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Abstract(s)
O desenvolvimento de resistências bacterianas tornou-se um importante problema de saúde pública, contribuindo para uma maior morbilidade e mortalidade dos doentes e, também, com forte impacto nos custos associados aos cuidados de saúde. O consumo excessivo e inadequado de antibióticos é uma das principais causas responsáveis pela propagação de bactérias resistentes como evidenciado por vários estudos ecológicos em que a prevalência de resistências é maior em regiões com grande consumo de antibióticos. O surgimento de infeções graves, por bactérias multirresistentes para as quais os antibióticos disponíveis deixaram de ser eficazes, representa uma importante ameaça a nível mundial, a qual é agravada pela falta de investimento em novos fármacos antibacterianos, demonstrando a necessidade de promover o uso racional de antibióticos. Os farmacêuticos comunitários são importantes intervenientes na decisão do consumo de medicamentos pelos doentes, pelo que intervenções para promover o uso adequado de antibióticos na comunidade devem incluir estes profissionais de saúde. Tendo em conta estes factos, com este trabalho pretendeu-se realizar uma intervenção educativa em farmacêuticos comunitários com o objetivo de diminuir o consumo de antibióticos na população.
Inicialmente realizou-se uma revisão sistemática da literatura sobre intervenções educativas dirigidas a médicos e/ou farmacêuticos para melhorar a prescrição e dispensa de antibióticos. Verificou-se que as intervenções educativas multifacetadas, desenhadas tendo em conta as atitudes e conhecimentos dos profissionais de saúde e focando as habilidades de comunicação com os doentes, são muito eficazes.
Para explorar as atitudes e conhecimentos dos farmacêuticos em relação às resistências bacterianas e ao consumo de antibióticos realizou-se um estudo qualitativo na forma de grupos focais.
Com base nos dados obtidos no estudo qualitativo foi construído um questionário para determinar as atitudes e conhecimentos dos farmacêuticos em relação às resistências bacterianas e ao consumo de antibióticos e avaliar a sua influência na propensão para dispensar antibióticos sem receita médica. Através de um estudo piloto, provou-se a fiabilidade e reprodutibilidade do questionário.
Realizou-se um estudo transversal, que consistiu na aplicação do questionário aos farmacêuticos comunitários da região centro de Portugal. Os resultados mostraram que a complacência com o doente, a atribuição da responsabilidade a causas externas e a precaução/medo são atitudes que influenciam a propensão para dispensar antibióticos sem receita médica. Com base nas atitudes identificadas, desenhou-se uma intervenção educativa ativa dirigida aos farmacêuticos comunitários, que inicialmente incidiu na gravidade do problema das resistências bacterianas e do consumo inadequado de antibióticos, na análise das atitudes identificadas e por último na definição de estratégias de comunicação com o doente.
De seguida, realizou-se um ensaio controlado aleatório por clusters em que 4 clusters pertenciam ao grupo controlo e outros 4 ao grupo intervenção. Cerca de 55% (n=173) dos farmacêuticos pertencentes ao grupo intervenção assistiram à intervenção educativa. A intervenção teve um impacto positivo na redução do consumo total de antibióticos nos 12 meses após a intervenção.
The emergence of bacterial resistance has become a significant public health problem, contributing to patients’ morbidity and mortality, with a major impact on the costs of health care. Excessive or inappropriate use of antibiotics is one of the main causes for the spread of bacterial resistance, as evidenced by various ecological studies in which the prevalence of resistance is greater in regions where antibiotic use is more widespread. The rise of severe infections by multidrug-resistant bacterias for which the available antibiotics are no longer effective is a major threat worldwide, aggravated by the lack of investment in new antibacterial drugs, demonstrating the need to promote the rational use of antibiotics. Community pharmacists are key decision makers regarding which drugs patients will use and how they will use them, such that, any interventions to promote the appropriate use of antibiotics in the community should include pharmacists. Accordingly, a study was carried out based on an educational intervention with community pharmacists to reduce antibiotic use in the population. Initially it was carried out a systematic review of the literature on educational interventions directed at physicians and/or pharmacists to improve, respectively, the prescribing and dispensing of antibiotics was carried out. These interventions were found to be multifaceted and very effective, designed taking into account the attitudes and knowledge of health professionals and focusing on communication skills with patients. To explore the attitudes and knowledge of pharmacists regarding bacterial resistance and antibiotic use, a qualitative study was carried out in the form of focus groups. Based on the data obtained from the qualitative study, a questionnaire was prepared to determine the attitudes and knowledge of pharmacists regarding not only bacterial resistance and antibiotic use but also to evaluate their propensity to dispense antibiotics without a prescription. The reliability and reproducibility of the questionnaire was proved through a pilot study. A cross-sectional study was conducted by applying the questionnaire to community pharmacists in the central region of Portugal. The results showed that complacence with patients, the attribution of responsibilities to external causes and precaution/fear are attitudes that influence their propensity to dispense antibiotics without a prescription. Based on the identification of these attitudes, an active educational intervention aiming community pharmacists was designed to focus on the seriousness of bacterial resistance, the attitudes that had been discovered and, additionally, on communication strategies with the patient. A random controlled trial was finally carried out by clusters, of which four belonged to the control group and the other four to the intervention group. About 55% (n=173) of pharmacists in the intervention group attended the educational intervention, which had a positive impact on reducing the overall use of antibiotics in the 12 months after the intervention.
The emergence of bacterial resistance has become a significant public health problem, contributing to patients’ morbidity and mortality, with a major impact on the costs of health care. Excessive or inappropriate use of antibiotics is one of the main causes for the spread of bacterial resistance, as evidenced by various ecological studies in which the prevalence of resistance is greater in regions where antibiotic use is more widespread. The rise of severe infections by multidrug-resistant bacterias for which the available antibiotics are no longer effective is a major threat worldwide, aggravated by the lack of investment in new antibacterial drugs, demonstrating the need to promote the rational use of antibiotics. Community pharmacists are key decision makers regarding which drugs patients will use and how they will use them, such that, any interventions to promote the appropriate use of antibiotics in the community should include pharmacists. Accordingly, a study was carried out based on an educational intervention with community pharmacists to reduce antibiotic use in the population. Initially it was carried out a systematic review of the literature on educational interventions directed at physicians and/or pharmacists to improve, respectively, the prescribing and dispensing of antibiotics was carried out. These interventions were found to be multifaceted and very effective, designed taking into account the attitudes and knowledge of health professionals and focusing on communication skills with patients. To explore the attitudes and knowledge of pharmacists regarding bacterial resistance and antibiotic use, a qualitative study was carried out in the form of focus groups. Based on the data obtained from the qualitative study, a questionnaire was prepared to determine the attitudes and knowledge of pharmacists regarding not only bacterial resistance and antibiotic use but also to evaluate their propensity to dispense antibiotics without a prescription. The reliability and reproducibility of the questionnaire was proved through a pilot study. A cross-sectional study was conducted by applying the questionnaire to community pharmacists in the central region of Portugal. The results showed that complacence with patients, the attribution of responsibilities to external causes and precaution/fear are attitudes that influence their propensity to dispense antibiotics without a prescription. Based on the identification of these attitudes, an active educational intervention aiming community pharmacists was designed to focus on the seriousness of bacterial resistance, the attitudes that had been discovered and, additionally, on communication strategies with the patient. A random controlled trial was finally carried out by clusters, of which four belonged to the control group and the other four to the intervention group. About 55% (n=173) of pharmacists in the intervention group attended the educational intervention, which had a positive impact on reducing the overall use of antibiotics in the 12 months after the intervention.
Description
Keywords
Antibióticos Intervenções educativas Farmacêuticos comunitários Resistências bacterianas Antibiotics Bacterial resistance Community pharmacists Educational intervention