ABSTRACT
Medicines are considered one of the main tools of western medicine to resolve health problems. Currently, medicines represent an important share of the countries' healthcare budget. In the Latin America region, access to essential medicines is still a challenge, although countries have established some measures in the last years in order to guarantee equitable access to medicines. A theoretical model is proposed for analysing the social, political, and economic factors that modulate the role of medicines as a health need and their influence on the accessibility and access to medicines. The model was built based on a narrative review about health needs, and followed the conceptual modelling methodology for theory-building. The theoretical model considers elements (stakeholders, policies) that modulate the perception towards medicines as a health need from two perspectives - health and market - at three levels: international, national and local levels. The perception towards medicines as a health need is described according to Bradshaw's categories: felt need, normative need, comparative need and expressed need. When those different categories applied to medicines coincide, the patients get access to the medicines they perceive as a need, but when the categories do not coincide, barriers to access to medicines are created. Our theoretical model, which holds a broader view about the access to medicines, emphasises how power structures, interests, interdependencies, values and principles of the stakeholders could influence the perception towards medicines as a health need and the access to medicines in Latin American countries.
Subject(s)
Health Services Accessibility/ethics , Health Services Needs and Demand/ethics , Medication Systems/economics , Models, Theoretical , Ethics, Medical , Health Policy/economics , Health Services Accessibility/trends , Humans , Latin America , Medication Systems/ethicsABSTRACT
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Subject(s)
Female , Humans , Male , Prothionamide/therapeutic use , Tuberculosis/diagnosis , Tuberculosis/prevention & control , Tuberculosis/therapy , Dose-Response Relationship, Drug , Medication Systems/ethics , Medication Systems/standards , Societies, Medical/standards , Societies, Medical , Fluoroquinolones/therapeutic use , World Health Organization/organization & administrationABSTRACT
La sociedad ha desplazado al campo médico problemas de la realidad subjetiva y social de las personas, y la obsesión por una salud perfecta se ha convertido en un factor patógeno predominante existiendo un aumento del número de enfermedades y enfermos, a la vez que mejora el nivel de salud de la población. El poder de la medicina ha hecho atractiva la idea de «medicalizar» aspectos de la vida que se pueden percibir como problemas médicos aun sin serlo. Vivir conlleva momentos de infelicidad y de angustia, pero ¿deberíamos tratar dichos momentos? Estamos en la cultura sanitaria del «todo, aquí y ahora». En este artículo se analizan las implicaciones éticas de las intervenciones innecesarias y se plantean distintas alternativas que pueden realizar los profesionales implicados para reconducir dicha situación; reflexionamos si queremos un mundo donde todos llevemos etiquetas de riesgo de presentar esta o aquella enfermedad (AU)
Society has shifted issues of subjective and social reality of the population into the medical field, with the obsession with perfect health becoming a predominant pathogenic factor in the increase in the number of diseases and patients, while the level of health in the population is improving. The power of medicine has made the idea of «medicalising» various aspects of life that can be perceived as medical problems as attractive even when it is not the case. Living entails times of unhappiness and anguish but, should we treat these episodes? We are in the health culture of «everything, here and now». In this article, the ethical implications of unnecessary interventions are analysed, along with the different alternatives that the professionals involved may perform to redirect this situation. It is reflected if we want a world where we all risk wearing labels for this or that disease (AU)
Subject(s)
Humans , Male , Female , Medication Therapy Management/ethics , Medication Adherence/statistics & numerical data , Medicalization/ethics , Medicalization/instrumentation , Medicalization/trends , Primary Prevention/methods , Secondary Prevention/methods , Medication Systems/ethics , Medication Systems/standards , Medication Systems , Medicalization/methods , Primary Health Care/methods , Primary Health Care , Risk FactorsABSTRACT
Objetivo: Detectar, prevenir y resolver los resultados negativos asociados a la medicación que presentaron los pacientes con insuficiencia cardiaca congestiva dispensarizados en la Farmacia Principal Municipal Santiago de Cuba. Método: Estudio prospectivo y de intervención realizado a 30 pacientes en el periodo comprendido desde enero de 2009 hasta enero de 2010 siguiendo la metodología Dáder actualizada adaptada a las condiciones concretas de la investigación. Resultados: Se detectaron 141 sospechas y resultados negativos asociados a la medicación, siendo la inseguridad no cuantitativa (40,42%) y la inefectividad no cuantitativa (29,08%) los de mayor incidencia. Las interacciones (63,15%) y la probabilidad de efectos adversos (31,57%) constituyeron los problemas relacionados con medicamentos que más influyeron en el resultado negativo asociado a la medicación de tipo inseguridad no cuantitativa, mientras que las interacciones (51,21%) y las características personales (48,78%) resultaron los más prevalentes en la inefectividad no cuantitativa. Se realizaron 141 intervenciones farmacéuticas que posibilitaron la solución del 100% de los resultados negativos asociados a la medicación y la prevención del 97,89% de las sospechas. Conclusiones: Resultó adecuado el desarrollo del servicio farmacéutico, pues posibilitó la detección de las sospechas y los resultados negativos asociados a la medicación, que fueron prevenidas -en el primer caso- y resueltos -en el segundo- satisfactoriamente gracias a la identificación de los problemas relacionados con medicamentos, en los que el profesional farmacéutico actuó para alcanzar los objetivos terapéuticos planteados en estos pacientes, ayudándoles a conseguir mejores resultados en salud mediante el control de su enfermedad y la optimización de la terapéutica medicamentosa (AU)
Objectives: To detect, prevent and resolve the negative outcomes associated with medication which was shown by the patients with congestive heart failure dispensed in the Principal Municipal Pharmacy at Santiago de Cuba. Methods: Prospective and intervention study done in 30 patients in the period comprehended from January 2009 to January 2010, following the Dáder methodology, adapted to the specific conditions of the investigation. Results: 141 suspicion and negative outcomes associated with the medication were detected this being the non-quantitative safety problem (40.42%) and non-quantitative ineffectiveness (29.08%) the ones with highest incidence. The interactions (63.15%) and the probability of adverse effects (31.57%) the drug related problems were that once which most influenced on the negative outcome associated with the medication type nonquantitative safety problem while the interactions (51.21%) and the personal characteristics (48.78%) were most prevalent in the non-quantitative ineffectiveness. 141 pharmaceutical interventions were done, enabling the solution of 100% of the negative outcomes associated with medication and prevention of 97.89% of suspicion. Conclusion: An adequate pharmaceutical service was developed, since it made possible the detection of suspicion and negative outcomes associated with medication, which were prevented and resolved satisfactorily with the identification of drug related problems by operating in such a professional pharmacist, to achieve therapeutic goals outlined in these patients, helping them achieve better health outcomes through control of their disease and optimize drug therapyAU)
Subject(s)
Humans , Male , Female , Heart Failure/drug therapy , Medication Systems/ethics , Medication Systems/organization & administration , Drug Administration Schedule , Drug Dispensaries , Pharmaceutical Services/ethics , Pharmaceutical Services/organization & administration , Pharmaceutical Services/standards , Drug Prescriptions/standards , Pharmaceutical Services/trends , Heart Failure/complications , Heart Failure/diagnosis , Pharmaceutical Services , Drug Interactions/physiologyABSTRACT
A hipertensão arterial (HA) desempenha papel determinante na ocorrência de eventos clínicos graves, havendo entretanto controvérsias quanto ao seu impacto no cotidiano do portador. A incapacidade temporária para a realização de atividades habituais definida como uma restrição temporária na capacidade funcional habitual do indivíduo, é um indicador de saúde recomendado pela Organização Mundial da Saúde para uso em estudos populacionais. A partir do objetivo geral de investigar a associação entre hipertensão arterial e incapacidade temporária para atividades habituais, delineamos os seguintes objetivos específicos: A) Investigar se a elevação dos níveis pressóricos determina a freqüência e o período acumulado de incapacidade temporária para atividades habituais; B) Investigar se o uso de medicações anti-hipertensivas associa-se a alterações na freqüência e no período acumulado de incapacidade temporária para atividades habituais. Estudo seccional com dados de 2953 participantes obtidos de questionário auto-administrado no Estudo Pró-Saúde, uma coorte de funcionários técnicos administrativos de universidade localizada no estado do Rio de Janeiro. A exposição foi avaliada a partir do valor aferido da PA e do uso de drogas anti-hipertensivas. Conduzimos a análise separando os participantes em 4 grupos, combinando as informações quanto à PA aferida...
Arterial hypertension (AH) plays a determinant role in the occurrence of severe clinical events; however, there are controversies about its impact on daily life. The temporary disability for daily activities, which is defined as a temporary restriction in an individuals usual level of functioning, is a health indicator proposed by the World HealthOrganization for utilization in population studies. Objectives: To investigate the association between arterial hypertension and temporary disability for daily activities, we proposed thefollowing specific objectives: A) To investigate whether elevated blood pressure (BP) determine the frequency or accumulated period of temporary disability for daily activities; 2) To investigate whether the use of anti-hypertensive drugs are associated with changes in the frequency or accumulated period of temporary disability for daily activities. Methods: Across-sectional study with data obtained from 2953 participants who answered a selfadministered questionnaire in the Pro-Saude Study, a cohort of university emplyees in Rio de Janeiro state. The exposure was evaluated using the measured value of BP and the report ofthe use of anti-hypertensive drugs. We conducted the analysis classifying the participants in 4 groups, combining the information about measured BP (< or ³ 140/90 mmHg) and the report of the use of anti-hypertensive drugs or not. The outcome was evaluated with a composite variable with information about the report and period of disability. Multivariate analyses were conducted using multinomial logistic regression. Results: 690 (23.4 %) were classified as hypertensives, and 704 (23.8 %) reported temporary disability. The use of anti-hypertensive drugs, among the participants with BP < 140/90 mmHg, was directly associated with theprevalence of temporary disability for daily activities for a longer period (OR=2.25, CI 95 %: 1.31 - 3.87)...
