RESUMO
Argentina is a federal republic with approximately 44 million people, divided into 23 provinces and an autonomous city, Buenos Aires. The health system is segmented into public, social security and private subsystems. The social security and private sectors cover more than 60% of the population. Total health expenditure in 2017 was 9.4% of gross domestic product. Primary health care (PHC) was considered as the principal strategy for universal coverage policy for health system reform in Latin America at the end of 20th century. The most remarkable characteristics of the Argentinian health system are its fragmentation and disorganization. An increase of public sector demands, due to a socioeconomic crisis, led to the subsequent collapse of the system, caused primarily by a sustained lack of investment. First care level decentralization to the Integral Health Service Delivery Networks (IHSDN) becomes the cornerstone of a PHC-based system. Pharmacists and community pharmacies are not formally mentioned in PHC policies or IHSDN. However, pharmacies are recognized as healthcare establishments as part of the first care level. Community pharmacists are the only health care professional whose profit comes from the margin on product sales. Contracts with social security and private insurances provide small margins which reduce the viability of community pharmacies. There is a preference by community pharmacies to diversify product sales instead of providing professional services. This is driven by marketing and economic pressures rather than patient care and health policies. Dispensing is the main professional activity followed by management of minor illness and associated product recommendations. Currently, there are no national practice guidelines or standard operating procedures for the provision of pharmaceutical services and there is no nationally agreed portfolio of services. National pharmacy organizations appear to have no official strategic statements or plans which would guide community pharmacies. There are some isolated experiences in community pharmacies and in public first care level pharmacies that demonstrate the possibilities and opportunities for implementing pharmaceutical services under the PHC approach. There is a real lack of integration of community pharmacies and pharmacists in the healthcare system.
RESUMO
El objetivo general de esta tesis fue evaluar la calidad de productos y procesos asociados al suministro de medicamentos en programas de salud para pacientes diabéticos, desde 2 perspectivas: del acceso a medicamentos esenciales de la población (área 1) y de la calidad biofarmacéutica de los medicamentos y su intercambiabilidad (área 2). Los programas de salud y los efectores analizados fueron los del subsector público de la ciudad de Alta Gracia (Córdoba): Programa Córdoba Diabetes (PROCORDIA, provincial), en el Hospital Arturo Umberto Illia. Programa de Detección de Diabetes Tipo 2 de la Dirección de Salud Pública y Remediar (PROAPS, nacional), en la red de 12 Dispensarios, dependientes de la Municipalidad de Alta Gracia. Se trabajó en coordinación con los servicios de farmacia de ambos establecimientos asistenciales. Se consolidaron las bases de datos de pacientes con Diabetes Mellitus (DM) en cada efector y se generó una unificada del subsector público. La prevalencia calculada de DM fue de 3,1%, con más del 80% correspondiente al tipo 2 y uno de cada cuatro pacientes era mayor de 65 años. Se realizaron estudios de utilización de medicamentos de consumo basados en el sistema de clasificación ATC y la DDD como unidad técnica de medida (expresada como número de DDD por 1000 habitantes/día ó DHD). Los consumos globales fueron de 3,37 DHD de insulina y 11,99 DHD de antidiabéticos orales (ADO). Entre los ADO, se utilizaron en mayor proporción Metformina en combinación con Sulfonilureas, seguida por Sulfonilureas y Metformina, sin asociar. Se calculó la adherencia global porcentual a partir del registro de dispensaciones mensuales por paciente, observándo se una baja adherencia promedio entre los pacientes con DM tipo 2 (< 50%) en comparación con los tipo 1 y tipo 2 insulino-requirentes (> 70%).
SUMMARY: The general objective of this thesis was to evaluate the quality of products and processes associated to drug supply in health programs for diabetic patients from 2 perspectives: one of essential medicines access for population (area 1), and the other of biopharmaceutical quality of drugs and their interchangeability (area 2) The health programs and the facilities analyzed were form the public subsector in Alta Gracia city (Córdoba): Programa Córdoba Diabetes (PROCORDIA, provincial), at the Arturo Umberto Illia Hospital. Programa de Detección de Diabetes Tipo 2 of the Dirección de Salud Pública and Remediar (PROAPS, national), into the net of 12 health centers depending to the Municipality of Alta Gracia. This work was coordinated with the pharmacy services of both health care facilities. Databases of patients with Diabetes Mellitus (DM) were consolidated on each center, and a unified one of the public health subsector was generated. The calculated prevalence of DM was about 3.1%, with more than 80% corresponding to type 2, and one of four patients was older than 65 years. Drug utilization studies of consumption, based on the ATC classification system and the DDD as technical unit of measurement (expressed as number of DDD per 1000 inhabitants/day or DHD), were carried out. The global consumptions were 3.37 DHD for insulin and 11.99 DHD for oral antidiabetic drugs. Between the last ones, Metformin in combination with Sulfonylureas were utilized in the mayor proportion, followed by Sulfonylureas and Metformin, alone each one. The global adherence percentage was calculated from monthly dispensing records by patients. A low average adherence was observed among type 2 DM patients (< 50%) in comparison with type 1 and type 2 insulin-requirer ones (>70%).
Assuntos
Humanos , Masculino , Feminino , Diabetes Mellitus , Medicamentos Essenciais , Adesão à Medicação , Farmacoepidemiologia , Serviço de Farmácia Hospitalar , Planos e Programas de Saúde/normas , Argentina/epidemiologiaRESUMO
El objetivo general de esta tesis fue evaluar la calidad de productos y procesos asociados al suministro de medicamentos en programas de salud para pacientes diabéticos, desde 2 perspectivas: del acceso a medicamentos esenciales de la población (área 1) y de la calidad biofarmacéutica de los medicamentos y su intercambiabilidad (área 2). Los programas de salud y los efectores analizados fueron los del subsector público de la ciudad de Alta Gracia (Córdoba): Programa Córdoba Diabetes (PROCORDIA, provincial), en el Hospital Arturo Umberto Illia. Programa de Detección de Diabetes Tipo 2 de la Dirección de Salud Pública y Remediar (PROAPS, nacional), en la red de 12 Dispensarios, dependientes de la Municipalidad de Alta Gracia. Se trabajó en coordinación con los servicios de farmacia de ambos establecimientos asistenciales. Se consolidaron las bases de datos de pacientes con Diabetes Mellitus (DM) en cada efector y se generó una unificada del subsector público. La prevalencia calculada de DM fue de 3,1%, con más del 80% correspondiente al tipo 2 y uno de cada cuatro pacientes era mayor de 65 años. Se realizaron estudios de utilización de medicamentos de consumo basados en el sistema de clasificación ATC y la DDD como unidad técnica de medida (expresada como número de DDD por 1000 habitantes/día ó DHD). Los consumos globales fueron de 3,37 DHD de insulina y 11,99 DHD de antidiabéticos orales (ADO). Entre los ADO, se utilizaron en mayor proporción Metformina en combinación con Sulfonilureas, seguida por Sulfonilureas y Metformina, sin asociar. Se calculó la adherencia global porcentual a partir del registro de dispensaciones mensuales por paciente, observándo se una baja adherencia promedio entre los pacientes con DM tipo 2 (< 50%) en comparación con los tipo 1 y tipo 2 insulino-requirentes (> 70%).(AU)
SUMMARY: The general objective of this thesis was to evaluate the quality of products and processes associated to drug supply in health programs for diabetic patients from 2 perspectives: one of essential medicinesÆ access for population (area 1), and the other of biopharmaceutical quality of drugs and their interchangeability (area 2) The health programs and the facilities analyzed were form the public subsector in Alta Gracia city (Córdoba): Programa Córdoba Diabetes (PROCORDIA, provincial), at the Arturo Umberto Illia Hospital. Programa de Detección de Diabetes Tipo 2 of the Dirección de Salud Pública and Remediar (PROAPS, national), into the net of 12 health centers depending to the Municipality of Alta Gracia. This work was coordinated with the pharmacy services of both health care facilities. Databases of patients with Diabetes Mellitus (DM) were consolidated on each center, and a unified one of the public health subsector was generated. The calculated prevalence of DM was about 3.1%, with more than 80% corresponding to type 2, and one of four patients was older than 65 years. Drug utilization studies of consumption, based on the ATC classification system and the DDD as technical unit of measurement (expressed as number of DDD per 1000 inhabitants/day or DHD), were carried out. The global consumptions were 3.37 DHD for insulin and 11.99 DHD for oral antidiabetic drugs. Between the last ones, Metformin in combination with Sulfonylureas were utilized in the mayor proportion, followed by Sulfonylureas and Metformin, alone each one. The global adherence percentage was calculated from monthly dispensing records by patients. A low average adherence was observed among type 2 DM patients (< 50%) in comparison with type 1 and type 2 insulin-requirer ones (>70%).(AU)
Assuntos
Humanos , Masculino , Feminino , Planos e Programas de Saúde/normas , Diabetes Mellitus , Medicamentos Essenciais , Adesão à Medicação , Serviço de Farmácia Hospitalar , Farmacoepidemiologia , Argentina/epidemiologiaRESUMO
AIMS: To describe the characteristics of diabetic patients' population attended in the public health sector of Alta Gracia city. To analyze the use of amount of monthly dispensations as indicator of adherence to treatment, by comparing the results between settings. To assess the coordination of public facilities for patients attention. DESIGN: observational descriptive-analytical study. SETTINGS: Hospital Arturo Umberto Illia (HAUI) and Dirección de Salud Pública (DSP). Alta Gracia (province of Córdoba, Argentina). SUBJECTS: diabetic patients belonging to health programs at public facilities. MAIN MEASURES: demographic and epidemiological variables, amount of monthly dispensations, percentage of global adherence and coordination of settings. RESULTS: From diabetic patients' total (n=540): 52% were attended at HAUI, 39% at DSP, and 9% at both settings; 55% were female, and the average age was about 56 years old; 81% were type 2 Diabetes Mellitus (DM), 1% type 2 insulin-requiring DM, and 17% type 1 DM; the general mean of amount of monthly dispensations by patient was 4,9 in 12 months. Lack of trained personnel for information managing in both facilities was observed. CONCLUSIONS: The databases allowed knowing some demographic characteristics of diabetic population attended in the public sector of Alta Gracia. The dispensing frequency during 12 months was able to be used as an adherence to treatment indicator. The scarce coordination between care levels and jurisdictions (provincial and municipal) were confirmed. For decision making it is necessary to generate and maintain information systems.
Assuntos
Diabetes Mellitus/tratamento farmacológico , Sistemas de Informação/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Criança , Pré-Escolar , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Sistemas de Liberação de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Setor Público , Adulto JovemRESUMO
OBJECTIVE: Ascertaining pharmacists' views related to factors explaining the lack of visibility of community pharmacies as being health facilities and proposing strategies for improving community pharmacy professional service accessibility using qualitative research techniques. METHODS: The nominal group technique (NGT) was used in two successive rounds using separate guidelines for factors and strategies. Framework analysis was then carried out. RESULTS: Thirty-four ideas related to "factors" and 32 related to "strategies" were obtained. Strategies were grouped into 14 topics, emphasising those prioritising patient-orientated professional services, ethical aspects and pharmacists' ongoing education. DISCUSSION: The techniques used led to identifying situations perceived by pharmacists which are not formally described in the literature. Raising awareness of professional services in community pharmacies implies agreeing on and developing strategies which should be based on joint participation by the pharmacists themselves, professional associations and universities.
Assuntos
Relações Comunidade-Instituição , Farmácias , Argentina , Educação Continuada em Farmácia , Grupos Focais , Humanos , Farmácias/economia , Farmácias/organização & administração , Opinião Pública , Pesquisa Qualitativa , Melhoria de Qualidade , Percepção SocialRESUMO
Objetivo Conocer las opiniones de los farmacéuticos con relación a los factores que explican la falta de visibilidad de la farmacia comunitaria como establecimiento sanitario y proponer estrategias de desarrollo profesional a fin de lograr mejorar la accesibilidad a los servicios profesionales mediante técnicas de investigación cualitativa. Material y métodos Se utilizó una Técnica de Grupo Nominal (TGN) en 2 rondas sucesivas, respondiendo a 2 consignas guía sobre factores y estrategias. Posteriormente se realizó un Framework analysis. Resultados Se aportaron 34 ideas referidas a factores y 32 a estrategias. Las estrategias fueron agrupadas en 14 temas, destacándose las vinculadas a la priorización de los servicios profesionales orientados a los pacientes, al cumplimiento de la ética y a la formación continua del farmacéutico. Discusión Las técnicas utilizadas permitieron evidenciar situaciones percibidas por los farmacéuticos que no están formalmente descriptas en la literatura. Aumentar la visibilidad de los servicios profesionales en las farmacias comunitarias implica acordar y abordar estrategias que deben sustentarse en la participación conjunta de los propios farmacéuticos, las asociaciones profesionales y las universidades.
Objective Ascertaining pharmacists' views related to factors explaining the lack of visibility of community pharmacies as being health facilities and proposing strategies for improving community pharmacy professional service accessibility using qualitative research techniques. Methods The nominal group technique (NGT) was used in two successive rounds using separate guidelines for factors and strategies. Framework analysis was then carried out. Results Thirty-four ideas related to "factors" and 32 related to "strategies" were obtained. Strategies were grouped into 14 topics, emphasising those prioritising patient-orientated professional services, ethical aspects and pharmacists' ongoing education. Discussion The techniques used led to identifying situations perceived by pharmacists which are not formally described in the literature. Raising awareness of professional services in community pharmacies implies agreeing on and developing strategies which should be based on joint participation by the pharmacists themselves, professional associations and universities.
Assuntos
Humanos , Relações Comunidade-Instituição , Farmácias , Argentina , Educação Continuada em Farmácia , Grupos Focais , Farmácias/economia , Farmácias/organização & administração , Opinião Pública , Pesquisa Qualitativa , Melhoria de Qualidade , Percepção SocialRESUMO
OBJECTIVE: To identify the perceived barriers to implementing pharmaceutical care in Argentina. METHOD: A semi-structured questionnaire was designed to carry out a cross-sectional descriptive study. The questionnaires were distributed in different continuing professional development events for pharmacists during November-December 2005. RESULTS: Ninety completed questionnaires were collected with the following distribution: 16.7% at the national congress of hospital pharmacy, 18.9% after a conference, 64.4% during two courses related to pharmaceutical care. The surveyed pharmacists work for community pharmacies (76.7%), hospital/institutional pharmacies (20.0%) and primary care centers (2.2%). The most important barriers mentioned were lack of time, lack of specific training and lack of communication skills. CONCLUSION: The opinions of Argentinian pharmacists from different places and professional practice settings were obtained. In all work settings, "lack of time" is the main barrier to overcome for implementing pharmaceutical care.
Assuntos
Assistência Farmacêutica/economia , Assistência Farmacêutica/tendências , Argentina , Interpretação Estatística de Dados , Pesquisas sobre Atenção à Saúde , Farmácias , Farmacêuticos , Serviço de Farmácia Hospitalar , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To analyze the validity and reliability of a patient satisfaction questionnaire about drug dispensing in Argentine community pharmacies. DESIGN: Descriptive, cross-sectional study. SETTING: Community pharmacies of Argentina that voluntarily agreed to take part in the study. PARTICIPANTS: All patients or their careers who attended the pharmacies during the period of the study (March and April, 2006) and knew how to read and write. MAIN MEASUREMENTS: Scores on the satisfaction scale of the questionnaire. RESULTS: Twenty-seven pharmacies from 6 provinces of Argentina took part; 473 questionnaires were obtained with a 72.4% response rate. Factorial analysis revealed one single component that explained 54.8% of total variance. A 0.90 Cronbach's alpha coefficient was obtained and Pearson's correlation between each of the items and the total score on the scale showed that all items correlated with each other (P<.01). Patients expressed additional comments in 124 questionnaires (26.2%). These concerned the quality of care received and other aspects, such as gratitude, cost of medicines, insufficient stock, and friendliness. CONCLUSIONS: The questionnaire, in showing evidence of content validity, validity as internal structure, validity related to other variables, and reliability, could assess patient satisfaction with the drug dispensing service in the community pharmacies of Argentina.