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Resumen: Objetivo: Evaluar los factores relacionados con el uso del Expediente Clínico Electrónico (ECE) desde la percepción de los usuarios médicos y enfermeras de los servicios de salud de un hospital de 2do nivel en Morelos, México. Material y métodos: Se realizó el análisis cualitativo de 22 entrevistas semiestructuradas a personal médico, enfermeras, directivo y administrativo de un hospital de 2do nivel en Morelos, México, tomando como referencia de análisis las dimensiones de normatividad, operatividad y capacitación en la implementación del ECE. Resultados: Se identificó un número insuficiente de computadoras y personal capacitado para operar el ECE. Cuando se logra operar el expediente éste es lento o presenta fallas sistemáticas frecuentes debido a las redes de navegación dependen del navegador central que brinda soporte estatal a la plataforma del ECE sin una resolución pronta cuando hay fallas, las unidades hospitalarias trabajan 24 horas y a nivel central las operaciones del ECE tienen horarios de lunes a viernes de 8 horas. Esto incrementa la resistencia a adoptar el expediente como herramienta de trabajo. La organización colabora a la resistencia al no proporcionar un soporte técnico suficiente y permanente para afrontar las fallas de operatividad del ECE. Los usuarios consideran que el expediente es seguro y confiable, lo cual incrementaría la posibilidad de uso del ECE. Conclusiones: La falta de recursos e ineficiencias en la operación del ECE colaboran a una baja y lenta adopción del expediente; así como la resistencia a utilizarlo. La organización colabora a aumentar la resistencia si la capacitación no es eficiente. Falta le da soporte continuo y suficiente en la infraestructura técnica y recurso humano. A pesar la limitada e ineficiente adopción del ECE se identificaron áreas y personal donde se presenta una mayor utilización (hospitalización y personal médico). Éstas podrían ser las experiencias de aprendizaje positivo que pueden utilizarse para instruir a toda la organización

Abstract: Objective: To evaluate the factors related to the use of the Electronic Medical Record (ECE) from the perception of medical users of health services Morelos, Mexico. Material and methods: The qualitative analysis of 22 semi-structured interviews with medical personnel, nurses, managers and administrators of a 2nd level hospital in Morelos, Mexico was carried out, taking as a reference for analysis the dimensions of regulations, operability and training in the implementation of the ECE. Results: An insufficient number of computers and trained personnel were identified to operate the ECE. When it is possible to operate the file, it is slow or presents frequent systematic failures due to the navigation networks, they depend on the central browser that provides state support to the ECE platform without a prompt resolution when there are failures, the hospital units work 24 hours and centrally. ECE operations have 8-hour hours from Monday to Friday. This increases resistance to adopting the file as a working tool. The organization contributes to the resistance by not providing sufficient and permanent technical support to face the operational failures of the ECE. Users consider that the file is safe and reliable, which would increase the possibility of using the ECE. Conclusions: The lack of resources and inefficiencies in the operation of the ECE contribute to a low and slow adoption of the file; as well as the resistance to use it. The organization helps increase resistance if training is not efficient. Lack gives you continuous and sufficient support in the technical infrastructure and human resources. Despite the limited and inefficient adoption of ECE, areas and personnel were identified where there is greater use (hospitalization and medical personnel). These could be positive learning experiences that can be used to educate the entire organization

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AIMS: The aims were to analyze the dynamics of the medicines formulary in a middle-income country and to analyze the concordance of the included medicines with the national Clinical Practices Guidelines (CPG). METHODS: Medicines and their indications of use included in the Mexican Reference Drug List (Mex-RDL) from 1996 to 2013 were analyzed. The top 10 indications with the highest number of medicines in 2013 were analyzed retrospectively until 1996 in order to identify the increase in the number of medicines to treat each one, as well as the progressive specificity of the indication according to the International statistical Classification of Diseases (ICD-10). The concordance between the CPG and medicines approved for the top 10 indications was studied. RESULTS: The number of medicines included in the Mex-RDL kept constantly growing from 454 drugs in 1996 to 811 in 2013. Up to 26.3% of these medicines were approved to treat only 10 indications (1.5% of all possible indications of use). Many of these new medicines had been approved for more and more specific indications, while the oldest ones had been approved for general indications. Up to 27.6% of the medicines approved for these top 10 indications do not appear in the updated recommendations of the specific CPG for those indications. CONCLUSIONS: During the last 18 years, the new medicines and indications included in the Mex-RDL were redundant and concentrated into few similar clinical conditions. This is a factor that promotes an irrational use of these medicines and, thus, unnecessarily raises the price of health care, undermines the quality of the health system and probably increases the uncertainty of treatments.

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PURPOSE: To assess the rationality of the Mexican Formulary List (MEX-LIST). METHODS: MEX-LIST was compared with the World Health Organization Essential Medicines List (WHO-LIST) to identify drugs classified as unmet needs. For the MEX-LIST rationality evaluation, the assessment of a non-sponsored, systematic and unbiased source (Prescrire Journal) was used for medicines not listed in WHO-LIST. The rating scale of Prescrire classifies medicines as Bravo, Real Advance, Offers an Advance, Possibly Helpful, Nothing New (NN), Judgment Reserved (JR), or Not Acceptable (NA) depending on their comparative therapeutic value. The NN, JR, and NA categories of medicines are further classified as non-added value. RESULTS: The MEX-LIST contains 771 medicines, which is 2.4-fold more than the WHO-LIST (n = 321). Up to 236 medicines in the MEX-LIST perfectly match the WHO-LIST medicines, 40 could be considered as reasonable substitutes, but 45 (14.0 %) present in the WHO-LIST are not present in the MEX-LIST, including an oversupply of 495 medicines. Rationality level could be analyzed for 353 of these: 43.1 % (n = 152) were classified as NN, 12.2 % (n = 43) as NA, and 6.2 % (n = 22) as JR due to limited available information. In summary, 61.5 % of the evaluated medicines present in the MEX-LIST but not included in the WHO-LIST (n = 217) can be considered drugs that do not add substantial therapeutic benefits, this accounts for 28.1 % of the medicines in the MEX-LIST. CONCLUSIONS: MEX-LIST is characterized by a twofold irrationality in that essential medicines to treat prevalent diseases are missing and medicines without any rational added value are in oversupply. This type of study can be easily applied to other countries with the aim of providing a forum for further discussion and improvement of the medicines offered by their national formularies.

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