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.

Only a few of the widely used medications used to treat seizures are approved by the FDA for use in children. Your doctor can tell you the details of your child's specific medication including the indications for use and its safety profile. Learn more here.

Medication therapy is the most prevalent and critical intervention of health delivery and the source of most errors in healthcare. Medication errors and associated adverse drug events (ADE) have serious health and economic ramifications, and in elderly patients ADE are the leading cause of morbidity and mortality. Medication reconciliation is the process of evaluating current medication treatment to manage the risk and optimize the outcomes of medication treatment by detecting, solving, and preventing ADEs. This education project answered the question whether education provided to long term care staff would improve knowledge of medication reconciliation and be retained over time. The education program was developed through results of a literature search to identify evidence-based standards for medication reconciliation. The guiding theory for program was Kurt Lewin's theory of planned change. The test was developed on the medication reconciliation content and arrangements made for each of the 30 participants who were RNs, LPNs, and CMAs to take the test before and after the education program and again at 30 and 45 days. Results showed statistically significant improvement (p < 0.05) with knowledge of medication reconciliation retained at 30- and 45-days post intervention. Positive social change is possible as nurses and CMAs in the long-term care facility use the knowledge of medication reconciliation to improve patient medication safety for the long-term care residences in the facility. Through appropriate reconciliation, medication errors and ADEs can be reduced or prevented and patient outcomes improved.

Second-generation antipsychotics (SGAs) are prescribed for treatment of psychosis. A major side effect of SGAs is an increased risk of metabolic syndrome (MetS) with symptoms of hypertension, hyperlipidemia, hyperglycemia, and truncal obesity. A clinic in the northeastern United States was not screening patients for MetS when being treated with SGAs. The purpose of this project was to educate staff on MetS risk factors, signs, symptoms, and patient management with a goal to improve their knowledge of MetS. Lewin's change theory provided a conceptual framework for the project. The project question explored the development and evaluation of an educational module on MetS increased staff knowledge. Educational content was guided by current literature and the American Psychiatric Association and American Diabetic Association practice guidelines. Five expert panel members, consisting of 3 psychiatrists, an advance practice nurse, and a registered nurse reviewed the education program and evaluated content using a Likert-type questionnaire. Expert panel evaluations indicated that the module content contained useful clinical information on MetS screening for patients on SGAs. After panel review, the program was presented to 7 clinic staff. Pretest and posttest questionnaires asked 10 multiple choice questions and results were compared. Questions on SGA side effects, MetS complications, prevalence, baseline assessment measures, lab work, and needed collaboration were answered correctly by 6 of the participants pretest and all questions after receiving the education program. The project has the potential to promote positive social change through staff education on MetS screening for patients, thus improving patient outcomes.

To date, the most common pharmacological treatments for dementia are cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists (antidementia medications), which are associated with a delay in the progression of the cognitive and functional symptoms. Studies of the effects of antidementia medications on neuropsychological symptoms (NPS) show varying results. Presence of NPS can also affect the amount of time caregivers spend with persons with dementia, which can affect informal costs of the condition. This project used extant data from the longitudinal, population-based Cache County Study on Memory and Aging (CCSMA) and the Dementia Progression Study (DPS), which included permanent residents aged ≥ 65 of Cache County, Utah. Linear mixed models were used to assess the association between antidementia medications with informal costs and NPS. The first study examined whether antidementia medications were associated with a decrease in informal costs. Use of antidementia medications was not significantly associated with informal costs (expβ = .79, p = .090). When restricting the sample to only the participants who were of mild dementia severity at baseline, antidementia medications were associated with a 28% decrease in informal costs (expβ = .72, p = .039). The second study evaluated whether antidementia medications were associated with a decrease in NPS. Results indicated that use of antidementia medications was associated with a 28% increase in NPS (expβ = 1.28, p < .001). However, this association was no longer significant with the inclusion of covariates, in particular, the use of psychotropic medications. Use of any psychotropic medication was significantly associated with a 30% increase in Neuropsychiatric Inventory (NPI) score. Overall, the use of antidementia medications may not significantly reduce informal costs or NPS. The use of antidementia medications may reflect patterns of use that are prompted by severity of dementia and NPS.

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.

Purpose To investigate associations between maternal use of selected medications during early pregnancy and the risk of hypospadias in male infants. Methods We used data from the National Birth Defects Prevention Study, a multi-site, population-based, case-control study. We analyzed data from 1,537 case infants with second or third degree isolated hypospadias and 4,314 male control infants born from 1997-2007. Exposure was based on reported use of any prescription or over-the-counter medication or herbal product, for which there were at least 5 exposed cases, from 1 month before to 4 months after conception, excluding topicals, vitamins, minerals, and products for which the components were unknown. Adjusted odds ratios (aORs) and 95% confidence intervals (CI) were estimated using multivariable logistic regression, adjusting for several confounders. Results Of the 195 medication components with at least 5 exposed cases, 89 components met the inclusion criteria and were assessed-28 herbal and 61 non-herbal components. Hypospadias was associated with reported use of cephalexin (aOR 3.06; 95% CI 1.02, 9.18), phenylpropanolamine HCl (aOR 2.68; 95% CI 1.06, 6.80), and ibuprofen (aOR 1.16; 95% CI 1.00, 1.34), in primary analyses. Conclusions We replicated a previously observed association between maternal exposure to phenylpropanolamine HCl and hypospadias. The associations with cephalexin and ibuprofen have not previously been reported. Given the exploratory nature of the analyses, these results should be considered hypothesis-generating. Better understanding of the potential fetal effects will allow clinicians and women of childbearing age to make more informed decisions regarding the use of medications during pregnancy.

Psychopharmacological and behavioural interventions are used to treat challenging behaviours (e.g., self-injury, aggression, stereotypy, bizarre vocalizations) in individuals with intellectual disability (ID), often in combination. However, little is known about the behavioural mechanisms underlying psychopharmacological treatment. Establishing a better understanding of these mechanisms could contribute to improving treatment efficacy. For this study, I conducted repeated functional analyses using single-subject experimental designs to assess the impact of naturally varying dosages of psychotropic medications on behaviour function. Four individuals with ID who engaged in challenging behaviour and were undergoing psychotropic medication changes participated. Medication impact across two topographies for one participant, and three topographies for another participant were assessed, for a total of seven cases. For Analysis 1, I calculated standardized mean differences between baseline and final drug administration phases to estimate the overall effect of medication. I used this information to examine whether response rate following drug administration was related to response rate during baseline, referred to as rate-dependency. Rate-dependency was not observed. Analysis 2 explored the relation between psychotropic medications and behaviour function identified through functional analyses. Challenging behaviour was the dependent variable, while functional analysis conditions and psychotropic medication level served as independent variables. The latter was a quasi-experimental variable given participants’ psychiatric team prescribed changes independent of the researchers. Behaviour function correspondence, defined as no function change after a medication manipulation, was observed across 14 of the 21 medication manipulations (67%). / October 2015

In Manitoba, as elsewhere, there is a growing trend towards the use of pharmaceuticals and medical technology (pharmaceuticalization) on children and youth in care (C/YIC). As legally mandated guardians and trained experts on children and youth, social workers in Manitoba may play pivotal roles in the decision to medicate C/YIC with psychotropics. Yet there are no studies on Manitoba social workers’ experiences with medicated children/youth or on their perceptions and attitudes towards medicating C/YIC with psychotropics. Using a multilevel Social Structure and Personality analytic, I explored what Manitoba social workers from various fields of practice have to say about this trend. Data consisted of five in-depth interviews and 29 self-completed questionnaires. Findings highlighted that social workers in Manitoba are dealing with increasingly complex cases within a system of residual social welfare. Funding and resource constraints, lack of skilled medical professionals and educators quick to refer all contribute towards medicating C/YIC.

Major Depressive Disorder (MDD) is a highly prevalent mental disorder that will affect 12.2% of Canadians over the course of their lifetimes, and 4.8% annually (Patten, et al., 2006). One of the most robust findings in the MDD literature is that the gold-standard treatments – Cognitive-Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), and anti-depressant medications - are equal in their efficacy, and superior to placebo. However, it is unclear whether rates of remission for certain types of symptoms differ among treatments with theoretically different mechanisms. This study re-analyzed data from the Treatment of Depression Collaborative Research Program, which included 158 adults with MDD randomized to CBT, IPT, imipramine or placebo. We statistically derived 4 factors from the baseline Hamilton Depression Rating Scale. We hypothesized that the rate of remission of somatic factors (sleep and appetite) would be most rapid in the group receiving imipramine plus clinical management (IMI-CM), and that the rate of remission for cognitive-affective factors would be fastest in IPT and CBT. Hierarchical regression analyses predicted the sum of symptom scores corresponding to each factor using linear and quadratic time (measured in weeks). Treatment-by-time interactions were entered in a stepwise fashion. There were no significant interactions found in the appetite factor, suggesting that all therapies acted on these symptoms at similar rates. Consistent with hypotheses, IMI-CM produced more rapid remission in sleep symptoms compared to psychotherapy. Surprisingly, IMI-CM was also more rapid at relieving cognitive-affective symptoms. The results lend partial support to the idea that different treatments for MDD may target specific symptoms at different rates according to their underlying mechanisms of action. The findings present some exciting possibilities for elevating response rates through empirically-based “tailored treatments”. / Thesis (Master, Psychology) -- Queen's University, 2009-09-03 14:41:46.163