RESUMEN
As the number of people with diabetes increases, the disease with it's complications takes an ever-increasing toll on health care budgets. It is projected to become one of the world's main disablers and killers by 2025. In the Caribbean the rates of diabetes are also projected to continue to climb rapidly. Immediate action is needed to prevent the rise of new diabetics and instill cost-effective interventions in patients with established diabetes. A multidisciplinary team approach is recommended in the provision of diabetes care. The benefits of this approach to diabetes management are well established globally. A "pharmacist-managed" diabetic clinic operating in collaboration with health care team has extended quality and cost-effective services to diabetic population. In the Caribbean, the multidisciplinary team needs an improved collaborative approach within which the vital role of pharmacy practitioner can be defined. The objective of this study is to recommend evidence-based approaches that Caribbean pharmacists as members of diabetes multidisciplinary team, can adopt in order to develop pharmacist-managed diabetes practice. A literature search was conducted from 1995 to present. Of the 49 studies identified only 14 met the inclusion criteria. There were no published studies on diabetes disease management by pharmacists in the Caribbean. The selected studies were reviewed to determine the primary care functions that Caribbean pharmacists should opt to introduce in a pharmacist managed diabetes practice and thereby assist with quality of care and cost effectiveness. Studies from several countries have confirmed the improved quality of health care and positive impact on costs that pharmacists' involvement had on the management of diabetic patients. A Caribbean pharmacist-managed diabetic practice can result in a meaningful and sustained impact on the diabetes epidemic and its escalating cost to regional health systems.
Asunto(s)
Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Gatos , Humanos , Farmacia , Farmacéuticos , Diabetes Mellitus Tipo 2 , Región del Caribe , Trinidad y TobagoRESUMEN
Objective: To describe, analyze, and interpret patterns of psychotropic drug prescribing in new psychiatric patients attending psychiatric outpatients clinics in the Caribbean island of Trinidad. Design and Methods: This was a cross-sectional study of psychotropic drug prescribing by psychiatrists for 132 new psychiatric outpatients who were seen at the outpatient clinics surveyed and who were entering the mental health system during the period of research, November 1998 through February 1999. Results: A single patient could be prescribed more than one psychotropic drug. Antidepressant drugs were the class of psychotropic drugs most prescribed (70 of 132 patients, 59.8 percent), followed by antipsychotropic drugs (67 of 132 patients, 50.8 percent). Tricyclic antidepressants (TCAs) were the antidepressants most prescribed (58 of the 79 patients), mainly amitriptyline (53 of the 58). Fluoxetine was the only selective serotonin reuptake inhibitor (SSRI) prescribed (21 of the 79 patients prescribed antidepressants). Of the 67 patients receiving antipsychotic drugs, phenothiazines accounted for 41 of those 67, including trifluoperazine (14 of the 41) and thioridazine (13 of the 41). The individual antipsychotic most prescribed was sulpiride (21 of the 67 patients). Anticholinergic drugs were prescribed to 20 of the 132 patients (15.1 percent). Eighty-three of the patients were prescribed more than one drug concomitantly (either more than one psychotropic or a combination of psychotropic(s) and nonpsychotropic(s). Prescription by ethnicity, age, and gender coincided with the morbidity rates encountered in these patients. The prescribing of SSRIs to persons of African or East Indian ethnicity was significantly lower than it was for persons of mixed heritage. Conclusions: The prescription patterns of psychotropic drugs in Trinidad revealed the psychiatrists' preferences for traditional psychotropic drugs, the moderate use of anticholinergic drugs, and polypharmacy in some cases, with probable predisposition to adverse drug reactions. Given our results and based on the evaluation of the individual patients, consideration should be given to a broader use of the newer antidepressants (SSRIs) and antipsychotics. Unless justified, polypharmacy should be avoided (AU)