.9%). CONCLUSIONS: The polypharmacy reduction policy reduced the proportions of patients with three or more drugs in four drug categories, but not BZs. Only limited effects were seen for reducing the proportions of patients above clinically recommended doses. The policy was revised in April 2018 again. Further investigation is needed to examine the effect of the revision in 2018.


Assuntos
Bases de Dados Factuais/tendências , Prescrições de Medicamentos , Revisão da Utilização de Seguros/tendências , Polimedicação , Psicotrópicos/administração & dosagem , Adolescente , Adulto , Idoso , Antidepressivos/administração & dosagem , Antipsicóticos/administração & dosagem , Bases de Dados Factuais/normas , Prescrições de Medicamentos/normas , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Revisão da Utilização de Seguros/normas , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
Paediatr Drugs ; 21(5): 357-369, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432433

RESUMO

Obesity rates continue to rise in children, and little guidance exists regarding the need for adjustment away from total body weight-based doses for those prescribing drugs to this population of children. A majority of drugs prescribed to children with obesity result in either sub-therapeutic or supra-therapeutic concentrations, placing these children at risk for treatment failure and drug toxicities. In this review, we highlight available obesity-specific pharmacokinetic and dosing information for the most frequently prescribed drugs to children in the inpatient and outpatient clinical settings. We also comment on available dosing recommendations for drugs prescribed to treat common pediatric obesity-related comorbidities. This review highlights that there is no safe or proven 'rule of thumb,' for dosing drugs for children with obesity, and a striking lack of pharmacokinetic data to support the creation of dosing guidelines for children with obesity for the most commonly prescribed drugs. It is important that those prescribing for children with obesity are aware of these gaps in knowledge and of potential drug treatment failure or adverse events related to drug toxicity as a result of these knowledge gaps. Until more data are available, we recommend close monitoring of drug response and adverse events in children with obesity receiving commonly prescribed drugs.


Assuntos
Cálculos da Dosagem de Medicamento , Prescrições de Medicamentos/normas , Obesidade Pediátrica/tratamento farmacológico , Criança , Comorbidade , Humanos
15.
Public Health Rep ; 134(5): 567-576, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31365317

RESUMO

OBJECTIVES: High-risk opioid-prescribing practices contribute to a national epidemic of opioid-related morbidity and mortality. The objective of this study was to determine whether the adoption of state-level opioid-prescribing guidelines that specify a high-dose threshold is associated with trends in rates of opioid overdose hospitalizations, for prescription opioids, for heroin, and for all opioids. METHODS: We identified 3 guideline states (Colorado, Utah, Washington) and 5 comparator states (Arizona, California, Michigan, New Jersey, South Carolina). We used state-level opioid overdose hospitalization data from 2001-2014 for these 8 states. Data were based on the State Inpatient Databases and provided by the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, via HCUPnet. We used negative binomial panel regression to model trends in annual rates of opioid overdose hospitalizations. We used a multiple-baseline difference-in-differences study design to compare postguideline trends with concurrent trends for comparator states. RESULTS: For each guideline state, postguideline trends in rates of prescription opioid and all opioid overdose hospitalizations decreased compared with trends in the comparator states. The mean annual relative percentage decrease ranged from 3.2%-7.5% for trends in rates of prescription opioid overdose hospitalizations and from 5.4%-8.5% for trends in rates of all opioid overdose hospitalizations. CONCLUSIONS: These findings provide preliminary evidence that opioid-dosing guidelines may be an effective strategy for combating this public health crisis. Further research is needed to identify the individual effects of opioid-related interventions that occurred during the study period.


Assuntos
Overdose de Drogas/epidemiologia , Prescrições de Medicamentos/normas , Guias como Assunto , Hospitalização/tendências , Bases de Dados Factuais , Humanos , Análise de Regressão , Transtornos Relacionados ao Uso de Substâncias , Estados Unidos/epidemiologia
16.
Farm. hosp ; 43(4): 140-145, jul.-ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183901

RESUMO

Objetivo: Elaborar un protocolo de uso de fármacos antipsicóticos en pacientes institucionalizados que presenten alteraciones conductuales que incluya criterios de prescripción y deprescripción y valorar su aplicabilidad en el ámbito de los centros sociosanitarios. Método: El protocolo de actuación se elaboró por consenso de un equipo interdisciplinar a partir de una búsqueda bibliográfica de las propuestas publicadas sobre el uso de antipsicóticos en estos pacientes. La valoración de su aplicabilidad en la deprescripción de antipsicóticos se realizó mediante un estudio prospectivo antes-después con un seguimiento de 6 meses tras la intervención en una residencia para personas mayores dependientes. Resultados: Se elaboró un protocolo que incluye criterios de prescripción y deprescripción de antipsicóticos. La intervención se realizó sobre 35 pacientes, 21 (60%) de las cuales eran mujeres. La retirada del tratamiento antipsicótico fue completa en 28 pacientes (80%) y se redujo a la mínima dosis eficaz en 7 (20%). El tratamiento se reinició en 2 pacientes por agravamiento de los síntomas. Los resultados de la evaluación conductual previa y a los 6 meses indicaron que no se produjeron modificaciones significativas en dichas alteraciones (12,91 ± 12,80 frente a 13,76 ± 16,68; p = 0,124). Conclusiones: El establecimiento de un protocolo que incluya criterios de prescripción y deprescripción, unido a la incorporación del farmacéutico en el equipo interdisciplinar, puede ser una herramienta eficaz para mejorar el uso de este tipo de medicamentos en los pacientes institucionalizados con demencia


Objective: To develop a clinical protocol for the use of antipsychotic drugs in dementia patients with behavioral disturbances that includes prescribing and deprescribing criteria and to assess its applicability in longterm care institutions. Method: The protocol was developed from an interdisciplinary perspective based on a literature search of the published proposals on antipsychotic drug use in dementia patients. Its applicability to the antipsychotic deprescribing process was assessed in a single center in a prospective before-after study with a follow-up of 6 months after the intervention study. Results: A protocol was developed that includes prescribing and deprescribing criteria. The intervention was performed in 35 patients (21 [60%] female). Antipsychotic treatment was completely withdrawn in 28 patients (80%) and was reduced to the minimum effective dose in 7 (20%). Treatment was resumed in 2 patients due to worsening symptoms. The pre- and 6-month post-test results showed that there were no significant changes in neuropsychiatric symptoms (12.91 ± 12.80 vs 13.76 ± 16.68; P = 0.124). Conclusions: The establishment of a protocol that includes prescribing and deprescribing criteria, in combination with the incorporation of a pharmacist in the multidisciplinary team, can be effective in improving the use of these drugs in elderly dementia patients in long-term care institutions


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Desprescrições , Antipsicóticos/uso terapêutico , Protocolos Clínicos , Demência/tratamento farmacológico , Prescrições de Medicamentos/normas , Estudos Prospectivos , Análise Estatística
19.
Am J Health Syst Pharm ; 76(13): 970-979, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31361884

RESUMO

PURPOSE: To examine the extent to which outpatient clinicians currently document drug indications in prescription instructions. METHODS: Free-text sigs were extracted from all outpatient prescriptions generated by the computerized prescriber order entry system of a major academic institution during a 5-year period. Natural language processing was used to identify drug indications. The data set was analyzed to determine the rates at which prescribers included indications. It was stratified by provider specialty, drug class, and specific medications, to determine how often these indications were in prescriptions for as-needed (PRN) versus non-PRN medications. RESULTS: During the study period, 4,356,086 prescriptions were ordered. Indications were included in 322,961 orders (7.41%). From these orders, 249,262 indications (77.18%) were written for PRN orders. Although internal medicine prescribers generated the highest number of medication orders, they included indications in only 6.26% of their prescriptions, whereas orthopedic surgery providers had the highest rate of documenting indications (33.41%). Pain was the most common indication, accounting for 30.35% of all documented indications. The drug class with the highest number of sigs-containing indications was narcotic analgesics. Non-PRN chronic medication prescriptions rarely included the indication. CONCLUSION: Prescribers rarely included drug indications in electronic free-text prescription instructions, and, when they did, it was mostly for PRN uses such as pain.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Sistemas de Registro de Ordens Médicas/estatística & dados numéricos , Assistência Ambulatorial/normas , Conjuntos de Dados como Assunto , Prescrições de Medicamentos/normas , Humanos , Sistemas de Registro de Ordens Médicas/normas , Erros de Medicação/prevenção & controle , Processamento de Linguagem Natural
20.
Ann Surg Oncol ; 26(10): 3109-3114, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342372

RESUMO

BACKGROUND: No clear standards regarding number or type of narcotics for adequate postoperative pain control have been established in breast surgery. The authors of this study reviewed their opioid-prescribing patterns and implemented a planned change, evaluated the effectiveness of a departmental practice adjustment, and prospectively evaluated patient narcotic usage. METHODS: The narcotic prescriptions for 100 consecutive breast surgery patients were reviewed to establish baseline postoperative narcotic-prescribing patterns. The median of narcotics prescribed was used to educate surgeons and implement a planned change in prescribing practices. Data on narcotic prescriptions for 100 consecutive breast surgery patients then were prospectively collected, and the number of pain pills the patients actually took after discharge was recorded using a standardized template. RESULTS: A baseline review of narcotic-prescribing practices showed that the median number of pills given was 15 for excisional biopsy/lumpectomy, 20 for mastectomy, and 28 for mastectomy with reconstruction. After departmental education, the median number decreased to 10 for excisional biopsy/lumpectomy (p < 0.01) and 25 for mastectomy with reconstruction (p < 0.01). Prospective recording of patient usage compared with the prescribed number of pills indicated that most prescribed pills were not used, with the excisional biopsy or lumpectomy patients using a median of 1 pill (p < 0.01), the mastectomy patients using a median of 3 pills (p < 0.01), and the mastectomy with reconstruction patients using a median of 18 pills (p < 0.01) postoperatively. Only three patients, all of whom had breast reconstruction performed, required a refill of narcotics. CONCLUSIONS: Successful reduction in narcotic prescriptions can be implemented for breast surgery patients. Further reductions in narcotic prescriptions may be feasible based on prospective collected patient usage.


Assuntos
Neoplasias da Mama/cirurgia , Prescrições de Medicamentos/normas , Mastectomia/efeitos adversos , Entorpecentes/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Padrões de Prática Médica , Prognóstico , Estudos Prospectivos , Inquéritos e Questionários
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