Measuring the assessment and counselling provided with the supply of non-prescription asthma reliever medication: a simulated patient study

BACKGROUND: Over one quarter of asthma reliever medications are provided without prescription by community pharmacies in Australia. Evidence that community pharmacies provide these medications with sufficient patient assessment and medication counseling to ensure compliance with the government's Quality Use of Medicines principles is currently lacking. OBJECTIVE: To assess current practice when asthma reliever medication is provided in the community pharmacy setting and to identify factors that correlate with assessment of asthma control. METHODS: Researchers posing as patients visited a sample of Perth metropolitan community pharmacies in May 2007. During the visit, the simulated patient enacted a standardized scenario of someone with moderately controlled asthma who wished to purchase a salbutamol (albuterol) inhaler without prescription. Results of the encounter were recorded immediately after the visit. Regression analysis was performed, with medication use frequency (a marker of asthma control) as the dependent variable. RESULTS: One hundred sixty community pharmacies in the Perth metropolitan area were visited in May 2007. Pharmacists and/or pharmacy assistants provided some form of assessment in 84% of the visits. Counseling was provided to the simulated patients in 24% of the visits. Only 4 pharmacy staff members asked whether the simulated patient knew how to use the inhaler. Significant correlation was found between assessment and/or counseling of reliever use frequency and 3 independent variables: visit length (p < 0.001), number of assessment questions asked (p < 0.001), and the simulated patient who conducted the visit (p < 0.02). CONCLUSIONS: Both patient assessment and medication counseling were suboptimal compared with recommended practice when nonprescription asthma reliever medication was supplied in the community pharmacy setting. Pharmacy and pharmacist demographic variables do not appear to affect assessment of asthma control. This research indicates the need for substantial improvements in practice in order to provide reliever medication in line with Quality Use of Medication principles of ensuring safe and effective use of medication.

Non-prescription medicine misuse, abuse and dependence : a cross-sectional survey of the UK general population

This study was supported by the Society of the Study of Addiction in the form of a PhD studentship awarded to NF.

Prevalência da Automedicação nos alunos do Mestrado Integrado em Ciências Farmacêuticas da ULHT

A automedicação é uma prática cada vez mais comum em todo o mundo e quando praticada de forma responsável oferece diversos benefícios, nomeadamente uma maior autonomia das populações na gestão da sua saúde. No entanto, o consumo de medicamentos não deve ser banalizado e a orientação e aconselhamento por parte de um profissional de saúde como o farmacêutico será sempre uma mais-valia, na medida em que proporciona uma automedicação responsável, eficaz e segura. O presente trabalho teve como principais objectivos, determinar a prevalência da automedicação nos alunos do Mestrado Integrado em Ciências Farmacêuticas da Universidade Lusófona de Humanidades e Tecnologias e avaliar os factores associados a esta prática. Nesse sentido, foi desenvolvido um estudo descritivo transversal, com base num questionário aplicado a esta população. Os dados recolhidos foram posteriormente sujeitos a tratamento estatístico através do programa SPSS®. Considerando uma amostra de 138 indivíduos, os resultados mostraram que a prevalência da automedicação foi de 95,7%. Os principais sintomas que motivaram o recurso à automedicação foram os estados gripais e constipações (14,2%), as dores menstruais (11,1%), a tosse/rouquidão (10,2%), cefaleias (9,5%), febre (8.6%), rinorreia e congestão nasal (6,7%) e a rinite alérgica (5,1%). Os medicamentos mais usados, nos últimos dois anos, foram os anti-inflamatórios não esteróides (19,4%), os analgésicos e antipiréticos (19,2%), os descongestionantes nasais (12,8%), os antitússicos e expectorantes (11,8%), os anti-histamínicos (9,5%) e as vitaminas e sais minerais (7,9%). A grande maioria dos inquiridos (89,9%) mostrou-se consciente dos possíveis riscos inerentes à automedicação. Ainda assim, 29% afirmou já se ter automedicado, usando medicamentos sujeitos a receita médica.

Does humor work in advertising of pharmaceutical products?

This thesis aims to evaluate whether humorous television commercials (TVCs) work for non-prescription drugs, known as “over-the-counter” (OTC). The construct humor in advertising is controversial since it involves complex and broad typology, and depends on the audience characteristics. Several studies within different product categories indicated that some consumer goods are better suited for humorous TVCs, while others, such as OTC drugs, may not take advantage from it. Paradoxically, drug announcers spend billions of dollars worldwide in humorous OTC ads. An experiment with real consumers was designed as between-and-within-subjects, to test three hypotheses. Sixty women were exposed to pairs of humorous and non-humorous TVCs, for each of the three drug categories (analgesics, vitamins, and laxatives). We used fictional brand names and real ads, and measured four dependant variables: attitude toward the advertising (AAD), attitude toward the brand (ABR), purchase intention (PI), and brand choice (BC), after subjects being exposed to manipulations of two independent variables: humorous vs. non-humorous TV commercials, for the drug categories. Conditional logit model confirmed that humor does not help to persuade respondents, whose choices, attitudes, and purchase intention were less favorable with humorous TVCs, in comparison to non-humorous executions. Future research is presented regarding marketing for pharmaceutical products.

Internações hospitalares por reações adversas a medicamentos (RAM) em um hospital de ensino

Pós-graduação em Ciências Farmacêuticas - FCFAR

Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland

OBJECTIVES This study compared the profile of intentional drug overdoses (IDOs) presenting to emergency departments in Ireland and in the Western Trust Area of Northern Ireland between 2007 and 2012. Specifically the study aimed to compare characteristics of the patients involved, to explore the factors associated with repeated IDO and to report the prescription rates of common drug types in the population. METHODS We utilised data from two comparable registries which monitor the incidence of hospital-treated self-harm, recording data from deliberate self-harm presentations involving an IDO to all hospital emergency departments for the period 1 January 2007 to 31 December 2012. RESULTS Between 2007 and 2012 the registries recorded 56,494 self-harm presentations involving an IDO. The study showed that hospital-treated IDO was almost twice as common in Northern Ireland than in Ireland (278 vs 156/100,000, respectively). CONCLUSIONS Despite the overall difference in the rates of IDO, the profile of such presentations was remarkably similar in both countries. Minor tranquillisers were the drugs most commonly involved in IDOs. National campaigns are required to address the availability and misuse of minor tranquillisers, both prescribed and non-prescribed.

Non-medical prescription drug and illicit street drug use among young Swiss men and associated mental health issues.

Non-medical use of prescription drugs (NMUPD) is increasing among the general population, particularly among teenagers and young adults. Although prescription drugs are considered safer than illicit street drugs, NMUPD can lead to detrimental consequences. The aim of the present study was to investigate the relationship between drug use (NMUPD on the one side, illicit street drugs on the other side) with mental health issues and then compare these associations. A representative sample of 5719 young Swiss men aged around 20 years filled in a questionnaire as part of the ongoing baseline Cohort Study on Substance Use Risk Factors (C-SURF). Drug use (16 illicit street drugs and 5 NMUPDs, including sleeping pills, sedatives, pain killers, antidepressants, stimulants) and mental health issues (depression, SF12) were assessed. Simple and multiple linear regressions were employed. In simple regressions, all illicit and prescription drugs were associated with poorer mental health. In multiple regressions, most of the NMUPDs, except for stimulants, were significantly associated with poorer mental health and with depression. On the contrary, the only associations that remained significant between illicit street drugs and mental health involved cannabis. NMUPD is of growing concern not only because of its increasing occurrence, but also because of its association with depression and mental health problems, which is stronger than the association observed between these problems and illicit street drug use, excepted for cannabis. Therefore, NMUPD must be considered in screening for substance use prevention purposes.

Factors influencing psychotropic prescription by non-psychiatrist physicians in a nursing home for the elderly in Brazil

CONTEXTO E OBJETIVO: Embora os psicotrópicos sejam uma das classes de medicações mais prescritas em abrigos para idosos, os estudos avaliando o seu padrão de prescrição são limitados em número e escopo. Este estudo visou investigar os fatores associados ao uso de psicofármacos em um abrigo para idosos no Brasil. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo observacional realizado no Abrigo da Velhice de Rio Claro, Instituto de Biociências, Universidade Estadual Paulista. MÉTODOS: Dados sobre prescrições foram extraídos dos prontuários médicos dos 108 idosos moradores do abrigo. Sessenta e cinco sujeitos (idade média ± desvio padrão = 74,5 ± 9,4 anos), em uso regular de medicação, constituíram a amostra. Foram examinados os efeitos das variáveis sociodemográficas e clínicas sobre o padrão de prescrição de psicofármacos. RESULTADOS: As mulheres recebiam mais psicofármacos (p = 0.038); indivíduos em uso de medicações para doenças cardiovasculares recebiam menos psicofármacos (p = 0.001). Houve correlação negativa entre número de psicofármacos prescritos e, ambos, idade (p = 0.009) e número de medicações clínicas (p = 0.009). CONCLUSÃO: Embora preliminares, os resultados indicam as doenças cardiovasculares como a variável clínica que mais influenciou a prescrição de psicofármacos. Uma excessiva precaução por parte dos clínicos pode explicar parcialmente este resultado. Novas investigações, com amostras maiores e de diferentes regiões são desejáveis para confirmação destes dados.

Drugs Associated with Hepatotoxicity and their Reporting Frequency of Liver Adverse Events in VigiBase (TM) Unified List Based on International Collaborative Work

BACKGROUND Challenges exist in the clinical diagnosis of drug-induced liver injury (DILI) and in obtaining information on hepatotoxicity in humans. OBJECTIVE (i) To develop a unified list that combines drugs incriminated in well vetted or adjudicated DILI cases from many recognized sources and drugs that have been subjected to serious regulatory actions due to hepatotoxicity; and (ii) to supplement the drug list with data on reporting frequencies of liver events in the WHO individual case safety report database (VigiBase). DATA SOURCES AND EXTRACTION (i) Drugs identified as causes of DILI at three major DILI registries; (ii) drugs identified as causes of drug-induced acute liver failure (ALF) in six different data sources, including major ALF registries and previously published ALF studies; and (iii) drugs identified as being subjected to serious governmental regulatory actions due to their hepatotoxicity in Europe or the US were collected. The reporting frequency of adverse events was determined using VigiBase, computed as Empirical Bayes Geometric Mean (EBGM) with 90% confidence interval for two customized terms, 'overall liver injury' and 'ALF'. EBGM of >or=2 was considered a disproportional increase in reporting frequency. The identified drugs were then characterized in terms of regional divergence, published case reports, serious regulatory actions, and reporting frequency of 'overall liver injury' and 'ALF' calculated from VigiBase. DATA SYNTHESIS After excluding herbs, supplements and alternative medicines, a total of 385 individual drugs were identified; 319 drugs were identified in the three DILI registries, 107 from the six ALF registries (or studies) and 47 drugs that were subjected to suspension or withdrawal in the US or Europe due to their hepatotoxicity. The identified drugs varied significantly between Spain, the US and Sweden. Of the 319 drugs identified in the DILI registries of adjudicated cases, 93.4% were found in published case reports, 1.9% were suspended or withdrawn due to hepatotoxicity and 25.7% were also identified in the ALF registries/studies. In VigiBase, 30.4% of the 319 drugs were associated with disproportionally higher reporting frequency of 'overall liver injury' and 83.1% were associated with at least one reported case of ALF. CONCLUSIONS This newly developed list of drugs associated with hepatotoxicity and the multifaceted analysis on hepatotoxicity will aid in causality assessment and clinical diagnosis of DILI and will provide a basis for further characterization of hepatotoxicity.

Epidemic: Responding to America's Prescription Drug Abuse Crisis, 2011

Prescription drug abuse is the Nation’s fastest-growing drug problem. While there has been a marked decrease in the use of some illegal drugs like cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that nearly one-third of people aged 12 and over who used drugs for the first time in 2009 began by using a prescription drug non-medically.1 The same survey found that over 70 percent of people who abused prescription pain relievers got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.2 Additionally, the latest Monitoring the Future study—the Nation’s largest survey of drug use among young people—showed that prescription drugs are the second most-abused category of drugs after marijuana.3 In our military, illicit drug use increased from 5 percent to 12 percent among active duty service members over a three-year period from 2005 to 2008, primarily attributed to prescription drug abuse.

Effectiveness of highly active antiretroviral therapy using non-brand name drugs in Brazil

In Brazil, HIV-infected individuals receive drugs (including non-brand name drugs which comprise locally produced generics and drugs that have not been tested in bioequivalence trials) free of charge from the government. The objective of the present study was to evaluate the effectiveness of highly active antiretroviral therapy (HAART) in Rio de Janeiro, Brazil, where non-brand drugs are widely used. For this purpose, we estimated the proportion of subjects with virologic failure (plasma HIV viral load greater than 400 copies/mL at 6 months after initiation of treatment). This was a retrospective cohort study of drug-naive HIV-infected subjects who initiated HAART. Subjects were included in the analysis if they were 18 years of age or older, were treatment naive, started HAART with a minimum of 3 drugs, and had available information on blood plasma HIV-1 viral load after 6 months on therapy. All subjects used antiretrovirals in dosing regimens recommended by the Brazilian National Advisory Committee for Antiretroviral Therapy. Chart reviews were conducted in three settings: at two public health outpatient units, at one clinical trial unit and at one private office. No comparisons of the effectiveness of non-brand name with the effectiveness of brand name drugs were made. We present results for 485 patients; of these, 354 (73%), 55 (11%), and 76 (16%) were seen at the public health outpatient units, private office, and clinical trial unit, respectively. Virologic failure was observed in 119 (25%) of the subjects. This study demonstrates the effectiveness of HAART in a setting where non-brand name drugs are widely used.

Drug Use and Attitudes Toward Drugs among Young Bulgarian Males

This project aimed to evaluate young people's attitudes towards drugs and to draft preventive strategies for use among young people at school and during military service. Three target groups were surveyed: young heroin users in Sofia, drug users undergoing treatment in the Military Medical Academy, and male students between the ages of 16 and 18. The research showed that more than half the respondents had used heroin for the first time before they were 16 and 11% tried it first at the age of 13, the lowest age registered since drug use in Bulgaria has been studied. One in five male students aged 16 to 18 has used hashish or marijuana at least once and amphetamines and non-prescription medications are the second-choice drugs for Bulgarian school pupils. The best predictors of drug use among young people are drug use among friends, early alcohol and tobacco use, perceived availability of drugs, an underrating of the health hazards of drug use and a lack of proper information about these, willingness to take drugs, where and with whom the young people have grown up, and a sensation-seeking attitude.

Evaluation of pharmaceutical assistance in public primary care in Brasília, Brazil

OBJECTIVE: Pharmaceutical assistance is essential in health care and a right of citizens according to Brazilian law and drug policies. The study purpose was to evaluate aspects of pharmaceutical assistance in public primary health care. METHODS: A cross-sectional study using WHO drug indicators was carried out in Brasília in 2001. From a random sample of 15 out of 62 centers thirty exiting patients per center were interviewed. RESULTS: Only 18.7% of the patients fully understood the prescription, 56.3% could read it, 61.2% of the prescribed drugs were actually dispensed, and mean duration of pharmaceutical dispensing was 53.2 seconds. Each visit lasted on average 9.4 minutes. Of prescribed and non-dispensed drugs, 85.3% and 60.6% were on the local essential drug list (EDL) respectively. On average 83.2% of 40 essential drugs were in stock, and only two centers had a pharmacist in charge of the pharmacy. The mean number of drugs per prescription was 2.3, 85.3% of prescribed drugs were on the EDL, 73.2% were prescribed using the generic denomination, 26.4% included antibiotics and 7.5% were injectables. The most prescribed groups were: cardiovascular drugs (26.8%), anti-infective drugs (13.1%), analgesics (8.9%), anti-asthmatic drugs (5.8%), anti-diabetic drugs (5.3%), psychoactive drugs (3.7%), and combination drugs (2.7%). CONCLUSIONS: Essential drugs were only moderately available almost 30 years after the first Brazilian EDL was formulated. While physician use of essential drugs and generic names was fairly high, efficiency was impaired by the poor quality of pharmaceutical care, resulting in very low patient understanding and insufficient guarantee of supply, particularly for chronic diseases.

Equidade na utilização de medicamentos em Portugal

RESUMO - Este estudo teve como objectivo contribuir para o conhecimento sobre a equidade no sector do medicamento, com uma análise empírica aplicada ao sistema de saúde português. Para o efeito avaliou-se se indivíduos com as mesmas necessidades em saúde, mas com diferentes níveis de rendimento, tiveram idêntica prestação no que diz respeito ao medicamento. Adicionalmente, aprofundou-se esta análise através da identificação de factores associados ao sistema de prestação ou ao utente que contribuíram para gerar iniquidades, com particular destaque para os comportamentos de não aquisição de medicamentos – não adesão primária. A avaliação da equidade foi efectuada através de duas abordagens distintas, mas complementares: uma sob a perspectiva da utilização e outra sob a perspectiva da distribuição da despesa pública com medicamentos. Para estas análises aplicaram-se métodos baseados nos índices de concentração, utilizando dados do Inquérito Nacional de Saúde 2005/06 e dados relativos aos encargos do Serviço Nacional de Saúde com medicamentos. Os resultados revelaram que, perante as mesmas necessidades, o sistema de prestação tende a favorecer os indivíduos de nível socioeconómico superior, quer na utilização quer na distribuição de recursos do Estado com medicamentos. Adicionalmente, a aplicação do método da decomposição do índice de concentração revelou que tanto o rendimento como o nível educacional são atributos individuais que estão associados à iniquidade na utilização de medicamentos. A iniquidade observada neste estudo pode resultar de barreiras em diferentes fases do processo terapêutico, entre as quais se destacam o não acesso à prescrição médica ou a não aquisição dos medicamentos prescritos. Foi este comportamento - designado de não adesão primária - que se analisou na segunda parte da tese. Para tal cruzaram-se os dados de prescrição electrónica com os dados de dispensa no Serviço Nacional de Saúde. Os resultados revelaram que a taxa de não adesão primária foi cerca de 20% e que este comportamento está associado ao sexo feminino ou ser jovem, assim como a características do sistema de prestação como o valor dos copagamentos. Estes dados indiciam que as barreiras na aquisição podem ser indutoras de iniquidades na utilização de medicamentos. A identificação de iniquidade na utilização de medicamentos e dos factores que contribuem para esta situação constituem o primeiro passo para uma estratégia de redução da iniquidade que, de acordo com os resultados desta tese, deve abranger não só o sistema de saúde mas também outras áreas das políticas públicas em Portugal.