The aim of this study was to assess drug use and costs before and after bariatric surgery (BS). A systematic review of the literature was carried out using the MeSH terms obesity, bariatric surgery, and drug costs for searches of 10 electronic databases up to July 2014. Data were extracted from the 11 studies (37,720 patients) that fulfilled the inclusion criteria. Where applicable, data were pooled by meta-analysis. The average number of drugs per patient decreased from 3.9 ± 1.86 before surgery to 1.75 ± 1.85 after surgery. Mean reduction in total cost of drugs was 49.8 % over a follow-up duration of 6-72 months. BS is effective for the improvement or resolution of comorbidities and significantly reduces drug use and costs.
As práticas integrativas e complementares estão em fase de expansão. O estudo objetivou conhecer o ambiente entre gestores para a inclusão de fitoterápicos na assistência. Nesta série de casos, descrevemos as percepções de coordenadores de unidades de saúde sobre as práticas integrativas. Os dados foram coletados em um questionário estruturado. O interesse pela inserção das terapias foi demonstrado por 13 dos 15 entrevistados, e o mesmo número relatou uso de fitoterapia. A fitoterapia também é indicada aos usuários por 13 dos coordenadores. O grupo percebe haver maior prescrição de plantas medicinais do que de fitoterápicos. Conclui-se que há boa perspectiva de aceitação da fitoterapia na rede.
CONTEXT AND OBJECTIVE: Bariatric surgery has been an effective alternative treatment for morbid obesity and has resulted in decreased mortality, better control over comorbidities and reduced use of drugs. The objective of this study was to analyze the impact of bariatric surgery on medication drug and nutritional supplement use. DESIGN AND SETTING: Longitudinal study of before-and-after type, on 69 morbidly obese patients in a public hospital in Porto Alegre. METHODS: Through interviews, the presence of comorbidities and use of drugs with and without prescription were evaluated. RESULTS: Among the 69 patients interviewed, 85.5% had comorbidities in the preoperative period, with an average of 2.3 (± 1.5) per patient. The main comorbidities reported were hypertension, diabetes and dyslipidemia. 84.1% of the patients were using prescribed drugs in the preoperative period. The mean drug use per patient was 4.8, which decreased to 4.4 after the procedure. The surgery enabled significant reduction in use of most antidiabetic (84%), antilipemic (77%) and antihypertensive drugs (49.5%). On the other hand, there was a significant increase in use of multivitamins and drugs for disorders of the gastrointestinal tract. The dosages of most of the drugs that continued to be prescribed after surgery were decreased, but not significantly. CONCLUSION: After bariatric surgery, there were increases in the use of vitamins, gastric antisecretory drugs and antianemic drugs. Nevertheless, there was an overall reduction in drug use during this period, caused by suspension of drugs or dose reduction. RESUMO CONTEXTO E OBJETIVO:A cirurgia bariátrica tem sido uma alternativa efetiva de tratamento para a obesidade mórbida, resultando na diminuição da mortalidade, melhor controle das comorbidades e redução no uso de medicamentos. O objetivo deste estudo foi analisar o impacto da cirurgia bariátrica sobre a utilização de medicamentos e suplementos nutricionais. TIPO DE ESTUDO E LOCAL: Estudo longitudinal do tipo antes e depois com 69 pacientes obesos mórbi-dos em um hospital público de Porto Alegre. MÉTODOS: Nas entrevistas, foram avaliados a presença de comorbidades e o uso de medicamentos com e sem prescrição médica. RESULTADOS: De 69 pacientes entrevistados, 85,5% apresentaram comorbidades no período pré-cirúrgi-co, média de 2,3 (± 1,5) por paciente. As principais comorbidades relatadas foram hipertensão, diabetes e dislipidemias. 84,1% dos pacientes estavam em uso de medicamentos sob prescrição médica, no período pré-cirúrgico. A média de uso de medicamentos por paciente foi de 4,8, reduzindo para 4,4 após o procedimento. A cirurgia proporcionou diminuição significativa do uso da maioria dos antidiabéticos (84%), antilipêmicos (77%) e anti-hipertensivos (49,5%). Por outro lado, observou-se aumento significativo na utilização de multivitamínicos e medicamentos para desordens do trato gastrointestinal. A maior parte dos medicamentos que continuaram sendo prescritos após a cirurgia teve sua dose reduzida, no entanto, esta redução nã...
Objective: to estimate usage and wastage of multi-dose and single-dose vaccine vials in the Metropolitan Region of Porto Alegre, Rio Grande do Sul, Brazil, from 2015 to 2017. Methods: a descriptive study was carried out based on secondary data from the National Immunization Program Information System (SIPNI) and the Strategic Health Supplies Information System (SIES). Results: a total of 12,342 records were examined; mean wastage rate was 45.8% (95%CI 39.5;51.7), while usage rate was 54.2% (95%CI 48.3;60.5); vaccines with the highest mean annual wastage rate were MMR (68.8%-95%CI 66.5;71.1), BCG (68.1%-95%CI 65.4;70.7), Hepatitis B (56.4%-95%CI 53.0-59.7) and Yellow Fever (55.9%-95%CI 51.4;60.4). Conclusion: the highest rates of vaccine wastage were for multi-dose vials; although single-dose vaccines also exceeded the acceptable limit defined by the World Health Organization.
Background: Expenses with medicines are relevant and growing in health sector. Therefore, Pharmaceutical Services (PS) operations are designed to play a significant role in improving the social and economic contexts of health.Objective: This article aims to analyze if the Lean Healthcare (LH) practices have been contributing to the improvement of the PS processes.Methods: This study is based on PRISMA guidelines. The search was made in the literature through databases, such as Web of Science, Scopus, Medline (via PubMed), and Embase. In this study, 2878 identified papers were screened. Articles published up to the end of 2017 (and considering a 10-year period) were surveyed. In total, 43 studies met the pre-defined inclusion and exclusion criteria for data analysis in this work, 37 of which were published in 25 periodicals and six in congresses.Results: United States and United Kingdom concentrated 65% of the articles. A predominance of studies was observed in the context of the Hospital Pharmacy sector, emphasizing the LH practices in the Distribution and Use steps in the PS context.Conclusion: The literature on lean thinking applied in the specific context of the PS is relatively recent and scarce, highlighting a more pronounced growth in recent years. It was verified that LH practices in PS have been applied with more emphasis on reducing time and waste of resources, while contributing to process improvement and increased patient safety.
The Pharmaceutical Service (PS) involves a set of drug-related processes, including all logistic movement and promotion of rational use of these products. To deliver the desired value to the users of the health system, the PS network consists of several actors interacting to perform a set of activities, classified in selection, programming, acquisition, storage, distribution and dispensing of medicines (S-P-A-S-D-D). The objective in this research was to test the application of Value Network Analysis in a complex health process. The construction of value network of the PS happened through workshops with the managers of the PS of the municipality of Porto Alegre. As a result, it was observed that the graphical representation provided by the NVA tool, at first, surprised the managers involved, when observing the complexity of the tangible and intangible flows exchanged between the actors of the network. The analysis of the network led to the restructuring of functions and reallocation of pharmaceutical professionals, increasing the number of pharmacists acting directly in the district pharmacies, and structuring a support position for the management of the logistics processes. The changes take place by improving the overall performance of the professionals without any increase in staff or additional expenses with salaries.
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