Desde a publicação da primeira relação de medicamentos essenciais da Organização Mundial da Saúde (OMS), em 1977, essa instituição de saúde e diversas outras em todo o mundo têm fomentado a importância da promoção de políticas de medicamentos essenciais para os serviços de saúde. Apesar da inegável contribuição para a promoção do uso racional de medicamentos, a implantação de comitês que gerenciem a implantação de listas de medicamentos essenciais ainda é um desafio para os gestores do Sistema Único de Saúde (SUS). Este trabalho teve como objetivo utilizar uma ferramenta de gestão, proposta pelo economista Carlos Matus, para a superação das dificuldades de implantação de Comissões de Farmácia e Terapêutica nos serviços hospitalares do estado de Sergipe. Para isso, a equipe de pesquisadores realizou, em conjunto com os atores do serviço, a implantação do Planejamento Estratégico Situacional (PES) por meio dos momentos explicativo, normativo, estratégico e tático-operacional. Por meio deste trabalho, observou-se que o método PES caracteriza-se como uma ferramenta recomendada para a implantação de atividades fundamentais da seleção de medicamentos, agrupadas em três objetivos gerais alcançados: 1) a regulamentação de fluxos e procedimentos para a seleção de medicamentos; 2) a organização de comissões de farmácia e terapêutica e 3) a elaboração de listas de medicamentos essenciais.
ABSTRACT ABSTRACTObjective Objective Objective Objective Objective: To evaluate the improper use of antimicrobials during the postoperative period and its economic impact. Methods Methods Methods Methods Methods: We conducted a prospective cohort study by collecting data from medical records of 237 patients operated on between 01/ 11/08 and 31/12/08. Results
Results ResultsResults Results: from the 237 patients with the information collected, 217 (91.56%) received antimicrobials. During the postoperative period, 125 (57.7%) patients received more than two antimicrobials. On average, 1.7 ± 0.6 antimicrobials were prescribed to patients, the most commonly prescribed antibiotic being cephalothin, in 41.5% (154) of cases. The direct cost of antimicrobial therapy accounted for 63.78% of all drug therapy, this large percentage being attributed in part to the extended antimicrobial prophylaxis. In the case of clean operations, where there was a mean duration of 5.2 days of antibiotics, antimicrobials represented 44.3% of the total therapy cost. ConclusionConclusion Conclusion Conclusion Conclusion: The data illustrate the impact of overuse of antimicrobials, with questionable indications, creating situations that compromise patient safety and increasing costs in the assessed hospital.
Each year, evidence-based clinical guidelines gain more space in the health professionals’ practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations.
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