Los pacientes con reacciones adversas a medicamentos presentan una mayor prevalencia de alteraciones emocionales

Arch Community Med Public Health

2019

Adverse drug reactions (ADRs) cause considerable mortality and morbidity. Its importance becomes greater in relation to the current increase in the use of drugs and multimorbidity. Premarketing studies do not allow a complete knowledge of the safety of a medicine. Many ADRs occurring in the outpatient setting, but there is a signifi cant lack of information regarding the epidemiology of ADRs in this level of health care. Thus, guidance on how to direct attention to effective targets for improvement of medication safety in ambulatory care settings is missing. In this scenario, the general practitioner (GP) is in a rare, special position in the health system, which allows him to combine the clinical tasks of diagnosis and treatment on individuals with epidemiological and public health tasks on communities, including a important role in the study of ADRs's epidemiology. Among the methods aimed at identifying and quantifying the ADRs, in the GP consultation, we have: 1) Data derived from pure clinical observation; 2) Voluntary spontaneous notifi cation systems; 3) Effective local initiatives for improving the collection of reports on ADRs; 4) Careful epidemiological studies, which may include descriptive studies (crosssectional), retrospective (case-control), prospective (cohort), clinical trials, and single-case studies, seasonal variations, longitudinal studies, etc.; 5) Patient reporting of ADRs; 6) The use of algorithms for the diagnostic of ADRs; 7) Intensive telephone surveillance; 8) Collaborative work with Pharmacists working in the community; 9) From the position of the GP (where the entire medical care process begins and ends) the incidence rate of ADRs caused by hospital prescribed drugs can also be observed and collected from discharge of the hospital admissions; And 10) Genetics and electronic health records can go together to identify heritable traits to predisposition to ADRs."The scientifi c purist, who will wait for medical statistics until they are nosologically exact, is no wiser than Horace's rustic waiting for the river to flow away. " Major Greenwood, 1948.

Section: The Distribution Of Adrs In the Populationmentioning

confidence: 99%

The role of general practitioner in the study of adverse drug reactions epidemiology in ambulatory care setting

Arch Community Med Public Health

2019

Strategies and methods to improve compliance in special patient groups and with specific health problems

Arch Community Med Public Health

2020

Adherence to long-term treatments for chronic conditions remains a challenging issue in general medicine. A low proportion of patients follow the recommendations from general practitioners. The attention of all recurrent or chronic health problems and turning points of natural or physiological situations but that present medical health risks requires cooperation with patients and changes in behavior. Taking into account the complexity of the phenomenon of therapeutic compliance, it is necessary to individualize the strategies of approach in general medicine. Some strategies and methods to increase compliance are: 1. Rapport and continuity of care; 2. Confi dentiality; 3. Prevention of effects of adverse drug reactions on compliance; 4. Simplify the therapeutic regimen; 5. Self-monitoring; 6. Avoid giving the impression that the drug replaces the need for changes in habits; 7. Know the patient's agenda, the perceptions of the disease, and the importance and their confi dence about adherence; 8. Involve the patient in the decision; and 9. Motivational interview and negotiation. Emphasis should be placed on the importance of doctor-patient relationship and continuity of care, as well as knowing the patient's agenda, but other strategies are presented according to specifi c groups of patients and diseases and risk factors, as: 1) Cardiovascular risk factors and coronary heart disease; 2) Hypertension; 3) Hyperlipidemia; 4) Diabetes mellitus; 5) HIV; 6) Osteomuscular diseases; 7) Contraception; 8) Gastroenterological diseases; 9) Psychiatric diseases; 10) Bronchial asthma and chronic obstructive pulmonary disease; 11) Kidney diseases; 12) Elders; 13) Teenagers; and 14) Disabled people. Multiple strategies are probably necessary in most cases.

Psychotropic drugs prescription block the positive effects of the doctor-patient communication and relationship

Arch Psychiatr Ment Health

2021

The fact that general practitioner (GP) or psychiatrist understands the psychosocial effects of prescribing on the doctor-patient relationship is as important, if not more so, than knowing pharmacology. Any prescription of drugs modifies the doctor-patient relationship. Drugs, especially psychotropic drugs, act on symptoms and change thoughts, feelings, and behaviors; they can create both physical and psychological dependency; they can discourage a deep search for real solutions, both on the part of the doctor and the patient; they can affect the doctor’s access to the patient and the problem will be out of their reach. Psychotropic drugs can make the effect of the doctor in himself as a drug more difficult, favor an insignificant or problematic or little human relational context, where the GP/psychiatrist does not delve into the true meaning of the symptoms, and the patient tends not to get involved, to make an emotional withdrawal, to be passive before the prescribed drug, and can result in the chronification and structuring of functional symptoms that become organic, with lack of cooperation of the doctor and the patient, and paradoxically with over-compliance or therapeutic discontinuity and the lack of pharmacological adherence, absences to appointments or delays or cancellations of visits, and the denial of responsibility of both the doctor and the patient.