Objetivos: Descrever o uso e determinar a prevalência de medicamentos potencialmente perigosos e de uso off label e não aprovados em prescrições de unidades de pediatria geral de um hospital universitário no sul do Brasil. Método: Estudo transversal, realizado de novembro de 2007 a janeiro de 2008, envolvendo pacientes até 14 anos de idade, com período de internação superior a 24 horas. Pacientes de unidades de terapia intensiva e oncologia pediátrica foram excluídos. A classificação quanto aos critérios de aprovação da Food and Drug Administration foi realizada pela fonte terciária DrugDex-Micromedex e a classificação dos potencialmente perigosos, pelo Institute for Safe Medication Practices. Resultados e discussão: No período de estudo foram analisadas 342 prescrições de 342 pacientes. O sexo masculino foi o mais freqüente (57%) e mais da metade dos pacientes já apresentavam doenças crônicas à internação. Analgésicos foi a classe terapêutica mais prescrita (26,9%) e entre os off label, os antiespasmódicos (31,5%) foram os mais prevalentes. Das prescrições analisadas, aproximadamente 39% tiveram pelo menos um medicamento de uso off label prescrito, principalmente em relação à indicação terapêutica (38,4%) e à idade (21,9 %), e 11,8% dos pacientes fizeram uso de fármacos não aprovados. Do total de itens (2026), cerca de 6% foram classificados como potencialmente perigosos, destacando-se os analgésicos opióides (35%). Não houve relação de associação entre medicamentos de uso off label e os potencialmente perigosos. Conclusão: As frequências encontradas de medicamentos off label e não aprovados estão de acordo com a literatura e podem ser consideradas elevadas. Os potencialmente perigosos, apesar da baixa prevalência, oferecem risco pelos efeitos prejudiciais que possam vir a causar nos pacientes. Assim, os medicamentos em destaque neste estudo representam uma preocupação constante em hospitais. / Objectives: Describe the use and determine the prevalence of high-alert medications, off label use and unlicensed drugs in prescriptions of general pediatric units of a university hospital in southern Brazil. Method: Cross-sectional study, performed from November 2007 to January 2008, involving patients up to 14 years of age, with admission period over 24 hours. Patients of intensive care and pediatric oncology units were excluded. The classification regarding the Food and Drug Administration approval criteria was performed according to the DrugDex-Micromedex tertiary source and the classification of high-alert medications according to the Institute for Safe Medication Practices. Results e discussion: In the study period, 342 prescriptions were analyzed. Males were more frequent (57%) and over half of the patients already presented chronic diseases for admission. Analgesic drugs were the most frequently prescribed therapeutic class of drugs (26.9%) and among the off-label drugs, antispasmodic drugs (31.5%) were the most prevalent. Around 39% of the analyzed prescriptions had at least one off-label use drug, especially in relation to therapeutic indication (38.4%) and age (21.9%), and 11.8% of the patients received unlicensed drugs. About 6% of the total items (2026) were classified as high-alert medications, such as opioid analgesic drugs (35%). No relation of association was observed between off-label use and high-alert medications. Conclusion: The frequency analyses found of off-label and unlicensed drugs are according to the literature and can be considered as high. The high-alert medications, although of low prevalence, offer risks due to negative effects that can occur in patients. Then, the drugs highlighted in this study constitute a constant concern in hospitals.

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No. of bitstreams: 1 alessandraestherdemendonca.pdf: 404434 bytes, checksum: aba5fda737e161858557304e2a521675 (MD5) Previous issue date: 2008-09-26 / A Organização Mundial da Saúde (OMS) estabeleceu que: “O uso racional de medicamentos (URM) ocorre quando o paciente recebe fármacos apropriados para as suas necessidades clínicas, em doses que satisfaçam suas necessidades individuais, por um período de tempo adequado e ao menor custo para ele e sua comunidade.” Uma das principais preocupações mundiais nesse contexto é o uso inadequado de antimicrobianos, que gera aumento da resistência microbiana e elevação nos custos do sistema de saúde. Este estudo observacional transversal investigou as prescrições de antimicrobianos em três Hospitais Sentinela a partir de 210 prontuários de pacientes idosos (com 60 anos ou mais) hospitalizados e submetidos à antibioticoterapia. Verificou-se o predomínio de infecções respiratórias (67 prontuários) no período de maio de 2007 a março de 2008. Esses 67 prontuários foram selecionados para o estudo. Foram identificadas as tendências de prescrição de antimicrobianos nos hospitais, a freqüência de prescrição desses fármacos para infecções respiratórias, os grupos de antimicrobianos prescritos e os parâmetros para o seu uso não-racional. Houve predomínio do gênero masculino e da faixa etária de 80 anos ou mais. Os grupos dos betalactâmicos e das quinolonas foram os mais prescritos. Os medicamentos foram classificados como pertencentes ou não à Relação Nacional de Medicamentos Essenciais (RENAME), sendo este um critério de uso racional. O uso empírico correspondeu a 93% das prescrições, ocorrendo coleta de amostra de material biológico em apenas 21 pacientes. Foram isolados microrganismos em 5 pacientes para os quais se realizou o Teste de Susceptibilidade a Antimicrobianos (7%). As amostras bacterianas isoladas com maior freqüência foram: Staphylococcus aureus, Enterococcus faecalis e Pseudomonas aeruginosa. Dentre os microrganismos isolados, verificou-se a presença de microrganismos reconhecidamente multirresistentes. Os diagnósticos registrados com maior freqüência foram pneumonia e doença pulmonar obstrutiva crônica (DPOC). Foram estabelecidas as distribuições dos pacientes por número de princípios ativos e de especialidades farmacêuticas prescritos, via de administração, dose diária utilizada e tempo de tratamento. Houve associação de até 8 princípios ativos, porém com predomínio do regime de monoterapia (39%). A associação de 2 princípios ativos ocorreu em 34% dos pacientes. Observou-se associações de princípios ativos com possível ação terapêutica antagônica em 28% dos prontuários. A via mais utilizada foi a intravenosa (78%). Houve diferenças entre as doses diárias prescritas e as usuais em 30% dos prontuários. Observou-se variabilidade nos tempos de tratamento instituídos, sugerindo a ausência de padrões ou não seguimento dos protocolos de prescrição. Verificou-se a ausência sistemática de registro de informações gerais nos prontuários. O estudo demonstrou a necessidade de intervenções que assegurem o cumprimento dos protocolos como forma de garantir o uso adequado dos antimicrobianos, o estabelecimento de estratégias e diretrizes de conduta direcionadas para determinados grupos de antimicrobianos e para pacientes geriátricos, além da integração das ações de controle de infecção hospitalar com o serviço de farmácia. / The World Health Organization (WHO) established: “Rational drug use occurs when patients receive medicines appropriated to their clinical needs, in doses that meet their individual requirements, for an adequate period of time, and at the lowest cost to them and their community”. One of the greatest world concerns in this context is the inadequate use of antibiotics that increase both microbial resistance and the costs elevation of health system. This observational transversal study investigated antibiotic prescriptions in Sentinels Hospitals from 210 patient’s charts of elderly patients (with 60 years old or more) which were hospitalized and submitted to antibiotic therapy. The predominance of respiratory infections (67 patient charts) between May, 2007 and March, 2008 was verified. Tendencies of these antibiotic prescriptions were identified in hospitals such as the frequencies for respiratory infections, the antibiotic groups prescribed and the triggering factors to the irrational use of these medicines. The predominance was observed in the male gender and in the age bracket of 80 or more years old. Beta-lactamics and quinolons were the most prescribed ones. Drugs were classified as belonging or not to the RENAME (National Relation of Essential Drugs) as a rational use criterion. The empiric use was responsible for 93% of the prescriptions; biological material was collected in only 21 patients. In 5 patients, microorganisms were isolated and the Antibiotic Susceptibility Test was performed (7%). Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa were the most frequently isolated ones. Amongst the isolated microorganisms, potentially or knwon multiresistant organisms were verified. Pneumonia and chronic pulmonary obstructive disease (CPOD) were the most frequent diagnosis registered. The distributions of patients were established using the number of active principles, pharmaceutical specialty, treatment duration, daily dose and route of administration. An association including as much as 8 active principles was found, but monotherapy was predominant (39%). The association of 2 active principles was observed in 34% of patients. Active principles with possible antagonic therapeutic action were associated in 28%. Intravenous route was the most used one (78%). In 30% of the patient’s charts, the daily doses were different from the usual ones. Variability concerning duration of treatment was evidenced, suggesting that the absence of patterns or non-use of prescription protocols. The dearth of general information registries in the patient’s chart was verified. The study demonstrated the need of interventions able to assure that people meet the protocols as a way of guarantee the adequate use of antibiotics, the establishment of strategies and conduct guidelines directed to certain groups of antibiotics and to geriatric patients; and the action integration between hospital infection control and the pharmaceutical service.

No Brasil, poucos estudos investigaram a prevalência de medicamentos potencialmente inapropriados (MPIs) em idosos ambulatoriais. Este estudo visa determinar a prevalência de MPIs prescritos para estes pacientes, identificando os mais comumente envolvidos e verificando se a idade, o sexo e o número de medicamentos estão relacionados à prescrição de tais medicamentos. Foram coletadas prescrições de 3070 pacientes idosos (60 anos) em banco de dados, provenientes dos ambulatórios de Geriatria e Clínica Geral de um hospital universitário de atenção terciária em São Paulo-Brasil entre fevereiro e maio de 2008, que foram divididas de acordo com o sexo e faixa etária (60-69; 70-79 e 80). Os critérios de Beers versão 2003 foram utilizados para a avaliação de MPIs. A maior parte da casuística foi composta por mulheres em ambos os ambulatórios (66,6% na Clínica Geral e 77,7% na Geriatria). Os pacientes da Clínica Geral apresentaram média de idade de 71,3 anos e os da Geriatria, 80,1 anos. Na Clínica Geral a prevalência média de prescrição de MPIs foi de 37,6% e na Geriatria de 26,9%, sendo que em ambos as mulheres de 60-69 foram as que apresentaram a maior prevalência destes medicamentos. Os MPIs mais prescritos nos dois ambulatórios foram o carisoprodol, a fluoxetina e a amitriptilina, sendo que houve diferenças nos perfis de prescrições entre homens e mulheres. A chance de uso de MPI no sexo feminino é maior que no masculino (p<0,001); a chance de uso de MPI na faixa de 70-79 anos é menor que na faixa de 60-69 anos (p=0,030), assim como na faixa de 80 (p=0,024). Estas conclusões não dependem do ambulatório (p=0,164).O efeito de ambulatório depende do número de medicamentos (p=0,009). Se o número de medicamentos é < 9 a chance de uso de MPI na Clínica Geral é maior que na Geriatria (p=0,041). Quando o número de medicamentos é 7 ou 8, a chance de uso de MPI é maior do que quando são prescritos 1-4 medicamentos (p<0,001), nos dois ambulatórios (p=0,098). Quando são usados 9 medicamentos, a chance de uso de MPI depende do ambulatório (p=0,044). Na Geriatria, a chance de uso de um MPI é 8,2 vezes a RC na categoria 1-4 medicamentos; enquanto que na Clínica Geral a razão de chances é 4,6. As prevalências de MPIs encontradas foram semelhantes ao relatado na literatura e estão correlacionadas ao sexo feminino. A chance de prescrição de MPIs foi menor em pacientes com 70 anos; observou-se que se o número de medicamentos for <9, a chance de uso de MPI na Clínica Geral é maior que na Geriatria, porém, se o número de medicamentos for 9 não há diferença entre as chances de uso de MPI nos dois ambulatórios / In Brazil, few studies have investigated the prevalence of potentially inappropriate medications (PIMs) among elderly outpatients. This study aimed to determine the prevalence of PIMs prescribed to such patients, identify the medications most commonly involved and investigate whether age, sex and number of medications are related to the prescription of such medications. Prescriptions issued to 3,070 elderly patients (60 years) were gathered from a database. These patients were attended at the geriatric and general clinical outpatient services of a tertiary-level university hospital in São Paulo, Brazil, between February and May 2008. They were divided according to sex and age group (60- 69; 70-79; and 80 years). The Beers criteria (2003 version) were used to evaluate PIMs. The majority of the sample comprised women, at both outpatient services (66.6% in the general clinic and 77.7% in geriatrics). The mean age of the general clinical patients was 71.3 years and the mean for the geriatric patients was 80.1 years. At the general clinic, the mean prevalence of prescriptions of PIMs was 37.6%, and it was 26.9% at the geriatric clinic. At both outpatient services, women aged 60-69 years presented the highest prevalence of such medications. The PIMs most prescribed at the two outpatient services were carisoprodol, fluoxetine and amitriptyline, and there were differences in the prescription profiles between the men and women. The chances of using PIMs were greater for the women than for the men (p < 0.001). The chances of using PIMs in the 70-79 years group were lower than in the 60-69 years group (p = 0.030), and likewise for the group 80 years (p = 0.024). These conclusions were independent of the outpatient service (p = 0.164). The outpatient effect depended on the number of medications (p = 0.009). If the number of medications was < 9, the chances of using PIMs at the general clinic were greater than the chances at the geriatric clinic (p = 0.041). When the number of medications was 7 or 8, the chances of using PIMs were greater than when prescribed 1-4 medications (p < 0.001), at both outpatient services (p = 0.098). When 9 medications were used, the chances of using PIMs depended on the outpatient service (p = 0.044). At the geriatric clinic, the chances of using PIMs were 8.2 times greater than the chances in the category of 1-4 medications; while at the general clinic, the odds ratio was 4.6. The prevalence of PIMs encountered was similar to what has been reported in the literature, and it correlated with female sex. The chances of being prescribed PIMs were lower among patients 70 years. If the number of medications was < 9, the chances of using PIMs at the general clinic were greater than the chances at the geriatric clinic. However, if the number of medications was 9, there was no difference in the chances of using PIMs between the two outpatient services

No / There is a substantial body of evidence that prescribing for care home residents is suboptimal and requires improvement. Consequently, there is a need to identify effective interventions to optimise prescribing and resident outcomes in this context. OBJECTIVES: The objective of the review was to determine the effect of interventions to optimise prescribing for older people living in care homes. SEARCH METHODS: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library (Issue 11, 2012); Cochrane Database of Systematic Reviews, The Cochrane Library (Issue 11, 2012); MEDLINE OvidSP (1980 on); EMBASE, OvidSP (1980 on); Ageline, EBSCO (1966 on); CINAHL, EBSCO (1980 on); International Pharmaceutical Abstracts, OvidSP (1980 on); PsycINFO, OvidSP (1980 on); conference proceedings in Web of Science, Conference Proceedings Citation Index - SSH & Science, ISI Web of Knowledge (1990 on); grey literature sources and trial registries; and contacted authors of relevant studies. We also reviewed the references lists of included studies and related reviews (search period November 2012). We included randomised controlled trials evaluating interventions aimed at optimising prescribing for older people (aged 65 years or older) living in institutionalised care facilities. Studies were included if they measured one or more of the following primary outcomes, adverse drug events; hospital admissions;mortality; or secondary outcomes, quality of life (using validated instrument); medication-related problems; medication appropriateness (using validated instrument); medicine costs. Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. A narrative summary of results was presented. The eight included studies involved 7653 residents in 262 (range 1 to 85) care homes in six countries. Six studies were cluster-randomised controlled trials and two studies were patient-randomised controlled trials. The interventions evaluated were diverse and often multifaceted. Medication review was a component of seven studies, three studies involved multidisciplinary case-conferencing, two studies involved an educational element for care home staff and one study evaluated the use of clinical decision support technology. Due to heterogeneity, results were not combined in a meta-analysis. There was no evidence of an effect of the interventions on any of the primary outcomes of the review (adverse drug events, hospital admissions and mortality). No studies measured quality of life. There was evidence that the interventions led to the identification and resolution of medication-related problems. There was evidence from two studies that medication appropriateness was improved. The evidence for an effect on medicine costs was equivocal. Robust conclusions could not be drawn from the evidence due to variability in design, interventions, outcomes and results. The interventions implemented in the studies in this review led to the identification and resolution of medication-related problems, however evidence of an effect on resident-related outcomes was not found. There is a need for high-quality cluster-randomised controlled trials testing clinical decision support systems and multidisciplinary interventions that measure well-defined, important resident-related outcomes.

Os medicamentos são um recurso terapêutico que vêm ganhando cada vez mais importância no tratamento dos pacientes, o que tem levado várias instituições nacionais e internacionais a implementarem esforços no sentido de estimularem boas práticas de prescrição. Entretanto, várias influências têm levado médicos ao redor do mundo a adotarem práticas irracionais de prescrição, levando a custos cada vez mais elevados e riscos para a saúde dos doentes. Este estudo teve por objetivos descrever as práticas de prescrição de uma amostra de médicos de Curitiba, Paraná, a partir de respostas dadas a um questionário auto-aplicado, bem como investigar se médicos atuando na Estratégia Saúde da Família (ESF) prescrevem de forma diferente dos que atuam em Unidades Básicas de Saúde (UBS) e em outros serviços e explorar o uso de um questionário auto aplicado para este fim. Trata-se de um estudo transversal com uma amostra de conveniência. Foram entrevistados 17 indivíduos nas unidades da ESF, 22 em UBS, 5 no Hospital Universitário Cajuru e 5 no Centro Clínico Nossa Saúde através de um questionário sobre dados demográficos e com 20 questões em uma escala Likert de 5 pontos que explorava ideias a respeito da prescrição de fármacos. O escore resultante destas questões foi comparado aos dados demográficos e foi constatado que médicos sem especialidade, médicos de família e comunidade, médicos da ESF, que atuam em apenas um local de trabalho, que se encontram nas faixas etárias entre 25 e 34 anos e entre 40 e 59 anos de idade e que se formaram entre os anos de 1985 a 1994 e entre 2005 e 2012 obtiveram escores maiores. Estes resultados permitem levantar a hipótese de que médicos na cidade de Curitiba com este perfil prescrevem de forma mais racional do que seus pares. / Medicines are therapeutic options which are gaining more and more importance in the treatment of patients, leading several national and international institutions to efforts in order to stimulate good prescribing practices. However, many influences have led physicians around the world to adopt irrational prescribing practices, leading to increasingly high costs and risks to patients\' health. This study aimed to describe the prescribing practices of a sample of doctors from Curitiba, Paraná, from responses to a self-administered questionnaire as well as to investigate if doctors working in the Family Health Strategy may prescribe differently of those working in Basic Health Units and in other services and to explore the use of a self-applied questionnaire for this purpose. This is a cross-sectional study with a convenience sample. 17 individuals were interviewed in Family Health Units, 22 in Basic Health Units, 5 in the Cajuru University Hospital and 5 in the Nossa Saúde Clinical Center through a questionnaire on demographic data and 20 questions in a 5-point Likert scale that explored ideas concerning drug prescription. The resulting score from these questions was compared to demographic data and it was found that doctors with no medical specialty, family and community physicians, those working in Family Health Units, those working in just one workplace, who are in the age groups between 25 and 34 years and between 40 and 59 years of age and who graduated between the years 1985 to 1994 and between 2005 and 2012 had higher scores. These results raise the hypothesis that physicians in the city of Curitiba with this profile prescribe more rationally than their peers.

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2017-02-24T13:52:37Z No. of bitstreams: 1 tiagoamaschiodelima_dissert.pdf: 1551815 bytes, checksum: 306de498464b225cff49cd1ad34c1862 (MD5) / Made available in DSpace on 2017-02-24T13:52:37Z (GMT). No. of bitstreams: 1 tiagoamaschiodelima_dissert.pdf: 1551815 bytes, checksum: 306de498464b225cff49cd1ad34c1862 (MD5) Previous issue date: 2016-05-31 / Introduction: Despite the need, it is verified the use of high number of drugs in patients affected by Acute Coronary Syndrome, causing problems related to drugs, among them, the drug interactions representing serious problems, resulting in severe adverse events or inefficacy of drug therapy. Objectives: The aim of this study was to investigate the prescriptions for elderly diagnosed with acute coronary syndrome hospitalized in the clinical cardiology unit of a teaching hospital and to determine the rate of theoretical potential drug interactions present in prescriptions. Methods: Descriptive exploratory study with analysis of 607 medical prescriptions throughout the period of hospitalization of 119 elderly patients 60 years or older in the period from April to July 2014. We collected demographic data from the patients, the information related to prescription drugs and the prescription indicators. The computerized databases Micromedex, Drugs and Medscape were used to identify the drug interactions that were classified according to their intensity level, mechanism and documentation. Results: The average age was 71 ± 8 and 55% were male. It was identified the quantitative of 7266 prescription drugs and the average of 12 ± 3 drugs per prescription, minimum of three and maximum of 23 prescription drugs. The most prescribed therapeutic classes were antiplatelets, anticoagulants, analgesics and antilipemics. Acetylsalicylic acid, Atorvastatin, dipyrone, and clopidogrel were the most prescribed drugs. The oral administration and the tablets were the most used. Only 74% were prescribed in accordance with the generic nomenclature, most obeyed the hospital standardization list, and there was a low frequency of antimicrobial and controlled drugs. 10162 interactions were detected and distributed among 554 types of different combinations of prescribed drugs and 99% of prescriptions presented at least one and maximum of 53 interactions, being highlighted the prevalence of moderate and major, 64% and 25%, respectively. There was a correlation between the number of interactions and the number of prescription drugs and hospitalization time. Conclusions: The high rate of interactions present in the prescriptions of patients with Acute Coronary Syndrome emphasizes the importance of clinical pharmacists activities for the identification and management of interactions, and monitoring of patients through critical analysis based on evidence, contributing to the necessary medical interventions and achieves better therapeutic results. The information gathering on the profile of prescription performed by clinical pharmacists in partnership with the multidisciplinary health team contributes to the analysis of clinical and scientific data, optimization of pharmacotherapy, the reduction of pharmacotherapeutic results unfavorable and pharmacoeconomics in the health system. / Introdução: Verifica a utilização de elevado arsenal de medicamentos em pacientes hospitalizados acometidos por Síndrome Coronariana Aguda, que apesar da necessidade, acarreta problemas relacionados aos medicamentos, dentre eles, as interações medicamentosas representam sérios problemas, resultando em eventos adversos graves ou ineficácia da terapia medicamentosa. Objetivos: Investigar as prescrições para idosos com idade igual ou superior a 60 anos e com diagnóstico de Síndrome Coronariana Aguda, hospitalizados na unidade da Cardiologia Clínica de um hospital de ensino e identificar as interações medicamentosas potenciais teóricas presentes nas prescrições. Métodos: Estudo descritivo exploratório com análise de 607 prescrições médicas durante todo o período de hospitalização de 119 pacientes idosos no período de abril a julho de 2014. Foram coletados os dados demográficos dos pacientes, as informações relacionadas aos medicamentos prescritos, e os indicadores de prescrição. Foram utilizadas as bases de dados informatizadas Micromedex, Drugs e Medscape para identificação das interações medicamentosas que foram classificadas de acordo com seu nível de intensidade, mecanismo e documentação. Resultados: A média de idade foi 71 ± 8 e 55% eram do gênero masculino. Identificou-se o quantitativo de 7266 medicamentos prescritos e média de 12 ± 3 medicamentos por prescrição, mínima de três e máxima de 23 medicamentos prescritos. As classes terapêuticas mais prescritas foram antiplaquetários, anticoagulantes, antilipêmicos e analgésicos. Ácido Acetilsalicílico, atorvastatina, dipirona, e clopidogrel foram os fármacos mais prescritos. A via oral e a forma farmacêutica comprimido foram as mais utilizadas. 74% foram prescritos de acordo com a nomenclatura genérica, a maior parte obedeceu à lista de padronização do hospital, e houve baixa frequência de antimicrobianos e medicamentos controlados. Foram detectadas 10162 interações, distribuídas entre 554 tipos de combinações diferentes dentre os medicamentos prescritos, e 99% das prescrições apresentaram pelo menos uma e máximo de 53 interações, destacando-se a prevalência das moderadas e maiores, 64% e 25%, respectivamente. Houve correlação entre o número de interações e o número de medicamentos prescritos e o tempo de hospitalização. Conclusões: A elevada taxa de interações encontradas nas prescrições de pacientes com Síndrome Coronariana Aguda demonstra a importância da atuação de farmacêuticos clínicos para a identificação e manejo das interações, e monitoramento dos pacientes, através de análise crítica baseada em evidências, contribuindo para as intervenções médicas necessárias, e alcançar melhores resultados terapêuticos. O levantamento de informações sobre o perfil da prescrição realizado por farmacêuticos clínicos em parceria com a equipe multidisciplinar em saúde contribui para a análise de dados clínicos e científicos, a otimização da farmacoterapia, a redução de resultados terapêuticos desfavoráveis, e farmacoeconomia no sistema de saúde.

Os medicamentos são um recurso terapêutico que vêm ganhando cada vez mais importância no tratamento dos pacientes, o que tem levado várias instituições nacionais e internacionais a implementarem esforços no sentido de estimularem boas práticas de prescrição. Entretanto, várias influências têm levado médicos ao redor do mundo a adotarem práticas irracionais de prescrição, levando a custos cada vez mais elevados e riscos para a saúde dos doentes. Este estudo teve por objetivos descrever as práticas de prescrição de uma amostra de médicos de Curitiba, Paraná, a partir de respostas dadas a um questionário auto-aplicado, bem como investigar se médicos atuando na Estratégia Saúde da Família (ESF) prescrevem de forma diferente dos que atuam em Unidades Básicas de Saúde (UBS) e em outros serviços e explorar o uso de um questionário auto aplicado para este fim. Trata-se de um estudo transversal com uma amostra de conveniência. Foram entrevistados 17 indivíduos nas unidades da ESF, 22 em UBS, 5 no Hospital Universitário Cajuru e 5 no Centro Clínico Nossa Saúde através de um questionário sobre dados demográficos e com 20 questões em uma escala Likert de 5 pontos que explorava ideias a respeito da prescrição de fármacos. O escore resultante destas questões foi comparado aos dados demográficos e foi constatado que médicos sem especialidade, médicos de família e comunidade, médicos da ESF, que atuam em apenas um local de trabalho, que se encontram nas faixas etárias entre 25 e 34 anos e entre 40 e 59 anos de idade e que se formaram entre os anos de 1985 a 1994 e entre 2005 e 2012 obtiveram escores maiores. Estes resultados permitem levantar a hipótese de que médicos na cidade de Curitiba com este perfil prescrevem de forma mais racional do que seus pares. / Medicines are therapeutic options which are gaining more and more importance in the treatment of patients, leading several national and international institutions to efforts in order to stimulate good prescribing practices. However, many influences have led physicians around the world to adopt irrational prescribing practices, leading to increasingly high costs and risks to patients\' health. This study aimed to describe the prescribing practices of a sample of doctors from Curitiba, Paraná, from responses to a self-administered questionnaire as well as to investigate if doctors working in the Family Health Strategy may prescribe differently of those working in Basic Health Units and in other services and to explore the use of a self-applied questionnaire for this purpose. This is a cross-sectional study with a convenience sample. 17 individuals were interviewed in Family Health Units, 22 in Basic Health Units, 5 in the Cajuru University Hospital and 5 in the Nossa Saúde Clinical Center through a questionnaire on demographic data and 20 questions in a 5-point Likert scale that explored ideas concerning drug prescription. The resulting score from these questions was compared to demographic data and it was found that doctors with no medical specialty, family and community physicians, those working in Family Health Units, those working in just one workplace, who are in the age groups between 25 and 34 years and between 40 and 59 years of age and who graduated between the years 1985 to 1994 and between 2005 and 2012 had higher scores. These results raise the hypothesis that physicians in the city of Curitiba with this profile prescribe more rationally than their peers.

Thesis Univ. College London, 2006. / Includes bibliographical references and indexes.

La prescription médicamenteuse est l’un des principaux outils thérapeutiques utilisé par le médecin. Si la médecine somatique décline sa clinique selon l’enchaînement symptômes- diagnostic-traitement, la psychiatrie se démarque d’une telle linéarité. En effet, bien qu’elle se soit calquée sur le modèle médical depuis la découverte des psychotropes en 1952, elle relève d’une clinique spécifique : en psychiatrie, d’une part le symptôme constitue une adresse à l’Autre, il contient donc une dimension relationnelle essentielle, d’autre part, le soin psychique implique une participation active du sujet, toute thérapie étant aussi auto-thérapie. La neuropharmacologie, en plein essor depuis 1952, propose un schéma thérapeutique se voulant plus scientifique car de plus en plus éloigné de la psychopathologie clinique. Le psychiatre est alors convoqué en tant que technicien de la prescription de psychotropes, le médicament se suffisant à lui-même d’un point de vue thérapeutique. Face à une telle évolution de la psychiatrie, comment préserver un abord clinique ?Notre pratique esquisse la possibilité de dégager l’acte de prescrire d’une technicité exclusive. En effet, sous certaines conditions, la prescription de psychotropes constitue un acte psychothérapeutique à part entière. Pour cheminer dans notre réflexion, nous sommes passés par le paradigme du pharmakon afin de complexifier la question du prescrire. La clinique suggère une possible alliance entre parole et médicament. Prescrire dans la parole, au-delà de la molécule, consiste à qualifier la substance par la parole, de façon à ce qu’elle devienne un médicament spécifique de la rencontre clinique. La molécule, guidée par la magie des mots, sera plus efficace. L’acte de prescrire se conçoit donc comme une création à deux, à réinventer à chaque nouvelle rencontre, le moment de la prescription relevant d’un cheminement intime du côté du clinicien. Ainsi, loin de s’exclure mutuellement, psychothérapie analytique et pharmacothérapie ont tout intérêt à croiser leurs regards sur la question du prescrire. Penser conjointement effet pharmacologique et relation clinique permet au clinicien de s’engager dans une authentique rencontre humaine avec le patient. La psychopathologie s’ouvrira, peut-être, sur de nouvelles perspectives thérapeutiques. / Prescribing medication is one of the main therapeutic tools used by physicians. If somatic medicine clinically acts according to a 'symptom-diagnosis-treatment' model, psychiatry does not follow this linear pathway. Although it has copied the medical model since the discoveryof psychoactive drugs in 1952, it possesses a specific clinical approach. First of all, in psychiatric care, the symptom is an address to the Other, it contains an essential social dimension. Moreover, it implies the subject's active participation, each therapy also being a self-therapy. Neuropharmacology, in full expansion since 1952, has taken a therapeutic scheme aiming at more scientificity by moving away from clinical psychopathology. Hence psychiatrists are seen as technicians of psychoactive drugs prescription, drugs being considered as self sufficient therapeuticaly. With regard to this evolution in psychiatric care, how can a clinical approach be maintained ? In practice, the act of prescribing can free itself from being exclusively technical. Prescribing psychoactive drugs can indeed, under certain conditions, be a true psychotherapeutic act. To guide us through this reflection, we used the pharmakon paradigm to make the issue of prescribing more complex. Clinical practice suggests a possible alliance between patients'words and medication. Beyond molecular action, prescribing through talking qualifies the substance by words, so it becomes a clinical-interaction-specific drug. The molecule, guided by the magic of words, will be more efficient. The act of prescribing is thus conceived as a creation made possible by two people, that must be reinvented at each encounter. The moment for prescribing is rather the fruit of the clinician intimate decision process. Thus, far from excluding each other, analytical therapy and pharmacotherapy would gain much from sharing their views on the issue of prescribing. Integrating both the pharmacological effect and the clinical interaction would allow clinicians to engage in an authentic human encounter with patients. Psychopathology may then open up to new therapeutic perspectives.

No / OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals. METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England. RESULTS: Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills. CONCLUSIONS: Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.