Patients' use of medicines is widely recognised as sub-optimal with a high proportion of patients with a long-term condition not taking their medicines as prescribed. Research and policy guidance emphasise the importance of partnership within the patient-prescriber encounter in enhancing patients' use of medicines. There is however considerable evidence that this is not usually achieved by medical prescribers, limiting the extent to which shared decision-making occurs about prescribed medicines. There is a general assumption that nurse prescribers, who within the United Kingdom have comparable prescribing rights to medical doctors, demonstrate greater abilities in collaborative working with patients leading to an enhanced use of medicines. Research evidence is however limited, particularly in relation to the ways in which patients' use of medicines is discussed and negotiated within the patient-nurse prescriber encounter. This study focused on the management of patients' use of medicines within the patient-nurse prescriber encounter. Seven nurse prescribers, working within a number of clinical specialities in both primary and secondary care settings, were recruited to the study together with their patients who were living with one or more long-term conditions (n=21). Data collection involved the non-participant observation of out-patient consultations to examine the management of patients' use of medicines within the encounter and semi-structured interviews with both patients and prescribers. Discourse analysis was undertaken to examine underpinning assumptions, views and beliefs regarding the management of patients' use of medicines. Asymmetry was evident within the encounters with prescribers controlling the agenda for discussion and interrupting patients' attempts to demonstrate their knowledge. Patient accounts of the moral approach adopted in managing their condition in the context of their everyday lives were also ignored. Biomedical and contrasting moral discourses are examined. An interpretive framework derived from the work of Michel Foucault is used to explain the operation of disciplinary, pastoral and bio-political power within the encounter and the extent to which subjugation of patients' knowledge and resistance were evident. Foucault's concept of technologies of the self is examined to explore its potential application in enhancing patients' medicines use.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-19T16:40:44Z No. of bitstreams: 1 evandrodeoliveiralupatini.pdf: 1858906 bytes, checksum: 5cce2914c24271bd66cff2c1d9dbc87f (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T18:00:31Z (GMT) No. of bitstreams: 1 evandrodeoliveiralupatini.pdf: 1858906 bytes, checksum: 5cce2914c24271bd66cff2c1d9dbc87f (MD5) / Made available in DSpace on 2016-01-25T18:00:31Z (GMT). No. of bitstreams: 1 evandrodeoliveiralupatini.pdf: 1858906 bytes, checksum: 5cce2914c24271bd66cff2c1d9dbc87f (MD5) Previous issue date: 2014-12-08 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A farmacoterapia sempre assumiu um importante papel na prevenção, manutenção e recuperação da saúde. Entretanto, a prescrição e a utilização inapropriada de medicamentos vêm causando graves problemas à saúde coletiva, de forma que há necessidade do uso racional de medicamentos. Há um consenso na literatura de que pacientes informados são mais propensos ao cumprimento de regimes terapêuticos. No contexto hospitalar, o momento da alta é considerado crítico, uma vez que envolve a transição do paciente em níveis assistenciais. O trabalho buscou verificar o conhecimento dos pacientes a respeito dos medicamentos prescritos na alta hospitalar em um hospital de ensino. Trata-se de um estudo exploratório, de corte transversal prospectivo, realizado no Hospital Universitário da Universidade Federal de Juiz de Fora no período de setembro a dezembro de 2013. Foram entrevistados 107 pacientes ou cuidadores de pacientes no momento da alta hospitalar sendo aplicados questionários com o intuito de verificar o conhecimento sobre a prescrição de alta, bem como investigar fatores associados a este conhecimento. Foi atribuída pontuação (0 a 13 pontos) e sua correspondência em três níveis de conhecimento: insuficiente, regular e bom. A pontuação média foi 9,66 pontos, correspondendo a um nível de conhecimento regular. Dez por cento dos entrevistados apresentaram nível insuficiente, 58,9% regular e 30,8% bom. Os dois maiores índices de acerto foram quanto à frequência de administração (94,4% de concordância) e via de administração (97,2%). Os dois piores índices de acerto foram para interações medicamentosas (15,9%) e efeitos adversos (29,0%). Houve diferença estatisticamente significativa entre a média da pontuação de grupos em função da raça/cor (autodeclarada) e polifarmácia. Mesmo estando satisfeitos com as orientações transmitidas, “precauções”, “efeitos adversos” e “interações medicamentosas” foram os temas mais demandados pelos entrevistados quanto a maiores orientações. Infere-se que as atividades de educação em saúde deveriam estar mais presentes, contribuindo para um maior conhecimento do paciente. Sugere-se o trabalho ordenado e conjunto dos diversos profissionais de saúde, tomando por base o diálogo com o paciente, preparando-o desde o primeiro dia de internação para o momento da alta. Neste âmbito, o profissional farmacêutico deve ser convocado a participar do planejamento da alta hospitalar, integrando a equipe multiprofissional de saúde e fornecendo ao paciente todas as informações necessárias para o uso seguro e racional dos medicamentos. / Pharmacotherapy has always played an important role in prevention, maintenance and restoration of health. However, the inappropriate prescribing and use of medicines are causing serious public health problems, and rational use of medicines is needed. There is a consensus in the literature that informed patients are more likely to comply with treatment regimens. In the hospital context, the discharge is considered critical, since it involves the transition levels of the patient care. This study aimed to evaluate the knowledge of patients regarding medications prescribed at discharge in a teaching hospital. This is an exploratory study, a prospective cross-sectional, conducted at University Hospital of UFJF from September to December 2013. 107 patients or caregivers were interviewed at discharge and questionnaires were used to verify the knowledge about prescribing medicines and to investigate factors associated with this knowledge. Score (0-13 points) and their correspondence in three levels of knowledge was given: poor, regular and good. The average score was 9.66 points, which corresponds to a regular level of knowledge. Ten percent of respondents had insufficient levels, 58.9% regular and 30.8% good. The two highest accuracy rate was about the frequency of administration (94,4% agreement) and route of administration (97.2%). The two worst rates were for drug interactions (15.9%) and adverse events (29.0%). There was a statistically significant difference between mean scores based on race / color (self-declared) and polypharmacy. Despite being pleased with the guidelines provided, "precautions", "adverse effects" and "drug interactions" were the topics most in demand by respondents as the major orientations. It is inferred that the activities of education and health should be more present, contributing to a greater understanding of the patient. It is suggested that the ordered work and all the different health professionals, based on a dialogue with the patient, preparing it since the first day of admission to discharge. In this context, the pharmacist should be asked to participate in hospital discharge planning, integrating multidisciplinary health care team to the patient and providing all information necessary for the safe and rational use of medicines.

L’accès financier limité aux soins de santé a suscité l’instauration de politiques sanitaires de subvention des soins en Afrique. Au Burkina Faso, une ONG, en complémentarité avec la politique sanitaire nationale subventionne à 100% depuis septembre 2008 les soins et les médicaments pour les enfants de moins de cinq ans dans le district sanitaire de Dori. L’intervention regroupe formation du personnel soignant, supervisions et suppression de paiement des soins et des médicaments. L’objectif de l’étude est d’analyser l’effet de cette intervention sur l’adéquation des prescriptions médicales. Neuf centres de santé ont été pris en compte. Au total 14956 ordonnances d’enfants de moins de cinq ans ciblés par l’intervention ont été sélectionnées par échantillonnage systématique à partir des registres de consultation un an avant et un an après l’instauration de l’intervention. Quatorze prescripteurs ont été interviewés. Les prescriptions ont été analysées par comparaison au référentiel de l’OMS ainsi qu’au référentiel national. Le discours des prescripteurs a été analysé en vue de comprendre leur perception de leur changement de pratiques depuis de début de la subvention. L’intervention a eu pour effet de diminuer l’utilisation des injections (Rapport de cote (RC) =0,28; p<0,005) dans le cas des infections respiratoires aiguës (IRA). Elle a entraîné une diminution de l’utilisation inappropriée des antibiotiques dans les cas de paludisme seul (RC=0,48; p<0,0005). Le nombre moyen de médicaments par ordonnance a également diminué de 14% dans les cas d’IRA (p<0,0005). Les prescripteurs ont affirmé pour la plupart que leurs pratiques se sont soit maintenues soit améliorées. L’intervention a entrainé une amélioration de l’adéquation des prescriptions médicales dans certains cas. / The limited financial access to health care has encouraged the creation of health policies for subsidizing care in Africa. In Burkina Faso, an NGO, in line with the national health policy has been subsidizing care and medicines for children under five years in the health district of Dori since September 2008. The program includes training of health workers, supervision and removal of fees for health care and medication. The aim of the study was to analyze the effect of this free care program on the adequacy of drugs prescriptions. Nine health centers were taken into account. A total of 14,956 prescriptions of the target group of children under five years were collected from consultation records a year before and after the introduction of free care program. In addition, fourteen prescribers were interviewed. The prescriptions were analyzed in comparison to the WHO and the national reference. The prescribers’ responses were analyzed to understand their perception of their change in practice since the introduction of the free care program. The study showed that the free care program had an effect by decreasing the use of injections (Odds Ratio (OR) =0.28, p < 0.005) in acute respiratory infections (ARI) cases. It also led to decrease in inappropriate use of antibiotics in the case of malaria (OR=0.48, p<0.0005). The average number of drugs per prescription was also found to have decreased by 14% (p<0.0005) in ARI cases. Several prescribers asserted that their practices are maintained or improved. The program leads to an improvement in the adequacy of drugs prescriptions.

Made available in DSpace on 2016-05-02T13:54:42Z (GMT). No. of bitstreams: 1 Dissertacao completa Fabio de Souza Terra.pdf: 1253899 bytes, checksum: 97e2a9b443864eee5e5db5722e7f2770 (MD5) Previous issue date: 2007-03-23 / Coordenacao de Aperfeicoamento de Pessoal de Nïvel Superior / This study evaluated the QL of end-stage renal patients submitted to hemodialysis and their adhesion to daily pharmacologic treatment knowing their life expectancy and the main complications presented during HD It is an epidemiologic descriptive tranversal and quantitative research carried out at a hemodialysis clinic of a university hospital of Alfenas State of Minas Gerais Brazil with the participation of all the 30 dialysis patients in the period of the collection of data A questionnaire was used for the obtainment of data about the participants' characterization adhesion to pharmacologic treatment and life expectation QL was analyzed through the instrument WHOQOL-bref of the World Health Organization The data were tabulated in the statistical program SPSS version 10.0 and analyzed by means of the medium score with application of the following tests Qui-square Coefficient of Correlation of Pearson Test of Wilcoxon Student s t test Cronbach s Alpha Coefficient The results showed that most of the interviewees referred that HD interfered in their professional activities and in leisure and recreation but 53.33% were calm during the permanence in the clinic The most frequent complications were the arterial hypotension vomit and dizziness All the patients take medicines mainly antihypertensives With regard to knowledge of the indication of the medicines 40% of the dialysis patients know all the drugs that they take Thirty patients informed to take the medicines daily but 16.66% have already interrupted the treatment on their own account due to adverse reactions The average scores of QL were General QL 3.26 physical domain 3.10 psychological domain 3.58 social relationships 4.19 and environment 3.54 Therefore the participants of the study classified their QL as being above "neither bad, nor good" while the domain social relationships was evaluated between "good" and "very good" The variables did not interfere in the patients' QL in other words they did not present any correlation with the domains of WHOQOL-bref Through the reproducibility it was verified that the interviewees' QL was stable between the "test" and the "retest" having satisfactory reliability while the internal consistency of WHOQOL-bref was acceptable for the facets and domains indicating a homogeneity in the appraised items The main expectation of the patients' life is receiving a renal transplantation 82.35% are in the waiting list and 47.06% encountered the refusal of their relatives in donating the organ It can be verified that the instrument WHOQOL-bref showed to be effective to evaluate QL of end-stage renal patients submitted to HD thus being a reliable instrument for such a measure Finally dialysis patients will have a better QL when they are informed about their disease and treatment when cared for in a solid supportive system and rehabilitation in order to make them capable to lead an active productive and self-sufficient life / Este estudo avaliou a QV dos nefropatas crônicos submetidos à hemodiálise e sua adesão ao tratamento farmacológico de uso diário conhecer a expectativa de vida dessa população com relação ao futuro e as principais complicações apresentadas durante a HD Trata-se de uma pesquisa epidemiológica descritiva transversal e quantitativa realizada em uma clínica de hemodiálise de um hospital universitário de Alfenas-MG com todos os 30 pacientes submetidos à HD no período da coleta de dados Utilizou-se para a coleta um questionário com dados sobre a caracterização dos participantes adesão ao tratamento farmacológico e expectativa de vida e a QV foi analisada por meio do instrumento WHOQOL-bref da Organização Mundial da Saúde Os dados foram tabulados no programa estatístico SPSS versão 10.0 e analisados por meio do escore médio com aplicação dos seguintes testes Qui-quadrado Coeficiente de Correlação de Pearson Teste de Wilcoxon Teste t de Student Coeficiente Alfa de Cronbach Os resultados mostraram que a maioria dos entrevistados referiram que a HD interferiu em suas atividades profissionais e de lazer e recreação mas 53,33% se sentem tranqüilos durante a permanência na clínica As complicações de maior ocorrência foram a hipotensão arterial vômito e tontura Todos os pacientes fazem uso de medicamentos sendo os antihipertensivos os mais utilizados Quanto ao conhecimento da indicação dos medicamentos 40% dos renais crônicos conhecem todos os fármacos que usam Os 30 pacientes estudados informaram tomar os medicamentos diariamente mas 16,66% já interromperam o uso por conta própria devido a reações adversas Os escores médios referentes à QV foram QV geral 3,26 domínio físico 3,10 psicológico 3,58 relações sociais 4,19 e meio ambiente 3,54 Assim os participantes do estudo classificaram a QV como sendo acima do nem ruim nem boa enquanto o domínio relações sociais foi avaliado entre boa e muito boa As variáveis estudadas não interferiram na QV dos pacientes ou seja elas não apresentaram correlação com os domínios do WHOQOL-bref Por meio da reprodutibilidade verificou-se que a QV dos entrevistados foi estável entre o teste e o reteste tendo uma confiabilidade satisfatória enquanto a consistência interna do WHOQOL-bref foi aceitável para as facetas e domínios indicando uma homogeneidade nos itens avaliados A principal expectativa de vida dos pacientes é a realização do transplante renal sendo que 82,35% estão na lista de espera e 47,06% se depararam com a recusa dos familiares em doar o órgão Pode-se verificar que o instrumento WHOQOL-bref mostrou-se eficaz para avaliar a QV de renais crônicos submetidos à HD sendo confiável para essa medida Por fim o paciente submetido à HD terá uma melhor QV quando ele for informado acerca de sua doença e tratamento quando existir um sólido sistema de suporte e reabilitação e ser capaz de levar uma vida ativa produtiva e autosuficiente

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