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Abstract

BackgroundParkinson’s disease (PD) is a neurodegenerative disease characterized by motor manifestations, autonomic and neurological disorders and sensorial symptoms. Medication therapy management (MTM) consists of a service undertaken by pharmacists to optimize pharmacological therapy results. This way, the pharmacist monitors the treatment prescribed by the doctor and formulates a healthcare plan to guarantee the treatment’s effectiveness, safety and convenience, thereby improving the patient’s quality of life (QoL).ObjectiveTo analyze the effect of MTM upon medicine-related problems, motor symptoms, autonomic disorders and QoL of patients with Parkinson’s disease, and describe the pharmaceutical interventions.MethodsQuasi-experimental uncontrolled before-and-after study carried out between September 2012 and March 2013 in a community pharmacy. Pharmacotherapy data were collected from medical prescriptions, patient diaries, medical charts and all the medicines (over-the-counter and prescription) brought by the patients to the appointment with the pharmacist. The medicine-related problems were classified as indication, effectiveness, safety and adherence. Adherence was measured through clinical interviews and the Morisky questionnaire. PD symptoms were assessed according to the patients’ and/or caregivers’ perceptions about the On/Off state of the motor symptoms and relief of the nonmotor symptoms. QoL was assessed using the PDQ-39 scores. The interventions were targeted to patients/caregivers and/or doctors, with pharmacological and non-pharmacological measures.ResultsSeventy patients were followed up, showing a decrease in medicine-related problems (1.67 ± 1.34 to 0.8 ± 0.9 (p < 0.001), positive impact on adherence (from 37 to 10 non-adherent patients, p < 0.001), QoL improvement related to emotional wellbeing (p = 0.012) and autonomic disorder. Most interventions were performed directly with the patients (73.8%), including non-pharmacological guidance (28.5%), pharmacological guidance (24.3%) and rescheduling (13.6%).ConclusionsTo carry out MTM with PD patients, the pharmacist’s expertise needs to transcend the technical knowledge about the PD pharmacological treatment. The study showed a positive effect with a decrease in the medicine-related problems after the interventions, especially improving adherence and patients’ QoL.

Background The valuation of medicines as health needs vary depending on the stakeholders involved (users, prescribers, managers, etc.) and their expectations. These factors modulate the role of medicines as a health need and influence access to medicines, and could be useful to explain the rising of Judicialization of access to medicines. Aim To conduct a comparative analysis of the causes and consequences of judicialization of access to medicines in Argentina, Brazil, Colombia and Chile from the perspective of medicines as health needs. Methods A qualitative, cross-country study was carried out in these 4 countries. Semi-structured interviews were conducted with 50 representatives of the different stakeholders involved in the judicialization of access to medicines, including Executive branch, Judiciary, health system managers, patient organizations. The interviews were audio-recorded and transcribed verbatim. Thematic analysis used a framework approach based on the theoretical model for medicines as health needs. Findings Representatives from Argentina, Brazil and Colombia considered judicialization of access to medicines as a widespread phenomenon in their respective countries. Meanwhile in Chile, the respondents highlighted that most lawsuits related to the right to health were filed against private insurers because of unjustified increases in the insurance premiums. The comparative analysis showed that judicialization of access to medicines emerged in the four countries regardless of the constitutional protection or the health system population coverage. Among the causes were mentioned difficulties in guaranteeing access to covered medicines and the influence of pharmaceutical marketing on needs assessment and prescription behaviours. The interviewees highlighted the pressure to health system managers to fulfil their responsibilities as a positive impact of litigation. In contrast, the funding of medicines without evidence of efficacy or safety was considered a negative impact. Only in Brazil, judicialization has had impact on R&D policies. In Colombia, litigation also encouraged the recognition of the right to health as a fundamental right and the development of policies for controlling medicines prices. Conclusion The results suggest that applying the adopted theoretical model creates the possibility of identifying critical points to guide policy makers to improve the health systems performances and to control lawsuits for access to medicines. Electronic supplementary material The online version of this article (10.1186/s12939-019-0960-z) contains supplementary material, which is available to authorized users.

Resumo: O Componente Especializado daAssistência Farmacêutica (CEAF) do Sistema Único de Saúde tem como objetivo garantir a integralidade do tratamento medicamentoso em nível ambulatorial. Visando analisar a percepção dos atores envolvidos sobre o Componente, foi realizada pesquisa qualitativa (grupo focal e entrevistas semiestruturadas). Observou-se que há forte dependência do CEAF em relação às outras ações estruturantes na política de saúde. Segundo os atores, a forma de organização e gestão dos serviços não propicia a continuidade da atenção, o que resulta em um cuidado fragmentado. Destacaram-se fatores como falta de articulação entre serviços e profissionais, problemas na organização dos fluxos e oferta insuficiente de serviços. Ainda o foco dos serviços farmacêuticos no medicamento, ou seja, visão minimalista da assistência farmacêutica, tem impactado de diferentes formas no cuidado ao usuário. É necessária a coordenação dos serviços adequados às necessidades em saúde, que deve se traduzir na percepção de continuidade dos cuidados na perspectiva do usuário. Desta forma, o entendimento é: o medicamento tem sido garantido, mas a integralidade do atendimento preconizada nas linhas de cuidado se vê comprometida. Palavras-chave: assistência farmacêutica; integralidade; serviços de saúde; integração de sistemas; avaliação de serviços de saúde.

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Although access to CEAF medicines has improved, there are still some difficulties in guaranteeing treatment access and comprehensiveness.

O Componente Especializado da Assistência Farmacêutica (CEAF) tem como objetivo a garantia da integralidade do tratamento medicamentoso em nível ambulatorial. Dada sua recente implementação, é necessário analisar se os estados possuem condições de executar as ações, atingir e sustentar os resultados esperados. Com este objetivo, é necessária uma avaliação da capacidade de gestão do CEAF no âmbito estadual. Uma das fases da avaliação é o desenvolvimento de um modelo teórico e um modelo lógico, apresentados neste artigo. Com os modelos apresentados, fica clara a complexidade e os diversos fatores que influenciam a capacidade de gestão do CEAF.  Observou-se que há forte dependência do CEAF em relação à outras ações estruturantes na própria política de saúde, nas políticas econômicas, em relação à indústria farmacêutica, entre outros. Somado a isso, os conceitos de gestão e de capacidade de gestão adotados refletem a necessidade de superar a fragmentação e a redução tecnicista imposta à área. Por fim, a construção dos modelos de forma contextualizada auxilia de forma singular no processo de avaliação e auxiliará na análise das condições de estruturação do Componente nos estados, assim como das condições para execução e o alcance dos resultados. Palavras-chaves: Avaliação em Saúde; Gestão em Saúde; Modelos Lógicos; Assistência Farmacêutica; Componente Especializado da Assistência Farmacêutica.