Servícios farmacéuticos integrados al proceso de cuidado en salud: gestión clínica del medicamento INTRODUCCIÓNEl resultado de un tratamiento farmacológico está ligado a la interrelación de diversos eventos, actores y condiciones, de forma compleja y no siempre previsible. La farmacoterapia obtiene éxito cuando resultados como la prevención de enfermedades, el control, la cura, la normalización de parámetros de laboratorio y/o el alivio 1 de síntomas se alcanzan conforme lo esperado .La farmacoterapia ocurre de forma adecuada cuando: I) el usuario obtiene acceso y utiliza los medicamentos conforme sus necesidades de salud correctamente identificadas; II) cuando comprende y es capaz de cumplir el régimen terapéutico establecido y está de acuerdo y adhiere al tratamiento con una postura activa; III) cuando el medicamento es efectivo en el alcance de los objetivos terapéuticos establecidos; IV) cuando problemas de salud 2,3 no se generan o agravan por el uso de medicamentos . Fallos en esas condiciones esenciales llevan al sufrimiento humano, incapacidad, reducción de la calidad de vida y muerte. La promoción del uso racional de medicamentos se torna, así, una necesidad urgente para asegurar el máximo de beneficios, minimizando los riesgos en su 4 utilización .Como marcos de referencia en el campo de la promoción del uso racional de medicamentos en Brasil, se pueden citar la Política Nacional de Medicamentos (PNM), firmada en octubre de 1998 (Resolución GM Nº. 3.916/1998) -un instrumento orientador de todas las acciones en el campo de la política de medicamentos en el país -y la Política Nacional de Asistencia Farmacéutica (PNAF), aprobada por el Consejo Nacional de Salud 6 (Resolución Nº. 338/2004) , que contribuyen a la construcción de un nuevo capital social (valores morales, principios éticos y recursos cognitivos) para el campo de la Asistencia Farmacéutica (AF).La AF constituye uno de los sistemas de apoyo de las redes de atención a la salud, junto con el sistema de apoyo diagnóstico y terapéutico y los sistemas de información en salud, con foco en la garantía de acceso y del uso racional 7 de medicamentos . Se comprenden como componentes de la AF la gestión técnica de la asistencia farmacéutica y la gestión clínica del medicamento. La gestión técnica de la asistencia farmacéutica se caracteriza como un conjunto de actividades farmacéuticas interdependientes y enfocadas a la calidad, al acceso y al uso racional de medicamentos, o sea, a la producción, selección, programación, adquisición, distribución, almacenamiento y dispensa de los 8,9 medicamentos .La gestión clínica del medicamento está relacionada a la atención a la salud y a los resultados terapéuticos efectivamente obtenidos, teniendo como foco principal al usuario. Se configura como una actividad asistencial fundamentada en el proceso de cuidado. El medicamento debe estar disponible en el momento adecuado, en óptimas condiciones de uso y debe ser suministrado junto con las informaciones que permitan su correcta utilización 10 por parte del usuario ....
Introdução: A Assistência Farmacêutica é um conjunto de ações voltadas à promoção, proteção e recuperação da saúde, tanto individuais como coletivo, tendo o medicamento como insumo essencial e visando o acesso e ao seu uso racional. Neste sentido, o presente estudo teve como objetivo construir coletivamente uma proposta de reestruturação da assistência farmacêutica em Belém. Metodologia: Trata-se de um relato de experiência ocorrido entre setembro de 2014 e agosto de 2015, fundamentado na pesquisa-ação. Resultado: Pactuação de estratégias para a reestruturação da assistência farmacêutica. Discussão: O processo de trabalho foi fundamentado nos conceitos de governança, planejamento estratégico situacional e gestão por resultados. Conclusão: O processo de governança, planejamento estratégico e gestão da Assistência Farmacêutica necessita ser aprimorado.
Background: Patients over 65 years of age taking multiple medications face several risks, and pharmaceutical interventions can be useful to improve quality of care and reduce those risks. However, there is still no consensus on the effectiveness of these interventions aimed at promoting changes in clinical, epidemiological, economic, and humanistic outcomes for various service delivery, organizational, financial, and implementation-based interventions. The objective of this overview of systematic reviews was to summarize evidence on the effectiveness of community-level pharmaceutical interventions to reduce the risks associated with polypharmacy in the population over 65 years of age. Method: This overview used a previously described protocol to search for systematic review articles, with and without meta-analysis, and economic evaluations, without any language or time restrictions, including articles published up to May 2018. The following databases were searched: the Cochrane Library, Epistemonikos, Health Evidence, Health Systems Evidence, Virtual Health Library, and Google Scholar. The basic search terms used were “elderly,” “polypharmacy,” and “pharmaceutical interventions.” The findings for outcomes of interest were categorized using a taxonomy for health policies and systems. Equity-related questions were also investigated. The studies were evaluated for methodological quality and produced a narrative synthesis. Results: A total of 642 records were retrieved: 50 from Health Evidence, 197 from Epistemonikos, 194 from Cochrane, 116 from Health Systems Evidence, and 85 from the Virtual Health Library. Of these, 16 articles were selected: 1 overview of systematic reviews, 12 systematic reviews, and 3 economic evaluations. There is evidence of improvement in clinical, epidemiological, humanistic, and economic outcomes for various types of community-level pharmaceutical interventions, but differences in observed outcomes may be due to study designs, primary study sample sizes, risk of bias, difficulty in aggregating data, heterogeneity of indicators and quality of evidence included in the systematic reviews that were assessed. It is necessary to optimize the methodological designs of future primary and secondary studies. Conclusion: Community-level pharmaceutical interventions can improve various clinical, epidemiological, humanistic and economic outcomes and potentially reduce risks associated with polypharmacy in the elderly population.
The present article aims at contextualizing the first Brazilian experience with compulsory licensing, which functions as a defense mechanism to prevent excessive pricing by holders of patents. According to this mechanism, a government can authorize a third party to explore the patented object (in this case a drug) without previous consent from the patent holder. On May 4, 2007, Brazil officially issued compulsory licensing of the antiretroviral drug efavirenz for public, non-commercial use. Initially, generic versions of the drug were purchased from laboratories in India. The next step was the manufacture of efavirenz by Farmanguinhos, official pharmaceutical laboratory (Fundação Osvaldo Cruz). It is concluded that the decision made by the Brazilian government to issue compulsory licensing of efavirenz was correct, taking into account the projected savings of US$ 236.8 until 2012 and the guarantee of availability of efavirenz, the most usual free antiretroviral treatment provided in Brazil.
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