{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T06:43:39Z","timestamp":1700289819655},"reference-count":19,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2010,4,15]],"date-time":"2010-04-15T00:00:00Z","timestamp":1271289600000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J Technol Assess Health Care"],"published-print":{"date-parts":[[2010,4]]},"abstract":"<jats:p><jats:bold>Objectives:<\/jats:bold>Since 2002, the treatment with cholinesterase inhibitors (CHEIs) for Alzheimer's disease (AD) has been paid for by the public health system of the Brazilian Ministry of Health for any patient that fulfills clinical criteria established by an evidence-based guideline developed and published by the Ministry. The aim of this study was to evaluate compliance of prescription patterns to the national guideline for use of CHEIs\u2019 in the southern Brazilian state of Rio Grande do Sul.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold>We created a regional expert-committee reference center to review all prescriptions of CHEIs and to send feedback to physicians whenever prescriptions without compliance to the guideline were noted. One thousand three hundred ninety-nine (1,399) CHEI prescriptions presented to the public health system from 2005 to 2007 were evaluated by an expert team of neurologists and psychiatrists. Clinical history, performance on mental status screening by Mini Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), laboratory results, and neuroimaging findings were evaluated in relation to the adherence to the national guideline's recommendations. If the prescription was rejected because of lack of adherence to the criteria of the guideline, a written response was sent by the expert committee to physicians concerning the request.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold>The majority of the requests (<jats:italic>n<\/jats:italic>= 1,044; 75 percent) did not meet the AD guideline's criteria, either for diagnosis or for treatment, and were not granted. A diagnostic mistake was evident in 64.3 percent of cases. Findings of vascular or Parkinson's dementia or severe AD were the main reasons for rejection. Rivastigmine was the most prescribed cholinesterase inhibitor, used in 86 percent of cases. Of note was the reduction in the number of CHEIs prescriptions in the years following this intervention.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold>The public health strategy of using expert-review of prescriptions and their compliance to national guideline revealed a low rate of rational use of CHEIs for dementia. Such a strategy is relevant for protecting patients from unproven medical interventions and for reducing waste of resources.<\/jats:p>","DOI":"10.1017\/s0266462310000097","type":"journal-article","created":{"date-parts":[[2010,4,15]],"date-time":"2010-04-15T10:49:30Z","timestamp":1271328570000},"page":"205-210","source":"Crossref","is-referenced-by-count":9,"title":["Increasing rational use of cholinesterase inhibitors for Alzheimer's disease in Brazil: Public health strategy combining guideline with peer-review of prescriptions"],"prefix":"10.1017","volume":"26","author":[{"given":"Paulo Dornelles","family":"Picon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Luiza","family":"Camozzato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elaine A.","family":"Lapporte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael V.","family":"Picon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Humberto Moser","family":"Filho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Ot\u00edlia","family":"Cerveira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00e1rcia L. F.","family":"Chaves","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2010,4,15]]},"reference":[{"key":"S0266462310000097_ref3","first-page":"CD001190","article-title":"Donepezil for dementia due to Alzheimer's disease","volume":"1","author":"Birks","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"S0266462310000097_ref16","unstructured":"16. NICE Technology Appraisal. Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer's disease. NICE technology appraisal no. 111. 2006. www.nice.org.uk\/TA111."},{"key":"S0266462310000097_ref11","doi-asserted-by":"crossref","unstructured":"11. Krug BC , Schwartz IVD , de Oliveira FL , et al. The management of Gaucher disease in developing countries: A successful experience in Southern Brazil. Public Health Genomics. 2009 [Epub ahead of print].","DOI":"10.1159\/000217793"},{"key":"S0266462310000097_ref1","first-page":"CD005593","article-title":"Cholinesterase inhibitors for Alzheimer's disease","volume":"1","author":"Birks","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"S0266462310000097_ref2","first-page":"CD001191","article-title":"Rivastigmine for Alzheimer's disease","volume":"4","author":"Birks","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"S0266462310000097_ref8","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000242630.52203.8f"},{"key":"S0266462310000097_ref14","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.43.18"},{"key":"S0266462310000097_ref18","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-148-5-200803040-00009"},{"key":"S0266462310000097_ref15","unstructured":"15. National Institute for Clinical Excellence. Guidance on the use of Donepezil, Rivastigmine and Galantamine for the treatment of Alzheimer's disease. London: NICE; 2001."},{"key":"S0266462310000097_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S0035-3787(05)85159-8"},{"key":"S0266462310000097_ref12","first-page":"CD001747","article-title":"Galantamine for Alzheimer's disease and mild cognitive impairment","volume":"1","author":"Loy","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"S0266462310000097_ref5","first-page":"167","volume-title":"Protocolos Cl\u00ednicos e Diretrizes Terap\u00eauticas: Medicamentos Excepcionais","author":"Costa","year":"2002"},{"key":"S0266462310000097_ref19","doi-asserted-by":"publisher","DOI":"10.1002\/gps.727"},{"key":"S0266462310000097_ref10","doi-asserted-by":"publisher","DOI":"10.4065\/81.2.223"},{"key":"S0266462310000097_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70195-3"},{"key":"S0266462310000097_ref4","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-200522001-00002"},{"key":"S0266462310000097_ref17","doi-asserted-by":"publisher","DOI":"10.1002\/gps.1591"},{"key":"S0266462310000097_ref7","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.9.1154"},{"key":"S0266462310000097_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afm002"}],"container-title":["International Journal of Technology Assessment in Health Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0266462310000097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T20:34:14Z","timestamp":1685565254000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0266462310000097\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,4]]},"references-count":19,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2010,4]]}},"alternative-id":["S0266462310000097"],"URL":"https:\/\/doi.org\/10.1017\/s0266462310000097","relation":{},"ISSN":["0266-4623","1471-6348"],"issn-type":[{"value":"0266-4623","type":"print"},{"value":"1471-6348","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,4]]}}}