Prescott Gina M, Patzke Ciera L, Brody Peter M, Prescott William A
University at BuffaloSchool of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Buffalo, New York, USA.
University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Buffalo, New York, USA.
Int Health. 2018 Jan 1;10(1):27-32. doi: 10.1093/inthealth/ihx045.
Short-term medical missions (STMMs) have increased and are viewed as a way to extend care in low- and middle-income countries (LMICs). Although benefits may exist, visiting teams may lack insight into using medications safely and effectively. The primary objective was to assess prescribing differences between US-based and Dominican Republic (DR) healthcare providers on STMMs in the DR.
A retrospective database review between January 2013 and 2015 was conducted. Data from US and DR groups were compared for differences in diagnoses, medication classes prescribed and prescriptions per patient.
The mean number of medical conditions diagnosed per patient in the DR (n=423) and US groups (n=1585) were 1.4±0.9 and 1.0±0.8, respectively. The diagnosis of infectious diseases was the same as non-communicable diseases. The DR group prescribed more medications at each patient encounter (mean 2.6 vs 2.2, respectively; p<0.001). The US group prescribed more antibiotics for respiratory infections (US 46.2% vs DR 25.0%; p=0.0001), used more metronidazole than albendazole alone for parasite infections (p=0.0022) and used more oral fluconazole for vaginal candidiasis (p<0.0001) and tinea infections (US 44.6%, DR 14.3%, respectively; p=0.0020).
Although some significant prescribing differences exist between US and DR providers, many similarities were present. Visiting providers should understand the medication use system and disease burden before providing care in an LMIC.
短期医疗任务（STMMs）有所增加，并被视为在低收入和中等收入国家（LMICs）扩大医疗服务的一种方式。尽管可能存在益处，但来访团队可能缺乏安全有效用药的相关知识。主要目的是评估美国和多米尼加共和国（DR）的医疗服务提供者在多米尼加共和国进行短期医疗任务时的处方差异。
对2013年1月至2015年期间的数据库进行回顾性研究。比较美国和多米尼加共和国两组的数据，以分析诊断、所开药物类别和每位患者的处方数量的差异。
多米尼加共和国组（n = 423）和美国组（n = 1585）每位患者诊断出的平均疾病数分别为1.4±0.9和1.0±0.8。传染病的诊断与非传染性疾病相同。多米尼加共和国组在每次患者就诊时开出的药物更多（平均分别为2.6和2.2；p<0.001）。美国组针对呼吸道感染开出的抗生素更多（美国为46.2%，多米尼加共和国为25.0%；p = 0.0001），在寄生虫感染中使用甲硝唑多于单独使用阿苯达唑（p = 0.0022），在阴道念珠菌病中使用口服氟康唑更多（p<0.0001），在癣感染中也是如此（美国分别为44.6%，多米尼加共和国为14.3%；p = 0.0020）。
尽管美国和多米尼加共和国的医疗服务提供者之间存在一些显著的处方差异，但也有许多相似之处。来访的医疗服务提供者在低收入和中等收入国家提供医疗服务之前，应了解当地的用药体系和疾病负担。
