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Advisor(s)
Abstract(s)
A antibioterapia oral é um tema actual quer pela resistência dos agentes face aos químicos, agravada pela selecção menos apropriada dos antibióticos, pela utilização de doses ineficazes ou por uma insuficiente duração dos tratamentos; quer pela perigosa vulgarização do seu uso, e,
mais grave ainda pelo aumento da auto-medicação ou torna sem vigilância médica. Um outro problema actual prende-se com os elevados custos com a saúde em geral e com os custos de comparticipação dos medicamentos por parte de cada país em particular, o que leva há
necessidade imperiosa da sua redução. Perante estes cenários, surgiram recentemente algumas tentativas de uniformização das prescrições terapêuticas, através do aparecimento de formulários terapêuticos, tendo por base o da Organização Mundial de Saúde, com as terapêuticas de
referência que cada médico deve adoptar em cada patologia, sendo as substâncias nele contidas as mais económicas e eficazes, segundo os seus autores. Para este estudo foi considerado o caso particular do "European formulary", destinado exclusivamente à realidade dos países europeus. Tendo por base as orientações terapêuticas deste formulário pretende-se com o presente trabalho verificar a importância deste na prática da clínica geral e a concordância dos médicos às suas orientações, e, paralelamente conhecer a incidência das áreas terapêuticas e das patologias do tracto respiratório e urinário, assim como, saber quais os antibióticos e anti-infecciosos orais de primeira e segunda escolha, e, respectivas substâncias químicas consideradas no tratamento das principais infecções do tracto respiratório e urinário, comparando os dados obtidos com as recomendações do formulário europeu. Para as divergências verificadas entre as indicações terapêuticas do formulário e as que caracterizam a prática da clínica geral da amostra, irá ser realizada em termos económicos uma análise custo-efectividade, em que as conclusões serão apresentadas em termos de custos e de dias de incapacidade poupados.
Os resultados obtidos permitiram concluir que mais de dois terços dos médicos concordam com as orientações terapêuticas dos formulários, no entanto na prática clínica verificou-se um enorme desvio entre o que é designado nos formulários e as suas opções terapêuticas, em especial no que diz respeito ao tratamento das infecções do tracto urinário, ficando assim demonstrada a pouca importância das terapêuticas de referência na prática médica. Os dados apurados indicam ainda a maior incidência da área terapêutica do tracto respiratório em relação à do tracto urinário, assim corno, o domínio absoluto da incidência das patologias do tracto respiratório superior. As penicilinas e suas associações e as quinolonas são os dois principais tipos de antibióticos orais como primeiras escolhas e as cefalosporinas como segunda escolha terapêutica. As substâncias químicas eleitas foram a cefuroxima nas cefalosporinas, a claritromicina, nos macrólidos, a ofloxacina nas quinolonas e nas penicilinas a amoxicilina mais o ácido clavulânico. Em termos da análise custo-efectividade foi possivel concluir que em termos de custos para ambas as escolhas terapêuticas as substâncias prescritas pelos médicos da amostra têm custos muito mais elevados do que as do formulário europeu, sendo a efectividade entre as alternativas semelhante excepto num caso em que se poupa cerca de seis dias de incapacidade.
The oral antibiotherapy is an actual theme be it by the resistance of it's agents to the chemicals, agravated by the less appropriate selection of the antibiotics, by utilization of inefficacious dosage, or by insufficient duration of treatments, be it by the dangerous vulgarization of it's use, and yet more serious by the increase of automedication taken without medicai supervision. One other actual problem is connected with the high cost of health in general and also with the cost of comparticipation on the medicine by each country in particular, which brings the imperative necessity of it's reduction. Facing such cenerys, recently emerged some efforts on the uniformization of therapeutical prescriptions, through the appearance oftherapeutical formularys, having as a base the World Health Organization formulary, with the therapeutical references that each physician must adopt in each pathological case being the mentioned substances the most economic and efficacious, according to it's authors. For this study was consídered the particular case of the " European Formulary," bound exclusively to the reality of the European countrys. Having as a base the therapeutical orientations in this formulary is intended with this work to verify it's importance on the general practice and the physicians concordance to it's orientations, and in parallel to know the incidence of the therapeutical arcas and pathologies of the respiratory and urinary tract, as well as knowing which antibiotics and oral anti-infectious of first and second choice, and respective chemical substances considered in the treatment of the primary infections of the respiratory and urinary tract, comparing the attaineid data with the European Formulary recornmendations. For the verified deviations between, the therapeutical indic,ations, the formulary and the ones that characterize the general practice of the examples, will be accomplished in economical terms a cost effectiveness analysis in which the conclusions will be presented in terms of the cost and saved days of incapacity. Attained results permitted to conclude that more than two thirds of the doctors agree with the therapeutical orientations of the formulary's, however on the clinicai practice was found an enormous deviation between what is designated on the forrnulary's and its therapeutical options, especially on the treatment of infections of the urinary tract, it demonstrates the little importance of the therapies orientation in the clinicai practice. The collected data indicates yet a higher prevalence in the therapeutical area of the respiratory tract in relation to the urinary tract. As well as the prevalence and absolute dominion on the pathologies of the upper respiratory tract. Penicillins its associates and the quinolones are the two principal oral antibiotics given first therapeutical choice and the cephalosporins as the second choice. The elected chernical substances were the cefuroxime on the cephalosporins, the clarithromycin on. the macrolides, the ofioxacin on the quinolones and on penicillin the amoxicillin plus the clavulanic acid. In terms of the cost effectiveness analysis it was possible to conclude that in terms of cost for both therapeutical choices the prescribed substances by the physicians of the example have much higher costs than those in the European Formulary, being the effectiveness between altematives identical except on a case were about six days of incapacity were saved.
The oral antibiotherapy is an actual theme be it by the resistance of it's agents to the chemicals, agravated by the less appropriate selection of the antibiotics, by utilization of inefficacious dosage, or by insufficient duration of treatments, be it by the dangerous vulgarization of it's use, and yet more serious by the increase of automedication taken without medicai supervision. One other actual problem is connected with the high cost of health in general and also with the cost of comparticipation on the medicine by each country in particular, which brings the imperative necessity of it's reduction. Facing such cenerys, recently emerged some efforts on the uniformization of therapeutical prescriptions, through the appearance oftherapeutical formularys, having as a base the World Health Organization formulary, with the therapeutical references that each physician must adopt in each pathological case being the mentioned substances the most economic and efficacious, according to it's authors. For this study was consídered the particular case of the " European Formulary," bound exclusively to the reality of the European countrys. Having as a base the therapeutical orientations in this formulary is intended with this work to verify it's importance on the general practice and the physicians concordance to it's orientations, and in parallel to know the incidence of the therapeutical arcas and pathologies of the respiratory and urinary tract, as well as knowing which antibiotics and oral anti-infectious of first and second choice, and respective chemical substances considered in the treatment of the primary infections of the respiratory and urinary tract, comparing the attaineid data with the European Formulary recornmendations. For the verified deviations between, the therapeutical indic,ations, the formulary and the ones that characterize the general practice of the examples, will be accomplished in economical terms a cost effectiveness analysis in which the conclusions will be presented in terms of the cost and saved days of incapacity. Attained results permitted to conclude that more than two thirds of the doctors agree with the therapeutical orientations of the formulary's, however on the clinicai practice was found an enormous deviation between what is designated on the forrnulary's and its therapeutical options, especially on the treatment of infections of the urinary tract, it demonstrates the little importance of the therapies orientation in the clinicai practice. The collected data indicates yet a higher prevalence in the therapeutical area of the respiratory tract in relation to the urinary tract. As well as the prevalence and absolute dominion on the pathologies of the upper respiratory tract. Penicillins its associates and the quinolones are the two principal oral antibiotics given first therapeutical choice and the cephalosporins as the second choice. The elected chernical substances were the cefuroxime on the cephalosporins, the clarithromycin on. the macrolides, the ofioxacin on the quinolones and on penicillin the amoxicillin plus the clavulanic acid. In terms of the cost effectiveness analysis it was possible to conclude that in terms of cost for both therapeutical choices the prescribed substances by the physicians of the example have much higher costs than those in the European Formulary, being the effectiveness between altematives identical except on a case were about six days of incapacity were saved.
Description
Mestrado em Economia Internacional
Keywords
Formulário terapêutico Infecções do tracto respiratório e urinário Clínica geral Classes terapêuticas Antibióticos orais Análise custo-efectividade Therapeutical formulary Infections of the respiratory and urinary tract General practice Therapeutical classes Oral antibiotics Cost-effectiveness analysis
Pedagogical Context
Citation
Santos, Vitor Manuel Vidal (1998). "A prescrição de antibióticos orais na prática da clínica geral: sua concordância com o formulário terapêutico europeu". Dissertação de Mestrado. Universidade Técnica de Lisboa. Instituto Superior de Economia e Gestão.
Publisher
Instituto Superior de Economia e Gestão