Overuse of medications in low- and middle-income countries: a scoping review

Bulletin of the World Health Organization, Journal Year: 2023, Volume and Issue: 101(1), P. 36 - 61D

Published: Jan. 1, 2023

To identify and summarize the evidence about extent of overuse medications in low- middle-income countries, its drivers, consequences potential solutions.We conducted a scoping review by searching databases PubMed®, Embase®, APA PsycINFO® Global Index Medicus using combination MeSH terms free text words around overtreatment. We included studies any language published before 25 October 2021 that reported on overuse, screened 3489 unique records 367 reporting over 5.1 million prescriptions across 80 countries - with from 58.6% (17/29) all low-, 62.0% (31/50) lower-middle- 60.0% (33/55) upper-middle-income countries. Of studies, 307 (83.7%) medications, estimates ranging 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes antimicrobials, psychotropic drugs, proton pump inhibitors antihypertensive drugs. Drivers limited knowledge harms polypharmacy, poor regulation financial influences. Consequences were patient harm cost. Only 11.4% (42/367) evaluated solutions, which regulatory reforms, educational, deprescribing audit-feedback initiatives.Growing suggests is widespread within multiple drug classes, few data solutions randomized trials. Opportunities exist build collaborations rigorously develop evaluate reduce medications.Identifier et résumer les données démontrant l'ampleur de la surconsommation médicaments dans pays à revenu faible intermédiaire, mais aussi causes cette surconsommation, ses conséquences pistes solution.Nous avons mené une analyse exploratoire en effectuant recherche bases l'Index mondial l'aide d'une combinaison termes mots texte libre liés aux surtraitements. Nous inclus des études rédigées toutes langues publiées avant le octobre 2021, qui mentionnaient causes, passé revue documents uniques conservé faisant état plus 5,1 millions d'ordonnances intermédiaire – ces concernaient 58,6% faible, 62,0 % ceux tranche inférieure 60,0% supérieure. Sur l'ensemble reprises, (83,7%) signalaient médicaments, avec estimations comprises entre 7,3% 98,2% (écart interquartile: 30,2-64,5). Cette s'observait principalement catégories telles que antimicrobiens, substances psychotropes, inhibiteurs pompe protons antihypertenseurs. Plusieurs étaient évoquées: méconnaissance dégâts polypharmacie, mauvaise réglementation influences économiques. Les surtout néfastes pour santé patients coûts engendrés. À peine 11,4% examinaient parmi lesquelles réformes réglementaires, ainsi initiatives sensibilisation, déprescription d'audit–feedback.Un faisceau croissant preuves indique est largement répandue nombreuses substances, peu d'informations circulent quant issues essais randomisés. Il existe néanmoins opportunités collaboration permettraient développer d'évaluer rigoureusement solution lutter contre médicaments.Identificar y resumir evidencia sobre el grado del uso excesivo medicamentos los países ingresos bajos medios, sus causas, consecuencias posibles soluciones.Se realizó una revisión exploratoria mediante búsquedas las datos partir combinación términos palabras texto sobretratamiento. Se incluyeron estudios cualquier idioma publicados antes octubre informaran excesivo, examinaron registros únicos se informaron más millones recetas con 58,6 todos bajos, medios 60,0 altos. De incluidos, (83,7 %) medicamentos, estimaciones oscilaban 7,3 98,2 (rango intercuartil: Las clases usadas exceso incluían antimicrobianos, psicofármacos, inhibidores bomba protones antihipertensores. Los factores causantes conocimiento limitado daños polifarmacia, falta regulación influencias financieras. daño pacientes coste. Solo 11,4 evaluaron soluciones, encontraban reformas normativas, iniciativas educación, desprescripción retroalimentación auditorías.Cada vez hay evidencias está muy extendido múltiples dispone insuficientes soluciones procedentes ensayos aleatorizados. Hay oportunidades crear colaboraciones para desarrollar evaluar rigor reducir medicamentos.الغرض تحديد وتلخيص الأدلة على مدى الاستخدام المفرط للأدوية في الدول ذات الدخل المنخفض والمتوسط، ودوافع هذا الاستخدام، وعواقبه، والحلول الممكنة له. الطريقة لقد أجرينا مراجعة عن كثب طريق البحث قواعد البيانات PubMed®‎، وEmbase®‎، وAPA PsycINFO®‎، وGlobal باستخدام مجموعة من مصطلحات MeSH، وكلمات نصية حرة بخصوص والمعالجة المفرطة. وقمنا بتضمين دراسات ‎‎‎نُشرت بأية لغة قبل أكتوبر/تشرين أول 2021، وكنا نُبلغ ودوافعه، وحلوله. النتائج قمنا بفحص سجلاً فريداً، وتضمين دراسة كشفت أكثر مليون وصفة طبية دولة دخل منخفض إلى متوسط مع %58.6 كل المنخفض، و%62.0 المتوسط الأدنى، و%60.0 الأعلى. بين الدراسات المشمولة، (%83.7) للأدوية، تقديرات تتراوح %7.3 %98.2 (المدى الشرائح الربعية: 30.2 64.5). وشملت الفئات الأكثر استخدامًا بشكل شائع مضادات الميكروبات، والعقاقير المؤثرة العقل، ومثبطات مضخة البروتون، والأدوية الخافضة للضغط. تضمنت الدوافع معرفة محدودة بأضرار المفرط، وتعدد الأدوية، وسوء التنظيم، والتأثيرات المالية. كانت العواقب هي حدوث الضرر للمرضى، فضلًا التكلفة. قامت %11.4 فقط بتقييم الحلول، والتي الإصلاحات التنظيمية، والمبادرات التعليمية، ومبادرات الحد الوصفات الطبية، التدقيق والمراجعة. الاستنتاج تشير الدلائل المتزايدة أن هو ظاهرة منتشرة والدخل المتوسط، عبر فئات عديدة بيانات قليلة الحلول التجارب العشوائية. توجد فرص لبناء علاقات تعاون لتطوير، وتقييم فعال للحد للأدوية.旨在确定和概述关于中低收入国家药物滥用的程度、其驱动因素、后果和潜在解决方案的证据。.我们通过搜索 PubMed®、Embase®、APA 和 数据库,结合使用 主题词和自由词,对药物滥用和过度治疗情况进行了一项范围审查。我们纳入了 年 10 月 日之前以任何语言发表的研究,并报告了药物滥用的程度、其驱动因素、结果和解决方案。.我们筛选了 项独特记录,纳入了 份研究,报告涉及 个中低收入国家的 510 多万份处方,其中所有低收入国家的研究占 (17/29)、所有中下收入国家的研究占 以及中上收入国家的研究占 (33/55)。纳入的研究中,307 份研究报告了药物滥用的程度,估计范围为 至 98.2%(四分位距:30.2–64.5)。常见的滥用药物包括抗菌药物、精神治疗药物、质子泵抑制剂和抗高血压药。驱动因素包括对药物滥用危害的认识有限、多重用药、监管不力以及财务影响。后果是患者受到伤害并承担费用。只有 研究评估了解决方案,其中包括监管改革、教育、取消处方和审查反馈方案。.越来越多的证据表明中低收入国家普遍存在药物滥用情况,涉及多种药物类别,但有关随机试验中得出的解决方案的数据却很少。应创建机会建立合作,严格开发和评估潜在解决方案,以减少药物滥用情况。.Определить и обобщить данные о масштабах чрезмерного использования лекарственных средств в странах с низким средним уровнем дохода, его движущих факторах, последствиях возможных способах решения проблемы.Авторы провели предварительный обзор путем поиска данных базах Medicus, используя комбинацию терминов слов произвольного текста, касающихся употребления передозировки ими. Были включены исследования на всех языках, опубликованные до октября г., которых сообщалось употребления, причинах, проанализировали уникальных записей включили исследований, более чем млн рецептов дохода. Среди них были из стран 62,0% дохода ниже среднего выше среднего. Из включенных исследований степени средств, при этом оценки колебались от (межквартильный диапазон: 30,2–64,5). Как правило, к числу классов чрезмерно используемых относятся: противомикробные препараты, психотропные средства, ингибиторы протонной помпы антигипертензивные препараты. К движущим факторам ограниченные знания вреде использования, полипрагмазия, слабое регулирование финансовое влияние. Последствия для пациентов заключаются во вреде, причиненном их здоровью, дополнительных затратах. Только оценивались способы проблемы, которые включали программу по реформированию нормативно-правовой базы, инициативы области образования, а также направлении постепенного прекращения определенных внедрения аудита обратной связью.Все больше свидетельствуют том, что чрезмерное использование широко распространено отношении нескольких лекарств, полученных ходе рандомизированных немного. Существуют возможности налаживания сотрудничества целью тщательной разработки потенциальных способов сокращения средств.

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Global prevalence of polypharmacy and potentially inappropriate medication in older patients with dementia: a systematic review and meta-analysis

Frontiers in Pharmacology, Journal Year: 2023, Volume and Issue: 14

Published: Aug. 24, 2023

Background: Older patients with dementia always need multiple drugs due to comorbidities and cognitive impairment, further complicating drug treatment increasing the risk of potentially inappropriate medication. The objective our study is estimate global prevalence polypharmacy medication (PIM) explore factors PIM for older dementia. Methods: We searched PubMed, Embase (Ovid), Web Science databases identify eligible studies from inception 16 June 2023. conducted a meta-analysis observational reporting in using random-effect model. associated were meta-analyzed. Results: Overall, 62 included, which 53 reported 28 polypharmacy. pooled was 43% (95% CI 38–48) 62% 52–71), respectively. Sixteen referred use, 15 pooled. Polypharmacy (2.83, 95% 1.80–4.44), diabetes (1.31, 1.04–1.65), heart failure (1.17, 1.00–1.37), depression (1.45, 1.14–1.88), history cancer (1.20, 1.09–1.32), hypertension (1.46, 1.05–2.03), ischemic disease (1.55, 0.77–3.12), any cardiovascular (1.11, 1.06–1.17), vascular (1.09, 1.03–1.16), chronic obstructive pulmonary (1.39, 1.13–1.72), psychosis (1.91, 1.04–3.53) are positively use. Conclusion: highly prevalent Among different regions, use varied widely. Increasing closely For other such as diabetes, prescribing should be cautioned.

Language: Английский

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Risk of falls or fall-related injuries associated with potentially inappropriate medication use among older adults with dementia

BMC Geriatrics, Journal Year: 2024, Volume and Issue: 24(1)

Published: Aug. 23, 2024

Potentially inappropriate medications (PIMs) are prevalent in older adults with dementia and subsequent falls or fall-related injuries. The present study determined the risk of injuries associated PIM use dementia. National Health Insurance Service-Elderly Cohort Database 2.0 (NHIS-ECDB 2.0) was used for this self-controlled case series (SCCS) study. This included 1430 participants who went through exposure non-exposure periods application among patients experienced outcome events between January 2016 December 2019. incidence during post-exposure compared that period. Beers Criteria were to define PIMs Negative binomial regression conducted. rate ratio (IRR) determine During which occurred, mean number 3.76 (SD = 2.99), most commonly first-generation antihistamines (n 283; 59.1%). Compared period, adjusted IRR period 1.57 (95% CI 1.39–1.76). increased when initiated (1–14 days: 2.76, 95% 2.31–3.28; 15–28 1.95, 1.48–2.56; ≥ 29 1.17, 1.01–1.35). Especially, an greater Among dementia, significantly increase Therefore, strategies should be developed manage prescriptions prevent falls.

Language: Английский

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Potentially Inappropriate Medication Among People With Dementia in China: A Nationwide Cross-Sectional Study

Frontiers in Pharmacology, Journal Year: 2022, Volume and Issue: 13

Published: June 13, 2022

Objectives: The purpose of this study was to explore the prevalence potentially inappropriate medication (PIM) among older outpatients (age ≥ 65 years old) with dementia in eight cities China using AGS Beers criteria 2019 and identify potential factor increasing number PIMs. Methods: A cross-sectional about PIM from January 2020 December carried out China, Chengdu, Beijing, Guangzhou, Shanghai, Shenyang, Tianjin, Zhengzhou, Hangzhou, distributing five major geographical regions (east, west, north, south, central). diagnosis based on International Classification Diseases (ICD-10) identify. Based criteria, prescriptions were evaluated. identification factors completed a binary logistic regression model. Results: Of 18,624 dementia, 3.52% detected 1 PIM, 35.91% received at least two antipsychotic drugs quetiapine olanzapine most frequently prescribed patients accounting for 8.01 7.36%, respectively. Logistic analyses showed that female aged >80 who took more medications exposed easily use. Conclusion: use is highly prevalent, associated risk age, sex, medications. by clinicians anpsychotropic drugs, which much frequent than other drugs.

Language: Английский

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Profile of Drugs Used by the Population of a Municipality in the Southern Brazil Region: Strategies for Pharmaceutical Service and Assistance

Journal of Community Medicine & Public Health, Journal Year: 2023, Volume and Issue: 7(2)

Published: April 21, 2023

Introduction: Pharmaceuticals remained a top priority for the government bodies in both national and international levels, contributing to significant rise overall healthcare cost.Objective: To describe medication waste its cost public health system that provides medicine free of charge.Methods: We analyzed permanent drug donation box collections located Basic Health Units Santa Maria, Brazil, total 12 months, starting September 2017.We outlined quantity, chemical substance, classification whether was expired, unused, leftover or sample.The wastage estimated.Results: collected 80.16 kilograms medication, which included 390 substances.On average, 69.6% medications were therefore wasted.More than half (53.3%) unused.Medication prescribed chronic diseases accounted 60.4% waste.Most medicines related nervous system, alimentary tract metabolism, cardiovascular system.Total wasted R$3,286.94 (US$878,86).Conclusion: In order reduce therapeutic non-adherence amount besides policies provide essential it is imperative enhance rational use through better medical pharmaceutical assistance.

Language: Английский

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O IMPACTO DO FARMACÊUTICO CLÍNICO ATUAÇÃO PERMANENTE DO FARMACÊUTICO NA ALIMENTAÇÃO PARENTERAL EM UTI’SUTI ADULTO

Published: May 23, 2023

utilização indiscriminada de antibióticos, devido a

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BIOPROSPECÇÃO IN SÍLICO DE MICRORGANISMOS PRODUTORES DE β-AMILASE NO SOLO

Published: May 23, 2023

utilização indiscriminada de antibióticos, devido a

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EFEITOS DA SUPLEMENTAÇÃO DE VITAMINA E NA DOENÇA HEPÁTICA GORDUROSA NÃO ALCOÓLICA

Published: May 23, 2023

utilização indiscriminada de antibióticos, devido a

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USO INDISCRIMINADO DE MEDICAMENTOS POR PESSOAS IDOSAS: RESISTÊNCIA MICROBIANA

Published: May 23, 2023

utilização indiscriminada de antibióticos, devido a

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SELEÇÃO DE BACTÉRIAS MULTIRRESISTENTES NO CONTEXTO HOSPITALAR: IMPORTÂNCIA DO TESTE DE SENSIBILIDADE AOS ANTIMICROBIANOS PARA UMA CORRETA FARMACOTERAPIA

Published: May 23, 2023

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