A carregar...
Publicação
Prescribing of psychotropic medication by primary health care physicians : a systematically constructed integrative review with narrative synthesis
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 831.26 KB | Adobe PDF |
Orientador(es)
Resumo(s)
Introdução: A prescrição de psicofármacos aumentou significativamente na Europa na última década. Antidepressivos, ansiolíticos e hipnóticos estão entre as classes de fármacos mais prescritas atualmente e os médicos de família são os principais responsáveis por esta prescrição, uma vez que os problemas de saúde mental são maioritariamente geridos nos Cuidados de Saúde Primários apesar da insuficiente informação sobre os padrões de prescrição de psicofármacos neste contexto. Objetivo: Descrever os padrões de prescrição de psicofármacos pelos médicos de família na Europa e identificar fatores comuns que influenciem esta prescrição. Métodos: Uma revisão sistemática de estudos heterogéneos publicados nos últimos dez anos foi realizada através de pesquisa em bases de dados e usando as guidelines PRISMA. Efetuou‐se análise temática e síntese narrativa dos seguintes parâmetros: prevalência; evolução temporal; características, motivos e determinantes da prescrição e desprescrição de psicofármacos. Resultados: 58 estudos representativos de 14 países europeus foram incluídos. A prevalência de prescrição de psicofármacos é maior para antidepressivos, ansiolíticos, sedativos e hipnóticos. Houve um aumento no número de psicofármacos prescritos, na sua variedade, doses e na duração do tratamento e salienta‐se o uso de medicação potencialmente inapropriada principalmente nos idosos, em parte por falta de revisão terapêutica regular. Patologia psiquiátrica como depressão e ansiedade são as indicações mais comuns, mas estes fármacos também são frequentemente prescritos em condições somáticas e funcionais. A prescrição é influenciada por fatores associados ao médico como o conhecimento, experiência, medos e convicções; características dos pacientes como idade, género, contexto social, comorbilidades e expetativas e fatores externos como tempo de consulta, normas informativas, disponibilidade de alternativas como a psicoterapia e pressão de outros profissionais de saúde. Existe importante variação na prescrição entre unidades de saúde. Conclusão: Apesar de analisar muitas variáveis, foi possível identificar padrões nas atitudes face à prescrição de psicofármacos que requerem um estudo mais pormenorizado.
Background: Prescribing and consumption of psychotropic medication has increased significantly across European countries during the last decade. Antidepressants, anxiolytics, and hypnotics are among the most prescribed classes of drugs worldwide and general practitioners are their major prescribers since mental disorders are mainly managed in primary care. There is little information about the overall trends in psychotropics prescribing in this setting. Aim: To describe patterns in psychotropic drug prescribing across European family physicians and identify common factors that affect their prescribing behaviours. Methods: A systematic review of heterogeneous studies published in the last ten years was conducted by electronic database search and using the PRISMA statement. Thematic analysis and narrative synthesis of the following outcomes were performed: prevalence and temporal evolution of prescribing patterns; characteristics of prescribing; reasons for prescribing/deprescribing and determinants of prescribing. Results: Fifty‐eight studies representative of 14 European countries met the inclusion criteria. The prevalence of psychotropic drug prescribing is higher for antidepressants, anxiolytics, sedatives, and hypnotics. There has been an increase in the number of prescriptions, doses, variability of drugs, and treatment duration and there is a widespread use of potentially inappropriate medication mainly in the elderly, in part due to a lack of medication review. Psychiatric conditions like depression and anxiety are the most common indications for prescribing but these drugs are also frequently used in somatic and functional disorders. Prescribing behaviours are influenced by physician’s factors like medical skills, experience, concerns, and beliefs; patient´s characteristics like age, gender, social background, comorbidities, and expectations and external factors like consultation time, guidelines, the availability of treatment alternatives such as psychotherapy and other healthcare professional’s pressure. There is an important variation in psychotropic prescribing by practice. Conclusion: Despite the wide range of outcomes analysed it was possible to identify patterns in prescribing attitudes that require more focused review.
Background: Prescribing and consumption of psychotropic medication has increased significantly across European countries during the last decade. Antidepressants, anxiolytics, and hypnotics are among the most prescribed classes of drugs worldwide and general practitioners are their major prescribers since mental disorders are mainly managed in primary care. There is little information about the overall trends in psychotropics prescribing in this setting. Aim: To describe patterns in psychotropic drug prescribing across European family physicians and identify common factors that affect their prescribing behaviours. Methods: A systematic review of heterogeneous studies published in the last ten years was conducted by electronic database search and using the PRISMA statement. Thematic analysis and narrative synthesis of the following outcomes were performed: prevalence and temporal evolution of prescribing patterns; characteristics of prescribing; reasons for prescribing/deprescribing and determinants of prescribing. Results: Fifty‐eight studies representative of 14 European countries met the inclusion criteria. The prevalence of psychotropic drug prescribing is higher for antidepressants, anxiolytics, sedatives, and hypnotics. There has been an increase in the number of prescriptions, doses, variability of drugs, and treatment duration and there is a widespread use of potentially inappropriate medication mainly in the elderly, in part due to a lack of medication review. Psychiatric conditions like depression and anxiety are the most common indications for prescribing but these drugs are also frequently used in somatic and functional disorders. Prescribing behaviours are influenced by physician’s factors like medical skills, experience, concerns, and beliefs; patient´s characteristics like age, gender, social background, comorbidities, and expectations and external factors like consultation time, guidelines, the availability of treatment alternatives such as psychotherapy and other healthcare professional’s pressure. There is an important variation in psychotropic prescribing by practice. Conclusion: Despite the wide range of outcomes analysed it was possible to identify patterns in prescribing attitudes that require more focused review.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Psicofármacos Prescrição Médico de família Cuidados de saúde primários