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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
21

Prevalence of drug-drug interactions of warfarin prescriptions in South Africa / Stephanie Blaauw

Blaauw, Stephanie January 2012 (has links)
Background: Warfarin is an anticoagulant that is used for the prophylactic and therapeutic treatment for a wide range of thrombo-embolic disorders. The prescribing and monitoring of warfarin therapy is challenging due to the fact that warfarin exhibits numerous interactions with other drugs and a variety of factors that influence the dosing of warfarin. Objective: The general objective of this study was to investigate the prevalence of drugs prescribed with warfarin that may have a potential drug-drug interaction (DDI) with warfarin. Methods: This was a cross-sectional, observational or qualitative study that was conducted on medicine claims data of a pharmaceutical benefit management company for patients receiving warfarin therapy for a six year period, ranging from 1 January 2005 to 31 December 2010. Drug products that were co-prescribed with warfarin were also identified from the medicine claims database. The total number of prescriptions for all drug products during the study period were analysed and compared to the warfarin dataset. This was done by means of the SAS 9.1® computer package (SAS Institute, 2004). The total number of prescriptions and medicine items claimed from the database during the study period were respectively 49 523 818 and 118 305 941. Potential DDls between warfarin and coprescribed drugs were identified and classified according to a clinically significant rating. The clinically significance ratings of potential DDls are described in three degrees of severity, identified as major, moderate and minor (Tatro, 2011 :xiv). Results: The database consisted of 427 238 warfarin prescriptions and 427 744 warfarin medicine items, which represented 0.9% of the total number of prescriptions and 0.4% of total number of medicine items. The total number of patients who claimed warfarin prescriptions through the database represented 0.9% (n=68 575) of the total number of patients who claimed prescriptions in the total database (2005-2010). General practitioners prescribed the highest frequency of warfarin medicine items, representing 58.3% (n=249 202) of the total number prescribed. The age group that claimed the highest frequency of warfarin prescriptions (n=327 592, 76.6%) and the highest frequency of warfarin medicine items (n=327 984, 76.7%) was age group 4 (consisting of patients 59 years and older). The distribution between females and males regarding warfarin prescriptions claimed (n=205 999, 48.2%; n=221 117, 51.8%) and warfarin medicine items claimed (n=206 232, 48.2%; n=221 390, 51.8%) were almost equal. General practitioners prescribed the highest average PDD (7.01 mg ± 9.86 mg) of warfarin medicine items. Paediatric cardiologists prescribed the lowest average PDD (4.61 mg ± 1.29 mg) of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDD between general practitioners and paediatric cardiologists. The average PDD of warfarin medicine items between females (6.60 mg ± 9.06 mg) and males (6.74 mg± 8.41 mg) was almost equal. The age group who was prescribed the highest average PDD was age group 2 (consisting of patients 20 years to 39 years old) (7.42 mg± 7.42 mg). Age group 4 (consisting of patients 59 years and older) (6.50 mg± 8.90 mg) was prescribed the lowest average PDD of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDDs of warfarin medicine items between these two age groups. The results revealed that drugs with a significance rating (SR) of 1 (n=155 066, 43.3%), 2 (n=30128, 8.4%), 4 (n=137144, 38.3%), and 5 (n=36144, 10.1%) were co-prescribed with warfarin in the six year study period. The five drugs that was co-prescribed with warfarin most frequently was aspirin (n=48 903, 13.6%), thyroxine (n=33 954, 9.5%), amiodarone (n=25 056, 7.0%), simvastatin (n=19 070, 5.3%) and celecoxib (n=10 794, 3.0%). These five drugs have a SR of 1. Conclusions: This study showed that the top five drugs most frequently prescribed with warfarin are aspirin, thyroxine, amiodarone, simvastatin and celecoxib. These drugs can potentially interact with warfarin. The potential interactions of these drugs are rated with a significance rating of 1. This concludes that drugs that can potentially cause life threatening effects and permanent damage are commonly co-prescribed with warfarin. Clinical data concerning the INR or PT must be obtained in order to evaluate whether or not warfarin therapy is changed when a potentially interacting drug is co-prescribed. The age of the patients as well as the duration of warfarin treatment should also be obtained in order to assess whether warfarin treatment is changed with the progression of age. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2013
22

Prevalence of drug-drug interactions of warfarin prescriptions in South Africa / Stephanie Blaauw

Blaauw, Stephanie January 2012 (has links)
Background: Warfarin is an anticoagulant that is used for the prophylactic and therapeutic treatment for a wide range of thrombo-embolic disorders. The prescribing and monitoring of warfarin therapy is challenging due to the fact that warfarin exhibits numerous interactions with other drugs and a variety of factors that influence the dosing of warfarin. Objective: The general objective of this study was to investigate the prevalence of drugs prescribed with warfarin that may have a potential drug-drug interaction (DDI) with warfarin. Methods: This was a cross-sectional, observational or qualitative study that was conducted on medicine claims data of a pharmaceutical benefit management company for patients receiving warfarin therapy for a six year period, ranging from 1 January 2005 to 31 December 2010. Drug products that were co-prescribed with warfarin were also identified from the medicine claims database. The total number of prescriptions for all drug products during the study period were analysed and compared to the warfarin dataset. This was done by means of the SAS 9.1® computer package (SAS Institute, 2004). The total number of prescriptions and medicine items claimed from the database during the study period were respectively 49 523 818 and 118 305 941. Potential DDls between warfarin and coprescribed drugs were identified and classified according to a clinically significant rating. The clinically significance ratings of potential DDls are described in three degrees of severity, identified as major, moderate and minor (Tatro, 2011 :xiv). Results: The database consisted of 427 238 warfarin prescriptions and 427 744 warfarin medicine items, which represented 0.9% of the total number of prescriptions and 0.4% of total number of medicine items. The total number of patients who claimed warfarin prescriptions through the database represented 0.9% (n=68 575) of the total number of patients who claimed prescriptions in the total database (2005-2010). General practitioners prescribed the highest frequency of warfarin medicine items, representing 58.3% (n=249 202) of the total number prescribed. The age group that claimed the highest frequency of warfarin prescriptions (n=327 592, 76.6%) and the highest frequency of warfarin medicine items (n=327 984, 76.7%) was age group 4 (consisting of patients 59 years and older). The distribution between females and males regarding warfarin prescriptions claimed (n=205 999, 48.2%; n=221 117, 51.8%) and warfarin medicine items claimed (n=206 232, 48.2%; n=221 390, 51.8%) were almost equal. General practitioners prescribed the highest average PDD (7.01 mg ± 9.86 mg) of warfarin medicine items. Paediatric cardiologists prescribed the lowest average PDD (4.61 mg ± 1.29 mg) of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDD between general practitioners and paediatric cardiologists. The average PDD of warfarin medicine items between females (6.60 mg ± 9.06 mg) and males (6.74 mg± 8.41 mg) was almost equal. The age group who was prescribed the highest average PDD was age group 2 (consisting of patients 20 years to 39 years old) (7.42 mg± 7.42 mg). Age group 4 (consisting of patients 59 years and older) (6.50 mg± 8.90 mg) was prescribed the lowest average PDD of warfarin medicine items. A d-value of 0.1 indicates that there is no practical difference of the average PDDs of warfarin medicine items between these two age groups. The results revealed that drugs with a significance rating (SR) of 1 (n=155 066, 43.3%), 2 (n=30128, 8.4%), 4 (n=137144, 38.3%), and 5 (n=36144, 10.1%) were co-prescribed with warfarin in the six year study period. The five drugs that was co-prescribed with warfarin most frequently was aspirin (n=48 903, 13.6%), thyroxine (n=33 954, 9.5%), amiodarone (n=25 056, 7.0%), simvastatin (n=19 070, 5.3%) and celecoxib (n=10 794, 3.0%). These five drugs have a SR of 1. Conclusions: This study showed that the top five drugs most frequently prescribed with warfarin are aspirin, thyroxine, amiodarone, simvastatin and celecoxib. These drugs can potentially interact with warfarin. The potential interactions of these drugs are rated with a significance rating of 1. This concludes that drugs that can potentially cause life threatening effects and permanent damage are commonly co-prescribed with warfarin. Clinical data concerning the INR or PT must be obtained in order to evaluate whether or not warfarin therapy is changed when a potentially interacting drug is co-prescribed. The age of the patients as well as the duration of warfarin treatment should also be obtained in order to assess whether warfarin treatment is changed with the progression of age. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2013
23

The health care sector : a challenging or draining work environment : psychosocial work experiences and health among hospital employees during the Swedish 1990s /

Hertting, Anna, January 2003 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.
24

Maskulinitetskonstruktion, yrkesidentitet, könssegregering och jämställdhet /

Robertsson, Hans, January 1900 (has links) (PDF)
Diss. (sammanfattning) Stockholm : Univ., 2003. / Härtill 3 uppsatser.
25

Violence in caring : risk factors, outcomes and support /

Viitasara, Eija, January 1900 (has links) (PDF)
Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.
26

[en] METROLOGY RELIABILITY IN THE BRAZILIAN HEALTH SECTOR: A STUDY CASE IN THE PUBLIC HEALTH CARE AND METROLOGICAL CONTROL OF HOSPITAL MEDICAL EQUIPMENT / [pt] CONFIABILIDADE METROLÓGICA NO SETOR DA SAÚDE NO BRASIL ESTUDO DE CASO: QUALIDADE LABORATORIAL NA SAÚDE PÚBLICA E CONTROLE METROLÓGICO DE EQUIPAMENTOS MÉDICO-HOSPITALARES

ANGELO BENDER CORREA 07 November 2001 (has links)
[pt] A presente dissertação de mestrado em metrologia relaciona- se à qualidade laboratorial do setor da saúde, notadamente da saúde pública, contribuindo para o desenvolvimento da confiabilidade metrológica do setor médico-hospitalar em pelo menos 4 aspectos básicos: (i) identificação da legislação metrológica disponível no Brasil, via de regra organizada de forma esparsa e não facilmente acessível ao profissional usuário final,cuja pesquisa bibliográfica explicita grande carência de literatura especializada; (ii) análise do acervo de normas e recomendações metrológicas para o setor; (iii)diagnóstico da qualidade laboratorial em um Laboratório Central de Saúde Pública (LACEN), como implementação de uma estratégia alternativa para implantação de sistema da qualidade em laboratório da saúde pública com base em uma nova abordagem que focaliza a qualidade laboratorial da Rede nacional de laboratórios Oficiais de Controle da Qualidade e Saúde, criando um mecanismo que permite ao laboratório demonstrar sua competência técnica; (iv) diagnóstico da conformidade metrológica de instrumentos médico-hospitalares fundamentado nos estudos de caso de balanças para controle da massa de neonatos e de instrumentos biomédicos para medição da pressão arterial, como exemplo de ação do controle metrológico de instrumentos de amplo uso no ambiente médico-hospitalar.A despeito da complexidade e abrangência do setor da saúde no Brasil, a pesquisa desenvolvida revelou não apenas carência e inadequação da literatura técnica disponível bem como forte vulnerabilidade no controle metrológico de laboratório e de equipamentos médico-hospitalares. O diagnóstico realizado em um laboratório típico da saúde pública evidenciou também grandes desafios para a implantação do sistema da qualidade laboratorial.A despeito dos complexos problemas de natureza política e econômica que afetam o sistema da saúde no Brasil, as limitações de caráter metrológicos relacionam-se (i) à falta de uma adequada cultura metrológica no setor, fator intrínseco que entrava a implementação do sistema da qualidade laboratorial, imprescindível à comprovação da competência técnica do laboratório (credenciamento) e (ii) uma surpreendente diversidade de modelos, tipos e quantidade de instrumentos/equipamentos em uso no setor, via de regra dependentes de calibração sofisticada que demandam complexa infra-estrutura laboratorial e métodos e práticas de calibração não disponíveis nos laboratórios credenciados que integram as redes laboratoriais implementadas no País. Sem a pretensão de exaurir tema de tal abrangência e complexidade, porém com o propósito de exemplificar duas importantes áreas que apresentam nítida vulnerabilidade em setores tradicionais cujo envolvimento metrológico não se constitui em barreira ao profissional- usuário do equipamento, a pesquisa analisou (a) o desempenho de dezesseis balanças disponíveis em seis hospitais maternidades, utilizadas para controle da massa de recém- nascidos, como estratégia de orientação do diagnóstico médico e (b)resultados do desempenho de esfigmomanômetros para controle da pressão arterial no ambiente hospitalar. O presente trabalho constitui parte de um esforço mais amplo, desenvolvido em articulação com a Agência Nacional de Vigilância Sanitária (ANVISA), para fortalecer a qualidade laboratorial no setor da saúde pública brasileira. / [en] The present dissertation for a Master`s degree in metrology is related to laboratory quality in the health care sector in general and to public health services in particular, and its purpose is to contribute to the development of reliable measurement practices in the hospital care section within the scope of at least 4 basic aspects: (i) identification of the available metrology legislation in Brazil which, as a rule, is sparsely organized and is not easily accessible to the end-user/practitioner, whose bibliographical research reveals an explicit lack of specialized literature; (ii) analysis of the compiled measurement standards and recommendations for the sector; (iii) diagnosis of laboratory quality in a Central Public Health Care Laboratory (Laboratório Central de Saúde Pública - LACEN)as a means by which to implement an alternative strategy for introducing a quality system in a public health care laboratory based on a new approach that focuses on the quality of the laboratories that comprise the National Network of Official Quality and Health Care Control Laboratories, and the subsequent creation of a type of mechanism that will allow a laboratory to demonstrate its technical competence; (iv) diagnosis of instruments that are employed in hospital services in terms of their conformity to measurement standards based on case studies of scales for controlling the mass of neonates, and of biomedical instruments for measuring blood pressure, as an example of how measurement is controlled in the case of instruments that are widely used in the hospital care environment.Despite the complexity and reach of the Brazilian health care sector, the research that was carried out not only revealed that the technical literature available is insufficient and unsuitable, but also that the measurement provided by laboratories and hospital care equipment are controlled in a high vulnerable manner. The diagnosis that was performed in a typical health care laboratory also brought to light a number of major challenges for the introduction of a laboratory quality system. Apart from the complex political and economic problems that affect the Brazilian health care system as a whole, the limitations associated with measurements are related to (i)the lack of a suitable metrology culture within the sector because this intrinsic factor hampers the implementation of a laboratory quality system and the latter is an essential requirement for proving that a laboratory is technically competent (accreditation), and (ii) the astonishing variety and number of models and types of instruments/equipment that are in use in this sector, which, as a rule, depend on sophisticated calibration procedures and require complex laboratory infrastructures and calibration methods and practices that are not available in the accredited laboratories within the laboratorynetworks that have been implemented in the country. This paper does not propose to exhaust such a broad and complex topic. Rather, its purpose is to consider the examples of two important areas that are clearly vulnerable in traditional sectors whose involvement with metrology does not represent an obstacle to the practitioner/user of the equipment. To this end, the research has focused on (a) the performance of sixteen scales that are available in six maternity hospitals and are used for controlling the mass of newborn infants as a strategy for the orientation of medical diagnoses and (b) the performance results of sphygmomanometers that are used for controlling blood pressure in hospital environments. This paper is part of a more encompassing initiative towards the improvement of laboratory quality in the Brazilian public health care sector and has been developed as a joint effort with the National Agency of Sanitary Vigilance (Agência Nacional de Vigilância Sanitária - ANVISA).
27

Porozumění a postoje laické veřejnosti k současné reformě zdravotnictví / Understanding and Public Approach to Contemporary Health Reform

BORŮVKOVÁ, Eliška January 2009 (has links)
Abstract Understanding and attitudes of the public towards the current Health Care Reform This thesis summarizes the basic facts about the current reform within the Health Care Sector and how it is being perceived by the general public. The theoretical part focuses on the basic information about the development of the Health Care Sector in the Czech Republic and its current reform. The development of the Health Care Sector from the year of 1918 until present is highlighted. At the beginning of the last decade of the 20th century, a new set of laws were passed, which triggered the initial reform of the Czech Health Care Sector. However, a period of passivity regarding subsequent legislation has resulted in the present problems. Further, there is a focus on current Health Care Reform enquiring: why the reform is needed, the nature of its stages and its legislative and non-legislative changes. Only a small part of the reform measures came into force. This included the introduction of regulation fees, the introduction of an `annual safe limit{\crq}, and the pricing and payment for medication. The practical part presents the research findings in relation to the issues mentioned above. The research part of the thesis, carried out using questionnaires, is concerned with the views of the public with respect to current Health Care Reform and investigates whether it has been understood by the public. The research shows that most of the respondents disagree with the reform and think that it is not developing in the right direction. The majority of respondents with this view were found to be within the age group of 60 and over, and within the group of respondents with a basic level or vocational education. Further, the research suggests that the public is not adequately informed about the new Health Care Reform, and therefore demonstrates a lack of understanding of its nature. In addition, the current political climate suggests that the public may lose interest in these issues and will become disengaged with the reform without further consideration.
28

Den organisatoriska kontextens betydelse för chefers intention att stanna i rollen : En kvalitativ studie av första linjens chefers upplevelser

Mäcs, Hanna, Nilsson, Sofia January 2020 (has links)
Den mänskliga resursen är en organisations viktigaste tillgång då organisationen är beroende av mänsklig aktivitet för att existera. Chefer blir i avseendet viktiga då de kan ses som organisationens företrädare samt då de bidrar till och formar processer och arbetsförhållanden. Det blir därav av vikt att skapa förutsättningar för dem att hantera sin roll och vilja stanna i den. Tidigare forskning visar att organisatoriska förutsättningar påverkar chefsrollen, men inte specifikt hur den organisatoriska kontexten får betydelse för deras intention att stanna i rollen. Syftet med den här studien är att undersöka hur första linjens chefers intention att stanna i rollen kan förstås utifrån den organisatoriska kontexten. Vidare är syftet att skapa förståelse för hur cheferna upplever sina förutsättningar att hantera rollen. För att besvara syftet har en kvalitativ metod i form av semistrukturerade intervjuer med första linjens chefer inom vården i offentlig sektor legat till grund för empiri. Resultatet visar att chefsrollen är komplex med förväntningar från flera håll, vilket tydliggör varför den organisatoriska kontexten är betydelsefull för att förstå chefernas upplevelser och deras intention att stanna i rollen. Ur chefernas berättelser kan uttydas att arbetstillfredsställelse och organisatoriskt engagemang är betydelsefullt, vilket främst härleds till den kliniska verksamheten och medarbetarna. Vidare framgår att organisatoriska förutsättningar som samspel, kommunikation och stöd får betydelse för hur de hanterar krav och förväntningar. Sammantaget bidrar studien till en ökad förståelse för hur en organisation, genom den organisatoriska kontexten, kan verka för att behålla första linjens chefer. / The human resource is an organization's most important asset as the organization depends on human activity to exist. In this reference, managers become important as they can be seen as the organization's representatives as well as they contribute to and shape processes and working conditions. It therefore becomes important to create an environment for them to manage their role and a will to stay in it. Previous research shows that organizational conditions affect the managerial role, but not specifically how the organizational context will have an impact on their intention to stay in the role. The aim of this study is to investigate how the first-line managers' intention to stay in their position can be understood from the organizational context. Furthermore, the aim is to develop an understanding of how the managers experience their ability to handle the role. To answer the aim, a qualitative method in the form of semi-structured interviews with first-line managers in public healthcare sector has been the source for empirical data. The result shows that the managerial role is complex with expectations from several directions, which explains why the organizational context is important for understanding the managers' experiences and their intention to stay in their position. From the managers' stories it can be read that job satisfaction and organizational commitment are important, which is mainly attributed to the clinical activities and the employees. Furthermore, it appears that organizational conditions such as interaction, communication and support will have an impact on how they handle requirements and expectations. In summary, the study contributes to an increased understanding of how an organization, through the organizational context, can work to retain first-line managers.
29

En beskrivning av kunskapsläget om riskbedömning av organisatorisk och social arbetsmiljö : En intervjustudie med första linjens chefer verksamma på akutmottagningar inom hälso- och sjukvården

Janesten, Lizette January 2023 (has links)
Författare: Lizette Janesten Titel: “En beskrivning av kunskapsläget om riskbedömning av organisatorisk och social arbetsmiljö. En intervjustudie med första linjens chefer verksamma på akutmottagningar inom hälso- och sjukvården”. Kurs: Examensarbete i Arbetshälsovetenskap, masternivå, 30 högskolepoäng Lärosäte: Högskolan i Gävle Problemformulering: Brister i den organisatoriska och sociala arbetsmiljön ökar risken för ohälsa och sjukskrivning hos arbetstagare, vilket i sin tur leder till ökade kostnader för verksamheten och samhället i stort. Statistik visar att den främsta orsaken till sjukskrivning inom yrkesgrupper som arbetar i hälso- och sjukvården är psykisk ohälsa och stressreaktioner. Forskning visar dessutom att det finns brister i chefers kunskaper om psykisk ohälsa och dess riskfaktorer men också bristande kunskaper om systematiskt arbetsmiljöarbete. Detta motiverar studiens syfte att kartlägga första linjens chefers kunskaper och erfarenheter om just organisatorisk och social arbetsmiljö och hur den kan riskbedömas på olika sätt men också för att säkerställa att arbetstagarna arbetar i en arbetsmiljö som förebygger riskerna att drabbas av ohälsa. Syfte: Syftet med studien är att undersöka vilka teoretiska kunskaper och praktiska erfarenheter första linjens chefer verksamma på akutmottagningar inom hälso- och sjukvården har om riskbedömning av organisatorisk och social arbetsmiljö. Metod: För studien användes en kvalitativ metod med induktiv ansats. För att samla in information utfördes tio semistrukturerade intervjuer med chefer som arbetar på en akutmottagning på olika sjukhus i Sverige. För att analysera intervjuerna gjordes en kvalitativ innehållsanalys. Resultat: Analys av resultat resulterade i tre huvudkategorier och åtta underkategorier. Resultatet visade att det fanns en varierad kunskap och förståelse för vad riskbedömning av organisatorisk och social arbetsmiljö innebär. Många av deltagarna saknade möjligheten att vidareutbildas i ämnet. Samtliga deltagare upplevde dock ett bra stöd från sin chef i arbetsmiljöarbetet. Rutinerna för att utföra riskbedömningar såg annorlunda ut mellan deltagarna men den gemensamma faktorn var att de främst utfördes inför planerade förändringar i verksamheten eller när det redan hade hänt något.  Slutsats: Resultatet visar att det finns brister i teoretiska kunskaper och praktiska erfarenheter hos första linjens chefer på akutmottagningar om vad organisatorisk och social arbetsmiljö är och hur den riskbedöms. Det finns ett ökat behov av mer utbildning och praktisk övning hur de olika delarna inom organisatorisk och social arbetsmiljö kan riskbedömas med hjälp av olika verktyg. / Author: Lizette Janesten Title: “A description about the knowledge regarding risk assessment of organizational and social work environments. An interview study with first line managers working at emergency departments in the health care sector”. Course: Master thesis in Occupational Health Sciences, 30 credits University: University of Gävle Aim: The aim of the study is to investigate what theoretical knowledge and practical experience first-line managers working at emergency departments in the health care sector have about risk assessment of organizational and social work environments. Method: A qualitative method was used in this study with an inductive approach. To collect information ten semi-structured interviews were conducted on managers who work at an emergency department in different hospitals in Sweden. The interviews were then analyzed through a qualitative content analysis. Findings: Analysis of results resulted in three main categories and eight subcategories. The result showed that there was a varied knowledge and understanding of what risk assessment of the organizational and social work environment entails. Many of the participants lacked the opportunity to continue their education in this area. However, all participants experienced good support from their manager to handle the work environment. The routines for carrying out risk assessments looked different between the participants, but the common factor was that they were mainly carried out before planned changes in the business or when something had already happened. Conclusion: The results show that there are deficiencies in theoretical knowledge and practical experience among first-line managers in emergency departments about what organizational and social work environment is and how it can be risk assessed. There is an increased need for more training and practical practice in how the different parts of the organizational and social work environment can be risk assessed using different tools.
30

Medicine prescribing patterns in HIV/AIDS and non HIV/AIDS children : a comparative study in the private health care sector of South Africa / Mocke, M.

Mocke, Martlie January 2010 (has links)
Background: According to the United Nations AIDS Reference Group (2010) and World Health Organization (2010:2), approximately 33 million people in the world had HIV/AIDS in 2009 of which 2.6 million were children. More than 30 million of these individuals resided in low– and middle–income countries. South–Africa had the highest prevalence of HIV/AIDS in the world with an estimated 5.2 million patients in 2009 (Statistics South Africa, 2010:2). Although the prevalence of human immunodeficiency virus (HIV) infection among children is reported to be high, little is known about other medication administrated concomitantly with their antiretroviral drugs. Objective: The general objective of this study was to investigate possible changes in the medicine prescribing patterns of HIV/AIDS and non–HIV/AIDS children. Methods: A quantitative, retrospective drug utilisation review was performed utilising medicine claims data of a South African pharmacy benefit management company. Data for a four–year period (Jan 1, 2005 to Dec 31, 2008) were analysed. The study population consisted of all children <=12 years divided into those receiving ARVs (designated HIV positive) and those without (designated HIV negative). Descriptive statistics such as average mean, standard deviation, t–test, d–values, and two way frequency tables were used to describe the results. Data were analysed using the Statistical Analysis System ® SAS 9.1 ® programme. Results: The study population (children <= 12 years) represented 16.2% (n = 197 323) of the total population in 2005, 15.4% (n = 193 346) in 2006, 15.6% (n = 142 049) in 2007 and 13.3% (n = 98 939) in 2008. Children with HIV/AIDS represented 0.2% (n = 197 323) of the study population in 2005 and increased to 0.4% (n = 98 939) in 2008, whereas the percentage of children without HIV/AIDS decreased from 99.8% (n = 197 323) in 2005 to 99.6% (n = 98 939) in 2008. The total number of HIV/AIDS children that also received other medication concomitantly with their ARVs increased from 96.5% (n = 402) in 2005 to 97.2% (n = 427) in 2008. Males with HIV/AIDS who used other medication represented 52.6% (n = 388) in 2005 and increased to 53.3% in 2008 while female HIV/AIDS patients represented 47.4% in 2005 and decreased to 46.7% in 2008. Prescriptions containing three ARV items represented 69.5% (n = 2 969) of the total number of prescriptions received by HIV/AIDS patients in 2005 and decreased to 67.7% in 2008. The combination of lamivudine, nevirapine and stavudine were the three products that appeared most frequently on prescriptions for HIV/AIDS children in the age group 0 <= 1 years and 1 <= 5 years from 2005 to 2008. In the age group 5 <= 12 years the combination most frequently prescribed was lamivudine, nevirapine and zidovudine. HIV positive children received 6.2 ± 4.62 prescriptions for other medication (non–ARVs) per year during 2005 compared to HIV negative children with 3.9 ± 3.71 (p < 0.0001, d = 0.5). In 2008 HIV positive children received 6.4 ± 5.02 prescriptions per year compared to HIV negative patients who received 4.36 ± 4.05 prescriptions (p < 0.0001, d = 0.5) in 2008. HIV negative children received more central nervous system items, endocrine items and autacoids than HIV positive children, whereas HIV positive children received more respiratory system agents, dermatological, ear, nose throat and antimicrobials items. Conclusion: The study showed that HIV positive children received significantly more prescriptions for other medication per year compared to their HIV negative counterparts. The top pharmacological groups mostly prescribed to both groups were respiratory agents, antimicrobials, analgesics, dermatological and ear, nose and throat items. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2012.

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