Na atualidade, a questão dos eventos adversos a medicamentos nos idosos apresenta grande importância, dada a expansão populacional deste grupo e o impacto negativo destes eventos, que muitas vezes apresenta associação com o uso de medicamentos potencialmente inapropriados (MPI). Tendo em vista que os resultados dos estudos sobre o impacto do uso de MPI na mortalidade de idosos, ainda são inconclusivos, o objetivo foi identificar e analisar na literatura científica as evidências de que o uso de MPI em idosos, segundo critério de Beers, encontra-se associado a mortalidade. Trata-se de uma revisão sistemática finalizada em 20 de Julho de 2012, cujos procedimentos metodológicos seguiram as recomendações do Joanna Briggs Institutte e Systematic Reviews Centre for Reviews and Dissemination guidance for undertaking reviews in health care. Na busca das publicações foram utilizadas as bases de dados Pubmed/Medline, Lilacs, Scopus, Embase, International Pharmaceutical Abstracts, Web of science, Sciencedirect; CINAHL, Current contents connect, Proquest Dissertation and Theses, Banco de teses-CAPES. A seleção das publicações e extração das informações dos estudos foi realizada por dois investigadores de forma independente. A qualidade metodológica dos estudos foi avaliada pela lista de verificação Newcastle-Ottawa. A amostra da RS foi constituída por 17 estudos, sendo que destes, oito publicações compuseram a metanálise. Na síntese descritiva observou-se que a maioria dos estudos apresentou nível de evidência IV (94,1%), cujo delineamento foi coorte (94,1%), usou técnica de amostragem não probabilística (64,7%), coletou dados de modo prospectivo (64,7%), utilizou amostra superior a 1.000 idosos (64,7%), realizou seguimento de 12 a 24 meses (52,9%) e a obtenção do desfecho mortalidade ocorreu em bases de dados (64,7%). A metanálise que totalizou a participação de 90.611 participantes apontou que idosos que utilizaram MPI apresentaram maior risco relativo para o desfecho de mortalidade (RR=1,11; IC 95% 1,01 1,22; p = 0,023), de acordo com os critérios de Beers, independente do cenário do estudo, da existência de comorbidades, de polifarmácia ou do tipo de MPI usado. / Currently, the issue of adverse drug events in the elderly presents great importance, given the expansion of this population group and the negative impact of these events, which often presents association with the use of Potentially Inappropriate Medications (PIM). Having in mind that the results of studies on the impact of using MPI elderly mortality are still inconclusive, the aim was to identify and analyze the evidences in the scientific literature that the use of PIM in the elderly, according to the Beers criteria, is associated with mortality. This is a Systematic Review finalized in July 20, 2012, whose methodological procedures followed the recommendations of the Joanna Briggs Institutte and Systematic Reviews - Centre for Reviews and Dissemination Guidance for Undertaking Reviews in Health Care. In the search of the publications were used databases Pubmed / Medline, Lilacs, Scopus, Embase, International Pharmaceutical Abstracts, Web of science, Sciencedirect, CINAHL, Current Contents Connect, Proquest Dissertation and Theses database-CAPES. The selection of publications and extraction of the information of the studies was conducted by two researchers independently. The methodological quality of studies was assessed by checklist Newcastle-Ottawa. The sample was composed of RS 17 studies, of which eight publications were included in the meta-analysis. In the synthesis descriptive observed that most studies showed level of evidence IV (94.1%), whose design was cohort (94.1%) used non-probability sampling technique (64.7%), collected data from prospectively (64.7%) used sample of more than 1,000 elderly (64.7%), realized during 12 to 24 months (52.9%) and obtaining of outcome mortality occurred in databases (64.7% ). The meta-analysis which totaled the participation of 90,611 participants pointed out that the elderly who have used PIM had higher relative risk for the outcome of mortality (RR = 1.11, 95% CI 1.01 to 1.22, p = 0.023), according to Beers criteria, regardless of the setting of the study, the existence of co-morbidities, polypharmacy, or the type of PIM used.

The use of Electronic Prescribing Systems (EPS) has significant potential role in improving patient safety and reducing adverse drug events. However, the introduction of these systems can have negative outcome on delivery of care if healthcare providers are not utilizing regularly and accept it. This study aims to explore paediatrician’s attitude towards electronic prescribing systems as well as understand the possible factors affecting user acceptance at tertiary care using the Technology Acceptance Model (TAM). A qualitative research methodology was applied. Semi-structured interviews were developed according to TAM model and used as primary source of collecting empirical data. Seven research participants were interviewed. The findings of this study had identified factors that are important for paediatrician’s acceptance of EPS systems. Although paediatricians are positive to the usefulness of EPS, it appears that there are some acceptance problems due to ease of use concerns and usability issues of the system. The acceptance of EPS can be improved by leveraging ease of use as well as enhancing training.

Hospital electronic prescribing and medicines administration (HEPMA) system implementation is advocated by national e-health strategies to produce patient safety benefits. No previous study has evaluated HEPMA implementation impacting discharge information communication or assessed discharge prescribing errors. The aims were to assess HEPMA system implementation impact on medicines related discharge communication and prescribing errors, and to gain the perspective of hospital staff involved in the communication process. Following a narrative literature review, a convergent parallel mixed methods was selected, consisting of interpretative phenomenology and experimental before and after study design. Face-to-face semi-structured interviews of a purposive sample of hospital staff involved in discharge information communication were undertaken using the Theoretical Domains Framework (TDF) as a theoretical lens. In addition a quasi experimental retrospective case notes review, both before and after implementation was completed. Pre-implementation, staff described patient safety concerns with traditional discharge communication processes. They cited frequent prescribing errors, and associated adverse events and hospital readmissions. HEPMA implementation was anticipated to improve patient safety and create more efficient discharge communication. Post-implementation staff articulated improved information quality highlighting fewer omitted medicines and improved patient safety. TDF findings of behaviour change highlighted behavioural alteration including adaption of processes to improve discharge quality. Quantitative data collection (n=159 before and after) confirmed qualitative findings; increased compliance with discharge documentation, for example staff grade recorded increased from 40% to 100% (p<0.001). Prescribing error quantity and severity were reduced; errors reduced from 99% to 23% of patients (p<0.001); only 22% of identified errors likely to cause harm. Omitted medicines decreased from 42% to 11% of patients (p<0.001). The findings contribute original knowledge concerning HEPMA implementation impacting discharge information communication and prescribing errors. The study demonstrated reduced prescribing errors and improved patient safety which potentially impacted health and wellbeing. Qualitative findings and quantitative results are transferable and applicable to other NHS organisations or similar healthcare settings.

Master of Public Health - MPH / This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply. / South Africa

Master of Public Health - MPH / The World Health Organisation estimates that more than 50% of medicines are inappropriately used globally. The situation is worst in developing countries such as Nigeria, where irrational prescribing practices account for wastage of resources, catastrophic medicines costs and poor access to health services. In 2005, the Social Health Insurance Programme was launched as a financially sustainable model to achieve cost effective and affordable health care services including medicines. This study investigated prescribing practices and availability of medicines in the Social Health Insurance Programme in accredited public sector secondary hospitals in the Federal Capital Territory, Nigeria.Methodology:The study is a descriptive, cross-sectional and retrospective survey of prescriptions of insured outpatients in the Federal Capital Territory, Nigeria. Four hospitals were selected by stratification of thirteen (13) public secondary hospitals in the territory into urban/peri-urban areas, followed by random selection of two hospitals from each stratum.A total of seven hundred and twenty (720) retrospective prescription encounters of insured outpatients were systematically selected from encounters between July 2009 and June 2010 at the selected facilities. Data on prescribing practices and the extent to which prescribed medicines were provided were assessed with the use of modified WHO/INRUD indicators. Descriptive statistics were generated with Epi-info (version 3.4.3) and SPSS (version 17.0)Results: Out of the seven hundred and twenty (720) prescriptions that were assessed analgesics/NSAID, antibiotics, antimalarials and haematinics/vitamins collectively accounted for 67.4% of the medicines prescribed.A comparison of the results with WHO/Derived reference values showed that average number of medicines prescribed per prescription (3.5 ±1, p<0.001) and the rate of antibiotic prescribing (53.7%, p=0.009) were higher than the WHO recommended ranges of (1.6-1.8) and (20.0- 25.4%) respectively.The use of generic names in prescribing (50.9%, p<0.0009) and medicines prescribed from the Essential Medicine List (74.2%, p=0.05) were considerably lower than the standard (100%) However, the rate of injection prescribing (12.49%, p=0.4) was within the recommended range (10.1–17.0%).The study also found that 85.1%, (p=0.001) of prescribed medicines were dispensed, while 93.4% (p=0.256) of essential medicines were dispensed which was lower than the recommended standard (100%). Overall, only 58%,(p<0.0001) of patients had all prescribed medicines completely dispensed and this was significantly lower than the desired standard (100%.) in social health insurance programmes.Conclusions:The findings of this study show trends toward irrational prescribing practices as characterized by poly-pharmacy, overuse of antibiotics, sub-optimal generic prescribing, as well as poor adherence to the use of NHIS-Essential Medicine List. There was sub-optimal provision of prescribed medicines. These are potential threats to the scheme‟s goal of universal access to health care in the year 2015. Pragmatic multi-component interventions are recommended to promote rational prescribing and improve equity in access to essential medicines.

Magister Public Health - MPH / Background: The irrational use of medicines, and increasingly antimicrobials, remains a key health problem in many developing countries including Zambia. Inappropriate, ineffective and inefficient use of medicines is common in health facilities at all levels. There are many factors influencing irrational prescribing and dispensing of antimicrobials including patients, prescribers, dispensers, the supply system (including industry influences), government regulations and medicines information and misinformation. Study aim: The aim of the study was to assess the rational use and availability of antimicrobials at primary level health facilities under the Lusaka district community health office, Zambia. Study design: The study was a cross-sectional descriptive study, with prospective and retrospective components. A standardized research methodology, including tools and indicators, adapted from the World Health Organization, was employed. Study population and sampling: The study population included all the 30 government primary level health facilities (health centres) in Lusaka District, from which 20 primary health facilities were sampled using a combination of purposive and random sampling. Using the WHO standard indicators of rational drug use, this study assessed 800 patient encounters, 520 medicines inventory records, and other baseline data, from 20 health facilities at three different levels under the Lusaka district community health office, Zambia. Data collection: The data collection tools were numbered and labeled. Tool 1: Prescribing Indicator Form was used to collect prescribing data; Tool 2: Patient Care (Pharmacy) Form was used to record dispensing data; Tool 3: Antimicrobial Availability Form for recording data for the availability of the key indicator antimicrobials and their substitutes; Tool 4: Facility Indicator Consolidation Reporting Form was used for consolidating the data collected for each health facility under study; and Tool 5: Facility Medicines Use Indicator Consolidation Form was used for the consolidation of the drug use data for the entire study. Third year Pharmacy Technology students were trained for the data collection process. The patients were first observed from outside the prescriber's room and the dispensing area for consultation and dispensing times respectively, and then they were interviewed to collect the prescribing and dispensing data. The tools were pre-tested. Data analysis: After data checking and consolidation, quantitative data were categorized into continuous numerical variables. Calculations were done manually and using computerized analysis (Epi Info package) and presented as simple frequency and means. Ethics: Ethical clearance for the study was obtained from University of the Western Cape Senate Research Committee. Permission was obtained from the Lusaka Provincial and District health offices, being the authorities that are overseeing the health facilities included in the study. Furthermore, permission was obtained from the health centre in-charges. Consent was obtained from healthcare providers and patients. Key results and discussion: The study found that at the primary level facilities there were more Clinical Officers (55%) than Medical Doctors (25%) and Registered Nurses (20%) in charge of prescribing. The main dispensers were Pharmacy Technologists (85%); there were no Pharmacists available in any of the facilities. A third [259 (32.4 %)] of all the 800 patients in the study were children below 12 years of age. Across the clinics, a mean of 2.94 medicines were prescribed per prescription, with an extremely low rate of prescribing drugs by generic name (36.7%). The proportion of prescriptions including an antibiotic was 36.2 % and 3.4 % included an injectable drug. Linking the antimicrobials and injections to patient diagnoses indicated that many were probably irrational, prescribing decisions. Amoxicillin and metronidazole were by far the most commonly prescribed antimicrobials at 32.0 % and 17.2 % of total antimicrobials, respectively. The essential drugs list was available in 80.0% of facilities and a high percentage of medicines were prescribed from the essential medicines list (81.2%). The overall mean percentage of medicines packages correctly labeled was considerably low at 44.8 %. The average consultation time was short at 4.0 (range 1-8.4) minutes, whereas the dispensing times were equally short and averaged at 116.6 (range 15-360) seconds, with the range of 15 to 360 seconds. The average percentage of first line antimicrobials available at health facilities was 79 %; and the average percentage of second line, substitute, antimicrobials available was 15 %. Conclusion: In line with studies from other settings, this medicines use study found considerable overuse and irrational use of antimicrobials in the primary health care clinics in Lusaka District. Irrational medicine prescribing was common and poor dispensing practices were also seen, resulting in poor use of and adherence to medicines and, consequently, poor therapeutic outcomes. Recommendations: Several recommendations have been formulated. They include: Reinforcing the Drug Therapeutic Committees (DTCs) at the national and the local facility level to help manage medicines use; clarification of prescribers and dispensers roles and responsibilities; development, enforcement or adaption of standard operating procedures (SOPS) for prescribing and dispensing; and improvement of prescribing and dispensing practices through introduction of appropriate education, supervision and audit.

Please read the abstract in the 00front part of this document / Dissertation (MSc (Clinical Epidemiology))--University of Pretoria, 2006. / Clinical Epidemiology / unrestricted

Magister Pharmaceuticae - MPharm / South Africa

Magister Pharmaceuticae - MPharm / Infusions, decoctions, alcoholic preparations and other dosage forms of Artemisia afra are frequently used in South African traditional medicine. Generally when these preparations are made without applying good manufacturing practices they do not meet microbial quality control standards, safety and toxicity criteria and encourage poor patients compliance. To overcome the aforementioned disadvantages of traditional dosage forms a sold dosage form, i.e. a table might be recommended. The first objective of this study was to formulate and manufacture a rapid release tablet dosage of Artemisia afra that would contain an amount of plant material equivalent to that found in its traditional liquid dosage forms and that would meet conventional pharmaceutical standards. The second objective was to conduct a pilot study to obtain a preliminary profile of the bioavailability of select flavonoids presents in both the tablet and traditional liquid preparation of Artemisia afra in humans. / South Africa

Philosophiae Doctor - PhD / Studies on rational medicine use (RMU) have mainly focused on identifying, quantifying, and addressing irrational use without exploring reasons behind this irrational use. In addition, minimal work has been conducted on irrational use of medicines in the context of the growing burden of non-communicable diseases (NCDs). This PhD research examined medicine use in Eswatini, (previously Swaziland) between April 2017 and March 2019, with a focus on prescribing practices linked to specific diagnoses. It further explored factors influencing RMU, which included testing the effects of a short intervention - prescription audit and feedback coupled with small group education - on prescribing practices in health facilities.