Non-psychiatrist prescriptions within the Brazilian National Health System represents a risk to patients in the use of psychotropic pharmacotherapies
DOI:
https://doi.org/10.33448/rsd-v10i15.22971Keywords:
Psychotropic drugs; Prescription; Drug interaction; Medical records; Pharmacotherapy.Abstract
This cross-sectional study collected data from the Brazilian National Health System (NHS) patients’ that filled their psychotropic prescriptions in NHS owned pharmacies. The study aimed to identify oversights in psychotropic prescriptions leading to insecure therapeutic. Patients in use of at least one psychotropic drug in 12 months were identified by a retrospective data search and considered for the study. After examining 15,001 patients in use of psychotropic medicines, 7,440 met the inclusion criterion. The majority of patients were women (67.1%), 54.2% of prescriptions analysed over the studied period presented multiple medicines including one psychotropic, and 54.7% cursing with psychotropic monotherapy. In 92.7% of cases, only one medicine was dispensed and prescriptions from psychiatrists represented only 17.6% of cases. In terms of safety, 9.5% of patients had at least one potential drug interaction of clinical significance, and 71.5% of elder patients had at least one drug that was potentially inappropriate for their age group use. These findings suggest urgency in integrating patients’ medical records information to pharmacotherapy history at the pharmacy computer technology applied for dispensing, reducing harm to patients in the use of psychotropic drugs.
References
Agência Nacional de Vigilância Sanitária (Brasil), nº. 344 de 12 de maio de 1998. (1998) Regulamento Técnico sobre substâncias e medicamentos sujeitos a controle especial. Diário Oficial da União 31 dez 1998; Seção 1.
Alarcon, R. D., Lolas, F., Mari, J. J., Lazaro, J., & Bac-Baldomero, E. (2019). Latin American and Spanish-speaking perspectives on the challenges of global psychiatry. Braz J Psychiatry. 42:1.
Anacleto, T. A., Perini, E., Rosa, M. B., & César, C. C. Drug-dispensing errors in the hospital pharmacy. Clinics (Sao Paulo). 62(3):243-50.
Anacleto, T. A., Perini, E., Rosa, M. B., & César, C. C. (2005). Medication errors and drug-dispensing systems in a hospital pharmacy. Clinics (Sao Paulo). 60(4):325-32.
Andrade, M. F., Andrade, R. C. G., & Santos, V. (2004). Prescrição de psicotrópicos: avaliação das informações contidas em receitas e notificações. Rev. Bras. Cienc. Farm. 40(4): 471-479.
Aquino, D. S. (2008). Por que o uso racional de medicamentos deve ser uma prioridade. Ciênc. Saúde Colet. 13:733-736.
Aronson, J. K. (2009). Medication errors: definitions and classification. Br J Clin Pharmacol. 67(6):599-604.
Azermai, M., Elseviers, M., Petrovic, M., Van-Bortel, L., & Vander-Stichele, R. (2011). Geriatric drug utilisation of psychotropics in Belgian nursing homes. Hum. Psychopharmacol. 26(1):12-20.
Bianchi, S., Bianchini, E., & Scanavacca, P. (2011). Use of antipsychotic and antidepressant within the Psychiatric Disease Centre, Regional Health Service of Ferrara. BMC Clin Pharmacol. 11:21.
Brasil, Ministério da Saúde: Estudo de estimativas populacionais por município, in DATASUS. (2014).
Brasil. Instituto Brasileiro de Geografia e Estatística (2017). Banco de Tabelas Estatísticas.
Chow, W. S., & Priebe S. (2013) Understanding psychiatric institutionalization: a conceptual review, BMC Psychiatry. 13:169.
Correr, C. J., Pontarolo, R., Wiens, A., Rossignoli, P., Melchiors, A. C., Radominski, R., et al. (2009). Arq Bras Endocrinol Metabol. 53(7):825-33.
Faustino, C. G., Martins M. A., & Jacob-Filho W. (2011). Medicamentos potencialmente inapropriados prescritos a pacientes idosos ambulatoriais de clínica médica. Einstein (Sao Paulo). 9:18-23.
Fick, D., Semla T., Beizer J., Brandt N., Dombrowski R., DuBeau C. E., et al. (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc. 60(4): 616-31.
Guerra, C. S., Herculano M. M., Filha M. O., Dias M. D., Cordeiro R. C., & Araújo V. S. (2013). Epidemiologic profile, and prevalence of psychotropic use in one reference unit for mental health. J Nurs UFPE on line. 7:6.
Hasan S. S., Zaidi S. T. R., Nirwan J. S., Ghori M. U., Javid F., & Ahmadi K. (2019). Use of Central Nervous System (CNS) Medicines in Aged Care Homes: A Systematic Review and Meta-Analysis. J. Clin. Med. 8(9):1292.
Hedenrud T. M., Svensson S. A., & Wallerstedt S. M. (2013). "Psychiatry is not a science like others" - a focus group study on psychotropic prescribing in primary care. BMC Fam Pract. 14:115.
Klasco R. K., DRUGDEX® System (2017). Thomson Micromedex Publishing.
Kukreja S., Kalra G., Shah N., Shrivastava A. (2013). Polypharmacy in psychiatry: a review. Mens Sana Monogr. 11(1):82-99.
Lader M., Tylee A., & Donoghue J. (2009). Withdrawing benzodiazepines in primary care. CNS Drugs. 23(1):19-34.
Lai H., Hwang S., Chen Y., Chen T., Lin M., & Chen L. (2009). Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the Taiwanese National Health Insurance program. Clin Ther. 31(8):1859-70.
Landis J. R., & Koch G. G. (1977). The measurement of observer agreement for categorical data. Biometrics. 33(1):159-74.
Machado L. M., Colomé J. S., & Beck C. L. C. (2011). Estratégia de Saúde da Família e o sistema de referência e de contrarreferência: um desafio a ser enfrentado. R. de Enferm. UFSM. 1:1.
Popović B., Quadranti N. R., Matanović S. M., Lisica I. D., Ljubotina A., Duliba D. P., et al. (2014). Potentially inappropriate prescribing in elderly outpatients in Croatia. Eur J Clin Pharmacol. 70(6):737-44.
Quintana M. I., Andreoli S. B., Moreira F. G., Ribeiro W. S., Feijo M. M., Bressan R. A., Coutinho E. S., & Mari J. J. (2013). Epidemiology of psychotropic drug use in Rio de Janeiro, Brazil: gaps in mental illness treatments. PLoS One. 8(5):e62270.
Rocha B. S., & Werlang M. C. (2013). Psicofármacos na Estratégia Saúde da Família: perfil de utilização, acesso e estratégias para a promoção do uso racional. Ciênc. Saúde Colet. 18(11):3291-3300.
Rodrigues M. A. P., Fachinni L. A. & Lima M. S. (2006). Modificações nos padrões de consumo de psicofármacos em localidades do Sul do Brasil. Rev Saúde Públ. 40(1):107-114.
Rosa M. B., Perini E., Anacleto T. A., Neiva H. M., & Bogutchi T. (2009). Erros na prescrição hospitalar de medicamentos potencialmente perigosos. Rev. Saúde Públ. 43(3):490-8.
Schmidt I. M., Duncan B. B., Silva G. A., Menezes A. M., Monteiro C. A., & Barreto S. M. (2011). Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 377(9781):1949-61.
Tatro D. S. (2012). Drug Interactions Facts 2013: The Authority on Drug Interactions, Ed L. W. Wilkins.
Thakkar K. B., Jain M. M., Billa G., Joshi A., & Khobragade A. A. (2013). A drug utilization study of psychotropic drugs prescribed in the psychiatry outpatient department of a tertiary care hospital. J Clin Diagn Res. 7(12):2759-64.
Wagner G. A., & Andrade A. D. (2010). Pharmacist professionals in the prevention of drug abuse: updating roles, and opportunities. Braz. J. Pharm. Sci. 46(1):19-27.
World Health Organization (2021). Department of Mental Health and Substances Abuse: WHO Reports. World Health Organization.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Guilherme Vaz de Melo Trindade; Diego Alexandre Gomes Sousa; Ana Elisa Santos Duarte; Jássia Lopes Freitas da Silveira; Roberto Lazzarini de Oliveira; Laryssa de Cássia Ferreira; Pedro Polastri Lima Peixoto; Angelita Cristine de Melo
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.