Las enfermeras andaluzas realizan 3,1 millones de indicaciones de medicamentos y productos sanitarios en 2014

Las enfermeras andaluzas realizaron en 2014 un total de 3,1 millones de órdenes enfermeras por un importe de 81,8 millones de euros, lo que supone, por ejemplo, el 61% de indicaciones de productos sanitarios de los centros de atención primaria (llegando en algunos distritos sanitarios y áreas de gestión sanitaria al 80% de indicaciones).

De esta forma, las enfermeras se han convertido en las profesionales que prescriben más productos sanitarios en la sanidad pública andaluza. La consejera en funciones de Igualdad, Salud y Políticas Sociales, María José Sánchez Rubio, ha destacado esta actividad de las enfermeras y ha recordado que “Andalucía fue pionera, en 2009, en la implantación del modelo de prescripción enfermera que ha permitido ofrecer una respuesta más ágil y cómoda a la ciudadanía, especialmente a las personas que requieren cuidados a domicilio o a las personas con enfermedades crónicas, evitando desplazamientos innecesarios al centro de salud u hospital”.

En el marco del Día Internacional de la Enfermería, Sánchez Rubio ha destacado el desarrollo de las nuevas competencias de la enfermería y la labor fundamental que vienen realizando estas profesionales en áreas como atención a la dependencia, a las personas de mayor vulnerabilidad o su papel relevante en los cuidados ante la muerte.

La indicación de medicamentos que no necesitan prescripción médica ha supuesto el 0,30% del total de las indicaciones, frente al 99,7% de la prescripción de productos utilizados para el cuidado de las heridas (vendas, gasas, apósitos estériles…) o para la incontinencia urinaria.

En lo que respecta a órdenes enfermeras de absorbentes, apósitos y tiras reactivas, la prescripción enfermera en centros de salud supera a la prescripción médica. En centros de especialidades y hospitales las prescripciones de la enfermería suponen un 37% del total (alcanzando el 57% en algunos centros).

Respondiendo a los objetivos de la Estrategia de Cuidados de la Consejería de Igualdad, Salud y Políticas Sociales, entre los que se encontraba dotar a las enfermeras de un marco competencial más amplio, se aprobó esta nueva competencia que ahora se busca regular a nivel nacional.

Precisamente, la Consejería de Igualdad, Salud y Políticas Sociales viene demandando que el modelo andaluz, ampliamente desarrollado y con excelentes resultados, sea referente para el futuro Real Decreto que prepara el Ministerio de Sanidad, Servicios Sociales e Igualdad por el que se regulará la indicación, uso y autorización de dispensación de medicamentos y productos sanitarios de uso humano por parte de los profesionales de enfermería.

En Andalucía, se ha seguido avanzando, y los profesionales de enfermería colaboran con los equipos médicos en el seguimiento, a través de protocolos de actuación, de los pacientes que cuenten ya con determinados tratamientos farmacológicos, como es el caso de personas con diabetes, con anticoagulantes orales y en sedación paliativa.

New non-surgical treatment for uterine fibroids can improve quality of life and maintain fertility

A new, effective, non-surgical treatment for uterine fibroids can help women with this condition maintain their fertility, an American scientist told the 26th annual meeting of the European Society of Human Reproduction and Embryology in Rome today (Wednesday). Dr. Alicia Armstrong, Chief, Gynecologic Services, National Institutes of Health (NIH) Programme in Reproductive and Adult Endocrinology, Bethesda, Maryland, said that the outcome of two Phase II clinical trials of ulipristal acetate (UPA) had significant implications for both infertility and general gynaecology patients.
UPA belongs to a relatively new class of drug, the selective progesterone receptor modulators or SPRMs. It is currently used for emergency contraception, and acts by blocking the progesterone receptor and hence ovulation (release of the egg). Recent research has shown that progesterone also plays a role in the development of uterine fibroids, which affect 24 million women in Europe and can lead to a range of symptoms such as abdominal pain and discomfort and heavy and irregular menstrual bleeding. Fibroids are the major indication for hysterectomy in Europe and the US, and they also contribute to infertility by interfering with the ability of the embryo to implant in the womb and causing miscarriage.
"Both the fibroids and the surgical interventions commonly used to treat them can cause significant fertility problems," said Dr. Armstrong, "and we wanted to see whether fibroids could shrink and surgery could be avoided by using an SPRM."
Results from two Phase II randomised, placebo-controlled, double-blinded studies performed at NIH were pooled and analysed. In the trials, women aged from 25-50 years with symptomatic uterine fibroids were randomised to receive UPA or placebo once a day for three menstrual cycles. The researchers found that, out of the 57 patients who it was possible to evaluate for efficacy, 18 received placebo, 20 10mg of UPA per day and 19 20mg per day. Those taking UPA had reduced total fibroid volume, with those taking the higher dose doing better – 14 (70%) in the 10mg group and 16 (84%) in the 20 mg group. The patients on placebo did significantly less well with only six (33%) showing reduction in fibroid volume.
UPA also reduced bleeding compared with placebo and during the third month of treatment 16 (80%) of patients taking 10mg daily and 18 (95%) on a daily dose of 20mg experienced no menstrual bleeding. At the end of the treatment, patients on the active treatment scored higher in assessment of their quality of life, the severity of their symptoms, their energy levels and mood and their overall concern about the effects of fibroids.
Estradiol levels remained adequate for bone health during treatment in 77%, 100% and 95% of patients in the UPA 10mg and 20mg and placebo groups, respectively, indicating that the action of the ovaries was not impaired, and neither were there any serious side effects. Some women taking UPA had transient increases in liver function tests and a few had the changes in the endometrium that have previously been seen with this class of compounds.
"The results of these trials are convincing and lead us to conclude that UPA is an effective non-invasive treatment for fibroids that can help maintain fertility in women whose only option up to now was to have surgery," said Dr. Lynnette Nieman, Principal Investigator on the NIH trials. "We hope that the results from these trials, along with those from the Phase III trials currently being conducted by the Swiss company PregLem SA, will allow us to offer this treatment to women who do not want surgery or are unable to have it for medical reasons."
Researchers at the National Institute of Child Health and Human Development are currently carrying out further studies of the molecular action of UPA, Dr Nieman said. "These studies will not only help us understand how the treatment works in women with uterine fibroids, but may give us pointers about which patients might benefit most."