RESUMO
This study reports on a prospective Adverse Drug Reaction (ADR) surveillance programme at the Queen Elizabeth Hospital, Barbados, from September 1989 to November, 1992. ADR forms were prominantly displayed in each ward of the Queen Elizabeth Hospital and completed forms were collected by Hospital Pharmacy staff. Data were analysed in terms of frequency of ADRs with reference to age, gender, therapeutic category, the monthly variation in reporting according to department and medical team. A total of 145 reports were considered complete and valid. Antidiabetic agents were implicated in 35 per cent of all reports, while the most commonly reported ADR was hypoglycaemia (32 per cent). The frequency of ADRs was uniform over the age range 10 - 60 years, but increased greatly in patients over 60 years of age. Frequency of reports was dependent on intensity of education and lobbying of doctors to report, and fell sharply when two key team members left the hospital. This study, the first known report of ADR surveillance in the Caribbean, clearly demonstrates that adverse drug reactions contribute significantly to morbidity in our elderly population, as in other reports. Reporting is subject to many variables and is clearly incomplete, but it is an important aspect of total patient care and drug use review. It highlights the risks of some drugs (e.g. sulphonylureas, sulphonamides, potassium sparing diuretics) which may be carelessly used, as well as rare ADRs (AU)
Assuntos
Humanos , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , BarbadosRESUMO
An increasing number of new and expensive antibiotics on the market makes it imperative that costs be contained and an attempt made to rationalise use without comprising patient care. Prerequisites of any containment programme are education of health and medical personnel and a good communication system to provide timely reports on culture and sensitivity results to personnel concerned
Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/antagonistas & inibidores , Antibacterianos/diagnóstico , Antibacterianos/farmacocinética , Antibacterianos/provisão & distribuição , Antibacterianos/uso terapêutico , Antibacterianos/toxicidade , Custos e Análise de Custo/economia , Atenção à Saúde/economiaRESUMO
A pilot survey was conducted to determine use of medicines and patient compliance with therapeutic regimes. A questionnaire was used by interviewers to obtain the relevant information. One hundred respondents were chosen randomly from all parishes in Barbados, and those from group II were selected from medical outpatient prescriptions (one in every five) filled during part of the month of August, 1988 at the Queen Elizabeth Hospital. The data showed no significant overall difference in the prevalence of noncompliance (<90 percent of tablets taken) between group I (44 per cent) and group II (40 percent). However, the degree of non-compliance within certain therapeutic categories was very severe in both groups (zero for six patients in group II). Compliance with antihypertensive medication was particularly bad (24.9 percent) for tablets taken in the non-hospital group (group I). Hoarding was noted for the six (6) patients (with zero compliance) in group II. The cost of drugs wasted as a result of non-utilization for these six (6) patients was $296.00. There was no significant difference between the groups with respect to communication with health-care providers. More than half claimed to have asked drug-related questions of physicians. There was no significant difference between the groups with regards to the reading of the label correctly and knowing the indications for the drugs prescribed. Very few patients knew the names of their medication, although the number who knew the names of their medication was slightly higher in group II. The study shows a very wide spectrum of compliance and medication use. Further and larger stdies are indicated to define reasons for the differences observed and to identify areas for education to promote better compliance (AU)
Assuntos
Uso de Medicamentos , Assistência Ambulatorial , BarbadosRESUMO
The third generation cephalosporins are important additions to the antibiotic armamentarium. A review of 66 prescriptions issued between April 1, 1985 and December 31, 1986 was undertaken to elucidate the appropriateness of cefotaxime use at the Queen Elizabeth Hospital, Barbados. Data analysed included age, sex, diagnosis, whether microbial cultures were taken, culture results, changes in antibiotics therapy and immune status. The ages of the patients ranged from 6 wks to 86 yrs; 55 percent were male and 45 percent were female. The mean duration of antibiotic therapy was 6.4 days (range 1-14 days). Twenty-seven per cent of patients were on the medical service and 73 percent were on the surgical service. Four patients (6 percent) died. Cultures were taken in 53 percent. Fifty-four per cent received empiric, 23 percent prophylactic, and 23 percent definite therapy. A review of patients in whom cultures were done showed that there was a 22 percent incidence of overuse of cefotaxime in cases where alternative, less costly antibiotics could have provided equally effective therapy or prophylaxis. Potential cost savings were found to be significant. It is suggested that third-generation cephalosporins be dispensed only on a consultant's request for suspected gram-negative meningitis or positive cultures where there is resistance or hypersensitivity to effective alternative antibiotics. It is hoped that these guidelines will result in more cost-effective use of these agents (AU)