Padrões de uso de antimicrobianos na atenção básica à saúde em município do interior de São Paulo, Brasil
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Data
2022-09-01
Autores
Giacomini, Julia Laurindo
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O uso de antimicrobianos representou um avanço terapêutico considerável, mas tem como efeito indesejável o crescimento da resistência bacteriana. Uma proporção relevante desse uso ocorre em ambulatórios e na atenção básica (também chamada atenção primária à saúde). Faltam estudos que abordem de forma ampla esse uso (em termos quantitativos e qualitativos). ). O objetivo deste estudo é entender a prescrição de antimicrobianos e o impacto do seu uso na atenção básica de saúde.Metodologia: Realizamos um estudo epidemiológico ecológico misto (transversal e prospectivo) para avaliação dos padrões de prescrição e dispensação de antimicrobianos e resultados de exames microbiológicos realizados em 18 Unidades Básicas de Saúde (UBS) do município de Botucatu (SP). Resumidamente foram realizados: (i) quantificação do uso (através dos indicadores do sistema Anatomical Therapeutical Chemical / Defined Daily Dose (ATC/DDD); (ii) caracterização qualitativa de prescrições (apropriadas x não apropriadas); (iii) análise de grupamentos para identificar padrões de prescrição e sua distribuição espacial; (iv) estudo do conhecimento e atitudes de médicos prescritores nas UBS. Resultados: Em 2019, foram identificadas 33.262 dispensações de antimicrobianos, das quais 27.495 (82,7%) envolviam agentes sistêmicos. A dispensação total de agentes sistêmicos foi de 146.385,60 Doses Diárias Definidas (DDD) por 100.000 habitantes. Os medicamentos mais dispensados foram Amoxicilina (81.716,33), Cefalexina (25.843,20), Metronizadol (13.546,11) e Norfloxacina (11.094, 12). Em análise de cluster, o padrão de prescrição de antimicrobianos foi semelhante em um grupamento de UBS que se localizavam em regiões periféricas ou rurais do município. Dentre as 27. 495 instâncias de prescrição (IP) identificadas, somente 2.410 continham informações de prontuário suficientes para caracterização qualitativa. Destas, 60,10% apresentavam alguma inadequação, sendo metade destas o uso desnecessário. Idosos acima de 80 anos, tratamento de faringite e uso de penicilinas e quinolonas foram fatores estatisticamente associados a inadequações na análise multivariada. Por outro lado, UBS localizadas em áreas de vulnerabilidade social ou pertencentes ao cluster periférico apresentavam menor ocorrência de erros. Conclusão: A prescrição e a dispensação de antimicrobianos em UBS são intensas, com inadequações em quase dois terços dos casos. Curiosamente, a localização de unidades em regiões periféricas de baixa renda está associada a menor ocorrência de erros de prescrição.
Introduction: The use of antimicrobials represented a considerable therapeutic advance, but the undesirable effect is the growth of bacterial resistance. A relevant proportion of this use occurs in outpatient clinics and in primary care. There is a lack of studies that broadly address this use (in quantitative and qualitative terms). The objective of this study is to understand the prescription of antimicrobials and the impact of their use in primary health care. Methodology: We carried out a mixed-design epidemiological study (cross- sectional and prospective) to evaluate the patterns of prescribing and dispensing antimicrobials and the results of microbiological tests performed in 18 Basic Health Units (BHU) in the city of Botucatu (SP). Briefly, the following were performed: (i) quantification of use (through indicators of the Anatomical Therapeutical Chemical / Defined Daily Dose (ATC/DDD) system; (ii) qualitative characterization of prescriptions appropriateness; (iii) identification of prescription patterns and their spatial distribution; (iv) a small study the knowledge and attitudes of prescribing physicians in the BHU. Results: In 2019, 33,262 dispensations of antimicrobials were identified, of which 27,495 (82.7%) involved systemic agents. The total dispensing of systemic agents was 146,385.60 Defined Daily Doses (DDD) per 100,000 inhabitants. The most dispensed medications were Amoxicillin (81,716.33), Cephalexin (25,843.20), Metronidazole (13,546.11) and Norfloxacin (11,094.12). In cluster analysis, the pattern of antimicrobial prescribing was similar in a group of BHU that were located in peripheral or rural regions of the city. Among the 27,495 instances of prescription (IP) identified, only 2,410 contained enough medical recorded information for qualitative characterization. Of these, 60.10% had any inadequacy, half of which were unnecessary use. Elderly people over 80 years of age, treatment of pharyngitis and use of penicillins and quinolones were factors statistically associated with inadequacies in the multivariable analysis. On the other hand, UBS located in areas of social vulnerability or belonging to the peripheral cluster had a lower occurrence of errors. Conclusion: The prescription and dispensing of antimicrobials in BHU are intense, with inadequacies in almost two thirds of the cases. Interestingly, the location of units in low-income peripheral regions is associated with a lower occurrence of prescription errors.
Introduction: The use of antimicrobials represented a considerable therapeutic advance, but the undesirable effect is the growth of bacterial resistance. A relevant proportion of this use occurs in outpatient clinics and in primary care. There is a lack of studies that broadly address this use (in quantitative and qualitative terms). The objective of this study is to understand the prescription of antimicrobials and the impact of their use in primary health care. Methodology: We carried out a mixed-design epidemiological study (cross- sectional and prospective) to evaluate the patterns of prescribing and dispensing antimicrobials and the results of microbiological tests performed in 18 Basic Health Units (BHU) in the city of Botucatu (SP). Briefly, the following were performed: (i) quantification of use (through indicators of the Anatomical Therapeutical Chemical / Defined Daily Dose (ATC/DDD) system; (ii) qualitative characterization of prescriptions appropriateness; (iii) identification of prescription patterns and their spatial distribution; (iv) a small study the knowledge and attitudes of prescribing physicians in the BHU. Results: In 2019, 33,262 dispensations of antimicrobials were identified, of which 27,495 (82.7%) involved systemic agents. The total dispensing of systemic agents was 146,385.60 Defined Daily Doses (DDD) per 100,000 inhabitants. The most dispensed medications were Amoxicillin (81,716.33), Cephalexin (25,843.20), Metronidazole (13,546.11) and Norfloxacin (11,094.12). In cluster analysis, the pattern of antimicrobial prescribing was similar in a group of BHU that were located in peripheral or rural regions of the city. Among the 27,495 instances of prescription (IP) identified, only 2,410 contained enough medical recorded information for qualitative characterization. Of these, 60.10% had any inadequacy, half of which were unnecessary use. Elderly people over 80 years of age, treatment of pharyngitis and use of penicillins and quinolones were factors statistically associated with inadequacies in the multivariable analysis. On the other hand, UBS located in areas of social vulnerability or belonging to the peripheral cluster had a lower occurrence of errors. Conclusion: The prescription and dispensing of antimicrobials in BHU are intense, with inadequacies in almost two thirds of the cases. Interestingly, the location of units in low-income peripheral regions is associated with a lower occurrence of prescription errors.
Descrição
Palavras-chave
Antimicrobiano, Atenção Primária à Saúde, Resistência bacteriana, Farmacoepidemiologia, Antimicrobial, Primary health care, Pharmacoepidemiology, Bacterial resistance