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).

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Rates of prescription drug misuse in Texas are alarmingly high. One in five Texas high school students have taken prescription drugs without a doctor’s prescription. In 2015, Texas had the second highest total healthcare costs from opioid abuse in the nation ($1.96 billion), and Texas is home to four of the top 25 cities in the U.S. for opioid abuse. Meanwhile, only one in three prescribers is using the statewide Prescription Drug Monitoring Program (PDMP), leading to a massive loss of data. There is substantial need for increased infrastructure and prevention measures in Texas, especially related to the emergence of prescription drug misuse. This panel will describe the current landscape of prescription drug misuse and its consequences, discuss strategies to turn down misuse, and explain the proactive approach Texas is taking to enhance misuse prevention and data infrastructure across the state.

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Les sujets résidant dans les établissements d'hébergement pour personnes âgées dépendantes (EHPAD) sont fréquemment exposés à une polypathologie et sont polymédiqués, ce qui augmente le risque de prescriptions potentiellement inappropriées (PPI) et ainsi le risque d'événements iatrogènes tels que le décès et l'hospitalisation. La plupart des études réalisées en France sur la PPI se sont focalisées sur des classes médicamenteuses précises, et peu ont évalué l'impact des caractéristiques structurelles et organisationnelles des EHPAD sur la PPI des résidents, indépendamment des caractéristiques individuelles. Cette thèse a eu pour objectif de développer un nouvel indicateur de PPI, reflétant au mieux la prise en charge médicamenteuse globale des résidents d'EHPAD. Les travaux de thèse ont été réalisés sur un échantillon issu de l'étude IQUARE (Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des REsidents), étude quasi expérimentale (NCT01703689) évaluant l'impact d'une intervention basée sur l'éducation gériatrique du personnel de l'EHPAD sur des indicateurs de qualité des soins. Dans un premier temps, nous avons construit un outil original de détection de PPI, combinant des critères explicites et implicites, identifiant 71% des résidents avec une PPI à l'inclusion. Des caractéristiques organisationnelle (accès à un avis psychiatrique) et structurelle (présence d'une unité de soins spécialisée) de l'EHPAD expliquaient une part de cette PPI. Dans un second temps, afin de valider la pertinence de cet outil, nous avons évalué l'impact clinique de la PPI sur la survenue d'événements indésirables au cours du suivi. Nous n'avons pas retrouvé de risque augmenté de décès ou d'hospitalisation. Enfin, l'intervention gériatrique générale de l'étude IQUARE a significativement réduit la PPI des résidents à 18 mois. Ces travaux ont fourni des éléments importants à prendre en considération, lors de la construction de nouvelles études visant à modifier les pratiques de prescription et à réduire le nombre de médicaments prescrits chez les résidents d'EHPAD, mais aussi pour déterminer l'impact clinique de ces changements. / Older people living in nursing homes (NHs) suffer from numerous comorbidities and functional decline. Polymedication is frequent in this population. This increases the risk of potentially inappropriate drug prescribing (PIDP), which can lead to adverse drug events such as falls and hospitalization. Most French studies did not examine PPI with a global perspective, but focused on specific drug classes. Moreover, few studies have investigated, irrespective of the individual characteristics of residents, the structural and organizational characteristics of nursing homes on the quality of drug prescribing. Thesis work aimed to develop a new indicator of PIDP, which best reflects the global medication use of residents. Thesis works have been performed using the data of the IQUARE study (Impact d'une démarche Qualité sur l'évolution des pratiques et le déclin fonctionnel des REsidents), a quasi-experimental study (trial registration number: NCT01703689) investigating the impact of an intervention based on geriatric education with NH staff on quality indicators of care. First, we developed an indicator of PIDP, combining explicit and implicit criteria, identifying 71% of PIDP in NH residents at baseline. NH organizational (access to psychiatric advice and/or to hospitalization in a psychiatric unit) and structural (presence of a special care unit for dements) variables explained part of PIDP. In a second part, in order to validate the usefulness of this PIDP detection tool, we verified the long-term clinical impact of PIDP on adverse outcomes (death, number of hospitalizations...). We did not find any significant association between PIDP and death, nor between PIDP and number of hospitalizations. Finally, the general intervention implemented in the IQUARE study significantly reduced PIDP among NH residents at 18-month follow-up. Our research has provided important aspects that should be consider when constructing further new studies seeking to change prescribing patterns and to reduce the total number of drugs taken, but also to determine the final impact of these changes on clinical outcomes.