Histórico, desafios e mudanças da auditoria no SUS enquanto instrumento de gestão / History, challenges and changes of auditing in the SUS as a management tool

Este trabalho de pesquisa realizou um histórico da Auditoria no SUS, sua formação, organização e atuação nas duas primeiras décadas dos anos 2000, evidenciando o Sistema Nacional de Auditoria, e seu órgão, o DENASUS, cuja nomenclatura foi recentemente modificada para AUDSUS. Destacou também, nesse contexto, o componente estadual de Auditoria da Secretaria de Estado de Saúde do Rio de Janeiro e seu alinhamento com os Planos Estaduais de Saúde. Buscou evidenciar as legislações que acompanharam e acompanham a Auditoria no SUS e sua correlação com outros conceitos e outros Órgãos do Poder Público, como o Tribunal de Contas da União e a Controladoria Geral da União, pontuando os principais desafios e mudanças que se desdobraram. (AU)

This research work carried out a history of Auditing in the SUS, its formation, organization and performance in the first two decades of the 2000s, highlighting the National Audit System, and its body, DENASUS, whose nomenclature was recently changed to AUDSUS. He also highlighted, in this context, the state Audit component of the Rio de Janeiro State Health Secretariat and its alignment with the State Health Plans. It sought to highlight the laws that followed and follow the Audit in the SUS and its correlation with other concepts and other Public Power Bodies, such as the Federal Court of Auditors and the General Comptroller of the Union, pointing out the main challenges and changes that unfolded. (AU)

A comunicação de risco nas plataformas digitais oficiais da pandemia no Brasil / Risk communication in the official digital media of the pandemic in Brazil

Considerando a primeira onda do cenário pandêmico e a necessária operação de políticas e estratégias que promovam o autocuidado da população para a mitigação da disseminação do vírus da COVID-19, constatamos aqui, as ações adotadas nas plataformas digitais oficiais da administração pública federal no período de março a outubro de 2020. Para tal, utilizamo-nos do método da análise de conteúdo sobre tudo o material publicitado pelo Ministério da Saúde nas plataformas Twitter, Youtube, Facebook, Instagram, Spotify, Soundcloud, e sites oficiais; ministério da saúde, hotsite da pandemia, e blog da saúde. Com a análise, constatamos o prevalecimento de conteúdos que privilegiam a ilustração dos feitos do ministério, a 1. Autopromoção da própria gestão, com 27,57 parcent do total das publicações, 2. Promoção do autocuidado 18,87 por cento, 3. Dados oficiais com 18,55 por cento, 4. Notícias do cotidiano com 18,03 por cento 5. Comunicação técnica para públicos especializados com 9,25 por cento, e 6. Operação técnica estrutural com 7,73 por cento. Com 3428 postagens e 428 073 246 interações avaliadas, vimos os conteúdos de promoção do autocuidado (18,87 por cento) serem suprimidos por 81,13 por cento e outros aspectos abordados pela comunicação oficial do governo. Constatamos dessa forma que a ausência do devido suporte comunicativo oficial em nível equivalente às demandas sanitárias apresentadas na pandemia que se instaurou, abre espaço para lacunas de orientações essenciais à população, e até mesmo de desinformação, o que pode ter comprometido o enfrentamento rigoroso da disseminação do vírus(AU)

Considerando la primera ola del escenario pandémico y el necesario funcionamiento de políticas y estrategias que promueven el autocuidado de la población para mitigar la propagación del virus COVID-19, se recogen en este trabajo las acciones realizadas en los medios digitales oficiales de la ciudadanía federal en el período comprendido entre marzo y octubre de 2020. Para ello se utilizó el método de análisis de contenido en todo el material publicitado por el Ministerio de Salud en las plataformas Twitter, Youtube, Facebook, Instagram, Spotify, Soundcloud y sitios web oficiales; Ministerio de Salud, sitio de acceso a la pandemia y blog de salud. Con el análisis se constató la prevalencia de contenidos que privilegian la ilustración de los logros del Ministerio: 1. La autopromoción de la propia gestión, con el 27,57 por ciento del total de publicaciones, 2. promoción del autocuidado,18,87 por ciento, 3. Datos oficiales con 18,55 por ciento, 4. Noticias diarias con el 18,03 por ciento, 5. Comunicación técnica para públicos especializados con 9,25 por ciento, y 6. Operación técnica estructural con 7,73 por ciento. En las 3428 publicaciones y 428 073 246 interacciones evaluadas se apreció que el contenido de promoción del autocuidado (18,87 por ciento) fue suprimido por el 81,13 por ciento de otros aspectos abordados por la comunicación oficial del gobierno. De esta forma se encuentra que la ausencia de un adecuado soporte comunicativo oficial, que sea equivalente a las demandas de salud presentadas en la pandemia, abre espacio a lagunas en los lineamientos esenciales para la población e, incluso, a la desinformación que puede haber comprometido la situación para el enfrentamiento riguroso a la diseminación del virus(AU)

Considering the first wave of the pandemic scenario and the necessary operation of policies and strategies that promote the population's self-care to mitigate the spread of the COVID-19 virus, we see here the actions taken in the official digital media of the federal public administration in the period from March to October 2020. To this end, we used the method of content analysis on all material advertised by the Ministry of Health on the platforms Twitter, Youtube, Facebook, Instagram, Spotify, Soundcloud, and official websites; ministry of health, pandemic hotsite, and health blog. With the analysis, we verified the prevalence of contents that privilege the illustration of the ministry's achievements, the 1. Self-promotion of the management itself, with 27.57percent of the total publications, 2. Self-care promotion 18.87percent, 3. Official data with 18.55percent, 4. Daily news with 18.03percent, 5. Technical communication for specialized audiences with 9.25percent and 6. Structural technical operation with 7.73percent. With 3428 posts and 428,073,246 interactions evaluated, we saw self-care promotion content (18.87percent) being suppressed by 81.13percent of other aspects addressed by official government communication. In this way, we found that the absence of proper official communicative support at a level equivalent to the health demands presented in the pandemic that was established, leaves gaps in essential guidelines for the population, and even misinformation, which may have compromised the rigorous confrontation of the dissemination of the virus(AU)

The birth of a Ministry of Public Health in Colombia, 1946-1953: Cold War, invisible government and asymmetrical interdependence / El nacimiento de un Ministerio de Salud Pública en Colombia, 1946-1953: Guerra Fría, gobierno invisible e interdependencia asimétrica

Abstract This article studies the shift from a Ministry of Hygiene in Colombia to a Ministry of Public Health, from 1946 to 1953. This was not only a new name for the ministry, but a transitional process from government policies based on European public hygiene towards institutionalizing the North American model of public health. The process involved negotiations between local government representatives and the Currie Mission, which was sent to Colombia by the Inter-American Bank for Reconstruction and Development and the Inter-American Cooperative Health Service. These negotiations took place via asymmetrical relationships of interdependence, within the framework of the "invisible government" implemented by the United States in Latin America during the Cold War.

Resumen Este artículo estudia el cambio de un Ministerio de Higiene en Colombia a un Ministerio de Salud Pública, de 1946 a 1953. Este no fue solo un nuevo nombre para el ministerio sino un proceso de transición de políticas gubernamentales basadas en la higiene pública europea hacia la institucionalización del modelo norteamericano de salud pública. El proceso involucró negociaciones entre representantes del gobierno local y la Misión Currie, que fue enviada a Colombia por el Banco Interamericano de Reconstrucción y Desarrollo y el Servicio Cooperativo Interamericano de Salud. Estas negociaciones se dieron a través de relaciones asimétricas de interdependencia, en el marco del "gobierno invisible" implementado por Estados Unidos en América Latina durante la Guerra Fría.

Ética y jurisprudencia administrativa de los derechos de los sujetos de investigación en pandemia (COVID-19): función de los comités éticos científicos: Chile / Ethics and administrative jurisprudence of the rights of subjects of research in pandemic (COVID-19): role of the scientific ethics committees: Chile

RESUMEN: Todo gobierno debe reaccionar rápida y efectivamente ante cualquier pandemia, Chile no es la excepción y apoyado en el estado de Excepción Constitucional, ha tenido que implementar medidas que podrían involucrar poca información sobre las percepciones de las personas y las reacciones durante la implementación de las restricciones. Las instituciones internacionales de salud han determinado que es un deber moral realizar investigaciones que generen evidencia que promuevan y mejoren la atención de la salud y la mitigación de la pandemia, instando a reducir los "obstáculos" prácticos de la revisión ética. Los objetivos de este trabajo fueron analizar desde las perspectivas de las consideraciones éticas y jurídicas, el rol que cumplen los Comités Éticos Científicos en el manejo y la protección de las personas durante la pandemia de la COVID-19. La metodología de trabajo se basó en la recolección de la información de Instituciones nacionales e internacionales de Salud y luego analizarla según la jurisprudencia administrativa del gobierno de Chile. Se concluye que los cambios de criterios que deben observar los CECs en el proceso de revisión de los protocolos de los proyectos de investigación científica, deben velar por proteger los derechos de los pacientes y sujetos de investigación en cuanto puede involucrar información sensible, más aún, si se consideran las graves consecuencias de su transgresión, dar un sentido distinto al que corresponda a las normas sobre derechos de pacientes, puede resultar en "falta de servicio" y eventual vulneración en los derechos del sujeto de investigación. La labor de los CEC, debe realizarse siempre desde una interpretación restrictiva, reconociendo la función pública que cumplen como parte integrante de la labor ética encomendada por el legislador al efecto.

SUMMARY: Every government must react quickly and effectively to any pandemic, Chile is no exception and supported by the state of Constitutional Exception, it has had to implement measures that could involve little information about people's perceptions and reactions during the implementation of the restrictions. International health institutions have determined that it is a moral duty to carry out research that generates evidence that promotes and improves health care and the mitigation of the pandemic, urging to reduce the practical "obstacles" to ethical review. The objective of this study was to analyze from the perspectives of ethical and legal considerations, the role that Scientific Ethics Committees play in the management and protection of people during the COVID-19 pandemic. The methodology used was based on collecting information from national and international Health Institutions and then analyzing it according to the administrative jurisprudence of the Chilean government. It is concluded that the changes in criteria that the CECs must observe in the process of reviewing the protocols of scientific research projects, must ensure the protection of the rights of patients and research subjects insofar as it may involve sensitive information, even more if the serious consequences of its transgression are considered. Giving a different meaning to the one that corresponds may result in "lack of service" and eventual violation of the rights of the research subject. The task of the CEC, must always be carried out from a restrictive interpretation, recognizing the public function that they fulfill as an integral part of the ethical work entrusted by the legislators to that effect.

As campanhas contra o Influenza e seu caráter educacional: análise do material produzido em 2016 / Campaigns against Influenza and its educational character: analysis of the material produced in 2016 / Campañas contra la Influenza y su carácter educativo: análisis del material producido en 2016

O avanço das complicações desenvolvidas pelas doenças é notável, tanto no número crescente de mortes quanto no de internações, sendo o vírus Influenza um dos representantes dos causadores desses males. Dessa forma, buscam-se maneiras eficazes de prevenir doenças como a gripe; entre tais medidas estão lavar as mãos com frequência, não compartilhar determinados objetos e, como ação mais eficaz, a vacinação. Por tal motivo, o trabalho em que se baseia este artigo tem o objetivo de analisar os tipos de conteúdo presentes em materiais elaborados pelo Ministério da Saúde no Brasil para campanha de vacinação contra a gripe no ano de 2016. A pesquisa faz uso das categorias de análise prescritas por Antoni Zabala acerca das práticas de ensino e aprendizagem. No decorrer da análise foi observado que o modo como o material foi elaborado em 2016 e a forma como foram dispostos os conteúdos, imagéticos e textuais, podem influenciar a eficácia das campanhas de vacinação.

The advance on complications developed by diseases is notable, both in the growing number of deaths and in the number of hospitalizations, and the Influenza virus is one of the causes of these diseases. Thus, effective ways of preventing diseases such as the flu are sought; such measures include washing frequently the hands, do not sharing certain objects and, as the most effective action, vaccination. For this reason, the study on which this article is based aims to analyze the types of content found in materials prepared by the Ministry of Health in Brazil for the flu vaccination campaign developed in the year 2016. The research makes use of the analysis categories prescribed by Antoni Zabala about teaching and learning practices. During the analysis, it was observed that the way of preparing the material in 2016 and the way of arranging the contents, both imagery and text, can influence the effectiveness of vaccination campaigns.

Es notable el aumento de las complicaciones que las enfermedades provocan, tanto en el creciente número de muertes como en el número de casos que exigen hospitalización, siendo el virus de la Influenza una de las causas de esas enfermedades. Por eso se buscan formas eficaces de prevenir enfermedades como la gripe; tales medidas incluyen lavar las manos con frecuencia, no compartir ciertos objetos y, como acción más eficaz, la vacunación. Por esta razón, el estudio que fundamenta este artículo tiene como objetivo analizar los tipos de contenido presentes en los materiales preparados por el Ministerio de Salud en Brasil para la campaña de vacunación contra la influenza desarrollada en lo año 2016. La investigación hace uso de las categorías de análisis prescritas por Antoni Zabala sobre prácticas de enseñanza y aprendizaje. Durante el análisis, se observó que la forma en que se preparó el material en y la forma en que se organizaron los contenidos, tanto las imágenes como el texto, pueden influir en la efectividad de las campañas de vacunación.

Knowledge, Perception and Practice of Infection Control among Ministry of Health staff during COVID-19 Outbreak in Malaysia

@#Introduction Coronavirus Disease 2019 (COVID-19) was declared a pandemic in the middle of March as the disease is highly contagious and spread very quickly throughout the world. Understanding the knowledge and practice among healthcare staff is also crucial, especially among the frontlines staff, as they need to protect themselves and facilitate in educating their patients and public regarding disease prevention measures. This study's objective is to assess knowledge, practice, and perception on the effectiveness of the preventive measures taken by Ministry of Health (MOH) staff to prevent transmission of the disease and measures they would take should they develop symptoms of the disease on COVID-19 disease. (TPB). Methods We conducted a cross-sectional online survey from 30th March 2020 to 6th April 2020 among the Ministry of Health staff. 1719 staff completed the survey. Results The overall correct rate of knowledge was 46.6%. Most participants held good perceptions (range from 77.8% to 98.4%) and good practices (range from 88.8% to 99.7%) towards COVID-19 preventive measure. Meanwhile, the preventive measures practices if they develop symptoms of COVID-19 range from 89.8% to 99.7% and for the perception, it ranges from 85.5% to 98.9%. Conclusions There are also still some lower percentages of perceptions and practices than expected. Additional education intervention and campaigns are required to provide the Ministry of health staff with adequate knowledge towards COVID19 main symptoms, general knowledge and transmission route of COVID-19, and increase some of the perceptions and practices on COVID-19 preventive measures. Keywords

Bases para a reforma da Atenção Primária à Saúde no Brasil em 2019: mudanças estruturantes após 25 anos do Programa de Saúde da Família / Bases for Brazilian Primary Health Care Reform in 2019: structural changes after 25 years of the Family Health Program / Bases para la Reforma de la Atención Primaria de Salud en Brasil en 2019: cambios estructurales después de 25 años del Programa de Salud Familiar

Rev Bras Med Fam Comunidade. Rio de Janeiro, 2020 Jan-Dez; 15(42):23541Bases para a reforma da Atenção Primária à Saúde no Brasil em 2019: mudanças estruturantes após 25 anos do Programa de Saúde da FamíliaErno Harzheim1, Caroline Martins José dos Santos2, Otávio Pereira D'Avila3, Lucas Wollmann4, Luiz Felipe Pinto5Bases for Brazilian Primary Health Care Reform in 2019: structural changes after 25 years of the Family Health ProgramComo citar: Harzheim E, Santos CMJ, D'Avila OP, Wollmann L, Pinto LF. Bases para a reforma da Atenção Primária à Saúde no Brasil em 2019: mudanças estruturantes após 25 anos do Programa de Saúde da Família. Rev Bras Med Fam Comunidade. 2020;15(42):2354. https://doi.org/10.5712/rbmfc15(2)2354www.rbmfc.org.brPerspectivasBases para la Reforma de la Atención Primaria de Salud en Brasil en 2019: cambios estructurales después de 25 años del Programa de Salud FamiliarO ano de 2019 marcou a estruturação das bases para uma profunda reforma na Atenção Primária à Saúde (APS) do Brasil. Os desafios enfrentados através dessa reforma foram a falta de priorização política real da APS, o financiamento insuficiente da APS e focado na estrutura de serviços, os obstáculos ao acesso de primeiro contato, a escassez de profissionais qualificados, a necessidade de maior informatização da APS e a ausência de integração de dados clínicos, a fragilidade clínica e necessidade de ampliação do escopo profissional e a falta de informação de qualidade para tomada de decisão clínica e gerencial. Com ações direcionadas a cada um desses desafios, a Secretaria de Atenção Primária à Saúde do Ministério da Saúde criou estratégias sistêmicas e integradas entre si que representam mudanças estruturantes e investimentos em governança clínica para transformar a APS brasileira, garantindo mais e melhor saúde para a população, com mecanismos transparentes e técnicos para seu financiamento, organização, oferta, monitoramento e avaliação.

The year was 2019. It marked the foundations for a profound Primary Health Care (PHC) Reform in Brazil. The challenges faced through this were the lack of real PHC political prioritization, insufficient PHC funding and focused on the service structure, obstacles to first contact access, the shortage of qualified professionals, the need for greater PHC computerization and the lack of integration of clinical data. Also, the clinical fragility and the need to expand the professional scope and the lack of quality information for clinical and managerial decision making. Actions were directed to each of these challenges, and the Ministry of Health's Secretariat of Primary Health Care created systemic and integrated strategies which represented structural changes and investments in clinical governance to transform Brazilian PHC, ensuring more and better health for the population, with transparent and technical mechanisms for its financing, organization, provision, monitoring and evaluation.

El año era 2019. Marcó la estructuración de las bases para una reforma profunda en la Atención Primaria de Salud (APS) en Brasil. Los desafíos enfrentados a través de esta reforma fueron la falta de una priorización política real de APS, fondos insuficientes de APS y centrados en la estructura del servicio, obstáculos para el acceso de primer contacto, la escasez de profesionales calificados, la necesidad de una mayor informatización de APS y la falta de integración de datos clínicos, la fragilidad clínica y la necesidad de ampliar el alcance profesional y la falta de información de calidad para la toma de decisiones clínicas y gerenciales. Con acciones dirigidas a cada uno de estos desafíos, la Secretaría de Atención Primaria de Salud del Ministerio de Salud creó estrategias sistémicas e integradas que representan cambios estructurales e inversiones en la gobernanza clínica para transformar la APS brasileña, garantizando más y mejor salud para la población, con mecanismos transparentes y técnicos para su financiación, organización, provisión, seguimiento y evaluación.

Doctor Guillermo Soberón Acevedo: destacado médico mexicano / Doctor Guillermo Soberón Acevedo: outstanding Mexican doctor

En la presente entrevista, realizada en 1999, el doctor Guillermo Soberón Acevedo (1925- 2020) opina sobre distintos temas relacionados con la medicina y la salud pública. Comenta su proceso de formación como médico, la responsabilidad de los especialistas que se preparan en el extranjero y regresan a México, así como sus trabajos como rector de la UNAM y en el sector público, donde dirigió la transformación de la entonces Secretaría de Salubridad y Asistencia en la actual Secretaría de Salud. Asimismo, aborda temas como el carácter mutifacético de la medicina, la importancia de la investigación y las facultades de medicina, el valor de la certificación, el trabajo de los colegios y las asociaciones médicas y el futuro de la ciencia médica, además de que ofrece su punto de vista sobre la Homeopatía.

In this interview, conducted in 1999, Dr. Guillermo Soberón Acevedo (1925-2020) gives his opinion on different topics related to medicine and public health. He comments on his training process as a doctor, the responsabilities of the specialists who prepare abroad and return to Mexico, as well as his work as Rector of the Universidad Nacional Autónoma de México (National Autonomous University of Mexico) As well as his experience in the public sector, in which he directed the transformation of the then Secretaría de Salubridad y Asistencia (Ministry of Healthiness and Assistance) into the current Secretaría de Salud (Ministry of Health). It also addresses topics such as the multifaceted nature of medicine, the importance of research and medical schools, the value of certification, the work of medical colleges and associations, and the future of medical science, in addition to offering his point of view on Homeopathy.

National Survey of Pharmacy and Therapeutic Committee in Saudi Arabia: Meetings, Organization, and Management

Objective: Pharmacy and Therapeutic Committee (PTC) is required for the effective running of a hospital. In the beginning, there was no such concept of drug committee, but with the advent of time, the need for an effective PTC started increasing. In the PTC, the pharmacist, physicians and nurses play an important role, in addition to the presence of an administrative. This study aims to explore the importance of having effective meetings organization and management of PTC at Ministry of Health (MOH) hospitals in Saudi Arabia. The purpose of this study was to explore the meetings organization and management of PTC at MOH hospitals in Saudi Arabia. Methods: This is a 4-month cross-sectional national survey of PTC at MOH hospitals in Saudi Arabia. The survey consisted of two parts: the first part collected demographic information and the second part consisted of 93 questions divided into four domains: Domain 1: the scope, structure and responsibilities; domain 2: the formulary management system; domain 3: evaluation of drug formulary and decision-making; and domain 4: organization and management of committee meetings. This questionnaire was prepared in an electronic format and was distributed all drug information centers at MOH hospitals. It analyzed organization and management of committee meetings through Survey Monkey system. Results: A total of 50 drug information centers responded to the questionnaire (100% response rate). The person leads the discussion in PTC was a Chairman of the Committee (29 (58%)), Chief of Pharmacy (13 (26%)) and Director of Drug Information (3 (6%)). The number of scheduled meetings per year (1–4) was 18 (36%) per hospital with a duration (1-2 hrs) at 48 (96%). Most of discussions were related to medications of infectious diseases (26 (52%)) and cardiovascular diseases (21 (42%)). Most of the challenging recommendations that needed implementation was a lack of resources (37 (74%)), lack of hospital administrator support (23 (46%)) and lack of pharmacist role (18 (36%)). Conclusion: The PTC is a demanding scientific resource and administrative support. Total quality management system, workload analysis, positive outcomes of PTC were lacking. Special education and training needs to be provided to all the healthcare providers with hospital administrator’s support.

National Survey of Pharmacy and Therapeutic Committee in Saudi Arabia: Evaluation of Drug Formulary and Decision-Making

Objective: Ministry of Health (MOH) hospitals in Saudi Arabia should develop, organize and administer a formulary system that follows the principles to optimize patient care by ensuring access to clinically appropriate, safe and cost-effective medications. This can be achieved through the Pharmacy and Therapeutic Committee’s (PTC) role in the evaluation of hospital’s drug formulary and decision-making. The primary purposes of the PTC are policy development, communication and education and formulary management. Therefore, in this study, we aimed to explore the hospital drug formulary evaluation and decision-making at MOH hospitals in Saudi Arabia. Methods: This is a 4-month cross-sectional national survey of PTC at MOH hospitals in Saudi Arabia. The survey consisted of two parts: the first part collected demographic information and the second part consisted on 93 questions divided into four domains. An electronic survey was distributed to all drug information centers at MOH hospitals and analyzed the evaluation of drug formulary and decision-making through the Survey Monkey system. Results: A total of 50 drug information centers responded to the questionnaire (100%). Restricted drug usage (3.88), new drug entities (3.74), new dosage form (3.6) and new strength (3.6) were the majority of the requests for inclusion in the formulary. A total of 1-3 medications were evaluated monthly by the PTC at 41 (82%) hospitals. Most of the healthcare providers were allowed to request for the addition or deletion of medications: PTC members 38 (76%), attending medical staff 35 (70%), pharmacy staff 10 (20%) and formulary subcommittees 10 (20%). The formal economic analysis of the drug formulary revision was rarely or never conducted at 26 (42%) hospitals. The responsible person for the economic evaluation was drug information pharmacist (21 (42%)), pharmacy department (nonspecific) (17 (34%)) and the pharmacy and medical department (14 (28%)). Conclusion: Evaluation of hospital’s drug formulary and decision-making was not adequate at the majority of the hospitals. Education and training about drug evaluation with an emphasis on cost analysis and impact are mandatory. An electronic addition new medications with close formulary is required with close monitoring for all MOH hospitals in Saudi Arabia.

National Survey of Pharmacy and Therapeutic Committee in Saudi Arabia: Formulary Management System

Objective: Formulary management is an integrated patient care process which enables physicians, pharmacists and other healthcare professionals to work together to promote clinically sound cost-effective medication therapy and positive therapeutic outcomes. Effective use of healthcare resources can minimize overall medical costs, improve patient access to more affordable care and provide an improved quality of life. A formulary not only includes a list of medications and medication-associated products but also includes medication-use policies, important ancillary drug information, decision support tools and organizational guidelines. Therefore, in this study, we aimed to provide the guiding principles for the Formulary Management System at Ministry of Health (MOH) hospitals in Saudi Arabia. Methods: This is a 4-month cross-sectional national survey of Pharmacy and Therapeutic Committee at MOH hospitals in Saudi Arabia. The survey consisted of two parts: the first part collected demographic information and the second part contained 93 questions divided into four domains. The scope, structure and responsibilities, the formulary management system, the evaluation of drug formulary and decision-making and the committee meetings organization and management. The electronic survey was distributed to 50 drug information centers at MOH hospitals. It analyzed the formulary management system at MOH hospitals in Saudi Arabia through Survey Monkey system. Results: A total of 50 drug information centers responded to our questionnaire. The statement with highest score was related to the committee formulary system of medications usage through ensuring the safety of prescribing, distribution, administration and monitoring of medications (3.8); the process for managing drug product shortages (3.76); and the medications are requested for the addition or deletion from the drug formulary (3.68). Most of the hospitals had an open drug formulary (30 (60%)), with remaining responders having closed drug formulary (20 (40%)) with the total number of medications in the drug formulary (300–899) at 32 (64%) of the responded hospitals. The average score of type of method related to drug usage evaluation statements was 3.36, with the statement with high average score was review of medication error report (3.94) and review of medication sentinel incident reports (3.48), whereas the statement with lowest score was an investigational drug therapy approved (2.88). Conclusion: Two-thirds of the hospitals had open drug formulary. Drug utilization evaluation system should review for the majority of the hospital. update the formulary management system required with close monitoring for all MOH hospitals in Saudi Arabia.

National Survey of Pharmacy and Therapeutic Committees in Saudi Arabia: Scope, Structure and Responsibilities

Objectives: The Pharmacy and Therapeutics (PTC) committee, sometimes aptly named the Formulary Committee. PTC is charged with determining the hospital formulary, decisions are made about the inclusion or exclusion of new pharmacotherapeutic and diagnostic agents for inpatients and outpatients. This committee is typically composed of a multidisciplinary team of pharmacy, physician, nursing and hospital clinical and administrative leadership. The aim of the study was to explore the Therapeutic Committee at MOH hospitals in Saudi Arabia: scope, structure and responsibilities. Methods: It is a 4-month cross-sectional survey of National Survey of Pharmacy and Therapeutic Committee at MOH hospitals in Saudi Arabia. The survey consisted of 93 questions divided in two parts: the first part collects the demographic information, the second part contains questions on 4 domains: (1) scope, structure and responsibilities, that is including questions about the pharmacy and therapeutic committee membership, clear mission, vision and values of the pharmacy and therapeutic committee, the responsibilities of the PTC committee and the Sub-committees of Pharmacy and Therapeutic Committee, (2) formulary management system, (3) evaluation of drug formulary and decision-making, (4) committee meetings organization and management. The survey was distributed to the fifty-drug information centers at Ministry of Health hospitals. The survey was in an electronic format with analyzed scope, structure and responsibilities through the survey monkey system. Results: The total number responders were fifty drug information centers. Of those, 48 (96%) was Saudi and 2 (4%) was non-Saudi. There were 16 (32%) females and 34 (68%) were males. Most of the PTC committee members consisted of a chief of pharmacy department 45 (90%), medical director 41 (82%), physician medical 40 (80%) and head of drug information center 32 (64%). The highest score statements related to committee were the functions of PTC (3.78), objectives (3.61), mission (3.57), with least one was a vision (3.56) and values (3.5). The most responsibility scoring statement was distributed the addition and deletion (4.08), all the departments receive the copy of the revised formulary (4.04), drug evaluation and selection for the hospital was (3.9), drug policy development was (3.9), while the lowest scores were Holds educational programs within the hospital (3.25) and drug monitoring system was (3.57). Most of the subcommittee existed antibiotic committee 38 (76%), medication safety committee 38 (76%), followed by drug utilization committee 9 (18%) and therapeutic guidelines committee 9 (18%). Conclusion: One-third of hospital missed drug information center pharmacist as the member of PTC committee and the pharmacy qualifications of committee members need to improve. Update the committee system and close monitoring required for all MOH hospitals in Saudi Arabia.

Neonates and Pediatrics Electrolyte Replacement Therapy Order: New Initiative and Implementation System in Saudi Arabia

The national medications safety program founded in 2013 at the Ministry of Health hospitals and primary care centers in the Kingdom of Saudi Arabia. The program focused on adults, pediatrics and neonatal populations. The program was part of the pharmacy strategic plan. The electrolyte replacement therapy preparation and administration for neonates and pediatrics published and distributed as required of the medication safety program. The new initiatives as complementary project was a standardized concentration of electrolyte replacement therapy for neonates and pediatrics implemented at specific hospitals of the Ministry of health. The new project as regular physician’s order form and coveted to computerized physician order entry. The new project prevents neonates and pediatrics medication errors of electrolyte replacement therapy. The project is a new initiative at Ministry of Health hospitals in the Kingdom of Saudi, Gulf and Middle East countries.

The Physician Order for Standardized Concentration of Adult's Electrolyte Replacement Therapy: New Initiative in Saudi Arabia

The electrolyte replacement therapy consternation considered one of the high alert drugs. Most of the medication safety organizations have established preventive guidelines for the prescription of electrolyte therapy. The General Administration of Pharmaceutical Care at the Ministry of Health in the Kingdom of Saudi Arabia also has established guidelines for the preparation and administration of electrolyte replacement for adult patients. This new initiative is regarding the standardized concentration of electrolyte preparation and administration for adult patients. The electrolyte therapy may be prescribed via a physician order form, which may be easily converted as computerized physician order entry. This from is designed to prevent all electrolyte-related errors and improve patient outcomes. This project is a new tool implemented for electrolyte safety at the Ministry of Health hospitals in the Kingdom of Saudi Arabia.

Marketing social e digital do Ministério da Saúde no Instagram: estudo de caso sobre aleitamento materno / Social and digital marketing of the Brazilian Ministry of Health on Instagram: a case study of breast-feeding / Marketing social y digital del Ministerio de Salud brasileño en el Instagram: estudio de caso sobre lactancia

Este artigo mapeia as estratégias de atuação do Ministério da Saúde na rede social Instagram. Realizou-se um estudo de caso no período de agosto de 2017 a agosto de 2018 para verificar como o tema da amamentação foi abordado na rede oficial do governo brasileiro para saúde. O corpus tem 65 posts sobre a questão, que foram analisados considerando as métricas de monitoramento das redes sociais: alcance; volume; atividade; engajamento dos usuários e influência do conteúdo junto aos seguidores. Analisando as estratégias de atuação do marketing social e digital identificou-se a falta de interação e resposta aos usuários e a baixa diversidade de representação das mulheres. O levantamento aponta a necessidade de problematizar as práticas do Ministério nesta rede e propor melhorias para ampliar o diálogo com a sociedade.

This article maps out the strategies of performance of the Brazilian Ministry of Health in Instagram's social network. A case study was carried out in the period from August 2017 to August 2018 to verify how the topic of breast-feeding was approached in the official network of the Brazilian government for health. The corpus has 65 posts about that issue which were analised considering the measures to monitor social networks: scope, volume, activity, user engagement and influence of the content on the followers. Analyzing the strategies of social and digital marketing used by the Brazilian government for health, it was identified the lack of interaction with users and of response to them and the low diversity of women represented on its Instagram profile. The research points out that we need to problematize Ministry practices in this network and to propose improvements to broaden the dialogue with the society.

El artículo mapea las estrategias de actuación del Ministerio de Salud de Brasil en la red social Instagram. Se realizó un estudio de caso en el período de agosto de 2017 hasta agosto de 2018 para escudriñar como se abordó el tema de la lactancia en la red oficial del gobierno brasileño para salud. El corpus tiene 65 posts a respecto del asunto y fueron estudiados considerando las medidas para monitorizar redes sociales: alcance; volumen; actividad; interacción de los usuarios e la influencia del contenido en los seguidores. Analizando las estrategias de actuación del marketing social y digital se identificó falta de interactividad, usuarios sin respuesta y la baja diversidad de representación de las mujeres en lo perfil del gobierno brasileño en Instagram. La investigación apunta la necesidad de problematizar las prácticas del Ministerio en esta red y de proponer mejorías para ampliar el diálogo con la sociedad.

Patient's Satisfaction of Pharmacy Ambulatory Cares at the Emergency Hospital in Riyadh City, Saudi Arabia

Purpose: To explore the patient satisfaction of pharmacy ambulatory care services at the Emergency Hospital in Riyadh city, Saudi Arabia. Methods: This is a 4-month cross-sectional survey of patients’ satisfaction of ambulatory care pharmacy services at the Emergency Hospital, Saudi Arabia. The survey consisted of 48 questions divided into two parts: the first part collects demographic information and the second part contains questions on 11 domains: (1) medication availability (2) patient counseling (3) pharmacist and patient relationship (4) medication reconciliation (5) medication aberrance (6) pharmacy location (7) pharmacy-waiting area (8) pharmacy communications (9) pharmacy-waiting time (10) pharmacy recommends to others (11) overall patient satisfaction of pharmacy services. The survey was distributed to the Emergency Hospital in Riyadh city, included public, pediatrics and emergency hospitals ambulatory care patient. The study was in an electronic format and it analyze through the survey monkey system. Results: A total of 202 patients responded to the survey. Of those, 144 (71.6%) was Saudi and 57 (28.4%) was non-Saudi. The gender distribution 105 (52%) were females and 97 (48%) were males. The majority of them were in age group of 18-44 years (62%), while more than 44 years old was 68 (33.7%). The highest level of education was high school 81 (40.3%) followed by the Bachelor’s degree 51 (25.4%) and an intermediate school 44 (21.9%). The mean [±standard deviation (SD)] waiting time to get the medications was 19.36±11.02 (minute). The average scores of domains medication availability was 3.71, patient counseling was 3.48, pharmacist and patient relationship were 4.1 and medication reconciliation was 1.99. The medication adherence was 1.88, pharmacy location was 4.13, the pharmacy-waiting area was 3.31, pharmacy communications was 2.18, pharmacy-waiting time was 3.74 and pharmacy recommends to others was 3.69. The General evaluation of pharmacy services was found to be very good to excellent with 155 (76.7%) of responders, while 186 (92.1%) responders recommend the pharmacy to their family or friends and 176 (88.44%) responders prefer to revisit pharmacy. Conclusion: More than half of the patients were satisfied with ambulatory care pharmacy services at Riyadh, Saudi Arabia. Medication reconciliation, medication adherence and pharmacy communication domains were not found to be satisfied. Refining ambulatory care pharmacy services will avoid drug misadventures, avoid extra cost and surge patient satisfaction with pharmacy services.

National Survey of Pharmacokinetic Services in Saudi Arabia: Perceptions and Barriers of Service Implementations

Objectives: To explore the pharmacokinetic services at the Ministry of Health (MOH) hospitals in Saudi Arabia with an emphasis on perceptions and barriers of service implementation. Methods: This is a 2-month cross-sectional national survey of pharmacokinetic services with a focus on pharmacy management and resources at MOH hospitals in Saudi Arabia. The study consisted of two parts: the first part collected demographic information and the second part consisted of 43 questions divided into three domains. The questions were derived from the American Society of Health-System Pharmacists (ASHP) guidelines and from the literature. We used 5-point Likert response scale system with close-ended questions to obtain responses. An electronic questionnaire was distributed to the coordinators of the clinical pharmacy services or drug information centers at MOH hospitals and it analyzed the perceptions and barriers of pharmacokinetic service implementations section through the Survey Monkey system. Results: A total of 43 hospital pharmacies responded to the questionnaire, with the response rate of 86%. The majority of pharmacokinetic services were provided to the adult patients (37 (86.05%)) followed by the pediatric and geriatric patients (19 (44.19%) and 13 (30.23%), respectively) with most of the responding hospitals having less than 20 beds (23 (53.5%)). The categories with most of the barriers of pharmacokinetic service implementation were lack of knowledge (20 (64.52%)), lack of pharmacokinetic education (16 (51.61%)) and lack of an expert pharmacist in pharmacokinetic services (16 (51.61%)). Most of the responders agreed that clinical pharmacokinetic services were necessary for hospitals (23 (53.5%)). The responders agreed that the clinical pharmacist through pharmacokinetic services had a positive financial impact and cost avoidance on healthcare system (23 (53.5%)). Most of the responders stated that pharmacokinetic services improve the safety and efficacy of patient care (33 (89.2%)). Most of the responders agreed that the pharmacokinetic services improved patients’ clinical outcome (33 (89.2%)) and prevented drug-related problems (33 (89.2%)), whereas few of the pharmacokinetic services were provided only 10 (29.4%) over 24 hr per day. Conclusion: Despite the positive attitude of hospital management toward pharmacokinetic services, there was a lack of education and training regarding the same at MOH hospitals in Saudi Arabia. Revision of strategic planning of pharmacokinetic services with regard to their improvement and implementation are required at all MOH hospitals in Saudi Arabia.

Forecasting (2018-2030) and the Demand of Clinical Pharmacy Technician Workforce at Over Twelve Years (2006-2017) in Saudi Arabia

Background: The workforce of clinical pharmacy technician is one the elements of pharmacy strategic plan in Saudi Arabia. Objectives: The purpose of this study is to explore the demand clinical pharmacy technician’s workforce at Ministry of Health (MOH) hospitals and primary health care centers over the past twelve years (2006- 2017) and forecasting during the years (2018-2030) in the kingdom of Saudi Arabia. Methods: It is a retrospective analysis of twelve years (2006-2017) of MOH hospitals, Primary Health Care Center (PHCs) of the pharmacy technician’s workforce and forecasting for future years (2018-2030). All data were derived from the Ministry of Health statistical year books and any missing appropriate information about pharmacy technician’s workforce that will be estimated through allied healthcare professional’s data in each region including gender. It included all types of pharmacy technicians included in the study while excluded all pharmacists or clinical pharmacist’s workforce at MOH intuitions. All calculations were based on MOH workforce standards of hospitals or PHCs updated literatures. All calculation was done using Microsoft Excel version ten. Results: The total average of hospitals was 253.92 in the kingdom of Saudi Arabia. The total average demand of clinical pharmacy technician at MOH hospitals will be (4,579.08) over twelve years (2006-2017) with a range (2,899 to 6,619). The total average demand of clinical pharmacy technician at primary healthcare centers will be (1,303) over twelve years (2006-2017) with a range (891 to 1,623). The total average demand of clinical pharmacy technician at hospital forecasting will be (10,271.34) over thirteen years (2008-2030) with a range (8,797.44 to 11,887.11). The total average demand of clinical pharmacy technician at primary healthcare centers forecasting will be (14,270.87) over thirteen years (2018-2030) with a range (12,223.05 to 16,515.79). Conclusion: The Ministry of Health hospitals and primary care centers sectors will be with the highest demand for clinical pharmacy technician in the future. The ratio of pharmacist to clinical pharmacy technician needs to be standardized at hospitals and primary healthcare services. Further, the analysis of the clinical pharmacy technician workforce is required in the kingdom of Saudi Arabia.

Demand for Pharmacy Technician Workforce at Primary Healthcare Centers during the Past 12 Years (2006-2017) and in the Future (2018-2030) in Saudi Arabia

Objective: To explore the demand of pharmacy technician workforce at Ministry of Health’s (MOH) Primary Healthcare Centers (PHCs) over the past 12 years (2006–2017) and in the future (2018–2030) in the Kingdom of Saudi Arabia. Methods: This is a retrospective analysis of the demand of MOH’s pharmacy technician workforce during the past 12 years (2006-2017) and in the future (2018-2030). All data were derived from the MOH’s Statistical Year Books and any missing information regarding the pharmacy technician workforce will be estimated through allied healthcare professionals’ data from each region including data on gender or nationality. It included pharmacy technician and excluded all types of pharmacists or clinical pharmacist’s workforces at MOH hospital setting. All calculations were based on MOH’s workforce standards of PHCs and updated literature. All calculations were performed using Microsoft Excel version 10. Results: The demand for number pharmacy technicians based on the pharmacist: pharmacy technicians in the ratio standard (1:3) was (4–1,392) with an average number of (608.92) pharmacy technicians required. The demand for number of pharmacist: pharmacy technicians in the ratio standard (1:4) was (37,453–46,058) with an average number of (41,611.17) pharmacy technicians required. While the demand for pharmacist: pharmacy technicians in the ratio standard (1:2) was (18,281–22,218) with an average of (20,159.67). The number of pharmacist: pharmacy technicians required in the future based on the ratio standard (1:3) was 27,867–34,138 with an average number of (30,885.42) pharmacy technicians required. In the future (2018–2030), the pharmacist: pharmacy technicians based on the ratio standard (1:4) was (47,600–64,317) with an average of (54,895.23) pharmacy technicians required. However, the pharmacist: pharmacy technicians based on the ratio standard of (1:2) was (23,154–31,286) with an average number of (26,689.30) pharmacy technicians required. The number of pharmacist: pharmacy technician required based on the ratio standard (1:3) was (35,377–47,802) with an average number of (40,792.27) pharmacy technicians required. Conclusion: In this study, the demands and future forecasting of pharmacy technician workforces was determined. The pharmacist to pharmacy technician ratio should be standardized. Pharmacy technicians may be utilized at community pharmacies in the future. Periodic analysis of demand and forecasting at PHCs is highly recommended in Saudi Arabia.

Forecasting (2018-2030) and the Demand of Hospital Pharmacy Technician Workforce at Over Twelve Years (2006-2017) in Saudi Arabia

Objectives: The workforce of hospital pharmacy technician is one the elements of pharmacy strategic plan in Saudi Arabia.: The purpose of this study is to explore the demand workforce of pharmacy technician at MOH hospitals over the past twelve years (2006-2017) and forecasting during (2018-2030) in the kingdom of Saudi Arabia. Methods: It is a retrospective analysis of twelve years (2006-2017) of Ministry of Health pharmacy technician workforce demand and forecasting in the future (2018- 2030) at MOH organization practice. All data were derived from the Ministry of Health Statistical Year Books and any missing appropriate information about pharmacy technician workforce that will be estimated through allied healthcare professional’s data in each region including gender or nationality. It included pharmacy technician and exclude all types of pharmacists or clinical pharmacist’s workforce at MOH hospital setting. All calculations were based on MOH workforce standards of hospital with update literatures. All calculation was done used Microsoft Excel version ten. Results: The number of pharmacy technician demand based on optimum pharmacy and pharmacist. The pharmacy technician ratio (1:4) demand was (21,212.6-26,091) with an average (22,934.68). While with a ratio of (1:2) the number of pharmacy technician demand was (7,410-8,859) with an average (8,320.55). The number of pharmacy technician forecasting of a ratio (1:3) was (14,300-17,475) with an average (15,627.62). The forecasting number of pharmacy technician in the future within years (2018-2030) over thirteen years based on optimum pharmacy and pharmacist. The pharmacy technician ratio (1:4) forecast was (33,898.6-45,803) with an average (39,577.00). While with a ratio of (1:2) the number of the forecasting pharmacy technician was (16,303-22,028) with an average (19,034.31). The number of pharmacy technician forecasting of ratio (1:3) was (25,100 - 33,916) with an average (29,305.54). Conclusion: The demand of pharmacy technicians and forecasting in the future were determined. The ratio of pharmacist to pharmacy technician in the hospital practice should be standardized. An annual study on hospital pharmacy technician workforce is recommended in Saudi Arabia.