Proposição de estratégia para normatização das prescrições de antimicrobianos na rede de atenção à saúde pública do município de Alegre-ES

Abstract

The use of antimicrobials is related to a higher survival rate through the morbimortality reduction of patients suffering from bacterial, viral, fungal and protozoan infections. However, the use of these medicines very often happens in an uncoordinated way by means of empirical diagnosis and auto medication. Moreover, literature states that the prescribing errors present in clinical practice can lead to bacterial resistance and have a negative impact on the pharmacist’s working process as well as on the patient’s understanding of the therapeutic plan. Therefore, this study aimed at proposing a strategy to standardize the antimicrobial prescribing in the public healthcare network of the municipality of Alegre in the state of Espírito Santo. The theoretical framework is supported by studies related to medication errors, prescription errors and on microorganisms’ resistance to antimicrobials whenever these are used without defined criteria and without a complete/thorough understanding of the therapeutic plan. To this end, in the methodological aspect, a retrospective, cross-sectional study with documental analysis and quantitative approach was made, which corresponds with the analysis of duplicates of retained antimicrobial prescriptions during patients’ assistance at the public community Pharmacy in Alegre/ES between March 2018 and February 2019. This work was approved by the Research Ethics Committee (under number 3.428.060) and obtained a consent letter from the city hall. For Data collection, spreadsheet elaboration with the evaluated parameters, training of assessors and listing of all prescriptions from the period, which were submitted to a simple random sampling in order to obtain the sample for the study, were previously done. Furthermore, prescribers were asked to answer a questionnaire in order to raise their perception in relation to the difficulties and possible strategies to improve the medication prescription process. Data analysis was done through descriptive statistics and proportion statistics (z test), the SPPS software being used in the last one. As to the results, the obtained sample totalized 359 prescriptions with 373 prescribed antimicrobials which, after being evaluated, showed legibility and completeness of information problems, given that only 35,4% of the prescribed antimicrobials were considered completely legible in the parameters of medication name, concentration, quantity, pharmaceutical form, dose/dosage, frequency and duration of treatment; no to mention that in 28,2% there were no data related to the duration of treatment. On the other hand, it showed good/satisfactory conformity with the current legislation when 93% of antimicrobials were prescribed using the DCB (Brazilian Common Denomination). The z Test highlighted statistically significant differences when comparisons were made between physicians and dentists, antimicrobials’ classes, pharmaceutical forms and ultimately, among the levels of complexity existent in the public healthcare network. Finally, the questionnaire demonstrated that 100% of prescribers of the municipality agreed the possibility of using a software to aid prescriptions is necessary. Based on the results, a technical/technological product (PTT) was proposed to be applied in the public healthcare network of the municipality of Alegre/ES, it being elaborated from a situational diagnosis in which there is the proposition of developing a software/app to standardize and assist in the writing of medicament prescriptions as well as using it as a tool for continued education for prescribers. Furthermore, it configures itself as an instrument which promotes a rational and safe prescription. The proposed product complies with the Structuring Project 4 – Organizational transformation and innovation, in the research line 2 – Technology, innovation and operations in the public sector.