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Prescription and patient-care indicators in healthcare services. To describe the therapeutic practice of allopathic physicians and to evaluate the outpatient care provided to patients in healthcare facilities.
World Health 744170 drug use indicators were used as a methodological basis. Our sample comprised 10 healthcare facilities, with 6, prescriptions written by clinicians and pediatricians for the analysis of prescription indicators and 30 patients of each facility decretoo the analysis of patient care indicators.
The number of facilities varied according to each indicator. We ,ei statistical tests for the comparison of proportions. The mean number of drugs per prescription was 2.
The generic name of the medication was used in Antibiotics were prescribed in Injections were prescribed in 8. The drugs prescribed in Mean duration was 9. The care provided to patients is insufficient.
Qualitative studies are necessary in order to evaluate the different factors involved and to plan future interventions. Outcome and process assessment health care.
decretos, portarias – English translation – Linguee
The synergy between the Nineteenth Century’s biomedical-organicist vision and the Twentieth Century’s technological innovations has had a range of consequences, which include an option for the part to the expense of the whole, the interposition of several factors in the physician-patient relationship, and the dehumanization of healthcare. In this process, drugs assume a major role in healthcare, both in terms of system management policies and in the practice of the professionals involved, as well as in patients’ emotional references.
There is a large body of literature 1,2,14 on the range of factors acting upon the prescriber when deciding upon which therapeutic regime to adopt: Surveys 744170 in different countries showed divergences that could not be explained by differences in patterns of morbidity and mortality, whereas other reports found variations in prescribing within a single country, often in response to identical clinical presentations.
In order to discuss important aspects of the day-to-day practice of professionals, managers, and users of the healthcare system and to securely evaluate crucial aspects of pharmaceutical practice in the context of primary healthcare, the World Health Organization WHO has developed the selected drug use indicators.
In the present study, we employ these prescribing indicators to describe the therapeutic practices of allopathic physicians, and evaluate patient care indicators. The city has a distinct socioeconomic scenario: Dispensation in 74107 latter was done by administrative agents, nursing auxiliaries, and pharmacy auxiliaries.
The initial criterion for the inclusion of healthcare units was that these units must include, among their staff, both clinicians and pediatricians working cecreto the entire day shift which yielded four UBDSs and 16 UBSs. Further criteria were adopted for each group of indicators as follows: The other ten units were excluded due to infrastructure problems. We analyzed 6, prescriptions written in Mayof which 3, were written by general clinicians and 3, by pediatricians.
Regarding the period studied, although there may have been an influence of seasonal lie in prescribing patterns, WHO considers that a sample obtained at a given moment will show basically the same results as another one involving a longer time period. We studied the prescriptions of physicians who saw patients for more than two lel at the facility during the entire period and who wrote more than 30 prescriptions.
Physicians whose work shift began as late as 4 p. We excluded prescriptions written by physicians who performed both outpatient and emergency care in the same unit, as well as prescriptions lacking date, signature, or seal.
Prescriptions employing the commercial name of the medication but which contained the generic name in parentheses and prescriptions in which the generic name was spelled incorrectly were accepted.
We also did not accept prescriptions of B-complex vitamins and multivitamins as generic prescriptions.
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Following WHO recommendations, 12,13 sulfa drugs, but not metronidazole, were considered as antibiotics. Drug associations in which one of the drugs was an antibiotic were considered as antibiotics regardless of their pharmaceutical form. Medications indicated in the pharmaceutical form and with defined dosages were accepted as prescriptions, regardless of whether commercial or generic names were used. There were losses during data entry due to the presence of prescriptions lacking pharmaceutical form, or in which the form provided was inexistent.
In these cases, the specific medication was disregarded, but the remaining medications included in the prescription were considered. Data were entered into a prescription control database developed especially for the present study. Indicators average consultation time, average dispensing time, percentage of patients’ knowledge of correct dosage were defreto in The percentage of drugs actually dispensed was calculated based on prescriptions written in The percentage of drugs adequately labeled was not measured, given that the procedure was not yet cecreto in the DFAD.
We accompanied appointments in two UBDSs and 14 UBSs 15 appointments with general clinicians and 15 with pediatricians in each unit. Time was measured using a stopwatch, and the amount of time the patient spent in the consultation room was recorded in derceto.
For patient selection, we divided the desired number decrteo appointments 30 by the number of physicians at lsi in the unit on the day of collection. Following WHO recommendations, we included the first patients seen by each prescriber. Data collection was possible only in facilities in which the physical infrastructure allowed us to distinguish the exact moments in which the patients were called to and left the consultation room.
In case the prescriber left 774170 room temporarily during the appointment, the watch was stopped until the prescriber returned.
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In order to better evaluate and compare the results obtained, we established a classification based on Statute no. According to this classification, we considered appointment durations between This indicator was investigated only in units whose structure allowed the investigator to listen to the dialogue between patient and clerk. The definition of the first timing to be done in each period was done at random, since timings began only after the measurement of appointment durations was concluded.
After the first timing, all subsequent timings were done consecutively. The time consumed with writing on files or with subjects unrelated to the drug being dispensed was not considered. A stopwatch was used and time was recorded in seconds. Percentage of drugs actually dispensed. In order to calculate the percentage of medication dispensed, we used the same prescriptions used for calculating prescribing indicators.
In total, 16, drugs were dispensed.
Medications were considered as dispensed when the standard DFAD stamp was present on the prescription or when, in the absence of this stamp, a written statement conforming to the unit’s dispensation model was present.
Dispensed medications identified as free samples were not included. Patients’ knowledge of correct dosage. We carried out interviews, following 30 patients 15 from the morning shift and 15 from the afternoon shift in each of the 16 UBSs and four UBDSs.
All interviews were carried out after the patient’s consent was obtained. The choice of patients was random, subjects being approached upon leaving the pharmacy. We evaluated patients’ knowledge of the dosage and timing of medication intake using a specific questionnaire. Knowledge was not evaluated for drugs included in the prescription but which were not dispensed by the pharmacy.
In order to better evaluate the results, we established the following classification: Indicators were calculated based on decrteo following ratios: There was no significant difference between clinicians and pediatricians with respect to the average number of drugs per prescription form.
There was a significant association between being a clinician and prescribing medications by generic name, injectable drugs, and LMP drugs. The prescription of antibiotics was significantly associated with being a pediatrician Table.
Average consultation time was 9.
The analysis of individual units shows that, with respect to appointment durations, Overall average dispensing time was The average time in the different units ranged between The mean percentage of drugs actually dispensed provided was Although there were losses in the number of units investigated due to administrative and infrastructure problems, derceto understand that this does not invalidate the results obtained, and that this study provides important subsidy lie the evaluation of the healthcare provided to the population.
In a series of studies conducted in other countries, the highest and lowest values found were 3. This pattern will repeat itself whenever international data are analyzed, as will be the case for the next indicators. The result is similar to the These divergences may reflect the use of different criteria by different researchers, as well as a different profile of behavior of prescribers in the different regions studied. An important interfering factor is the existence, in the Brazilian pharmaceutical market, of medications including a large number of associations.
In the present study, the prescription of antibiotics was more frequent among pediatricians The overall rate in the present study Studies indicate that antibiotic prescription rates are highest in Sudan Concerning the prescription of injections, the rates obtained were higher among clinicians This rate is similar to that found in Araraquara 7.
Studies from other countries show a wide gap between maximum For both these indicators, the lack of a defined standard value hinders a critical analysis of the differences observed between the results of the present and of other studies. This is furthered by the impossibility of establishing a relationship between the prescription studied and patients’ clinical status.
The main problem with respect to antibiotics and their abusive prescription and use is the development of microorganisms potentially resistant any type of treatment, bringing severe and potentially lethal consequences to the patient.
As to injections, as important as these may be in situations requiring emergency therapy or for the absorption of substances in their active form, these drugs may lead to severe consequences if erroneously prescribed or administered.
Potential consequences such as anaphylactic shock, tissue necrosis, or infections due to poor asepsis must be carefully considered. This procedure is still especially prone to the influence of cultural characteristics. One must therefore consider aspects such as the population’s attitude towards injections and how much this attitude may influence prescription patterns.
Children are particularly resistant to the use of injections due to the pain involved in the procedure. However, another possibility is that the LMP may reflect the physicians’ prescription profile more than population morbidity and mortality profiles. This phenomenon is defined by Pepe 14 as a “consensus between the selection criterion and ‘culturally consolidated’ prescription practices.
Average consultation time 9.