Increasing rational use of cholinesterase inhibitors for Alzheimer's disease in Brazil: Public health strategy combining guideline with peer-review of prescriptions

Picon, Paulo Dornelles; Camozzato, Ana Luiza; Lapporte, Elaine A.; Picon, Rafael V.; Filho, Humberto Moser; Cerveira, Maria Otília; Chaves, Márcia Lorena Fagundes

doi:10.1017/s0266462310000097

Cited by 9 publications

(13 citation statements)

References 15 publications

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“…Como consequência, 38% dos processos de solicitação de IChE não foram deferidos, sendo uma prevalência alarmante se comparada ao não deferimento de outros medicamentos solicitados junto ao CEAF como, por exemplo, imunossupressores (0,7%) 34 . Em um estudo realizado no Rio Grande do Sul, observouse que 62% dos processos de solicitação de IChE para a doença de Alzheimer não foram deferidos e que as principais razões foram a presença de outras demências não-Alzheimer e diagnóstico de demência grave 35 . Uma possível explicação para o não cumprimento dos critérios do protocolo observado no presente estudo é o fato de que o PCDT do Estado de Minas Gerais 11 inclui critérios adicionais de avaliação em relação ao PCDT nacional, com o objetivo de aumentar a especificidade e melhorar a acurácia diagnóstica, a fim de diminuir os custos para o estado ao identificar erros diagnósticos ou grau avançado da doença de Alzheimer (CDR3) que sabidamente não se beneficia do tratamento.…”

Section: Macrorregião Da Grsunclassified

“…Prescritores com menor tempo de profissão apresentaram maior obediência ao PCDT e tiveram mais solicitações atendidas, sendo este o mesmo resultado encontrado pelo estudo realizado no Rio Grande do Sul 35 . Trata-se de um achado pouco investigado na literatura, mas pode sugerir que médicos com maior tempo de prática tenham dificuldade para cumprir o protocolo devido a hábitos ou costumes, chamados por outros autores como "inércia da práti-ca anterior" 36 , ou ainda, que profissionais mais jovens tenham maior acesso e credibilidade às evidências do PCDT.…”

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Acesso aos medicamentos para tratamento da doença de Alzheimer fornecidos pelo Sistema Único de Saúde em Minas Gerais, Brasil

et al. 2016

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Resumo: Avaliou-se as barreiras de acesso ao tratamento da doença de Alzheimer com base nos processos administrativos de medicamentos inibidores da colinesterase (IChE), enviados à Secretaria de Estado de Saúde de Minas Gerais, Brasil, entre 2012 e 2013. Utilizando-se informações de 165 processos selecionados aleatoriamente, abordaram-se as dimensões de acesso: acessibilidade geográfica, acomodação, aceitabilidade, disponibilidade e capacidade aquisitiva. O trâmite administrativo para o fornecimento dos IChE levou em média 39 dias e foi influenciado por características do trajeto percorrido pelo usuário. A maioria dos prescritores cumpriu menos de 80% dos critérios exigidos pelo Protocolo Clínico e Diretrizes Terapêuticas (PCDT) da doença de Alzheimer. Como resultado, 38% dos processos não foram deferidos. A capacidade aquisitiva para o tratamento privado mensal com IChE foi de cerca de 21 dias de salário mínimo. Conclui-se que a burocracia do trâmite administrativo e a dificuldade de seguimento do PCDT pelos prescritores prejudicam o acesso ao tratamento da doença de Alzheimer e constituem uma grande carga para o orçamento dos pacientes.

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Acesso aos medicamentos para tratamento da doença de Alzheimer fornecidos pelo Sistema Único de Saúde em Minas Gerais, Brasil

et al. 2016

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“…We considered possible factors that have prevented the Brazilian government's goal being reached. First, concerning the differences between the treatment rates of dementia and AD, we highlight that cholinesterase inhibitors, available free of cost in Brazil, are only provided to patients who fulfill the clinical diagnostic criteria established by the Brazilian guidelines for AD and not to patients with other types of dementia 18 . This may have influenced the differences found in the present study between the treatment for dementia syndromes (9.7%) and for AD (16.1%).…”

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confidence: 99%

“…Nevertheless, previous randomized trials have revealed that long-term use of Ginkgo Biloba extract did not reduce the risk of AD's progression when compared with a placebo 20,21 . Third, treatment with cholinesterase inhibitors needs periodic reevaluation, every six months, to analyze the drug's effectiveness 18 . If the patient has shown no improvement in, or stagnation of, his or her condition, the medication could be discontinued, as well as if cognition has been severely impaired (very low scores on the MiniMental State Examination) 22 .…”

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confidence: 99%

Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

Moraes

Souza

Lucchetti

et al. 2018

Arq. Neuro-Psiquiatr.

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In light of the high cost of dementia treatment, there is legislation authorizing free distribution of cholinesterase inhibitors to those suffering from Alzheimer’s disease in Brazil. However, the existence of this free distribution does not guarantee adequate distribution. Objectives The present study aimed to investigate the trends of prescriptions and the coverage of Alzheimer’s disease treatment using cholinesterase inhibitors from public pharmacies dispensing high-cost drugs in Brazil. Methods This was a retrospective study that collected data from the Brazilian public Unified Health System. All cholinesterase inhibitors distributed at no cost to Brazilians during the year 2014, as well as the estimated number and percentages of patients who used these medications, were evaluated and compared to data from the year 2008. Results Our estimates indicated that 9.7% of the population having dementia syndromes used cholinesterase inhibitors, as well as 16.1% of those with Alzheimer’s disease in Brazil. A clear disparity was noted between the use and distribution of cholinesterase inhibitors, depending on the region in which they were found. Over time, an increase in the distribution of cholinesterase inhibitors has been noted. In 2008, that use was 12.0% whereas, in 2014, it was 16.1%, an increase of 34% in six years. Conclusion It was estimated that 16.1% of patients with Alzheimer’s disease in Brazil use cholinesterase inhibitors. These values have increased and, in spite of not being satisfactory, they indicate a potential for improvement. However, there is still a significant disparity among the regions.

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“…A previous Brazilian study assessed compliance with the PCDTDA. 11 Only one in four requests for inclusion in the PCDTDA were in accordance with the guidelines. Most requests were from patients with dementia due to Parkinson's disease and vascular dementia (off-label use).…”

Section: Discussionmentioning

confidence: 99%

Monitoring compliance with Clinical Protocol and Therapeutic Guidelines for Alzheimer’s disease

Forgerini

Mastroianni

2020

Dement. neuropsychol.

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Dementia is a chronic neurodegenerative disease and Alzheimer’s disease (AD) is the most prevalent type. Objective: To describe the drug monitoring of patients enrolled in a Clinical Protocol and Therapeutic Guidelines of Alzheimer’s Disease (PCDTDA) in Brazil. Methods: A descriptive study based on interviews conducted in 2017 was performed. Patients diagnosed with Alzheimer’s disease (AD) enrolled on the PCDTDA were included. The variables assessed were age, sex, time since diagnosis, clinical parameters of Mini-Mental State Exam (MMSE) and Clinical Dementia Rating (CDR), drug therapy used and AD drug collection. Results: The drug monitoring of 143 patients was evaluated. Observing the requirements of the screening tests for patient enrolment on the PCDTDA, all patients had scores for at least one MMSE and CDR assessment at protocol admission. None of the patients underwent the first reassessment of the effectiveness of AD drug therapy or the semiannual reassessment. Conclusion: Although PCDTDA provides the best evidence of AD treatment, the data showed failures in the monitoring of the effectiveness of AD drug therapy at dispensing.

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Increasing rational use of cholinesterase inhibitors for Alzheimer's disease in Brazil: Public health strategy combining guideline with peer-review of prescriptions

Cited by 9 publications

References 15 publications

Acesso aos medicamentos para tratamento da doença de Alzheimer fornecidos pelo Sistema Único de Saúde em Minas Gerais, Brasil

Acesso aos medicamentos para tratamento da doença de Alzheimer fornecidos pelo Sistema Único de Saúde em Minas Gerais, Brasil

Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

Monitoring compliance with Clinical Protocol and Therapeutic Guidelines for Alzheimer’s disease

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