Introdução - Os efeitos prejudiciais envolvendo medicamentos pela cres- cente população idosa impulsionaram pesquisas para desenvolvimento e aplicação de diversos métodos e instrumentos para identificar padrões inadequados de prescrição/ uso e problemas farmacoterapêuticos envolvendo este grupo populacional. Objetivo - Verificar a prevalência do uso de medicamentos potencialmente inapropriados listados nos Critérios de Beers 2003 pelas pessoas idosas de 60 anos ou mais do município de São Paulo, entrevistadas pelo Estudo SABE no ano de 2006. Métodos - Trata-se de um estudo transversal de base populacional, com utilização de dados secundários obtidos do Estudo SABE. A amostra constituída de 1258 idosos de 60 anos ou mais. Os dados finais foram ponderados e expandidos de modo a representar a população idosa no ano de 2006. Os medicamentos foram classificados de acordo com a Anatomical Therapeutic Chemical Classification System. Para análise dos dados utilizou-se o pacote estatístico Stata com realização de regressão logística. Considerou-se nível de significância de p<0,05. Resultados Verificou-se a prevalência de 28 por cento de uso de MPI entre os idosos. Na análise pelo modelo de regressão logística multivariada as variáveis associadas ao consumo de MPI foram polifarmácia (p = 0,001), comorbidade (p = 0,011) e sexo (p = 0,007); ajustadas por fragilidade, idade e dificuldade em ABVD. Este estudo identificou 41 medicamentos ou classes potencialmente inadequados segundo os Critérios de Beers sendo utilizados pelos idosos moradores de São Paulo em 2006. Ao se analisar os MPI agrupados por sistema ATC notou-se que o de maior prevalência foi o grupo com os medicamentos que atuam no sistema cardiovascular (11,1 por cento ). Conclusões Entre outros problemas, os idosos, em especial as idosas, têm ainda a dificuldade de conviver com várias doenças o que leva a complexidade da terapêutica, em geral com polifarmácia e uso de medicamentos inadequados fatores ratificados pelo presente estudo situação agravada pelo contexto de alteração da farmacocinética, farmacodinâmica e as alterações relacionadas à composição corporal e fisiologia da idade avançada. Sugere-se a elaboração de método baseado em critérios explícitos de avaliação do uso de medicamentos por idosos adaptada a realidade nacional, levando-se em conta os medicamentos disponíveis no país, a opinião dos especialistas brasileiros e a literatura baseada em evidências na área de utilização de medicamentos / Introduction - The damaging effects involving drugs boosted by the growing elderly population research for developing and implementing a variety of methods and tools to identify patterns of inappropriate prescribing / use and drug related problems involving this population group. Objective - To assess the prevalence of potentially inappropriate medications (PIM) listed in the 2003 Beers criteria for people aged 60 or more of São Paulo, interviewed by the SABE survey in 2006. Methods - This is a population-based crosssectional study, using secondary data obtained from the SABE survey. The sample consisted of 1258 elderly aged 60 years or more. The final data were weighted and expanded to represent the elderly population in 2006. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System. For data analysis it was used the Stata® with performance of logistic regression. It was considered a significance level of p <0.05. Results - There was a prevalence of 28 per cent using MPI among the elderly. In the analysis by multivariate logistic regression model the variables associated with consumption of PIM were polypharmacy (p = 0.001), comorbidity (p = 0.011) and female gender (p = 0.007) adjusted for frailty, age and difficulty in ADL. This study identified 41 PIM or classes according to the Beers criteria being used by the elderly residents of Sao Paulo in 2006. When analyzing the PIM grouped by the ATC system was noted that the most prevalent was the group with drugs that act on the cardiovascular system (11.2 per cent ). Conclusion - Among other problems, the elderly, especially elderly women, still have the difficulty of living with various illnesses leading to the complexity of therapy, usually with polypharmacy and inappropriate drug use - factors that are ratified by this study - a situation exacerbated by the context of altered pharmacokinetics, pharmacodynamics and changes related to body composition and physiology of aging. We suggest the preparation method based on explicit criteria for evaluating the use of medications by elderly adapted for the national reality, taking into account the available drugs in the country, the opinions of Brazilian experts and evidence-based literature in the area of drug use

Os progressos na terapêutica medicamentosa têm sido notáveis, porém estudos da sua utilização e dos efeitos desejáveis ou indesejáveis necessitam ser amplamente desenvolvidos. O presente estudo averiguou a utilização de medicamentos, descrevendo o perfil de prescrição e dispensação de antimicrobianos com foco em custos no HCFMRP-USP, revelando a topografia dos gastos conforme sua utilização nos diversos setores e ao longo de um período. Objetivo: Estudar o perfil de utilização de medicamentos antimicrobianos através da análise de dados provenientes de sistema informatizado de prescrição e dispensação do HCFMRP-USP. Metodologia: A partir de banco de dados geral de prescrição e dispensação de itens de medicamentos no HCFMRP-USP, foi criado um banco de dados específico de itens de antimicrobianos (antibacterianos, antifúngicos, antivirais e antiparasitários) prescritos individualmente aos pacientes internados e a eles dispensados, no período de 2013 a 2015. As análises foram realizadas através do programa Excel®, versão 2007, pacote Office, Microsoft. Resultados: Os antimicrobianos representaram, em média, 12% dos itens prescritos totais e 16%, em média, dos itens dispensados. 30 itens antimicrobianos de maior custo do hospital correspondem a 97,48% dos custos e a 20,54% da dispensação; o item que mais custa ao hospital, dentre todas as classes analisadas é a Anfotericina B lipossomal (42,55%); Dos antibióticos, a classe que mais custa ao hospital são os cabapenens (22,94%), seguidos das tetraciclinas (21,69%) e polimixinas (15,85%) e as classes mais dispensadas são as cefalosporinas (30,03%), penicilinas (16,72%) e carbapenens (16,59%). CIDs mais registrados: Z380, I120 e Z383. Em média, 33,5 pacientes são responsáveis pelos gastos com antimicrobianos. Os centros de custos que mais gastam são Enf. Hematologia, pediatria e CTI. Já os que mais dispensam são UETDI, Ortopedia e moléstias infecciosas. Conclusões: O HCFMRP-USP tem como um dos seus maiores custos variáveis os medicamentos, em especial os antimicrobianos. Assim, a geração de informações através de EUM auxilia a tomadas de decisões estratégicas e gerenciais. Este trabalho só foi possível devido à prescrição informatizada, que possibilita o registro de todos os dados de prescrição e dispensação. / Advances in drug therapy have been remarkable, but studies of their use and the desirable or undesirable effects need to be fully developed. The present study investigated the use of drugs, describing the prescription profile and dispensing antimicrobials focusing on costs, at HCFMRP- USP, revealing the topography spending as their use in the various sectors and over a period. Objectives: To study the profile of use of antimicrobial drugs through analysis of data from the computerized system of prescribing and dispensing of HCFMRP- USP. Methodology: From general database of prescription and dispensing of medicines items in HCFMRP- USP, a specific database of antimicrobials items (antibacterial, antifungal, antiviral and antiparasitic) was created, individually prescribed to hospitalized patients and they exempt, from 2013 to 2015. Analyses were performed using Excel®, version 2007, Office suite, Microsoft. Results: The antimicrobial represented, on average, 12% of the total prescribed items and 16% on average of dispensed items. 30 antimicrobials items of higher cost of hospital correspond to 97.48% of the costs and 20.54% of the dispensation; the item that costs more to the hospital, among all analyzed classes is the liposomal amphotericin B (42.55%); From antibiotics, the class that more costs the hospital are cabapenens (22.94%), followed by tetracyclines (21.69%) and polymyxins (15.85%) and the most dispensed classes are cephalosporins (30.03%), penicillins (16.72%) and carbapenems (16.59%). ICDs (International Code Diseases) more registered: Z380, Z383 and I120. On average, 33.5 patients are responsible for spending on antimicrobials. Cost centers that spend more are Enf. Hematology, pediatrics and CTI. But those who dispense more are UETDI, orthopedics and infectious diseases. Conclusions: HCFMRP- USP has as one of its major cost variables medicines, especially antibiotics. Thus, the generation of information and through the use of these medications study aids taken strategic and management decisions. This work was only possible because of the computerized prescription, which allows the registration of all prescription and dispensing data in the system.

Submitted by Maria Aparecida (cidazen@gmail.com) on 2017-04-18T13:46:52Z No. of bitstreams: 1 Danielle Franca Furtado.pdf: 7455681 bytes, checksum: fc9fda3fdd2b6ae52059cbf214521deb (MD5) / Made available in DSpace on 2017-04-18T13:46:52Z (GMT). No. of bitstreams: 1 Danielle Franca Furtado.pdf: 7455681 bytes, checksum: fc9fda3fdd2b6ae52059cbf214521deb (MD5) Previous issue date: 2017-03-03 / Projeto BRISA, CNPQ, FAPEMA,FAPESP e PRONEX / To analyze the medication use and associated factors to antimicrobials use in children aged 13 to 35 months in the city of São Luis – MA. A descriptive, analytical and cross-seccional study was conducted using BRISA Cohort sample data at two moments: Stage of the birth from January to December 2010 and in the stage of the first follow-up from April 2011 to January 2013. The sample of this study was 3308 children aged 13 to 35 months. Descriptive analysis of socioeconomic, demographic and health variables was carried out. The medication use in the 15 days prior to the interview was classified by means of the Anatomical Therapeutic Chemical (ATC) and to analyze the factors associated with the use of antimicrobials the Poisson regression model with robust variance was adjusted with inclusion of the independent variables using the hierarchical approach. Of the children followed up, the use of at least one medication was 90.9%; at least one antimicrobial, considering antibacterial, antifungal, antiviral and antiparasitic drugs, was 23.8%. The medicines classified by the most used anatomic groups were: respiratory activity in 83.5%, followed by those in the nervous system 28.4%, by medicines of the alimentary tract and metabolism 23.5%, and anti-infectives of systemic use 10.5%. The factors associated with the use of antimicrobials after adjusted analysis were: Maternal perception about the child's health (Regular / Bad: PR = 1.37, p <0.001), post - birth morbidity (PR = 1.50, p <0.001) and time of breastfeeding (Suck between 3 and 6 months: PR = 1.34 p = 0.013). The high consumption of drugs reinforces the need to promote rational use for this age group, since the information about the effects of pharmacotherapy in the infant organism is limited. Factors associated with the use of antimicrobials point to the importance of these drugs in the health-disease process, allowing managers to better understand this process and the consequent implementation of actions directed at the health care of the child, with increased access to these medicines. Safe and appropriate to the specificities of infantile pharmacotherapy. / Para analisar o uso de medicamentos e os fatores associados ao uso de antimicrobianos em crianças de 13 a 35 meses no município de São Luís – MA um estudo descritivo, analítico, transversal foi conduzido, utilizando dados amostrais da Coorte BRISA, em dois momentos: na etapa do nascimento de janeiro a dezembro de 2010 e na etapa do primeiro seguimento de abril de 2011 a janeiro de 2013. A amostra deste estudo foi de 3308 crianças com idade de 13 a 35 meses. Realizada análise descritiva das variáveis socioeconômicas, demográficas e de saúde. O uso de medicamentos nos 15 dias anteriores à entrevista foi classificado por meio da Anatomical Therapeutic Chemical (ATC) e para analisar os fatores associados à utilização de antimicrobianos foi ajustado o modelo de regressão de Poisson com variância robusta com inclusão das variáveis independentes utilizando-se a abordagem hierarquizada. Das crianças acompanhadas, o uso de pelo menos um medicamento foi de 90,9%, já o uso de pelo menos um antimicrobiano, considerando antibacterianos, antifúngicos, antivirais e antiparasitários, foi de 23,8%. Os medicamentos classificados pelos grupos anatômicos mais utilizados foram: com ação no sistema respiratório 83,5%, seguidos pelos que atuam no sistema nervoso 28,4%, pelos medicamentos do trato alimentar e metabolismo 23,5% e antiinfecciosos de uso sistêmico 10,5%. Os fatores associados ao uso de antimicrobianos após análise ajustada foram: percepção da saúde da criança pela mãe (Regular/Ruim: RP=1,37, p<0,001), apresentar morbidade pós - nascimento (RP=1,50, p<0,001) e tempo de aleitamento materno (Mamar entre 3 a 6 meses: RP=1,34 p=0,013). O consumo elevado de medicamentos reforça a necessidade de promoção do uso racional para essa faixa etária, uma vez que são limitadas as informações a cerca dos efeitos da farmacoterapia no organismo infantil. Os fatores associados ao uso de antimicrobianos apontam a importância que esses medicamentos exercem no processo saúde-doença, permitindo aos gestores a melhor compreensão desse processo e a consequente realização de ações direcionadas à assistência à saúde da criança, com ampliação do acesso a esses medicamentos de forma segura e adequada às especificidades da farmacoterapia infantil.

Os progressos na terapêutica medicamentosa têm sido notáveis, porém estudos da sua utilização e dos efeitos desejáveis ou indesejáveis necessitam ser amplamente desenvolvidos. O presente estudo averiguou a utilização de medicamentos, descrevendo o perfil de prescrição e dispensação de antimicrobianos com foco em custos no HCFMRP-USP, revelando a topografia dos gastos conforme sua utilização nos diversos setores e ao longo de um período. Objetivo: Estudar o perfil de utilização de medicamentos antimicrobianos através da análise de dados provenientes de sistema informatizado de prescrição e dispensação do HCFMRP-USP. Metodologia: A partir de banco de dados geral de prescrição e dispensação de itens de medicamentos no HCFMRP-USP, foi criado um banco de dados específico de itens de antimicrobianos (antibacterianos, antifúngicos, antivirais e antiparasitários) prescritos individualmente aos pacientes internados e a eles dispensados, no período de 2013 a 2015. As análises foram realizadas através do programa Excel®, versão 2007, pacote Office, Microsoft. Resultados: Os antimicrobianos representaram, em média, 12% dos itens prescritos totais e 16%, em média, dos itens dispensados. 30 itens antimicrobianos de maior custo do hospital correspondem a 97,48% dos custos e a 20,54% da dispensação; o item que mais custa ao hospital, dentre todas as classes analisadas é a Anfotericina B lipossomal (42,55%); Dos antibióticos, a classe que mais custa ao hospital são os cabapenens (22,94%), seguidos das tetraciclinas (21,69%) e polimixinas (15,85%) e as classes mais dispensadas são as cefalosporinas (30,03%), penicilinas (16,72%) e carbapenens (16,59%). CIDs mais registrados: Z380, I120 e Z383. Em média, 33,5 pacientes são responsáveis pelos gastos com antimicrobianos. Os centros de custos que mais gastam são Enf. Hematologia, pediatria e CTI. Já os que mais dispensam são UETDI, Ortopedia e moléstias infecciosas. Conclusões: O HCFMRP-USP tem como um dos seus maiores custos variáveis os medicamentos, em especial os antimicrobianos. Assim, a geração de informações através de EUM auxilia a tomadas de decisões estratégicas e gerenciais. Este trabalho só foi possível devido à prescrição informatizada, que possibilita o registro de todos os dados de prescrição e dispensação. / Advances in drug therapy have been remarkable, but studies of their use and the desirable or undesirable effects need to be fully developed. The present study investigated the use of drugs, describing the prescription profile and dispensing antimicrobials focusing on costs, at HCFMRP- USP, revealing the topography spending as their use in the various sectors and over a period. Objectives: To study the profile of use of antimicrobial drugs through analysis of data from the computerized system of prescribing and dispensing of HCFMRP- USP. Methodology: From general database of prescription and dispensing of medicines items in HCFMRP- USP, a specific database of antimicrobials items (antibacterial, antifungal, antiviral and antiparasitic) was created, individually prescribed to hospitalized patients and they exempt, from 2013 to 2015. Analyses were performed using Excel®, version 2007, Office suite, Microsoft. Results: The antimicrobial represented, on average, 12% of the total prescribed items and 16% on average of dispensed items. 30 antimicrobials items of higher cost of hospital correspond to 97.48% of the costs and 20.54% of the dispensation; the item that costs more to the hospital, among all analyzed classes is the liposomal amphotericin B (42.55%); From antibiotics, the class that more costs the hospital are cabapenens (22.94%), followed by tetracyclines (21.69%) and polymyxins (15.85%) and the most dispensed classes are cephalosporins (30.03%), penicillins (16.72%) and carbapenems (16.59%). ICDs (International Code Diseases) more registered: Z380, Z383 and I120. On average, 33.5 patients are responsible for spending on antimicrobials. Cost centers that spend more are Enf. Hematology, pediatrics and CTI. But those who dispense more are UETDI, orthopedics and infectious diseases. Conclusions: HCFMRP- USP has as one of its major cost variables medicines, especially antibiotics. Thus, the generation of information and through the use of these medications study aids taken strategic and management decisions. This work was only possible because of the computerized prescription, which allows the registration of all prescription and dispensing data in the system.

Thesis (MPH.) -- University of Limpopo, 2012 / Tuberculosis (TB) is the cause of 1, 8 million deaths annually, 99% of the deaths occurs in the developing countries and among the poorest people of these countries. Studies between high and low income countries demonstrate that rates of TB are significantly higher in poorer populations. World Health Organization introduced DOTS as global strategy for providing TB services which was expected to be delivered primarily by government run public health services (Malmborg, Mann, Thomson, & Squire, 2006). AIM Investigate factors that influence compliance and non-compliance to treatment among patients on tuberculosis drug treatment. STUDY SITE This study was conducted in Shiluvane local area in Greater Tzaneen Municipality under Mopani District in Limpopo Province, South Africa. One district hospital, one health centre and five clinics were selected for this study: Dr CN Phatudi hospital, Shiluvane Health Centre, Moime, Lenyenye, Mogoboya, Maake and Lephepane Clinics. (v) STUDY DESIGN This is a quantitative and qualitative study as mixed methods were used to get a comprehensive research report. SAMPLING The sample size used 150 of a given population using Morgan and Krejcie table (1994). The case register was used to select respondents. The respondents were selected according to particular interval; each second name on the list was selected. Questionnaire and structured interview was selected for data collection. Questionnaires were distributed among clients who are able to read and write for them to complete, the researcher and the assistant helped to fill questionnaires for those who cannot read or write. The study was conducted at identified hospital, health center and clinics. RESULTS Education Level, the findings of this study displays that only 3,7% of participants hold tertiary qualifications, and 50% secondary education and 37,3% of primary education. Occupation, 76.4% of participants are unemployed. Income, 52,6% of participants earn between R1000-R2999 and 17,5% does not have income. (vi) CONCLUSION In conclusion based on the results and objectives of this study compliance with drug treatment among patients with tuberculosis in Shiluvane local Area, Mopani District, Limpopo province is 90.9%.

Malaria is more prevalent today and the death toll is on the increase annually. It is one of the leading causes of morbidity and mortality worldwide and most of these deaths are in the poorest regions of the world. About 500 million cases are reported annually with more than 2 million deaths, and most are children. It is the major killer in the tropics and a major public health problem in developing countries and Papua New Guinea (PNG) is no exception. Resistant strains have been reported. This may be enhanced by inappropriate human behaviour in the use of anti-malarial drugs. Human factors include inappropriate prescribing and patient behaviour in using anti-malarial drugs. Despite the establishment of the standard treatment guidelines for malaria in PNG, three out of every four patients have chloroquine-resistant falciparum malaria and malaria remains a major health problem. The aim of this study was to evaluate the influence of an education program on patients carers' understanding and effective use of anti-malarial drugs for the treatment of uncomplicated malaria in children in general health clinics in PNG. The trial design involved a pre-post intervention study with a control group. The study was undertaken in the National Capital District. Papua New Guinea using one Clinic as the intervention site and another as the control site. The two clinics were similar in characteristics as confirmed in the study by demographic data where there were no significant differences observed. The data collection took placed over the period February to April 2002. It included observation of drug provision at study sites and interviews of patient carers on the first day at the clinic and a follow up seven days later. Three questionnaires were developed to evaluate the process and outcomes of malaria drug treatment in the above health facilities. / Prescribing data were collected from prescriptions and patient carers' interviewed prior to the intervention program. Following the provision of drug information to patient carers. similar drug information and compliance questioning was undertaken. Differences in the pre-post elements of the study and in the control group over the study period were evaluated using Chi-Squared, Kruskal-Wallis, Fisher's Exact or Student's t-tests as appropriate. In excess of 100 patients in the pre- and in the post intervention phases were evaluated for their understanding and effective use of the anti-malarial drugs. In addition, 100 clients were in the control group at another clinic. Patients had attended the clinic up to 8 times in the previous year with a median of 2 visits. Amodiaquine, Fansidar, albendazole and paracetamol made up a total of 60% of the drugs prescribed. The use of medicines was strongly supported with 94.4% indicating no problems with the medication. Only 3% of patients received herbal or local remedies for malaria treatment. 1n patients 10 years or less or their carers, it was found, there was a significant improvement in the carers understanding of the medications. There was a statistically significant improvement in patient outcomes from 57.9% to 92.3% reported as cured following the intervention program. The study has also identified low levels of appropriate administration of antibiotic suspensions in children by patient carers. / For example, incorrect responses recorded for amoxycillin suspension were 80.8% (143). Septrim tablets 92% (23), Septrim suspension 86% (123), erythromycin suspension 100% (26), and chloramphenicol suspension 84.4% (38). In this study the face to face (one-to-one) education program was used to influence patient carers understanding and effective use of drugs. The intervention program involved advising, informing, encouraging, and counselling the patient carers verbally on the appropriate and effective use of medicines. The verbal message was reinforced by a suitable label typed in English and Pidgin-English where instructions were clear, simple and unambiguous. The label was then attached to the envelopes or containers containing the drugs. On feedback, the information on the understanding and effective use of drugs was re-emphasized to the carers to reinforce their understanding for future references. Results showed that the intervention program made an impact in improved patient carers understanding and effective use of drugs and children's health outcomes. In conclusion, it is evident that a patient intervention program designed to improve the dosages and frequency of administration of anti-malarial drugs in PNG had no statistically significant outcome. This may be because the current level of understanding was quite high (>70%) and the study experienced a ceiling effect. However, as shown in the results, the patient carers understanding on the appropriate and effective use of drugs was lower during the pre-intervention and control group. / When compared clinic-pre with clinic-post, there was a significant difference (P < 0.05) in the cured group and the improved cure rate increases from 57.9% to 92.3%. When compared control pre with control post groups, there was no significant difference (P > 0.05) in the cured group. Therefore, the study identified an improvement in patient outcomes with respect to malaria. Hence. the simple intervention program in influencing patient carers understanding of the appropriate and effective use of medications led to a marked improvement in patient outcomes.

Background: In the treatment of hypertension, physicians’ attitudes and practice patterns are receiving increased attention as contributors to poor blood pressure (BP) control. Thus, current use of antihypertensive drugs in primary care was analyzed and the association with selected physician and patient characteristics was assessed. Methods: The Hypertension and Diabetes Risk Screening and Awareness (HYDRA) study is a cross-sectional point prevalence study of 45,125 primary care attendees recruited from a representative nationwide sample of 1912 primary care practices in Germany. Prescription frequencies of the various antihypertensive drugs in the individual patients were recorded by the physicians using standardized questionnaires. We assessed the association of patient variables [age, gender; co-morbidities such as diabetes, nephropathy or coronary heart disease (CHD)] and physician variables (general practitioner vs internist, guideline adherence, etc.) with drug treatment intensity and prescription patterns. Results: Of all 43,549 patients for whom a physician diagnosis on hypertension or diabetes was available, 17,485 (40.1%) had hypertension. Of these hypertensive patients, 1647 (9.4%) received no treatment at all, 1191 (6.8%) received non-pharmacological measures only, and 14,647 (83.8%) were given one or more antihypertensive drugs. Drug treatment rates were lower in young patients (16–40 years: 57.4%). BP control was poor: 70.6% of all patients were not normalized, i.e., had BP ≥140/90 mmHg. Antihypertensive treatment was generally intensified with increasing age, or if complications or comorbidities were present. The use of the different drug classes was rather uniform across the various patient subgroups (e.g., by age and gender). Individualized treatment with regard to co-morbidities as recommended in guidelines was not the rule. Adherence to guidelines as self-reported by physicians as well as other physician characteristics (region, training etc.) did not result in more differentiated prescription pattern. Conclusions: Despite the broad armamentarium of drug treatment options, physicians in primary care did not treat hypertension aggressively enough. Treatment was only intensified at a late stage, after complications had occurred. Treatment should be more differentiated in terms of coexisting morbidities such as diabetes, nephropathy, or CHD.

Background and Objectives: Antipsychotic medications (APMs) are used for the treatment of behavioural symptoms of dementia. The use of APMs among residents of long-term care facilities (LTCFs), who have a high probability of dementia, is correspondingly high, and has been linked to adverse patient outcomes. The study objectives were to: (a) describe facility variation in APM discontinuation rates, (b) test the association between time to APM discontinuation and patient and facility explanatory variables, and (c) conduct a sensitivity analysis about the effect of changes in the measurement of APM discontinuation on variable associations. Methods: The study used a population-based retrospective cohort design. Saskatchewan’s (SK) administrative health databases for the period from April 1, 2004 to March 31, 2011 were the data sources. The study cohort included all seniors (≥65 years of age) with a first admission to a SK LTCF and an APM dispensation on or after the admission date. Discontinuation was defined as a 70-day gap after the last APM dispensation. Patient-level explanatory variables included socio-demographics, comorbidity, prior medication exposure, behavioural and cognitive status, and health services utilization. Facility-level explanatory variables included size, location, licensing status, and type. Percentage discontinuation across facilities was descriptively analyzed. Cox proportional hazards regression models with adjustment for clustering of patients within LCTFs were used to test associations with time to discontinuation. A sensitivity analysis of APM discontinuation was conducted by shortening (35 days) and lengthening (105 days) the time from last dispensation. Results: Among all residents eligible to be cohort members 35.7% were dispensed an APM. A total of 19.5% of the 8358 cohort members discontinued APMs in the observation period. The Kaplan-Meier estimate of the median time to discontinuation was 6.5 years. Demographic, comorbidity, behavioural, and drug exposure variables were most strongly associated with APM discontinuation. Discontinuation was not associated with facility characteristics. Variable associations were insensitive to the definition of APM discontinuation, but changed over time. Conclusion: Discontinuation of APMs is low, despite high rates of utilization over long periods of time. Patient characteristics are associated with APM discontinuation, but not facility characteristics, suggesting that LCTFs are applying consistent approaches to patient management. However, low levels of discontinuation suggest that there may be a need for health care providers to regularly review the prescribing, dispensing, and administration of APMs to LTCF residents in order to ensure appropriate use of these pharmaceuticals.

Tyrimo tikslas – įvertinti namų ūkio vaistų krepšelį ir vaistų vartojimo patirtis. Tyrimo uždaviniai: įvertinti vaistų krepšelio vertę, nustatyti farmakoterapines grupes, vaistų laikymo sąlygas, įvertinti vaistų tinkamumo terminus, vaistų utilizavimo įpročius bei nustatyti vaistų vartojimo patirtis. Metodai. Atliktas kiekybinis tyrimas: respondentams pateikta anketa sudaryta iš 34 klausimų. Tyrime dalyvavo 148 respondentai. Respondentai buvo lankomi jų namuose: jiems pateikta pildymui anketa, tyrėjas vaistų registracijos lape registravo turimus vaistus. Statistinė duomenų analizė atlikta, naudojant statistinę programą IBM SPSS Statistics 20 versiją. Statistinių ryšių įvertinimui naudotas susijusių požymių χ2 (chi kvadrato) kriterijus, laisvės laipsnių skaičius ir statistinis reikšmingumas (p). Gautų duomenų tikrinimui pasirinktas statistinio reikšmingumo lygmuo lygus 0,05. Rezultatai. Vaistų krepšelio vidutinė vertė buvo 241,9 Lt. Vidutinė vieno vaisto kaina siekė 14,96 Lt. Įvertinus vaistų krepšelio sudėtį nustatyta, kad vaistų krepšelyje vidutiniškai buvo 16,2 vaisto. 70,25% visų vaistų sudarė nereceptiniai vaistai. Daugiausiai užregistruota kvėpavimo sistemą veikiančių vaistų (24,57%), virškinimo traktą ir metabolizmą veikiančių vaistų (14,63%), nervų sistemą veikiančių vaistų (13,87%), raumenų ir skeleto sistemą veikiančių vaistų (13,83%). Nustatytas receptinių ir nereceptinių vaistų santykis – atitinkamai 1:2,36. Įvertinus vaistų laikymo sąlygas nustatyta, kad 18,92%... [toliau žr. visą tekstą] / Objective: To evaluate home medication cabinet and to fix drug using experience. Tasks: To evaluate home medication cabinet price, to set pharmacological groups, to estimate drug storage, drug expiry date, to evaluate habits of expired drug utilization and to fix drug using experience. Methods: Was made a qualitative study: questionnaire with 34 questions were given for respondents. Were 148 participants in study. They were visited in their homes: respondents filled in the questionnaire and their home medication cabinet was inventoried. Statistical data analysis was performed using the statistical software IBM SPSS Statistics 20 version. Statistical relationships were used to estimate the relevant features χ2 (chi-square) test, degrees of freedom and statistical significance (p). For received data verification chosen statistical significance level of 0.05. Results: An average price of 241,9 Lt were estimated per home medication cabinet. 14,96 Lt was at an average price of one drug package. A mean of 16,2 drug packages were identified per household. Prescription medications accounted 70.25% of all drugs. The most frequently encountered categories of registered medicines were respiratory system drugs (24.57%), alimentary tract and metabolism drugs (14.63%), nervous system drugs (13.87%), musculo-skeletal system drugs (13.83%). Ratio of prescription and non-prescription drug was 1:2.36. In 18.92% of the cases, the drug packages were not stored safely: 18.47% were not stored in... [to full text]

This research involved a rigorous implementation of the conceptual framework of Australia's National Strategy for Quality Use of Medicines through a planned sequence of studies across a large defined geographical region to test the hypothesis that: The National Strategy for Quality Use of Medicines can be used to design, implement and evaluate a research program to achieve sustained improvement in health care in a regional setting.