O descarte de medicamentos envolve dois fluxos: o fluxo institucional, dos resíduos de fármacos, classificados como resíduos de serviços de saúde, utilizados na indústria e nas instituições de saúde; e o fluxo domiciliar, dos medicamentos vencidos/em desuso em poder da população. O descarte dos resíduos de medicamentos de origem domiciliar pode ser promovido pela logística reversa, onde este tipo de resíduo é devolvido ao setor empresarial para destinação final ambientalmente segura. O objetivo deste estudo foi identificar as estratégias mais viáveis para operacionalização da logística reversa de medicamentos. Trata-se de uma pesquisa exploratória, descritiva, com abordagem quantitativa. As estratégias foram avaliadas junto a atores da cadeia de valor farmacêutica: representantes do poder público, da indústria e distribuição farmacêutica, e consumidores/potenciais consumidores de medicamentos. Foram elaborados três questionários de avaliação de estratégias segundo seis critérios: mediação (articulação entre atores da cadeia produtiva farmacêutica por meio de políticas públicas); fiscalização (das ações); complexidade (de implantação e operacionalização); custos (de implantação e manutenção); adesão (potencialidade de ser inserida no cotidiano da população) e abrangência (potencialidade de alcançar a população). As estratégias foram hierarquizadas em ordem decrescente de viabilidade: rientações à população por profissionais de saúde, farmácias e internet, sinalização de informações nas embalagens e bulas de medicamentos, campanhas publicitárias e de educação ambiental e a disponibilização de postos de entrega voluntária. Os resultados poderão contribuir para a operacionalização de um sistema de logística reversa de medicamentos, considerando todos os atores envolvidos e buscando conciliar suas necessidades, possibilidades, limitações e interesses / The medication disposal involves two settings: the institutional setting, waste of drugs, classified as medical waste, used in industry and healthcare facilities; and the household setting of expired/unused medicines at home. Disposal of medicine waste can be promoted by reverse logistics, where the waste is returned to the business sector to environmentally safe disposal. This study aimed to identify feasible reverse logistics strategies for medicine waste. It is an exploratory, descriptive research with a quantitative approach. The strategies were assessed by representatives of government, industry and pharmaceutical distribution, and consumers/potential consumers of medicines. We constructed three questionnaires to strategies assessment according to six criteria: mediation (articulation among actors of the pharmaceutical supply chain by means of public policies); inspection (of initiatives); complexity (set up and operation); costs (implementation and maintenance); adherence (potential to be inserted into the daily life of the population) and scope (potential to reach the population). The strategies were hierarchize in decrescent order of feasibility: information to people provided by health professionals, pharmacies and internet; signaling information on the packages and leaflet of medicines; advertising and environmental education campaigns; and the provision of waste stations for people to deliver medicine waste. The results can contribute to implement a reverse logistics system for medicine waste, considering all stakeholders in an attempt to reconcile their needs, possibilities, limitations and interests

O uso de medicamentos representa um dos recursos terapêuticos mais utilizados na resolução de grande parte dos problemas e situações em saúde. Nesse contexto, o interesse na forma como os pacientes gerem suas doenças e tratamentos farmacológicos tem crescido em importância. Esta tese objetivou compreender as dimensões da autogestão do uso de medicamentos e variáveis associadas na população brasileira. Para isso, foram analisados três comportamentos relacionados ao uso de medicamentos: a automedicação, a não-adesão intencional e as alterações das doses prescritas. Os dados analisados são provenientes da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), estudo transversal realizado entre os meses de setembro de 2013 e janeiro de 2014 em 245 municípios brasileiros distribuídos nas cinco regiões geográficas do país. A população do estudo foram os indivíduos residentes em domicílios permanentes na zona urbana do território brasileiro. Nesta tese, foram analisados os dados de 31.573 indivíduos com idade igual ou superior a 20 anos. Modelos de Regressão de Poisson com ajuste robusto da variância foram utilizados a fim de estimar o efeito independente de cada variável nos três comportamentos estudados. Entre os entrevistados, 73,6% declararam utilizar algum medicamento sem indicação médica quando já fizeram uso do mesmo produto anteriormente, 73,8% declararam utilizar medicamentos sem prescrição médica quando já tem o medicamento em casa e 35,5% declararam utilizar algum medicamento sem prescrição quando conhecem alguém que já tomou o mesmo medicamento. As variáveis que se mostraram associadas à maior probabilidade de uso de medicamentos por automedicação foram: região geográfica do Brasil, sexo, faixa etária, renda per capita, auto avaliação da saúde, declaração de que usa medicamento sem prescrição médica quando já usou o mesmo medicamento anteriormente e declaração de que usa medicamento sem prescrição médica quando já tem o medicamento em casa. Mais da metade dos entrevistados relataram alguma situação de automedicação, enquanto que 38% relataram deixar intencionalmente de tomar medicamentos prescritos em alguma situação. Com relação às alterações nas prescrições, 8,8% dos entrevistados relataram amentar a dose dos medicamentos em alguma situação e mais de 21% relataram diminuir a dose. Nos modelos de regressão ajustados, as variáveis sexo, idade e autoavaliação de saúde mostraram-se associadas à não-adesão intencional. As alterações de dose aparecem associadas à idade, renda e autoavaliação de saúde. Os resultados indicam, portanto, que um percentual significativo da população brasileira utiliza medicamentos não exclusivamente da forma como são prescritos pelo médico. Buscando contemplar esses diferentes comportamentos cotidianos dos indivíduos em relação aos medicamentos, a presente tese propôs o conceito de “autogestão do uso de medicamentos”. Esse conceito visa ampliar a compreensão do uso de medicamentos para além da adesão às prescrições médicas como já indicado no conceito de medication self-management e de compliance. A partir dessa perspectiva, destaca-se a necessidade de adoção de outros paradigmas nos cuidados em saúde, como o dos cuidados colaborativos e da corporalidade (lived body), onde o próprio indivíduo, com a colaboração dos profissionais da saúde, tome as decisões sobre as estratégias mais adequadas de tratamento e promoção da saúde. / The use of medications represents one of the most utilized therapeutic resources to the resolution of most health problems and situations. In this context, the interest in how patients manage their diseases and pharmacological treatment has increased. This thesis had as main objective to comprehend the self-management of medications use and related variables on the Brazilian population. Three behaviors related to the use of medications were analyzed: self-medication, intentional non-adherence and prescribed doses changes. Analyzed data are part of the “Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM)”, a cross-sectional study performed between September 2013 and January 2014 in 245 Brazilian cities in the five geographic regions. Study population were individuals living permanently in the urban area of Brazil. In this thesis, data from 31.573 individuals aged 20 years or above were analyzed. Poisson Regression Models with robust variance adjustment were used to estimate independent effect of each variable on the three studied behaviors. Among the interviewed, 73.6% have declared the use of any medication without medical prescription when they have used the same product previously, 73.8% have declared the use of not prescribed drugs when the medication is available at home and, 35.5% have declared to use any drug without medical prescription when someone they know have used the same medication. Variables related to higher probability of drug use by self-medication were: geographic region, gender, age, per capita income, health self-evaluation, the use without medical prescription of the same drug used before and the use without medical prescription when the drug is available at home declarations. More than half of the interviewed reported any situation of self-medication while 38% reported to, intentionally, stop taking prescribed medications in any situation. Regarding prescription alterations, 8.8% of the interviewed reported to increase the medication dose in any situation and more than 21% reported to decrease medication dose. On the adjusted regression models variables as gender, age and health self-evaluation showed to be related to intentional nonadherence. Dose changes are related to age, income and health self-evaluation. Therefore, results show that a significant percentage of the Brazilian population uses medications not exclusively as they are prescribed by the physician. Seeking to address these different daily behaviors of individuals regarding medications, this thesis has proposed the concept of “self-management of medications use”. This concept aims to amplify the comprehension of medications use beyond medical prescriptions adherence as already indicated in the concept of medication self-management and compliance. From this perspective stands out the need of other paradigms introduction on health care, such as collaborative care and lived body, in which the individual himself, with health professionals’ collaboration, take the decisions about the most adequate treatment strategies and health promotion.

The objectives of this study were to assess patient activation levels, to assess association between sociodemographic characteristics and patient activation, to assess association between health status characteristics and patient activation, and to assess association between patient activation and medication adherence among Medicare beneficiaries with type 2 diabetes. A retrospective cohort study was conducted using data from the 2009 through 2013 Medicare Current Beneficiary Survey (MCBS). Patient activation was measured with the Patient Activation Supplement in the MCBS and was categorized as low, moderate, and high levels based on activation scores. Medication adherence was assessed with proportion of days covered (PDC) using Medicare Part D administrative records from the MCBS within a period of six months after measurement of patient activation. The sample included Medicare beneficiaries who completed the MCBS Patient Activation questionnaire, who were diagnosed with type 2 diabetes, and who were 18 or older. Beneficiaries were excluded if they responded “Not ascertained,” “Not Applicable,” “Don’t know” or “Refused” to more than 50 percent of the Patient Activation questions, did not have continuous Medicare Part A and Part D coverage throughout the assessment period, had less than two Medicare Part D claims for an antidiabetic medication throughout the assessment period, used insulin during the assessment period, resided in long-term care facilities, or had Alzheimer’s disease, dementia, mental retardation or mental disorder. All analyses were conducted in SAS 9.4 for Unix environment. An <i>a priori</i> alpha level of 0.05 was used to determine significance. Bivariate and multivariable weighted ordinal logistic regression were applied for assessing associations. A total of 571 individuals met sample selection criteria. The mean age was 72.4 years. Of the 571 persons in the sample, 27.5 percent were at low activation level, 38.7 percent were at moderate activation level, and 33.7 percent were at high activation level. Approximately three-fourths of the sample persons were adherent to antidiabetic medications. Low activation was more likely to be found in males, less educated patients, and patients without arrhythmia. Ex-smokers as compared to non-smokers and overweight patients as compared to those with healthy weight were less likely to report low activation. In multivariable logistic analysis adjusting for race, gender, osteoporosis, Charlson Comorbidity Index score, and number of prescribed medications, patient activation level was not significantly associated with medication adherence. Non-Whites and patients with a Charlson Comorbidity Index score of 1 as compared to those with a score of 0 were more likely to be non-adherent. A lower number of prescribed medications was associated with higher odds of non-adherence.

Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.

O descarte de medicamentos envolve dois fluxos: o fluxo institucional, dos resíduos de fármacos, classificados como resíduos de serviços de saúde, utilizados na indústria e nas instituições de saúde; e o fluxo domiciliar, dos medicamentos vencidos/em desuso em poder da população. O descarte dos resíduos de medicamentos de origem domiciliar pode ser promovido pela logística reversa, onde este tipo de resíduo é devolvido ao setor empresarial para destinação final ambientalmente segura. O objetivo deste estudo foi identificar as estratégias mais viáveis para operacionalização da logística reversa de medicamentos. Trata-se de uma pesquisa exploratória, descritiva, com abordagem quantitativa. As estratégias foram avaliadas junto a atores da cadeia de valor farmacêutica: representantes do poder público, da indústria e distribuição farmacêutica, e consumidores/potenciais consumidores de medicamentos. Foram elaborados três questionários de avaliação de estratégias segundo seis critérios: mediação (articulação entre atores da cadeia produtiva farmacêutica por meio de políticas públicas); fiscalização (das ações); complexidade (de implantação e operacionalização); custos (de implantação e manutenção); adesão (potencialidade de ser inserida no cotidiano da população) e abrangência (potencialidade de alcançar a população). As estratégias foram hierarquizadas em ordem decrescente de viabilidade: rientações à população por profissionais de saúde, farmácias e internet, sinalização de informações nas embalagens e bulas de medicamentos, campanhas publicitárias e de educação ambiental e a disponibilização de postos de entrega voluntária. Os resultados poderão contribuir para a operacionalização de um sistema de logística reversa de medicamentos, considerando todos os atores envolvidos e buscando conciliar suas necessidades, possibilidades, limitações e interesses / The medication disposal involves two settings: the institutional setting, waste of drugs, classified as medical waste, used in industry and healthcare facilities; and the household setting of expired/unused medicines at home. Disposal of medicine waste can be promoted by reverse logistics, where the waste is returned to the business sector to environmentally safe disposal. This study aimed to identify feasible reverse logistics strategies for medicine waste. It is an exploratory, descriptive research with a quantitative approach. The strategies were assessed by representatives of government, industry and pharmaceutical distribution, and consumers/potential consumers of medicines. We constructed three questionnaires to strategies assessment according to six criteria: mediation (articulation among actors of the pharmaceutical supply chain by means of public policies); inspection (of initiatives); complexity (set up and operation); costs (implementation and maintenance); adherence (potential to be inserted into the daily life of the population) and scope (potential to reach the population). The strategies were hierarchize in decrescent order of feasibility: information to people provided by health professionals, pharmacies and internet; signaling information on the packages and leaflet of medicines; advertising and environmental education campaigns; and the provision of waste stations for people to deliver medicine waste. The results can contribute to implement a reverse logistics system for medicine waste, considering all stakeholders in an attempt to reconcile their needs, possibilities, limitations and interests

A percepção de risco teratogênico equivocada pode levar à privação de uso de medicamentos seguros e à relutância ou não adesão ao tratamento farmacológico durante a gestação. Estudos prévios realizados em países desenvolvidos sugerem que a percepção de risco teratogênico ao uso de medicamentos é superestimada por gestantes, não gestantes e profissionais de saúde. Grande parte destes estudos foi realizada em centros de aconselhamento teratogênico e utilizou apenas uma técnica de aferição da percepção de risco (Escalas Visuais Analógicas). Com o objetivo de caracterizar a percepção de risco teratogênico por gestantes e mulheres em idade fértil, conduzimos um estudo que combinou métodos qualitativos e quantitativos de investigação. Participaram da pesquisa usuárias de serviços de saúde da rede básica municipal de Porto Alegre. Em termos qualitativos, foram realizados dois grupos focais com gestantes. Os dados quantitativos resultaram da realização de entrevistas estruturadas com 287 mulheres em idade fértil divididas em dois grupos: gestantes e não gestantes. A percepção de risco de malformações congênitas na população geral e as percepções de risco teratogênico das exposições a paracetamol, metoclopramida, misoprostol e radioterapia na gestação foram aferidas por duas técnicas: Escalas Visuais Analógicas (EVA) e perguntas numéricas. A concordância entre as duas técnicas de aferição foi avaliada pela análise gráfica de Bland-Altman. Não encontramos concordância entre as medidas obtidas por EVA e por pergunta para nenhuma das percepções de risco em estudo. As medianas das percepções de risco teratogênico medidas por EVA foram superiores às obtidas através da pergunta numérica, para todas as variáveis. Para ambas as técnicas de aferição, as medianas das percepções de risco teratogênico ao paracetamol e à metoclopramida foram mais baixas que para o risco de malformações congênitas na população geral. Já as medianas das percepções de risco ao misoprostol e à radioterapia apresentaram os maiores valores. Não foram encontradas diferenças significativas nas percepções de risco entre gestantes e não gestantes. A lógica acionada pelas mulheres na estimação do risco teratogênico é a da classificação dos medicamentos em fortes e fracos. Dentro desta lógica, os medicamentos e as exposições percebidos por elas como fracos não apresentam riscos, enquanto que aqueles percebidos como fortes são vistos como perigosos e devem ser evitados na gestação. Concluímos que o uso de EVA leva à superestimação das percepções de risco teratogênico. Além disso, frente à dificuldade em operar a lógica probabilística na estimação de risco, as mulheres operam uma lógica própria, classificando os medicamentos em fortes ou fracos. / An erroneous perception of teratogenic risk can lead to the non-use of safe medications and reluctance to or abstaining from pharmacological treatment during pregnancy. Previous studies conducted in developed countries suggest that the perception of teratogenic risk in the use of medications is overestimated by pregnant women, non-pregnant women and health professionals. Most of these studies were performed in teratogen counseling centers and only used one technique for measuring risk perception (Visual Analogue Scales). In order to characterize the perception of teratogenic risk by pregnant women and women of childbearing age, we conducted a study that combined qualitative and quantitative research methods. Public health care users from the city of Porto Alegre participated in the research. In qualitative terms, two focus groups were carried out with pregnant women. The quantitative data was derived from structured interviews with 287 women of childbearing age divided into two groups: pregnant and non-pregnant women. The perception of risk of congenital malformations in the general population and the perception of teratogenic risk through exposure to acetaminophen, metoclopramide, misoprostol and radiation therapy during pregnancy were measured via two techniques: Visual Analogue Scales (VAS) and numerical questions. The agreement between the two measurement techniques was evaluated using Bland-Altman graphic analysis. We did not find an agreement between the measurements obtained through VAS and those obtained through questions for any of the risk perceptions in the study. The medians of the perceptions of teratogenic risk measured by VAS were higher than those obtained by numerical questions, for all variables. For both measurement techniques, the medians of the perceptions of teratogenic risk with acetaminophen and metoclopramide were lower than those for the risk of congenital malformations in the general population. However, the medians of the perceptions of risk with misoprostol and radiation therapy presented the highest values. There were no significant differences in risk perceptions among pregnant and non-pregnant women. The logic employed by women in estimating teratogenic risk is the classification of drugs according to strong and weak. According to this logic, the drugs and exposure to them, perceived by these women as weak, do not present risks, while those perceived as strong are seen as hazardous and should be avoided during pregnancy. Our conclusion is that the use of VAS leads to the overestimation of teratogenic risk perceptions. Moreover, given the difficulty to engage in probabilistic logic for estimating risk, women engage in their own logic, classifying medications as strong or weak.

INTRODUÇÃO: O tema segurança do paciente ganhou importância a partir da publicação dos Estudos Harvard I e II, e dimensão pública a partir do livro To Error is Human pelo Institute of Medicine em 1999, onde são apresentados números alarmantes sobre erros durante o processo do cuidado em saúde. Esses estudos demonstram que os erros com medicamentos são a causa mais frequente de incidentes em pacientes internados. O Institute for Safe Medication Practices (ISMP), uma organização que se dedica à prevenção de erros de medicação e ao uso seguro dos medicamentos publicou em 1989 a primeira lista de medicamentos reconhecidos como perigosos. Em 1995, o ISMP avaliou os erros notificados com medicamentos quanto à gravidade e os danos causados no Medication Error Reporting and Prevention (MERP). Após este estudo, o termo \"High Alert Medication\" foi adotado para designar um grupo de medicamentos mais relacionados a danos graves ou fatais quando ocorre alguma falha no seu processo de utilização. No Brasil estes medicamentos são conhecidos como Medicamentos de Alto Risco, Medicamentos de Alta Vigilância (MAV) ou Medicamentos Potencialmente Perigosos (MPP). OBJETIVOS: Avaliar a ocorrência de incidentes com medicamentos de acordo com a classificação MPP e suas variáveis no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP - USP), nos anos de 2013 e 2015. MÉTODOS: Estudo transversal descritivo retrospectivo com abordagem quantitativa dos incidentes notificados ao Núcleo de Segurança do Paciente relacionados aos MPP. RESULTADOS: Durante o ano de 2013, foram notificados 28% de incidentes envolvendo MPP na unidade Campus e 37,5% na Unidade de Emergência (UE). Os medicamentos quimioterápicos foram os mais notificados e com as maiores Taxas de Incidência (TI) na unidade Campus; o cloreto de potássio foi o mais notificado e com a maior TI na UE. A etapa de prescrição foi a mais notificada nas duas unidades. Utilizando a classificação ATC, os subgrupos terapêuticos que mais atingiram o paciente foram Análogos da Purina, Análogos do Ácido Fólico e Nutrição Parenteral (Campus); Insulina e Análogos Injetáveis, Outras Preparações Cardíacas foram os mais notificados na UE. Em 2015, os percentuais de notificações com MPP foram 8,8% (Campus) e 31,7% (UE). Nesse ano, os medicamentos mais notificados foram o cloridrato de tramadol e a enoxaparina nas duas unidades. Na unidade Campus a etapa de dispensação foi a mais notificada, e etapa de administração na UE. Os subgrupos com maiores TI foram Agentes Alquilantes, Anti Histamínico para Uso Sistêmico e Agente com Ação no Músculo Liso Arteriolar (Campus); na UE, Antiarrítmico, Classe III e Analgésico Opióide. CONCLUSÃO: A classificação MPP pode padronizar a atuação do farmacêutico clínico, além de prover indicadores clínico-gerenciais que auxiliem no desenho de processos proativos de prevenção de erros de medicação. / INTRODUCTION: The patient safety issue gained importance from the publication of Harvard Studies I and II, and public dimension from the book To Error is Human by the Institute of Medicine in 1999, which presents the alarming dates about errors during the process of healthcare. These studies demonstrate that the errors with medications are the most common cause of incidents in hospitalized patients. The Institute for Safe Medication Practices (ISMP), an organization dedicated to the prevention of medication errors and the safe use of medication published in 1989 the first list of recognized dangerous drugs. In 1995, the ISMP evaluated the reports of drugs errors according the severity and damage to the Medication Error Reporting and Prevention (MERP). After this study, the term \"High Alert Medication\" was adopted to designate a group of drugs more related to serious injury or death occurs when a fault in its usage. In Brazil, these drugs are known as high-risk drugs, high alert medications or potentially dangerous drugs. OBJECTIVES: Analyze the occurrence of reported incidents involving the high alert medication and its variables at the Hospital of Ribeirão Preto Medical School, University of São Paulo (HCFMRP - USP) in the years 2013 and 2015. METHODS: Retrospective descriptive cross-sectional study with a quantitative approach of the reported incidents to the Patient Safety Center related to high alert medication. RESULTS: During the year 2013 it was reported 28% of incidents involving high alert medication in the Campus Unit (CU) and 37.5% at the Emergency Unit (EU). Chemotherapeutic drugs were the most reported and with the highest Incidence Rates (IR) (CU) and 19.1% potassium chloride was the most commonly reported and the largest IR in the EU. Prescription stage was the most reported in both units. Using the ATC classification, therapeutic subgroups most reached the patient were Purine Analogues, Folic Acid Analogues and Parenteral Nutrition (CU), Insulin and Analogs for Injections and Other Cardiac Preparations (EU). In 2015, the percentage of notifications with high alert medication was 8.8% (CU) and 31.7% (EU). The most reported drugs were tramadol hydrochloride and enoxaparin in both units. On CU dispensing stage was the most notified and administration stage in the EU. Subgroups with higher IR were Alkylating Agents, Antihistamine for Systemic Use and Arteriolar Smooth Muscle, Agent Action On (CU) and Antiarrhythmic, Class III and Analgesic Opioid (EU). CONCLUSION: The MPP classification can standardize the performance of the clinical pharmacist, and provide clinical and management indicators to assist in the proactive process design to prevent medication errors.

No description available.

Prevalence rates of youth prescribed psychotropic medications have risen dramatically over the past decade. Many of these medications are prescribed to treat symptoms of a disorder that occur in the school setting. Some medications have negative side effects that can inhibit academic and social performance. School psychologists have been identified as professionals who are equipped to assist in monitoring both the beneficial and negative effects of medications for youth attending school. This study investigated the practices, training, types of disorders for which medication monitoring occurs, facilitators, and barriers to school psychologists engaging in medication monitoring in the schools. Survey data from 166 members of the Florida Association of School Psychologists were collected and analyzed. Seventy four percent of respondents endorsed medication monitoring as an appropriate role for school psychologists. Approximately half of the respondents in this study reported engaging in medication monitoring over the past school year. Over half the sample reported receiving training related to medication monitoring. Weak relationships were found among demographic and training variables and reported medication monitoring practices. Additionally, none of the interactions between demographic, professional background, and training variables was predictive of medication monitoring practices. Implications of these findings are discussed in relation to developing strategies to promote the medication monitoring practices of school psychologists.

The present study involved the analyses of the Texas Medicaid prescription claims data. The population studied was made up of subjects between 10 and 18 years who had at least 2 prescriptions of the same oral antidiabetic (OAD) medication from January 1, 2006 through December 31, 2009. Twelve months’ data for each subject were analyzed. The main aim of the study was to describe OAD medication use patterns in the study population, assess trends in Medication Possession Ratio (MPR) and persistence in the study population and determine the relationship between age and MPR and between age and persistence while controlling for covariates. Results of the descriptive statistics, multiple and logistic regression analyses are reported. The average age (± SD) of the 3,109 eligible subjects was 14 (± 2) years; minority populations made up the majority (87%) of the population; 67% of the population were females; and 91% were on the OAD metformin. The overall mean MPR (± SD) for the population was 45% (± 27). A significant negative relationship between MPR and age was reported while controlling for covariates (p<0.0001). Among the covariates, white race and male were significantly associated with a higher MPR, holding other variables constant. When adherence was dichotomized (MPR < 80% and MPR >= 80%), logistic regression analysis also found that age was significantly and negatively related to MPR (p < 0.0001). In addition, the white race and male were again significantly related to a higher level of adherence, holding other variables constant. The overall mean days to non-persistence (± SD) was 108 days (± 86). Persistence was significantly and negatively associated with age, holding other variables constant (p < 0.0001). Among the covariates, white race was significantly related to longer persistence. In conclusion, adherence and persistence are generally low in the study population. Age, gender and race were significantly associated with adherence. Being younger, male, and white were significantly associated with a higher level of adherence, while being younger and white were significantly associated with longer persistence. Healthcare providers therefore need to intensify efforts to improve adherence in pediatric patients especially those at the brink of adulthood. / text