RESUMO
El objetivo general de esta tesis fue evaluar la calidad de productos y procesos asociados al suministro de medicamentos en programas de salud para pacientes diabéticos, desde 2 perspectivas: del acceso a medicamentos esenciales de la población (área 1) y de la calidad biofarmacéutica de los medicamentos y su intercambiabilidad (área 2). Los programas de salud y los efectores analizados fueron los del subsector público de la ciudad de Alta Gracia (Córdoba): Programa Córdoba Diabetes (PROCORDIA, provincial), en el Hospital Arturo Umberto Illia. Programa de Detección de Diabetes Tipo 2 de la Dirección de Salud Pública y Remediar (PROAPS, nacional), en la red de 12 Dispensarios, dependientes de la Municipalidad de Alta Gracia. Se trabajó en coordinación con los servicios de farmacia de ambos establecimientos asistenciales. Se consolidaron las bases de datos de pacientes con Diabetes Mellitus (DM) en cada efector y se generó una unificada del subsector público. La prevalencia calculada de DM fue de 3,1%, con más del 80% correspondiente al tipo 2 y uno de cada cuatro pacientes era mayor de 65 años. Se realizaron estudios de utilización de medicamentos de consumo basados en el sistema de clasificación ATC y la DDD como unidad técnica de medida (expresada como número de DDD por 1000 habitantes/día ó DHD). Los consumos globales fueron de 3,37 DHD de insulina y 11,99 DHD de antidiabéticos orales (ADO). Entre los ADO, se utilizaron en mayor proporción Metformina en combinación con Sulfonilureas, seguida por Sulfonilureas y Metformina, sin asociar. Se calculó la adherencia global porcentual a partir del registro de dispensaciones mensuales por paciente, observándo se una baja adherencia promedio entre los pacientes con DM tipo 2 (< 50%) en comparación con los tipo 1 y tipo 2 insulino-requirentes (> 70%).(AU)
SUMMARY: The general objective of this thesis was to evaluate the quality of products and processes associated to drug supply in health programs for diabetic patients from 2 perspectives: one of essential medicinesÆ access for population (area 1), and the other of biopharmaceutical quality of drugs and their interchangeability (area 2) The health programs and the facilities analyzed were form the public subsector in Alta Gracia city (Córdoba): Programa Córdoba Diabetes (PROCORDIA, provincial), at the Arturo Umberto Illia Hospital. Programa de Detección de Diabetes Tipo 2 of the Dirección de Salud Pública and Remediar (PROAPS, national), into the net of 12 health centers depending to the Municipality of Alta Gracia. This work was coordinated with the pharmacy services of both health care facilities. Databases of patients with Diabetes Mellitus (DM) were consolidated on each center, and a unified one of the public health subsector was generated. The calculated prevalence of DM was about 3.1%, with more than 80% corresponding to type 2, and one of four patients was older than 65 years. Drug utilization studies of consumption, based on the ATC classification system and the DDD as technical unit of measurement (expressed as number of DDD per 1000 inhabitants/day or DHD), were carried out. The global consumptions were 3.37 DHD for insulin and 11.99 DHD for oral antidiabetic drugs. Between the last ones, Metformin in combination with Sulfonylureas were utilized in the mayor proportion, followed by Sulfonylureas and Metformin, alone each one. The global adherence percentage was calculated from monthly dispensing records by patients. A low average adherence was observed among type 2 DM patients (< 50%) in comparison with type 1 and type 2 insulin-requirer ones (>70%).(AU)
Assuntos
Humanos , Masculino , Feminino , Planos e Programas de Saúde/normas , Diabetes Mellitus , Medicamentos Essenciais , Adesão à Medicação , Serviço de Farmácia Hospitalar , Farmacoepidemiologia , Argentina/epidemiologiaRESUMO
El objetivo general de esta tesis fue evaluar la calidad de productos y procesos asociados al suministro de medicamentos en programas de salud para pacientes diabéticos, desde 2 perspectivas: del acceso a medicamentos esenciales de la población (área 1) y de la calidad biofarmacéutica de los medicamentos y su intercambiabilidad (área 2). Los programas de salud y los efectores analizados fueron los del subsector público de la ciudad de Alta Gracia (Córdoba): Programa Córdoba Diabetes (PROCORDIA, provincial), en el Hospital Arturo Umberto Illia. Programa de Detección de Diabetes Tipo 2 de la Dirección de Salud Pública y Remediar (PROAPS, nacional), en la red de 12 Dispensarios, dependientes de la Municipalidad de Alta Gracia. Se trabajó en coordinación con los servicios de farmacia de ambos establecimientos asistenciales. Se consolidaron las bases de datos de pacientes con Diabetes Mellitus (DM) en cada efector y se generó una unificada del subsector público. La prevalencia calculada de DM fue de 3,1%, con más del 80% correspondiente al tipo 2 y uno de cada cuatro pacientes era mayor de 65 años. Se realizaron estudios de utilización de medicamentos de consumo basados en el sistema de clasificación ATC y la DDD como unidad técnica de medida (expresada como número de DDD por 1000 habitantes/día ó DHD). Los consumos globales fueron de 3,37 DHD de insulina y 11,99 DHD de antidiabéticos orales (ADO). Entre los ADO, se utilizaron en mayor proporción Metformina en combinación con Sulfonilureas, seguida por Sulfonilureas y Metformina, sin asociar. Se calculó la adherencia global porcentual a partir del registro de dispensaciones mensuales por paciente, observándo se una baja adherencia promedio entre los pacientes con DM tipo 2 (< 50%) en comparación con los tipo 1 y tipo 2 insulino-requirentes (> 70%).
SUMMARY: The general objective of this thesis was to evaluate the quality of products and processes associated to drug supply in health programs for diabetic patients from 2 perspectives: one of essential medicines access for population (area 1), and the other of biopharmaceutical quality of drugs and their interchangeability (area 2) The health programs and the facilities analyzed were form the public subsector in Alta Gracia city (Córdoba): Programa Córdoba Diabetes (PROCORDIA, provincial), at the Arturo Umberto Illia Hospital. Programa de Detección de Diabetes Tipo 2 of the Dirección de Salud Pública and Remediar (PROAPS, national), into the net of 12 health centers depending to the Municipality of Alta Gracia. This work was coordinated with the pharmacy services of both health care facilities. Databases of patients with Diabetes Mellitus (DM) were consolidated on each center, and a unified one of the public health subsector was generated. The calculated prevalence of DM was about 3.1%, with more than 80% corresponding to type 2, and one of four patients was older than 65 years. Drug utilization studies of consumption, based on the ATC classification system and the DDD as technical unit of measurement (expressed as number of DDD per 1000 inhabitants/day or DHD), were carried out. The global consumptions were 3.37 DHD for insulin and 11.99 DHD for oral antidiabetic drugs. Between the last ones, Metformin in combination with Sulfonylureas were utilized in the mayor proportion, followed by Sulfonylureas and Metformin, alone each one. The global adherence percentage was calculated from monthly dispensing records by patients. A low average adherence was observed among type 2 DM patients (< 50%) in comparison with type 1 and type 2 insulin-requirer ones (>70%).
Assuntos
Humanos , Masculino , Feminino , Diabetes Mellitus , Medicamentos Essenciais , Adesão à Medicação , Farmacoepidemiologia , Serviço de Farmácia Hospitalar , Planos e Programas de Saúde/normas , Argentina/epidemiologiaRESUMO
OBJECTIVE: To analyze the validity and reliability of a patient satisfaction questionnaire about drug dispensing in Argentine community pharmacies. DESIGN: Descriptive, cross-sectional study. SETTING: Community pharmacies of Argentina that voluntarily agreed to take part in the study. PARTICIPANTS: All patients or their careers who attended the pharmacies during the period of the study (March and April, 2006) and knew how to read and write. MAIN MEASUREMENTS: Scores on the satisfaction scale of the questionnaire. RESULTS: Twenty-seven pharmacies from 6 provinces of Argentina took part; 473 questionnaires were obtained with a 72.4% response rate. Factorial analysis revealed one single component that explained 54.8% of total variance. A 0.90 Cronbach's alpha coefficient was obtained and Pearson's correlation between each of the items and the total score on the scale showed that all items correlated with each other (P<.01). Patients expressed additional comments in 124 questionnaires (26.2%). These concerned the quality of care received and other aspects, such as gratitude, cost of medicines, insufficient stock, and friendliness. CONCLUSIONS: The questionnaire, in showing evidence of content validity, validity as internal structure, validity related to other variables, and reliability, could assess patient satisfaction with the drug dispensing service in the community pharmacies of Argentina.
