FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / INTRODUÃÃO: A prescriÃÃo mÃdica à o principal determinante do uso de medicamentos e contribui para a efetividade da atenÃÃo à saÃde, agravos relacionados aos medicamentos e para os gastos pÃblicos em saÃde. A avaliaÃÃo da qualidade da prescriÃÃo tem sido compreendida como uma estratÃgia para sua melhoria. OBJETIVO: Desenvolver e testar indicadores de qualidade da prescriÃÃo (IQP) mÃdica em atenÃÃo primÃria de saÃde (APS) no municÃpio de Fortaleza-CE. METODOLOGIA: RevisÃo da literatura em bases de dados indexadas. SeleÃÃo, adaptaÃÃo e listagem dos IQP; convite aos prescritores da APS e distribuiÃÃo de material para leitura crÃtica; oficina de consenso com prescritores pela TÃcnica do Consenso Informal (TCI); aplicaÃÃo dos indicadores pactuados a uma amostra das prescriÃÃes em APS em Fortaleza no perÃodo de janeiro a fevereiro de 2008. Foram identificados na literatura 99 IQP, dos quais 43 foram excluÃdos obedecendo aos critÃrios de inclusÃo e exclusÃo. Os demais foram adaptados à realidade investigada e aos objetivos do estudo obtendo-se 59 indicadores que foram classificados em dois grupos: Indicadores dos processos gerais da prescriÃÃo (10) e Indicadores orientados ao medicamento (49). Um texto explicativo acompanhado da listagem dos IQP foi distribuÃdo aos prescritores com 7 dias de antecedÃncia e trazido para discussÃo em grupo, seguida de plenÃria de consenso, moderada pelas pesquisadoras. RESULTADOS: Participaram do consenso 17 prescritores (9 mulheres), idade mÃdia de 38 anos. Destes, 35,29% graduaram-se entre 1999 e 2007. Seis eram preceptores (3 mestres) e 11 residentes em medicina da famÃlia (6 especialistas). A mÃdia de atuaÃÃo no serviÃo pÃblico era de 10 anos. Durante a plenÃria, o grupo consenso decidiu aceitar todos os IQP prÃ-selecionados e acrescentaram mais seis. Os indicadores dos aspectos gerais da prescriÃÃo foram mais simples de calcular e interpretar, enquanto os indicadores orientados ao medicamento apresentaram maiores dificuldades devido à ausÃncia de requisitos tÃcnicos na prescriÃÃo que dificultaram a aplicaÃÃo. Todavia apÃs aplicaÃÃo dos IQP foi possÃvel conhecer o perfil da prescriÃÃo mÃdica de Fortaleza. Os indicadores foram aplicados a uma amostra das prescriÃÃes (N=624, sendo 30 por unidade de saÃde), envolvendo 1582 itens de medicamentos prescritos e uma mÃdia de 2,52 medicamentos por prescriÃÃo. 87% dos medicamentos prescritos pertenciam a lista padronizada do municÃpio, sendo o paracetamol o mais freqÃente. A prescriÃÃo por denominaÃÃo genÃrica aconteceu em 90,6% dos casos. 2,1% das prescriÃÃes possuÃam injetÃveis ou psicotrÃpicos e 8,3% das prescriÃÃes eram injustificÃveis. Em mÃdia o gasto por prescriÃÃo foi de R$ 2,40. A prevalÃncia dos grupos terapÃuticos analisados foi: 22,8% - anti-hipertensivos, 8,81% - antiagregante plaquetÃrio, 6,57% antidiabÃticos, 8,17% - anti-secretores, 27,08% - analgÃsicos, 22,25% - antibiÃticos. CONCLUSÃO: AtravÃs da TCI foi possÃvel elaborar um sistema de indicadores capazes de avaliar a prescriÃÃo mÃdica em APS. Esses IQP darÃo suporte ao profissional farmacÃutico para realizar avaliaÃÃes periÃdicas e planejarem intervenÃÃes necessÃrias, no sentido de aperfeiÃoar cada vez mais a prescriÃÃo tendo em vista o benefÃcio dos pacientes. / INTRODUCTION: The medical prescription is the main determinant of the use of medicines and contributes to the effectiveness of the health care, offences related to medicines and for the public costs in health. The evaluation of the quality of the prescription has been considered as a strategy to achieve its improvement. OBJECTIVE: Develop and test indicators of quality of the medical prescription (IQP) in primary health care (PHA) in the municipal district of Fortaleza-CE. METHODOLOGY: Revision of the literature in bases of indexed data. Selection, adaptation and listing of IQP; invitation sent to the doctors of PHA and material distribution for critical reading; consensus workshop with doctors using technique of the informal consensus (TIC); application of agreed indicators to a sample of the prescriptions in PAH in Fortaleza in the period of January to February 2008. 99 IQP were identified in the literature, of which 43 were excluded according to the criteria of inclusion and exclusion. The others were adapted to the reality investigated and the objectives of the study resulting in 59 indicators that were classified into two groups: indicators of processes of the general prescription (10) and targeted drug indicators (49). An explanatory text added of a list of IQP was distributed to prescribers 7 days in advance and brought to discussion groups, followed of full consensus, moderated by the researchers. RESULTS: Seventeen prescribers had participated of the consensus (9 women), average age 38 years. Among these, 35.29% graduated between 1999 and 2007. Six of them were preceptors (3 masters) and 11 residents in family medicine (6 experts). The average performance in the public service was 10 years. During the session, the consensus group decided to accept all IQP pre-selected and added six more. The indicators of the general aspects of the prescription was simple to calculate and interpret, while indicators targeted drug showed greater difficulties due to lack of technical requirements in the prescription that hampered the implementation. However after applying the IQP was possible to know the profile of the medical prescription in Fortaleza. The indicators were applied to a sample of prescriptions (N = 624, being 30 per health unit), involving 1,582 items of prescribed drugs and an average of 2.52 drugs per prescription. 87% of prescribed drugs were the standard list of the municipality, the paracetamol as being the most frequent drug. The prescription by generic denomination occurred in 90.6% of cases. 2.1% of prescriptions had injected drugs or psychotropics and 8.3% of prescriptions were unjustifiable. On average the cost per prescription was R $ 2.40. The prevalence of treatment groups was analyzed: 22.8% - antihypertensives, 8.81% - platelet aggregation inhibitor, 6.57% - antidiabetics, 8.17% - antiulcer, 27.08% - analgesics, 22.25 % - antibiotics. CONCLUSION: Through the TCI it was possible to devise a system of indicators able to evaluate the prescription in APS. These IQP will support the professional pharmacist to conduct periodic assessments and to plan necessary interventions, in order to improve prescribe aiming at the benefit of patients.

MEDICAL PRESCRIPTIONS IN CYPRUS Author: Papadopoulos V. Philippos Tutor: RNDr. Jana Kotlářová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis is to get: current knowledge about medical prescriptions (MP) in Cyprus and rules of their use their basic division according their kinds, formal look, practical handle, payment knowledge of the current Health system of Cyprus Results: The Health system of Cyprus is a unique arrangement in the EU since is a simultaneous participation of public and the private sector which has many phenomena of inequality and non- accessibility mainly from the economically weaker. In the future plans of Ministry of Health is the complete redesign of entire Health System in a direction of electronic services for all the parts of health system chain including doctors, pharmacists and insured patients. The basic and significant informations about medical prescriptions in Cyprus according aim of diploma thesis are demonstrated in the Summary Table at chapter 11. All prescriptions in Cyprus are in common form for all type of drugs and there is no rule for size and color of the paper. Pharmacist is checking the signature of the doctor as well as name of the patient and...

MEDICAL PRESCRIPTIONS IN GREECE Author: Naoum I. Panagiotis Tutor: RNDr. Jana Kotlářová, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Czech Republic Aim of diploma thesis: The aim of diploma thesis is: to get current knowledge about medical prescriptions (MP) in Greece and rules of their use; to prepare its basic division according their kinds, formal look, practical handle with them and their payment; to get sample of different MP and finally to describe the current Greek health, pension and insurance system as a secondary aim. Results: In this diploma thesis it has been described the existing model of medical prescriptions in Greece and have been given adequate information about their basic divisions, their kinds, their formal look, and their compensation. Also it is described the course of the prescription, from the doctor to the pharmacist, harmonized with modern electronic prescribing. In the recent years (from 2009), Greece started the pilot implementation of e-prescribing for the modernization of public administration. This reform was established in order to fight against impunity and seemingly anti-ethical actions. The measure was certified by the laws of the Greek State, whereas the first results are starting to show...

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Current evidence suggests that non-medical prescription stimulant (NMPS) use is on the rise, particularly among college students. Identifying individuals at risk for regular and problematic use is a critical step towards the development of effective intervention efforts. A growing body of work has noted that individuals with elevated levels of social anxiety (SA) or social anxiety disorder are at an enhanced risk for developing substance use problems, including NMPS use disorder. Despite the relevance of SA and NMPS use among college students, no studies have attempted to examine subclinical SA or the relation between SA and NMPS use among college students specifically. Thus, the present study sought to extend this area by testing the relation of SA symptoms and NMPS use frequency among college students. A large online study of college students was conducted (N=1604) to identify 252 NMPS users (18-25 years; 68.3% female). A hierarchical linear regression was used to test the moderation of positive prescription stimulant expectancies on SA symptoms in predicting past year NMPS use frequency. A subsample of 15 participants was also brought into the lab to assess subjective (State Anxiety) and physiological (salivary cortisol) responding to a social stressor task. Overall, the current study did not provide evidence that SA, via retrospective self-report or real-time responding was related to past year NMPS use frequency. Additional research is needed to resolve the discrepancies between the present findings and prior work.

Esta pesquisa tem por finalidade propor um modelo de automação e padronização do processo de controle da prescrição médica e dispensação de medicamentos no Brasil, baseado no Sistema Autenticador e Transmissor (SAT) aplicado ao controle fiscal do comércio varejista e implementado no Estado de São Paulo, Brasil. Busca-se analisar o cenário atual de prescrição médica no país, suas características operacionais, os problemas cada vez mais frequentes ligados ao comércio irregular de medicamentos e o uso abusivo de substâncias controladas. São apresentadas as medidas adotadas para o controle do setor no Brasil, em Portugal e nos Estados Unidos da América, bem como seus requisitos e grau de operacionalização. Com base na lacuna encontrada nas ações adotadas pelo Brasil, apresenta-se a motivação do presente trabalho, a busca pelas características do cenário brasileiro e a respectiva não aderência do mesmo às propostas internacionais, principalmente pelo fato dessas demandarem infraestrutura técnica, ordenamento jurídico e disponibilidade de investimentos incompatíveis. Diante de referida necessidade, buscou-se em outras áreas um modelo de controle de processos que fosse aderente à realidade brasileira apresentada, razão pela qual uma solução encontrada foi a utilizada para o controle do comércio varejista, por meio do equipamento SAT (Sistema Autenticador Transmissor), que é responsável pela geração de Cupons Fiscais Eletrônicos. Assim, o trabalho consiste em utilizar os conceitos traçados para o modelo fiscal e adaptar às necessidades da prescrição médica, propondo um novo modelo de automação e controle do processo de prescrição e dispensa de medicamentos baseado na Receita Médica Eletrônica (RM-e). / This research aims to propose a model of automation and standardization of the process of control of medical prescription and dispensing of medicines in Brazil, based on the Authentication and Transmission System (Sistema Autenticador Transmissor - SAT) applied to the fiscal control of the retail trade and implemented in the State of São Paulo, Brazil. The aim is to analyze the current scenario of medical prescription in the country, its operational characteristics, the increasingly frequent problems related to irregular drug trade and the abusive use of controlled substances. The measures adopted to control the sector in Brazil, Portugal and the United States of America, as well as their requirements and degrees of operation are presented. Based on the gap found in the actions adopted by Brazil, the motivation of the present study is the search for the characteristics of the Brazilian scenario and its non-adherence to the international proposals, mainly because they require technical infrastructure, legal order and availability Incompatible investments. In view of this need, a process control model was searched in other areas that adhered to the Brazilian reality presented, which is why a solution found was used to control the retail trade, through the SAT (Authentication and Transmission System), which is responsible for the generation of Electronic Tax Coupons. Thus, the work consists of using the concepts outlined for the fiscal model and adapting to the needs of the medical prescription, proposing a new model of automation and control of the prescription and dispensing process based on Electronic Medical Prescription (Receita Médica Eletrônica RM-e).

Esta pesquisa tem por finalidade propor um modelo de automação e padronização do processo de controle da prescrição médica e dispensação de medicamentos no Brasil, baseado no Sistema Autenticador e Transmissor (SAT) aplicado ao controle fiscal do comércio varejista e implementado no Estado de São Paulo, Brasil. Busca-se analisar o cenário atual de prescrição médica no país, suas características operacionais, os problemas cada vez mais frequentes ligados ao comércio irregular de medicamentos e o uso abusivo de substâncias controladas. São apresentadas as medidas adotadas para o controle do setor no Brasil, em Portugal e nos Estados Unidos da América, bem como seus requisitos e grau de operacionalização. Com base na lacuna encontrada nas ações adotadas pelo Brasil, apresenta-se a motivação do presente trabalho, a busca pelas características do cenário brasileiro e a respectiva não aderência do mesmo às propostas internacionais, principalmente pelo fato dessas demandarem infraestrutura técnica, ordenamento jurídico e disponibilidade de investimentos incompatíveis. Diante de referida necessidade, buscou-se em outras áreas um modelo de controle de processos que fosse aderente à realidade brasileira apresentada, razão pela qual uma solução encontrada foi a utilizada para o controle do comércio varejista, por meio do equipamento SAT (Sistema Autenticador Transmissor), que é responsável pela geração de Cupons Fiscais Eletrônicos. Assim, o trabalho consiste em utilizar os conceitos traçados para o modelo fiscal e adaptar às necessidades da prescrição médica, propondo um novo modelo de automação e controle do processo de prescrição e dispensa de medicamentos baseado na Receita Médica Eletrônica (RM-e). / This research aims to propose a model of automation and standardization of the process of control of medical prescription and dispensing of medicines in Brazil, based on the Authentication and Transmission System (Sistema Autenticador Transmissor - SAT) applied to the fiscal control of the retail trade and implemented in the State of São Paulo, Brazil. The aim is to analyze the current scenario of medical prescription in the country, its operational characteristics, the increasingly frequent problems related to irregular drug trade and the abusive use of controlled substances. The measures adopted to control the sector in Brazil, Portugal and the United States of America, as well as their requirements and degrees of operation are presented. Based on the gap found in the actions adopted by Brazil, the motivation of the present study is the search for the characteristics of the Brazilian scenario and its non-adherence to the international proposals, mainly because they require technical infrastructure, legal order and availability Incompatible investments. In view of this need, a process control model was searched in other areas that adhered to the Brazilian reality presented, which is why a solution found was used to control the retail trade, through the SAT (Authentication and Transmission System), which is responsible for the generation of Electronic Tax Coupons. Thus, the work consists of using the concepts outlined for the fiscal model and adapting to the needs of the medical prescription, proposing a new model of automation and control of the prescription and dispensing process based on Electronic Medical Prescription (Receita Médica Eletrônica RM-e).

This study examines student's nonmedical prescription drug (NMPD) and marijuana use and whether anxiety, depression, ADD or ADHD symptoms are associated with their use and if students are self-medicating to alleviate symptoms. The method of obtaining this information was provided by a total of 278 college students who voluntarily and anonymously completed a Web-based survey. This study fills in the gaps of previous research and reveals the most frequent NMPD's used by students and their overall perceptions of their intended effects of the drug and answers why students do not seek professional help for their anxiety, depression and impulsivity symptoms. Results from the survey indicate that students who report NMPD use self- reported higher symptoms of anxiety, depression and impulsivity. NMPD users reported higher percentages of other substance abuse compared to nonusers. The most prominent NMPD's used by students are Adderall and Vicoden or Codeine. Data also indicates student's primary reasons for their NMPD use are related to academic purposes; as opposed to nonacademic. This analysis is further supported by the fact that the majority of NMPD users did not use before they began college and do not use while classes are not is session. Furthermore, students perceive their overall intended effects of their NMPD use to be beneficial, despite the known risks associated with their drug use. By examining college student's current NMPD use we can provide alternative solutions to students who are self-medicating as a coping mechanism for underlying issues or mental health disorders. Also, we can provide them with the necessary services in order to address their problems professionally.

The non-medical use of prescription drugs is an important public health concern. Non-medical use of prescription stimulants (NMUPS), specifically medications used to treat Attention Deficit Hyperactivity Disorder (ADHD), is particularly concerning. One timely concern regarding NMUPS, especially among young adults, is their role in appetite suppression/weight loss. Indeed, some individuals are motivated to misuse such drugs for the purpose of losing weight. Engaging in NMUPS for weight loss has been examined only minimally in the research literature. However, extant data demonstrate that this behavior is associated with other unhealthy behaviors and poor psychosocial health. Limitations of prior research include the exclusive use of college student samples and little attention to relevant health behavior theory. The current study investigated NMUPS for weight loss in a national, young adult sample (n = 1526), ages 18-25 years, utilizing Amazon’s Mechanical Turk. Motivations and attitudes about NMUPS were evaluated, within the framework of the Theory of Planned Behavior (TPB). A structural equation model (SEM) was analyzed, which included attitudes; social norms; and perceived behavioral control (PBC) to lose weight without stimulants, as predictors of engaging in past year NMUPS for weight loss. Approximately 12.0% of participants reported lifetime NMUPS for weight loss, and of these, 48.4% reported past year use. Findings demonstrate that use is related to disordered eating and unhealthy weight loss behaviors, including vomiting; high rates of other substance use; and psychological concerns, including body dissatisfaction and depressive symptomatology. These results suggest that NMUPS for weight loss is associated with a variety of negative consequences and users are not well-informed regarding medication knowledge. The SEM provided adequate overall fit to the data; two of the four social norms and both PBC factors were significantly associated with NMUPS for weight loss. This study extends the literature on the utility of the TPB in examining NMUPS, and provides the first research on utilizing the TPB to examine NMUPS for weight loss. Methods aimed at increasing PBC regarding stimulant use and weight loss, and emphasizing healthful and sustaining weight loss strategies, improving mental health, and educating about polysubstance use are potential intervention targets.

Atualmente, uns dos assuntos mais discutidos na medicina quando se trata de erros é a prescrição médica. Estes erros podem causar grandes danos à saúde dos pacientes, e um dos grandes causadores destes erros é a prescrição feita de forma manual, ou seja, de forma escrita manuscrita pelos médicos. Outro problema decorrente é o fato que nos modelos existentes não contemplam todas as informações necessárias para a correta prescrição. A prescrição médica é um documento que deve conter dados do paciente e de seu tratamento, como medicamentos, doses, periodicidade e, entre outras informações. Como na maioria das vezes quem realiza a infusão dos medicamentos nos pacientes não são os mesmos médicos que os prescreveram, a escrita manuscrita pode dificultar a leitura e o entendimento para quem for realizar o procedimento no paciente. Assim, os problemas proporcionados pela prescrição médica manuscrita como a falta de informações, escrita ilegível, rasuras e informações incompletas, podem ocasionar interpretações errôneas por parte dos profissionais de saúde que os leem, provocando sérios prejuízos diretos aos pacientes. Como atualmente é inevitável à introdução da tecnologia da informação (T.I.) na medicina, houve a iniciativa de criar um questionário eletrônico com perguntas sobre quais informações devem contemplar uma prescrição eletrônica, a fim de não haver falta e nem excesso de informações no modelo de prescrição eletrônica evitando possíveis problemas. Foi criado um questionário contendo 24 questões de múltiplas escolhas, com respostas do tipo SIM ou NÃO. Os questionários foram enviados aos associados da Sociedade Brasileira de Oncologia Clínica. Foram 215 questionários respondidos, sendo que das 24 questões 17 tiveram 80% ou mais de respostas sim, onde significa que estas informações devem fazer parte do modelo de prescrição, que foi desenvolvido a partir destas informações. / Nowadays, one of the most discussed subjects in medicine when it comes to errors, is medical prescription. These errors can cause great harm to patients, and one of the great causes of these errors is the prescription made manually, that is, in handwritten by doctors. Another problem is the fact that in the existing models it is not include all the information necessary for the correct prescription. The medical prescription is a document that should contain data about the patient and their treatment, such as medications, doses, periodicity among other information. As most of the time those who infuse the drugs are not the same doctors who prescribed them, handwriting may make it difficult to read and understand for those who perform the procedure. Thus, the problems provided by medical prescription such as lack of information, illegible writing, erasures and incomplete information, can lead to misinterpretations by health professionals who read them, causing serious harm to patients. As it is currently unavoidable the introduction of informatics technology (IT) in medicine, there was the initiative to create an electronic questionnaire with questions about what information should contemplate an electronic prescription. In order to avoid lack or excess of information in the prescription model, avoiding possible problems, a questionnaire containing 24 multiple choice (YES or NO) questions was created. The questionnaires were sent to the members of the Brazilian Society of Clinical Oncology. There were 215 questionnaires answered, and of the 24 questions, 17 had 80% or more answers, which means that this information should be part of the prescription model.