No description available.

Direct-to-Consumer Advertising (DTCA) of prescription drugs has been a consistent controversial topic extensively debated in scholarly work by many authors. This thesis compares the arguments made by the proponents and opponents of this debate and comes to a conclusion that there is less justification in claims that DTCA benefits society. The thesis goes further in assessing the benefits from normative ethical principles, including using Rawls difference principle as a guide, to evaluate which side of the debate conforms more logically along the teachings of ethical philosophy. At the end it is apparent that the least advantaged members of society do not benefit from this aggressive marketing strategy. It concludes that the pharmaceutical industry makes exaggerated claims of providing the public increased autonomy when, in reality, it is trying to further its own cause of making huge profits for its shareholders. This thesis also reaches the conclusion that the industry uses patients as a means to achieve its own end, that end being unreasonable levels of profit.

No description available.

Lifetime prevalence estimates of psychotropic medicine use as well as prevalence of DSM-IV prescription drug use disorders from the baseline investigation of the Early Developmental Stages of Psychopathology (EDSP) Study are presented. Use of prescription medication at some time in their life was reported by 27.4% of the respondents. Illicit use of prescription drugs, which means an intake without medical legitimation, was reported by 4.5% of the sample. The findings suggest that abuse of and dependence on prescription drugs, with most cases reporting polysubstance use, is quite rare in the 14- to 24-year-olds. DSM-IV abuse was more prevalent than dependence (0.5 vs. 0.3%). In general, women reported higher prevalence rates of prescription drug use, whereas men reported higher prevalence rates of prescription drug disorders. This result suggests that men have a higher risk to develop a substance-use-related disorder.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Os Erros de MedicaÃÃo (EM) sÃo um importante desafio a ser superado na promoÃÃo do uso racional de medicamentos, fator contribuinte para o desenvolvimento de serviÃos de saÃde eficazes e seguros para os pacientes. EM podem ocorrer em vÃrias etapas da cadeia de utilizaÃÃo de medicamentos. No Brasil, pouco se conhece sobre o perfil dos erros e sobre a seguranÃa do processo de prescriÃÃo. Baseado na abordagem sistÃmica do erro foi realizado um estudo exploratÃrio, com determinaÃÃo da taxa de prevalÃncia de erros de prescriÃÃo clinicamente significativos (TPEPCS) e da taxa de seguranÃa do processo de prescriÃÃo de medicamentos (TSPPM) nas unidades de Cardiologia, Pneumologia e Pediatria de um hospital de referÃncia do CearÃ. No perÃodo de 20 de agosto a 03 de setembro de 2007, em dias alternados, foram analisadas 140 prescriÃÃes mÃdicas (PM), totalizando 1017 itens contendo medicamentos. A maioria das PM (75% - n=105) foram recebidas pelo serviÃo de farmÃcia no turno da tarde, 61,4% (n=86) pertencia a pacientes do sexo masculino e 22,2% (n=31) pertencia a pacientes com idade de 60 a 69 anos. No prontuÃrio dos pacientes das PM selecionadas, nÃo houve relato de alergia a medicamentos em 83,6% (n=117), nem registro do peso em 60% (n=84). Quanto aos componentes legais da prescriÃÃo, houve ausÃncia do registro do nÃmero do prontuÃrio em 63,3% (n=89), da unidade de internaÃÃo em 59,3% (n=83), do carimbo do prescritor em 28,6% (n=40) e da assinatura do mÃdico em 15% (n=21). Foram identificadas interaÃÃo medicamento-medicamento em 28,6% (n=40) das PM, interaÃÃo medicamento-alimento em 14,3% (n=20) e erros de prescriÃÃo clinicamente significativos (EPCS) em 25,9%, (n=30) sendo o mais recorrente a detecÃÃo de interaÃÃo medicamentosa potencialmente significante (26,61% - n=95). Boa parte dos medicamentos envolvidos nos EPCS (63,3% - n=201) pertenceu a classe terapÃutica de medicamentos cardiovasculares e houve a suspeita de ReaÃÃo Adversa a Medicamentos em apenas 1,8% (n=18) dos medicamentos prescritos. A denominaÃÃo mais utilizada na prescriÃÃo dos medicamentos foi a genÃrica (60,2% - n=612) e a concentraÃÃo nÃo foi prescrita em 56,4% (n=574) dos itens contendo medicamentos. Foi prescrito o diluente em 35,1% (n=65) dos medicamentos classificados como injetÃveis, enquanto nÃo foi prescrita a velocidade de infusÃo em 59,3% (n=121) dos injetÃveis e soluÃÃo para hidrataÃÃo. TambÃm foram prescritas informaÃÃes adicionais em 14,7% (n=150) dos itens contendo medicamentos e utilizadas abreviaturas em 97,6% (n=993) destes, sendo mais comum a abreviatura da via de administraÃÃo (36% - n=833). Ao final, foram calculadas a TPEPCS (35,10%) e TSPPM (64,9%), indicando a necessidade da reavaliaÃÃo do processo de prescriÃÃo e implementaÃÃo das estratÃgias educacionais. Portanto, a identificaÃÃo da taxas referidas constitui o primeiro passo na busca da prevenÃÃo de erros. PorÃm, para que ela possa estabelecer-se no Ãmbito hospitalar, sem propiciar um ambiente de puniÃÃes, faz-se necessÃrio que a responsabilidade pela seguranÃa do paciente seja vista como coletiva e que a abordagem sistÃmica do erro seja aplicada cotidianamente. / Medication errors are a great challenge to the rational use of drugs, which is a significant contributing factor to the development of effective and safe health assistance services to patients. Medication errors can occur at various stages in the drug use process. In Brazil, little is known about the profile of errors and the prescription process safety. In order to determine the prevalence rate of errors in prescribing clinically significant drugs (PREPCS) and the safety rate on prescription drug procedures (SRPDP), an exploratory study based on an approach in systematic error estimation was carried out at Cardiology, Pneumology and Pediatrics Units of a reference hospital in the State of CearÃ. From August 20 to September 3, 2007, on alternate days, 140 medical prescription â totaling 1,017 items containing drugs â were analyzed. Most medical prescriptions (75% - n=105) were received by the department of pharmacy in the afternoon shift; 61.4% (n=86) had been given to male patients and 22.2% (n=31) had been given to patients between 60 to 69 years of age. In 83.6% (n=117) of records of patients to whom the selected medical prescriptions had been given, no allergy to drugs were reported, and in 60% (n=84) of them the patientsâ weight was not informed. In regard to the legal components of the prescriptions, the patient record number was not informed in 63.3% (n=89) prescriptions; the hospital unit was not informed in 59.3% (n=83) prescriptions; the prescriberâs stamp was not stamped in 28.6% (n=40) prescriptions; and 15% (n=21) prescriptions had not been signed by the doctor. Drug-drug interactions were identified in 28.6% (n=40) medical prescriptions; drug-food interactions were identified in 14.3% (n=20) medical prescriptions; and clinically significant prescription errors (CSEP) were found in 25.9% (n=30) medical prescriptions, and the detection of potentially significant drug interactions (26.61% - n=95) was the most recurrent. Most drugs involved in CSEP (63.3% - n=201) belonged to a therapeutic class of cardiovascular medicines and there was suspicion of Adverse Drug Reaction in only 1.8% (n=18) of the prescription drugs. Generic names were most commonly used in the medical prescriptions (60.2% - n=612); and the concentration was not prescribed in 56.4% (n=574) of items containing drugs. The dilluent was prescribed in 35.1% (n=65) of injection drugs, while no infusion speed and hydration solution were prescribed in 59.3% (n=121) of injection drugs. Additional information was prescribed in 14.7% (n=150) of the items containing drugs; and abbreviations were used in 97.6% (n=993) of them, and administration routes were the most common abbreviations used (36% - n =833). And finally, the PREPCS (35.10%) and SRPDP (64.9%) were ascertained, thus indicating the need to reevaluate the process of prescribing and implementing educational strategies. Therefore, the identification of the aforesaid rates is the first step to be taken in order to prevent errors. However, in order to use them at hospitals without creating a punishment environment, the responsibility for the patientâs safety must be collective and an approach in systematic error estimation must be made regularly.

No description available.

No description available.

Lifetime prevalence estimates of psychotropic medicine use as well as prevalence of DSM-IV prescription drug use disorders from the baseline investigation of the Early Developmental Stages of Psychopathology (EDSP) Study are presented. Use of prescription medication at some time in their life was reported by 27.4% of the respondents. Illicit use of prescription drugs, which means an intake without medical legitimation, was reported by 4.5% of the sample. The findings suggest that abuse of and dependence on prescription drugs, with most cases reporting polysubstance use, is quite rare in the 14- to 24-year-olds. DSM-IV abuse was more prevalent than dependence (0.5 vs. 0.3%). In general, women reported higher prevalence rates of prescription drug use, whereas men reported higher prevalence rates of prescription drug disorders. This result suggests that men have a higher risk to develop a substance-use-related disorder.

Young adults are most at-risk for the non-medical use of prescription drugs (NMUPD) and many of its associated negative consequences. Understanding this population’s motivations for use can help to inform efforts to reduce NMUPD. Past research has been limited in scope, consisting primarily of cross-sectional work with college students focusing on prescription stimulants. The current study researched how motivations for NMUPD changed over young adulthood using three waves of data from a longitudinal, nationally representative sample of 14,990 19 to 24 year olds in the Monitoring the Future study cohorts collected between 1976 to 2013. Prescription stimulants, central nervous system (CNS) depressants, and opioids were investigated, along with sex and college attendance as potential moderators. Differences in NMUPD motivations for young adults who initiated NMUPD in high school versus in early young adulthood were studied. Additionally, motivation patterns of new users were investigated. Analyses indicated that both recreational and self-treatment motivations commonly were reported over time and across drug classes, with four to five popular motivations acknowledged in each class. In general, generalized estimated equations repeated measure analyses found that NMUPD motivations remained relatively stable across young adulthood, with some reductions for the motivations of experimentation and boredom, and an increase in select self-treatment motivations. Overall, men were more likely to endorse recreational motivations, while women were more likely to endorse self-treatment motivations, though this varied somewhat by prescription drug class. Young adults not enrolled in college courses were more likely to endorse using stimulants non-medically for different reasons than their peers who were enrolled. There also were differences in motivations based on if young adults initiated NMUPD in high school compared to when they were 19/20 years old. However, motivations were fairly consistent across young adult development regardless of when NMUPD was initiated. These data suggest that efforts aimed at preventing or reducing NMUPD in young adult populations should include targets to reduce both self-treatment and recreational motivations; may need to be tailored by prescription drug class, sex, and college attendance status; could start in high school; and can be used for new and continued users across young adulthood.

Le législateur français a intégré le critère d’efficience dans la détermination du prix du médicament remboursable en 2012. L’efficience des médicaments doit être documentée pour les produits susceptibles d’apporter un bénéfice thérapeutique important et d’avoir un impact significatif sur les dépenses d’assurance maladie. Elle vise à mesurer le coût du gain marginal en santé produit par une intervention, par rapport au coût et à l’efficacité d’une autre intervention substituable. La thèse se situe dans une perspective d’analyse empirique des relations de délégation à l’œuvre dans la régulation du médicament, en vue de son accès au remboursement et de la fixation de son prix en France. Elle se fonde sur une analyse de trois applications de l’évaluation de l’efficience reflétant un approfondissement progressif de l’évaluation économique de l’intervention de santé dans trois contextes institutionnels distincts. Leur comparaison permet d’identifier les enjeux soulevés par la mise en œuvre de la régulation, les facteurs de son efficacité et les risques associés au regard du cadre théorique de la théorie des incitations en se posant successivement les questions suivantes : 1) L’information produite par le calcul économique expose-t-elle le décideur à un risque de manipulation de l’outil ? 2) L’apport du calcul économique est-il amélioré dans un processus d’évaluation contraint? 3) Des approches complémentaires peuvent-elles enrichir l’évaluation économique et en améliorer l’usage en révélant d’autres déterminants de la décision en santé? Les travaux de la thèse mettent en évidence l’apport du critère d’efficience pour améliorer l’information du décideur. Le risque, réel, de capture de régulation peut être limité par un processus d’évaluation plus transparent et par une explicitation des enjeux de la décision et des objectifs de la régulation. / In 2012, cost-effectiveness has been formally introduced in the French legislation as a criterion to determine the price of prescription drugs. Cost-effectiveness is requested to claim for reimbursement of drugs expected to provide a therapeutic benefit and to have a significant impact on Social Insurance budget. Cost-effectiveness estimates the incremental cost and effectiveness produced by an intervention in comparison to other interventions that could have been used. The thesis is an empirical analysis of delegation relationships in the regulation of reimbursed drugs in France. The thesis analyses three different applications of cost-effectiveness evaluation to highlight the issues surrounding the use of economic calculation and the risks that are associated with it through three questions: 1) does the cost-effectiveness evaluation expose the regulator to regulation capture? 2) Is the contribution of the cost-effectiveness evaluation enhanced in a regulatory framed process? 3) Could complementary evaluations enrich cost-effectiveness evaluation and favour its usage via the clarification of the issues surrounding the decision? The thesis documents the benefit provided by the introduction of the cost-effectiveness criteria. The actual risk of regulation capture could be limited through a more transparent process of evaluation and through a clarification of the objectives of the regulation.