As diretrizes clínicas visam ao aperfeiçoamento do cuidado ao paciente, trazendo recomendações a serem seguidas por profissionais, gestores e pacientes acerca de uma condição de saúde. No sistema público de saúde brasileiro, são denominadas como Protocolos Clínicos e Diretrizes Terapêuticas (PCDT) e constituem-se como os documentos oficiais para garantir a assistência terapêutica integral. Objetivo: apresentar o processo de desenvolvimento e qualificação dos PCDT no Ministério da Saúde. Método: relato de experiência descritivo-reflexivo. Resultados: desenvolvidos desde o ano 2000, e com mais de 100 PCDT já publicados, a importância desses documentos como instrumento de gestão, informação e controle social é crescente. A incorporação da Saúde Baseada em Evidências, parcerias com instituições de excelência e a padronização de etapas para elaboração e atualização dos PCDT possibilitaram importantes avanços nesse processo. Para o aprimoramento contínuo desses documentos, o Ministério da Saúde propõe um guia metodológico para sua elaboração, ampliação da participação social, e a busca por novas estratégias de implementação. Espera-se, com isso, aumentar a credibilidade dos PCDT junto aos prescritores, gestores, agentes do direito e sociedade, qualificando a assistência à saúde no SUS com base na melhor evidência científica disponível, na transparência do processo e no empoderamento dos usuários do sistema.
Asthma is a chronic inflammatory disease of the airways that may lead to limitations in regular activities, to hospitalizations and a decrease in quality of life. Adherence to drug treatment is crucial for control of the disease. The use of medicinal herbs can reduce adherence to prescriptions, as the medication may be replaced by infusions or herbal products. The objective of this study was to evaluate the frequency of use of traditional herbal medicine among severe asthmatics in Salvador. Information on use of homemade remedies was obtained through application of a questionnaire during patient visits to a referral center. We also collected data on economic and social aspects as well as disease control. One hundred and forty-four (91,1%) out of one hundred and fifty-eight patients evaluated used herbal medicines, but only 26.5% attributed improvement of asthma symptoms to this alternative treatment and only 8 had substituted a prescribed medication by herbal medicines. There was a trend towards lower adherence to prescription drug treatment in this group of patients. Despite the high frequency of use of medicinal herbs in our sample, there was no improvement in the asthma treatment in this population compared to non-users. Adherence to conventional drug treatment was satisfactory and there was neither reduction in asthma control nor increase in hospitalizations among the users of medicinal plants.Uniterms: Asthma/adherence to drug treatment. Medicinal herbs/use.A asma é uma enfermidade inflamatória crônica das vias aéreas que pode resultar em limitações nas atividades diárias, internações e prejuízo da qualidade de vida. A adesão ao tratamento medicamentoso é fundamental para o controle da doença. O uso de plantas medicinais pode reduzir a adesão ao tratamento prescrito, à medida que os medicamentos são substituídos por chás ou ervas. O objetivo deste estudo foi avaliar a frequência de uso de plantas medicinais entre asmáticos graves em Salvador. As informações sobre uso de remédios caseiros foram obtidas por meio de questionário durante a visita dos pacientes a um centro de referência. Foram coletados dados econômicos, sociais e de controle da doença. Cento e quarenta e quatro (91,1%) dos cento e cinqüenta e oito pacientes avaliados utilizavam plantas medicinais, dos quais apenas 26,5% atribuíam melhora dos sintomas da asma a este tratamento alternativo e somente 8 pacientes já haviam feito a substituição de medicamento por alguma planta medicinal. Houve tendência a menor adesão ao tratamento medicamentoso neste grupo de pacientes. Apesar da alta frequência do uso de plantas medicinais na nossa amostra, não houve melhora no tratamento da asma desta população em relação aos não-usuários. A adesão ao tratamento medicamentoso foi satisfatória, não havendo piora no controle da asma ou aumento em hospitalizações entre os usuários de plantas medicinais.Unitermos: Asma/adesão ao tratamento medicamentoso. Plantas medicinais/uso.
INTRODUCTION:Since the creation of the National Committee for Health Technology Incorporation in the Brazilian Health System (CONITEC), a new phase started in the public Brazilian Health System (SUS): a continuous updating of the system based on Health Technology Assessment (HTA). CONITEC was created by federal law in 2012 and is responsible for advising the Ministry of Health regarding the incorporation or disinvestment of health technologies. The whole process involves a strong interaction with society, including the composition of the committee, which has the participation of the National Health Council. The objective of this study was to describe the results of CONITEC in five years of operation.METHODS:This is a retrospective descriptive study, based on information from the database (period 2012–2016) and CONITEC's website.RESULTS:Since 2012, CONITEC assessed 541 technologies, including drugs (360), health products (71) and procedures (110); 303 assessment requests came from SUS agencies and institutions and the other 238 requests from pharmaceutical companies, medical societies, patient associations and the judiciary bodies. In this period, there were 190 public consultations, during which more than 24,000 feedback from society were received. The average time for evaluation was 146 days. The committee recommended the incorporation of 186 technologies into SUS, the disinvestment of 43 and was unfavorable to the incorporation of 88, generating a budgetary impact of approximately BRL2.5 billion (USD764 million).CONCLUSIONS:From 2012–2016, CONITEC tripled the average annual incorporation of new technologies compared to the period 2006–2011. In this process, it was necessary to assess efficacy, safety and cost-effectiveness of technologies, generating positive results for the expansion of access, health gains for patients and sustainability for the system. It should be considered that the use of evidence for decision making strengthens transparency in public management and the development of active processes of information, communication and social participation.
IntroductionThe Brazilian Unified Health System (SUS) is known worldwide for ensuring universal assistance to citizens, which includes the supply of medicines free of charge. Biological drugs consume about 40 percent of the public budget for pharmaceutical services in the SUS and Rheumatoid Arthritis (RA) is the largest consumer of these resources, serving about 110,000 patients. Since 2002 there has been a clinical guideline for the care of patients with rheumatoid arthritis in Brazil, currently providing 10 biological drugs for treatment of RA. The objective of this study is to present data about the provision, expenditure and profile of users of biological drugs for rheumatoid arthritis in SUS.MethodsRetrospective and exploratory study, using administrative data regarding the purchase and consumption of biological drugs Infliximab, Etanercept, Adalimumab, Rituximab, Abatacept (intravenous and subcutaneous), Tocilizumab, Golimumab and Certolizumab pegol for the treatment of RA between 2012 and 2017 in SUS.ResultsThere was an expenditure of approximately USD 421.7 million from the Brazilian Ministry of Health with the supply of about 2 million pharmaceutical units of biological drugs for treatment of rheumatoid arthritis, 79 percent of them destined for female users and 89.2 percent for the 40-69 age group. The M05.8 and M.06.0 codes of the International Classification of Diseases (ICD-10) were the most prevalent among the arthritic population served. Adalimumab and Etanercept accounted for 68.3 percent of total expenditure. A reduction in the use of these medicines were observed after the availability of new drugs for the treatment of the disease between 2014 and 2017.ConclusionsBrazil is one of the largest consumers of biological medicines in the world. The use of real-life data allows monitoring trends and costs of the use of these drugs as well as changes with the entry of new therapies and biosimilar medicines.
INTRODUCTION:The National Committee for Health Technology Incorporation (CONITEC) (1) was created in 2011, when the participation of civil society in the Health Technology Assessment (HTA) process was formalized in Brazil. According to legislation, patient and public involvement (PPI) in HTA occurs through: public consultations (PC); representation of SUS (Brazilian Public Health System) users in the plenary of CONITEC and by public hearings in relevant cases. Due the incipient culture of social participation in Brazil, strategies involving better communication, direct participation and popular education were developed to broaden and qualify this participation.METHODS:•Case study about PPI strategies developed in 5 years of CONITEC•Analysis of documents and official records from the Brazilian Ministry of Health.RESULTS:Since its creation, the innovations of CONITEC regarding PPI were: creation of specific PC form to reproduce or represent the perspectives of patients and caregivers; summarized versions of technical reports written in a simplified language to improve users involvement; surveys prior to elaborating clinical guidelines, a bi-weekly educational program transmitted by streaming, and the recent launch of an HTA Users Guide and a mobile app.After the implementation of these strategies (which started in 2014), there was an increase of annual contributions, from 2,584 in 2014 to 13,619 in 2015. Most participants were patients, family members or caregivers. Surveys concerning clinical guidelines received about 3,000 contributions. There were thirty-seven published society reports until December 2016. The publication of the HTA Users Guide and other related actions increased the number of accesses to the CONITEC website and its subsection for social participation. The educational program had more than 800 online accesses in five months.CONCLUSIONS:These actions allowed expanding and qualifying PPI beyond what is legally defined, and it is possible to predict an increasingly favorable scenario regarding the patient and public participation in HTA in Brazil.
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