RESUMO
The management of healthcare waste and end-of-life medication coming from different sources are primary challenges faced by public health leaders. Several factors may be considered critical and inhibitive to reverse logistics within the context of waste management processes. If those factors are not addressed, they may become obstacles to reverse logistics implementation. The purpose of this study is to evaluate the effect that critical factors play in the adoption of end-of-life management practices for medication and its influence on logistics performance. Literature provided some critical factors: management factor, collaboration factor, information technology factor, infrastructure factor, politics factor, financial and economic factor, end-of-life management practices, and logistics performance factor. A sample of 67 professionals from the public pharmaceutical care process answered a structured questionnaire. The collected data was analyzed using partial least square-structural equation modeling. The theoretical structural test confirmed eleven out of the fifteen hypotheses considered. The results have indicated that end-of-life management practices exert a direct influence on logistics performance. The analysis confirmed a direct effect of the information technology factor on end-of-life management practices, but not a moderation effect. Findings have contributed to the literature by providing deeper insights into the relationship between end-of-life management practices for medicines and logistics performance. Moreover, it supports health managers' decision-making in the pharmaceutical care process improvement and engagement with solid waste management policies.
Assuntos
Assistência Farmacêutica , Gerenciamento de Resíduos , Gerenciamento de Resíduos/métodos , Resíduos SólidosRESUMO
End-of-use and end-of-life medicines waste management has been a challenge for public and private managers in different countries. Reverse logistics is a waste management strategy whose application to public pharmaceutical care processes faces legal restrictions and incertitude. Nevertheless, reverse logistics of end-of-use and end-of-life medicines may be both a saving and an environmental strategy in developing countries that manage health under limited resources. How to overcome restrictions to reverse logistics mainly in the context of primary health level? This study aims to investigate the most relevant critical factors for implementing medicine waste management in pharmaceutical care process. The unit analysis is the primary health level process in a developing country capital. Considering the characteristics of the issue at hand, it was designed a qualitative study. Data was collected through semi-structured interviews. The interviewees were key individuals who work directly with the process-from administering medicine to patients to managing waste at the end of the medicine's lifespan or after its use. Results indicated that despite reverse logistics arising from end users is legally forbidden, another type of reverse flow emerged from process analysis. The reverse flow, named reassignment flow, consists of still useful end-of-use medicines exchanged among the 10 government-ran pharmacies and over 140 health centers, where healthcare professionals administer and offer guidance on how to use them correctly. Another result was the identification of the most critical factors in implementing reverse logistics strategies in the public management context. The factors mentioned included aspects pertaining to management, information technology, infrastructure, and government, but they differ from the private context management, in which decision-makers has more freedom. Due to the barriers named by interviewees, the political barriers and complexity of primary health system, results of this investigation point to (i) reinforcing the reassignment flows inside pharmaceutical care logistics cycle, for saving purposes, and (ii) further development of a specific management unit to perform reverse logistics of end-of-use medicines arising from consumers, for environmental purposes. In times of shortage or resources caused by the COVID-19 pandemic, to know the critical factors is a step necessary in overcoming the current restrictions in direction of a well-succeeded medicines reverse logistics, either of reassignment or from final consumers. These results clarify the literature on end-of-use and end-of-life medicines reverse logistics. It also provides managers of 5000 municipalities in the country a perspective on the most relevant critical factors involved in their decision-making process, concerning the reuse of end-of-use medicines or the adequate disposal of end-of-life medicines in the environment.
Assuntos
Assistência Farmacêutica , Assistência Terminal , Gerenciamento de Resíduos , HumanosRESUMO
There is an increasing interest in product recovery, closed-loop supply chains, and reverse logistics (RL) for mitigating environmental impairment. Although RL is becoming a mandatory policy in developed countries, it is still in an embryonic stage in some industrial sectors of emerging economies. The purpose of this study is twofold: (1) identify the critical factors to the successful implementation of RL in the Brazilian pharmaceutical care process (PCP) and (2) determine the cause-and-effect relationships among them. We use snowball sampling to select the relevant RL studies and deductive reasoning and classification to identify the critical factors and a grey decision-making trial and evaluation laboratory (DEMATEL) to evaluate the cause-and-effect relationships among them. The study revealed management, collaboration, information technology, infrastructure, policy, financial and economic, end-of-life management practices, and logistic performance factors as the most relevant factors to the successful implementation of RL in the Brazilian PCP. The end-of-life management practices were identified as the most critical factor, and information technology was identified as the least critical factor. We further determined the end-of-life management practices and policy have the strongest casual relationship. The municipal PCP coordinators can use the findings of this study to formulate mitigating strategies to identify and eliminate barriers to the successful implementation of RL in the Brazilian PCP.