Doctor of Philosophy(PhD) / In the public hospital sector in Australia there is no dedicated scheme to offset costs associated with high cost medications (HCMs) to the institution or the public. (1) Concerns exist as to the equity of access and appropriate mechanisms to manage access to HCMs in public hospitals. (2) There are gaps in the literature as to how decisions are made, and in particular, decision-making processes by which ethical, clinical and economic considerations maybe taken into account. To date, limited work has been conducted regarding the use and funding of HCMs in public hospitals. There are no published data on perceptions, concerns and attitudes, among health care decision-makers or among the community-at-large about access to HCMs in public hospitals. The research reported in this thesis describes the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. The investigation triangulated quantitative and qualitative methods used to collect and analyse data. Four studies were conducted to describe the decision-making process and explore the perceptions, concerns and attitudes of health care decision-makers and the perceptions of members of the general public regarding access to HCMs in public hospitals. The first study, reported in Chapter Three, was a review of individual patient use (IPU) requests for non-formulary HCMs. This study showed that these requests had a significant impact on the capped expenditure of a public hospital. Subsequent to this review, a new policy and procedure for managing requests for HCMs for IPU was established. A high-cost drugs subcommittee (HCD-SC) operating under the auspices of the Drug and Therapeutics Committee (DTC) was created. The second study, reported in Chapter Four, described the operations of the newly formed HCD-SC. This study also evaluated the decision-making process using the ethical framework “accountability for reasonableness”. (3) Different factors were involved in decisions about access to HCMs and decisions were not solely based on effectiveness and cost. HCD-SC members considered it was important to have consistency in the way decisions were being made. The evaluation of this process allowed identification of good practices and gaps which were considered as opportunities for improvement. The third study, reported in Chapter Five, found that health care decision-makers in an Area Health Service echoed the concerns and agreed about the problems associated with access to HCMs expressed by the HCD-SC members. These studies concluded that the majority of decision-makers wanted an explicit, systematic process to allocate resources to HCMs. These studies also identified tensions between funding systems and hospital decision-making. According to participants there were no mechanisms in place to systematically capture, analyse and share the lessons learned between the macro level (ie. Federal, Pharmaceutical Benefits Scheme - PBS) and the meso level (ie. Institution, public hospital) regarding funding for HCMs. Furthermore, decision-makers considered there are strong incentives for cost-shifting between the Commonwealth and the States. Health care decision-makers also acknowledged the importance of public participation in decision-making regarding allocation of resources to HCMs in public hospitals. However the results of these studies showed that those decisions were not generally made in consultation with the community. Decision-makers perceived that the general public does not have good general knowledge about access to HCMs in public hospitals. A survey of members of the general public, reported in Chapter Six, was then conducted. The survey aimed to gather information about the knowledge and views of members of the general public about access to HCMs in public hospitals. Results of this fourth study showed that respondents had good general knowledge but were poorly informed about the specifics of funding of hospitals and HCMs in private and public hospitals. The results also offered support for the development of a process to involve community members in discussion on policy on the provision of treatment and services within health care institutions and specifically, to seek the views of members of the public on the provision of HCMs and expensive services within public hospitals. In summary, the research reported in this thesis has addressed the gaps in the literature as to how decisions are made, and in particular, the decision-making process and criteria used by health care decision-makers to allocate resources to HCMs in public hospitals. In a move towards more explicitness in decision-making regarding the allocation of scarce health care resources, the findings from these studies provide an evidence base for developing strategies to improve decision-making processes regarding access to HCMs the public sector.

Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-04-11T16:40:28Z No. of bitstreams: 1 Ailton.pdf: 777514 bytes, checksum: 2df253f8c7fd8f6f81678f6a47f030ad (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-05-07T12:08:35Z (GMT) No. of bitstreams: 1 Ailton.pdf: 777514 bytes, checksum: 2df253f8c7fd8f6f81678f6a47f030ad (MD5) / Made available in DSpace on 2013-05-07T12:08:35Z (GMT). No. of bitstreams: 1 Ailton.pdf: 777514 bytes, checksum: 2df253f8c7fd8f6f81678f6a47f030ad (MD5) Previous issue date: 2011 / O presente estudo discute o acesso a medicamentos por intermédio de decisões judiciais. A pesquisa parte de um pensamento problematizante que questiona a judicialização da saúde como um fenômeno observável pela pesquisa científica do direito. O primeiro alvo da pesquisa é compreender o que se entende por direito à saúde, falar de suas origens, ainda que de modo limitado. O direito à saúde é então examinado no tocante ao seu conteúdo, bem como nos seus aspectos de direito fundamental, social e prestacional. Ao longo de todo o texto, são expostos precedentes dos Tribunais brasileiros, com o propósito de ilustrar e melhor entender o fenômeno pesquisado. Sobre a judicialização, tem-se como foco a legitimidade do Poder Judiciário e ainda a relação entre política e direito que, no caso em questão, significa políticas públicas de saúde versus direito fundamental à saúde. Aborda-se ainda a dimensão econômica do direito à saúde, em princípio, com o debate sobre os custos dos direitos e, mais adiante, com a visão do problema a partir de fundamentos da análise econômica do direito, exercendo-se, em seguida, um juízo crítico sobre algumas conclusões encontradas. Por fim, são estudados alguns parâmetros úteis e critérios para a tutela jurisdicional de medicamentos, tomando-se em consideração aspectos da jurisdição constitucional, características das ações judiciais individuais e coletivas sobre a matéria, além da preocupação com os impactos das decisões judiciais, em micro e macrojustiça. / Salvador

O enfermeiro tem papel fundamental no processo da administração de medicamentos, pois a ele cabe promover segurança e manter a qualidade da assistência Para tanto é indispensável o domínio do conhecimento da farmacologia e de conteúdos relacionados aos métodos de administração, ação dos medicamentos, vias de administração, doses, efeitos tóxicos e colaterais. Este estudo teve como objetivo analisar o conhecimento de enfermeiros da Clínica Médica e Unidade de Terapia Intensiva de Hospitais Escola do Centro-Oeste sobre medicamentos específicos e relacionar os níveis de conhecimento entre os enfermeiros quanto ao tempo de atuação na enfermagem, capacitação profissional, formação obtida na graduação e conhecimento sobre medicamentos específicos. Realizou-se um estudo do tipo “survey” em quatro hospitais escola da região Centrooeste denominados de hospitais A, B, C e D. A amostra constituiu-se de 53 enfermeiros, sendo 12(22,6%) do hospital A, 17 (32,1%) do hospital B, 15 (28,3%) do hospital C e 9 (17,0%) do hospital D. Obtiveram-se os seguintes resultados. Dos 53 enfermeiros, 21 (39,6%) são graduados e 32 (60,3%) são especialistas; 33 (62,2%) foram formados depois de 2000, 32 (60,3%) atuam na área desde 2000 11 (20,7%) fizeram curso de atualização em farmacologia 37 (69,8%) cursaram ou estão cursando pós-graduação (nível especialização). Com relação à formação em farmacologia, 42 (79,2%) dos enfermeiros informaram que a disciplina de farmacologia cursada não foi suficiente para a prática profissional, 43 (81,1%) informaram que o conteúdo e a carga horária desta não foram suficientes e 51 (96,2) informaram que relação da teoria com prática, foi insatisfatória. Quanto ao conhecimento específico sobre medicamentos, 31 (58,5%) enfermeiros acertaram mais que 50% das questões e 22 (41,5%) acertaram 50% ou menos. Não foram encontradas diferenças, no nível de acerto dessas variáveis, entre os enfermeiros dos hospitais pesquisados, entre os que trabalham nas unidades de UTI e Clínica Médica e quanto ao tempo de atuação na enfermagem. Os enfermeiros com especialização e que fizeram curso de atualização em farmacologia possuíam um índice de acertos maior.Concluiu-se nesse estudo a necessidade dos profissionais de enfermagem buscarem conhecimentos após concluírem o curso de graduação.É importante que o profissional esteja constantemente se atualizando, ou seja, buscando novos conhecimentos que sustentem a qualidade da sua prática e a segurança dos pacientes na utilização de medicamentos. / The nurse has a fundamental role in the medication administration process, since it is up to him/her to promote safety and maintain the quality of assistance. For such, it is indispensable to have knowledge in pharmacology with contents related to administration methods, medication actions, administration approaches, doses, and toxic and collateral effects. This study aimed at analyzing the knowledge of nurses from medical clinics and intensive care units from School Hospitals in the Mid-West region as to specific medications and relate the knowledge levels among the nurses to the time working in nursing, professional training, background obtained in graduation and knowledge about specific medications. A survey-type study was carried out in school hospitals from the mid-west region, hereinafter referred to as hospitals A, B, C and D. The sample is composed of 53 nurses, being 12 (22.6%) from hospital A, 17 (32.1%) from hospital B, 15 (28.3%) from hospital C and 9 (17,0%) from hospital D. The following results were obtained: from the 53 nurses, 21 (39.6%) are graduates and 32 (60.3%) are specialists; 33 (62.2%) graduated after 2000, 32 (60.3%) have worked in the field since 2000, 11 (20.7%) took an updating course in pharmacology and 37 (69.8%) took or are taking post-graduation courses (specialization level). Regarding the background in pharmacology, 42 (79.2%) nurses informed that the pharmacology discipline studied as undergraduates was insufficient for professional practice, 43 (81,1%) informed that the content and hour load of this discipline were not sufficient either for quality work in the professional practice, and 51 (96,2%) informed that the relation between the theory and the practice, specifically in this discipline, was unsatisfactory. As to the specific knowledge of determined medicationsit was detected that 31 (58.5%) nurses got more than 50% of the questions right and 22 (41.5%) got 50% or less right. No differences were found in the number of correct answers of these items, among the nurses from the researched hospitals, between those that work in the ICU units, Medical Clinics, and the time working in nursing. The nurses with specialization and that took updating courses in pharmacology had a greater number of correct answers. This study pointed out the importance and necessity of the nursing professionals seeking knowledge after the conclusion of the graduation course and that teaching pharmacology in nursing courses offers the basis for professional performance. Nevertheless, it is important for the professional to update him/herself constantly, in other words, seek new knowledge that supports the quality of his/her practice and the safety of the patients in the use of medications.

A Constituição Federal Brasileira institucionalizou o direito a saúde no Brasil, o artigo 196 que diz: A saúde é um direito de todos e um dever do Estado apresenta esse direito. Ao regulamentar a criação do Sistema Único de Saúde a lei 8.080 reafirma a obrigação do Estado com a Saúde da população. Dentro desse contexto a Assistência Farmacêutica (AF) tem importante papel de garantir medicamentos seguros, eficácias, em tempo e quantidade necessária para atender a demanda dos cidadãos, porém apesar das constantes atualizações em prol de promover maior eficiência dos processos da AF, ainda acontecem situações em que o paciente não tem o medicamento requerido, seja por falta nas unidades dispensadoras ou a não presença nas listas de medicamentos padronizados. Essa situação faz com que o cidadão recorra à via judicial na tentativa de garantir o acesso ao medicamento pleiteado, fenômeno conhecido como judicialização da saúde, que traz grandes implicações sobre a gestão da assistência farmacêutica. Diante disso o objetivo do trabalho foi descrever o panorama geral das ações judiciais pleiteando medicamentos e insumos para insulina que foram assumidos pela prefeitura de Ribeirão Preto. Para alcançar esses objetivos, foi realizado um estudo do tipo descritivo. Foram analisados ao todo 1861 processos judiciais sendo 1083 ainda ativos e 778 que já haviam sido encerrados. Na maioria dos processos o juiz dava como prazo máximo 30 dias (99%) para se cumprir a ação, o que é insuficiente para realizar uma licitação pública obrigando a gestão a utilizar via paralela de compra. O Ministério Público foi o principal representante legal (71,7%) utilizado e a maioria das prescrições foram advindas de hospitais e clínicas particulares (50,1%). Os principais diagnósticos referidos nas ações foram diabetes e o transtorno de déficit de atenção e hiperatividade (TDAH). Já os medicamentos mais prevalentes foram as insulinas e o metilfenidato. Dentre os médicos prescritores 3% somam aproximadamente 30% das prescrições. Diante dos resultados expostos, o presente estudo evidenciou o impacto da judicialização da saúde no município de Ribeirão Preto, demandando da gestão pública organização estrutural e financeira para lidar com as demandas judiciais. / Brazilian Federal Constitution institutionalized the right of health in Brazil, the article 196 that says: \"Health is a right of everyone and a duty of State\" presents this right. The law 8.080, that regulates the foundation of Unit System of Health, reasserts the obligation of State to population\'s health. In this context, Pharmaceutical Service (PS) has an important role to ensure the request of medicines from population with security, efficacy, on time and in quantity required, but despite of frequently updates in favor to promote better procedures of PS, situations still taking place in which the patient does not have the drug required because of its lack in dispensing units or its absence in standardized list of drugs. This situation makes the citizens call on judicialization way, trying to ensure the access to drug claimed, this phenomenon is known like judicialization of health, and brings great implications about management of PS. As a result of that, the objective from this study was describing the general scenery of lawsuits claiming drugs and insulin inputs that have been assumed by administration of Ribeirão Preto. Thus to attain this objective, a descriptive study was conducted, resulting in 1861 lawsuits analyzed, in which 1083 still active and 778 had been closed. The judge set a term of 30 days for 99% of lawsuits to comply with the decision, which is insufficient to make a public bidding, thus the management feels obliged to buy drugs in a parallel way. Public Ministry was the main legal representative (71,7%) utilized and the most of prescriptions were from private clinical and hospitals (50,1%). The main diagnoses referred to lawsuits were diabetes and adult attention-deficit/hyperactivity disorder (ADHD), whereas the most prevalent drugs prescribed were insulin and methylphenidate. Among physicians, 3% of them prescribe 30% of prescriptions. As a result of that, the present study revealed the impact of health judicialization in Ribeirão Preto, demanding structural and financial organization from public management to labor with lawsuits.

Introduction: Older persons represent a quickly growing segment of the population worldwide and more vulnerable population to various adverse drug reactions and adverse outcomes. Many explicit criteria of potentially inappropriate medications (PIMs) have been developed in different countries in order to improve the quality and safety of geriatric prescribing and to reduce the risk of drugs in older adults. The aim of this diploma thesis was to summarize (using narrative literature review) the negative outcomes of potentially inappropriate medications documented in pharmacoepidemological studies published by 2016 year. The outputs of diploma thesis create a part of the effort of the research subgroup "Aging and Changes in the Therapeutic Value of Medications in the Aged" and EU COST Action initiative IS1402 (2015-2018). Methods: The literature review using PubMed and Web of Science datasets during the period 10/2015 - 1/2017 was conducted. 421 studies were identified during the primary literature search and after thorough consideration of abstracts 67 (16%) of studies were selected for works on summary tables (354 of studies were excluded because in these studies only prevalence of PIMs, no negative outcomes were documented, or PIMs were defined based on implicit criteria or full text of articles...

The purpose of this study is to identify and analyze the relationships that exist between mathematics anxiety and nurse self-efficacy for mathematics, and the medication calculation performance of acute care nurses. This research used a quantitative correlational research design and involved a sample of 84 acute care nurses, LVNs and RNs, from a suburban private hospital. the participants filled out a Mathematics Anxiety Scale, a Nurse Self-Efficacy for Mathematics Scale and also completed a 20-item medication calculation test. Significant practical and statistical relationships were discovered between the variables utilizing multiple linear regression statistics and commonality analysis. As the Nurse’s Mathematics anxiety score increased the scores on the medication test decreased and the scores on nurse self-efficacy for mathematics scale also decreased. the demographic item of “Hours a nurse worked in one week” had the greatest significance. the more hours a nurse worked the lower their score was on the medication calculation test. This study agrees with others that nurses are not good at mathematics. This study also correlated that as the number of hours worked increased so did the medication calculations errors. and many nurses have a measurable level of anxiety about mathematics and dosage calculations and this may influence calculation ability. Suggestions for further research include refinement of instruments used in study, further differentiation of barriers to successful medication calculation performance, and testing of interventions used to teach, train and evaluate accurate medication administration in nurses.

Orientador: Paulo José Fortes Villas Boas / Resumo: Introdução: A prescrição de Medicamentos Potencialmente Inapropriados (MPIs) possuem aspectos relevantes em idosos juntamente com a prevalência de automedicação, interações medicamentosas, reações adversas e polifarmácia, sendo, portanto, necessário utilizar medidas que proporcionem o uso racional destes medicamentos nessa população, além de elaborar medidas que possibilitem a diminuição de custos relacionados à essa prática para as Instituições de Saúde. Objetivo: Analisar os custos diretos das prescrições medicamentosas de idosos internados em enfermaria de Clínica Médica e comparar os custos das prescrições com e sem medicamentos potencialmente inapropriados (MPI) para idosos. Metodologia: Estudo observacional retrospectivo descritivo, realizado em enfermaria de Clínica Médica de hospital universitário público de nível terciário. Foram analisadas as prescrições de 124 idosos com 60 anos ou mais, internados por condições clínicas. Os dados das prescrições foram coletados por meio do sistema de prontuário eletrônico da instituição. Os custos das prescrições foram obtidos junto à Seção Técnica de Farmácia de acordo com a tabela de preço unitário do ano vigente de 2018, sendo realizada a somatória total dos custos de toda internação. Os medicamentos foram considerados MPI segundo critérios de Beers de 2019 da American Geriatrics Society. Resultados: Foram avaliadas prescrições de 124 pacientes com mediana de idade de 74,6 (percentil 25 – 75: 69 – 81) anos, sendo 60,5% do sexo ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Prescription of Potentially Inappropriate Medications (PIMs) have relevant aspects in the elderly along with the prevalence of self-medication, drug interactions, adverse reactions and polypharmacy, therefore, it is necessary to use measures that provide rational use of these drugs in this population, besides to elaborate measures that allow the reduction of costs related to this practice for the Health Institutions. Objective: To analyze the direct costs of the prescriptions of elderly patients hospitalized in a Clinical Medical ward and to compare the costs of prescriptions with and without potentially inappropriate medications (PIM) for the elderly. Methodology: Descriptive retrospective observational study, carried out in a Clinical Medical ward of a tertiary-level public university hospital. The prescriptions of 124 elderly patients 60 years of age or older hospitalized for clinical conditions were analyzed. Prescribing data were collected through the institution's electronic medical record system. Prescription costs were obtained from the Technical Section of Pharmacy according to the unit price table of the current year of 2018, and the total sum of the costs of all hospitalization was made. The drugs were considered PIM according to the 2015 Beers criteria of the American Geriatrics Society. Results: Prescriptions of 124 patients with a median age of 74.6 (25 - 75: 69 - 81 percentile) years were evaluated, with 60.5% being male. The median number of medi... (Complete abstract click electronic access below) / Mestre

No description available.

Abstract available in the Journal of the American Psychiatric Nurses Association.

As people age they are more likely to develop chronic conditions and will tend to be on multiple medications for long periods of time to manage those conditions. Some of these medications have side effects that are anticholinergic in nature. These side effects can impact different parts of the body including the central nervous system. As people enter their later years the permeability of the blood brain barrier increases, increasing their risk of these kinds of side effects. Sleep related disorders occur at a higher frequency in the older adults than in younger adults. This is a concern for older adults because poor sleep quality has been linked to chronic health conditions as well as declining function and quality of life. Although some medications are known to cause insomnia there has not been any work done to look at how an accumulative influence of anticholinergic burden may be influencing sleep despite their known influence on the central nervous system. The purpose of this research is to see if the anticholinergic burden of the medications is related to self-reported sleep quality. Fourteen outreach events targeting Medicare beneficiaries were conducted during the 2014 Medicare open enrollment window in northern/central California. Medication therapy management (MTM) services were provded by trained student pharmacists under the supervision of licensed pharmacists where demographic and medication information were collected. Beneficiaries who reported having trouble sleeping had higher anticholinergic burden than those who did not. Beneficiaries who only reported difficulty falling asleep had higher anticholinergic burden than those who did not. Correlations between anticholinergic burden and the number of nights with trouble sleeping was positive but this association only reached statistical significance with definite anticholinergic burden. Linear regression did not suggest that anticholinergic burden was a predictor of the number of nights with difficulty sleeping.