Cuidado farmacêutico domiciliar na Estratégia Saúde da Família / Home Pharmaceutical Care in the Family Health Strategy

Resumo Este trabalho desenvolveu e avaliou uma ferramenta para auxiliar no planejamento, execução, registro de dados e avaliação das ações da visita domiciliar farmacêutica na equipe de Estratégia Saúde da Família. A primeira fase consistiu na construção da ferramenta de visita domiciliar farmacêutica, através de grupo focal e análise de discurso. Discutiu-se a visão dos profissionais sobre o papel do farmacêutico e sua prática profissional, em especial na visita domiciliar em unidades de atenção primária à saúde. Na segunda fase, utilizou-se o formulário desenvolvido na etapa anterior durante a visita domiciliar por 32 farmacêuticos, e avaliaram-se adequação, clareza, efetividade/precisão, exequibilidade e sugestões para a ferramenta. Todos os participantes do estudo efetivamente realizam visita domiciliar na Estratégia de Saúde da Família no município do Rio de Janeiro. Segundo avaliação expressiva dos participantes, o instrumento foi considerado adequado, claro, efetivo, preciso e exequível para utilização na prática de visita domiciliar; representando importante auxílio ao profissional na realização do cuidado farmacêutico domiciliar naquele município.

Abstract This work developed and evaluated a tool to assist in the planning, execution, data recording and evaluation of the actions of the pharmaceutical home visit in the Family Health Strategy team. The first phase comprised the construction of the pharmaceutical home visit tool, through a focus group and discourse analysis. The professionals' view on the role of the pharmacist and his professional practice was discussed, especially in home visits in primary health care units. In the second phase, the form developed in the previous step was used during the home visit by 32 pharmacists, and adequacy, clarity, effectiveness / precision, feasibility and suggestions for the tool were evaluated. All study participants effectively perform home visits in the Family Health Strategy in the city of Rio de Janeiro. According to an expressive evaluation of the participants, the instrument was considered adequate, clear, effective, precise and feasible for use in the practice of home visits, and is an important assistance to the professional in performing home pharmaceutical care in that city.

Cuestiones bioéticas relacionadas con el acceso a medicamentos en el ejercicio de la oftalmología en Colombia / Bioethical issues on the access to drugs in the practice of ophthalmology in Colombia

Resumen La oftalmología se constituye como una especialidad de alto costo en lo que respecta a tratamiento médico, quirúrgico y de innovación tecnológica. Es preocupante que en algunos países los pacientes se vean afectados en su salud visual, y por ende en su calidad de vida, por no contar con los recursos necesarios para un acceso oportuno a medicamentos, citas médicas o procedimientos quirúrgicos. A partir de la búsqueda de artículos relacionados con cuestiones bioéticas y el acceso a medicamentos en el ejercicio de la oftalmología en cuatro bases de datos electrónicas (ScienceDirect, MEDLINE/PubMed, ClinicalKey y SciELO ), así como en libros de bioética y leyes de la jurisdicción colombiana, realizamos una reflexión sobre el problema del acceso a los medicamentos oftalmológicos, centrándonos en el interés por la aplicación de la bioética en la práctica clínica y en el acceso a medicamentos de los pacientes con patologías oftalmológicas. Las consideraciones éticas se abordan desde una mirada del modelo principialista de Beauchamp y Childress, en especial considerando el principio de justicia, de modo que brinde a los profesionales de la salud en este campo, argumentos para la toma de decisiones médicas y éticas que beneficien la atención y el acceso a medicamentos de los pacientes con patologías oftalmológicas.

Abstract Ophthalmology is a high-cost specialty in terms of medical, surgical and technological innovation and treatment. It is worrisome that in some countries patients are affected in their visual health, and therefore in their quality of life because they do not have the necessary resources for timely access to medications, medical appointments or surgical procedures. We searched in four electronic databases (ScienceDirect, MEDLINE/PubMed, ClinicalKey and SciELO), as well as in books on bioethics and Colombian laws, for articles related to bioethical issues and access to medicines in the exercise of ophthalmology. We reflect on the problem of access to ophthalmological drugs, with particular interest on how to apply the principles of bioethics on the clinical practice of patients with ophthalmological conditions. Ethical considerations are approached from the principles of Beauchamp and Childress, especially regarding the principle of justice, in order to provide health professionals in this field with arguments for medical and ethical decisions that benefit the healthcare and access to medicines for patients with ophthalmological conditions.

Essential medicines for emergency care in Africa

Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications.The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.Methods:We undertook a multi-step consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final in-person consensus process.Results:The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential, and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (e.g. district hospitals), and an additional 78 for advanced facilities (e.g. tertiary centres).Conclusion:The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation, and will be a useful tool for practical expansion of emergency care delivery in Africa

Use of Economic Evaluation in the Listing and Pricing of Pharmaceuticals / 예방의학회지

To curb a rapid increase in expenditures for pharmaceuticals, the Korean government introduced a positive list system and a negotiation process for drug prices at the end of 2006. Economic evaluation of pharmaceuticals has begun to have a pivotal role in the listing and pricing of drugs for the Korean National Health Insurance. There are some points to discuss regarding the use of economic evaluation in the listing and pricing in the context of the Korean system. First, the listing and pricing processes have been fragmented, evoking complaints from pharmaceutical companies and delaying the access of new drugs to patients. Second, there is a concern that the positive list system may limit the range and availability of drugs for patients to choose for treatment. Third, the time schedule for de-listing of existing drugs may not be realistic. Fourth, it is not always easy to provide reliable evidence of cost-effectiveness due to a lack of materials. Fifth, there is no consensus on the range of the ICER (incremental cost-effectiveness ratio) acceptable to the Korean society. In conclusion, in the near future, it will be necessary to evaluate the achievements that the economic evaluation has provided to the Korean society.

Current State and Challenges of Pharmacoeconomic Evaluation in Korea / 예방의학회지

Since the positive listing system for prescription drug reimbursement has been introduced in Korea, the number of pharmacoeconomic evaluation studies has increased. However it is not clear if the quality of pharmacoeconomic evaluation study has improved. Due to the lack of randomized clinical studies in Korean health care setting, Korean economic evaluation studies have typically integrated the local cost data and foreign clinical data. Therefore methodological issues can be raised in regard to data coherence and consistency. But the quality of data was not questiened and the potential bias has not been investigated yet. Even though changes in policy have encouraged the undertaking of pharmacoeconomic evaluations, there is few public-side funding for validation study of cost-effectiveness models and data. Several companies perform economic evaluation studies to be submitted on behalf of their own products, but do not want the study results to be disclosed to the academic community or public. To improve the present conduct of pharmacoeconomic evaluations in Korea, various funding sources need to be developed, and, like other multidisciplinary areas, the experts in different fields of study should collaborate to ensure the validity and credibility of pharmacoeconomic evaluations.

A prologue on "Vastuguna Dipika". The Andhra Ayurvĕda Nighantu of 1883 A.D.

Vastuguna Dipika is a Nighantu Grantha written in Telugu language on Ayurvĕda drugs, diets and deeds in an alphabetical order in Telugu language and it is a much popular book for more than a century. Yerra Venkata Swamy (retired district Munsif) has authored and published it on 23rd June, 1883 A.D. It is a period of printing facility introduced in India. It is edited and reprinted eight times by the successors of same "Yerra" family during a period of century. The subject content of the book has been slowly updated from edition to edition. Vastuguna Dipika comprising of 1148 pages in written. Drug like Coffee, Cabbage have been elaborately dealt with Ayurvĕda viewpoint. Certain drugs like Lasuna, Haridra also have been dealt very elaborately. In this book several drugs are grouped according to action and indications. Mineral drugs and mercurial preparations are also dealt in detail. Along with the properties of drugs and diet the properties and uses of certain routine deeds like bathing, sleeping exercise etc; are explained in the book. An alphabetical index of diseases in English in found along with the alphabetical indices of drugs in English, Telugu and Sanskrit languages.

Basic principles of pharmaceutical science in Ayurvĕda.

Pharmaceutical is one of the allied branches of science, which is closely associated with Medical science. Today pharmaceutical chemistry and pharmacognosy are playing important role in treatment for a disease and its prevention. Herbal medicines are being used by about 80% of the world population mostly in the developing countries in the primary health care. There has been an upsurge in demand for the Phyto-pharmaceutical products of Ayurvĕda in western nations, because of the fact that the synthetic drugs are considered to be unsafe. Due to this many national and multinational pharmaceutical companies are now concentrating on manufacturing of Ayurvĕdic Phyto-pharmaceutical products. Ayurvĕda is the Indian traditional system of medicine, which also deals about pharmaceutical science. The Ayurvĕdic knowledge of the pharmaceutical science is scattered in Ayurvĕdic classical texts. Săranghadhara Samhita, which is written by Săranghadhara, explain systematically about the information of the Ayurvĕdic pharmaceutical science and also updated it. Industrialized manufacturing of Ayurvĕdic dosage forms has brought in new challenges like deviation from basic concepts of medicine preparation. Săranghadhara Samrhită the devout text on pharmaceutics in Ayurvĕda comes handy to solve such problems, as the methods described are very lucid and easy to follow.

Confusing brand names: nightmare of medical profession.

OBJECTIVE: India has more than 20,000 registered pharmaceutical manufacturers. Consequently, there is a flood of brand names to choose from. We conducted this study to analyse and sort out the multitudinous brand names thronging the Indian market, and identified those that could create a possible confusion. MATERIALS AND METHODS: Recent issues of drug formularies like Indian Drug Review, Drug Index, and Monthly Index of Medical Specialities-India were checked and all the brand names given were included. Some other brand names that are available with the pharmacists but are not included in these indexes were also included in the study for analysis. OBSERVATIONS: Potentially confusing brand names were sorted out and categorised according to the severity of damage they can cause if misinterpreted by the pharmacist or the patient. Subgroups were made according to the brand name, the generic name, and the manufacturers of the drug. CONCLUSION: Several brand names are strikingly identical, similar looking (orthographic), or similar sounding (phonological). Preventing this possible confusion is not the work of any one person involved. We describe the role of prescribing doctors, dispensing pharmacists, consumer patients, and the manufacturing companies to prevent "wrong prescribing" due to similarities in brand names.

Standardization of Ayurvĕdic formulations : a scientific review.

Safety and efficacy of a drug mainly depends on the method of preparation. To assess the quality of a finished product, there should be some basic standards as well as methods of preparation. There are several parameters for testing the quality of a chemical drug, which have, are true indicators. So, there is no problem in assessing a synthetic drug's quality. As far as the preparation used in Ayurvĕdic system of medicine, a drug formulation or design may not be a problem, because many formulations are well documented in classical texts. But, there is confusion with respect to standards to be followed while preparing a formulation as well as basic parameters to assess the quality of the finished product. In Ayurvĕda, pañcavidhakaşăyakalpana are the basic pharmaceutical preparations, from which all the other preparations are developed. A specific method for each and every preparation and some basic standards of finished products are mentioned in Ayurvĕdic texts to maintain their quality. This information may some times vary from text to text. To overcome this problem Sărangdhara mentioned detailed information about various formulations with respect to their methods of preparation as well as basic standards and are documented in Sărangdhara Samhita.