Santos da Silva André, de Alcantara Maciel Gabriella, Soares de Lima Wanderley Luciane, Gonçalves Wanderley Almir
Universidade Federal do Vale do São Francisco Colegiado de Farmácia Petrolina (PE) Brasil Universidade Federal do Vale do São Francisco, Colegiado de Farmácia, Petrolina (PE), Brasil.
Centro Universitário Tabosa de Almeida Curso de Farmácia Caruaru (PE) Brasil Centro Universitário Tabosa de Almeida, Curso de Farmácia. Caruaru (PE), Brasil.
Rev Panam Salud Publica. 2017 Nov 11;41:e132. doi: 10.26633/RPSP.2017.132. eCollection 2017.
To analyze the rational use of medicines in the context of primary health care (PHC) according to the indicators recommended by the World Health Organization (WHO).
A systematic review of the literature was performed following PRISMA guidelines to synthesize the evidence produced by the application of drug use indicators in PHC in the period from 2011 to 2016. The following databases were searched: PudMed, SciELO and Google Scholar, Virtual Health Library/BIREME, and , using the keywords "World Health Organization," "indicators," "drug utilization," and "rational use of drugs" in Portuguese and English. Original articles describing studies performed at the PHC level, using at least one of the three sets of indicators (prescription, service-related, or health care) were included.
Of the 16 studies included, 56.2% were prospective, 37.5% were developed at a local level, 62.5% employed convenience sampling, 56.2% lasted up to 6 months, and 43.8% were performed in Brazil. Prescription indicators were used most (87.5%), followed by service-related indicators (37.5%) and health care indicators (31.3%). None of the scenarios described in the articles fully met the WHO recommendations. The most frequent interventions suggested to resolve the problems related to the rational use of medications included continuing education for rational prescription (56.3%), use of updated lists of essential medicines, including generic drug names and reflecting the needs of the population (31.3%), and implementation of clinical protocols to standardize therapeutic management (31.3%).
Application of the WHO indicators revealed irrational practices of drug use in PHC in several countries.
根据世界卫生组织（WHO）推荐的指标，分析初级卫生保健（PHC）背景下的合理用药情况。
按照PRISMA指南对文献进行系统综述，以综合2011年至2016年期间在初级卫生保健中应用药物使用指标所产生的证据。检索了以下数据库：PudMed、SciELO和谷歌学术、虚拟健康图书馆/BIREME，并使用葡萄牙语和英语的关键词“世界卫生组织”、“指标”、“药物利用”和“合理用药”。纳入了描述在初级卫生保健层面开展的研究的原始文章，这些研究至少使用了三组指标中的一组（处方、服务相关或卫生保健）。
在纳入的16项研究中，56.2%为前瞻性研究，37.5%在地方层面开展，62.5%采用便利抽样，56.2%持续时间长达6个月，43.8%在巴西进行。使用最多的是处方指标（87.5%），其次是服务相关指标（37.5%）和卫生保健指标（31.3%）。文章中描述的所有情况均未完全符合WHO的建议。为解决与合理用药相关问题而建议的最常见干预措施包括合理处方继续教育（56.3%）、使用更新的基本药物清单（包括通用药物名称并反映人群需求，31.3%）以及实施临床方案以规范治疗管理（31.3%）。
WHO指标的应用揭示了几个国家在初级卫生保健中存在不合理用药行为。
