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Preparação Individualizada da Medicação e Dispensa em Dose Unitária: Que futuro?
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Abstract(s)
Introdução: A falta de adesão à terapêutica é definida pela Organização Mundial de Saúde
(OMS) como a extensão com que o comportamento adotado no que concerne à toma de
medicamentos, seguimento de uma dieta e/ou implementação de mudanças do estilo de
vida corresponde às recomendações do profissional de saúde. Esta pode ser dividida em
intencional ou não intencional, se resulta de uma ação deliberada ou não, respetivamente.
A falta de adesão à terapêutica acarreta problemas médicos e psicossociais devido às
complicações das patologias subjacentes e um enorme desperdício de recursos em saúde.
Como possíveis soluções de intervenções práticas, surgem a Preparação Individualizada da
Medicação (PIM) e a Dispensa em Dose Unitária (DDU). A PIM consiste num serviço em
que se utilizam dispositivos auxiliares para a dispensa da medicação de acordo com a
posologia prescrita. Importa salientar que as revisões sistemáticas mais recentes admitem
a possibilidade de que este tipo de serviço possa ter efeitos positivos na adesão, segurança,
nos outcomes clínicos e na redução do desperdício. Em Portugal, a literatura é escassa mas
os 4 estudos que foram realizados nesse âmbito mostraram resultados muito positivos. A
DDU consiste num sistema de prescrição e distribuição em unidose especificamente
associado à PIM.
Objetivo principal: caracterizar e avaliar o impacto da implementação da PIM e da DDU
em Portugal.
Objetivos específicos: caracterizar a implementação da PIM em Portugal; avaliar o
impacto da PIM como instrumento de adesão à terapêutica, de redução do desperdício e de
aumento da segurança do utente, considerando a possibilidade de associar a revisão
terapêutica; avaliar o impacto, refletindo criticamente, da associação de DDU com a
introdução de um sistema de PIM pré-venda e da prescrição médica individualizada; refletir
criticamente sobre os diferentes modelos que podem ser seguidos em relação ao futuro da
PIM; identificar as limitações da introdução de um sistema de PIM pré-venda e possíveis
soluções para as ultrapassar; conhecer as posições dos principais decisores e entidades
diretamente envolvidas.
Metodologia: Foi realizado um estudo observacional descritivo, baseado na recolha de
dados objetivos e subjetivos junto de associações do sector farmacêutico e através de
entrevistas semiestruturadas aos intervenientes (utentes, farmacêuticos e proprietários de
farmácia) e decisores (representantes de ordens profissionais, associações do setor e
partidos políticos). Os dados subjetivos foram reportados utilizando a checklist de critérios
consolidados para relatar investigação qualitativa (COREQ). Resultados: De acordo com os dados objetivos disponibilizados pela Associação Nacional
de Farmácias, existem 366 farmácias com registo do serviço de PIM, verificando-se um
acréscimo de 47% desde 2016. Tendo em conta o número de farmácias estabelecidas no
território nacional, estima-se uma implementação a rondar os 10%. O preço médio do
serviço dos últimos 4 anos é de 4,57€/semana. Na amostra de 18 farmácias comunitárias
entrevistadas, o custo semanal médio para o utente foi de 3,23€ e o custo médio para a
farmácia foi de 8,74€/mês, sendo que o serviço foi disponibilizado em média há 4,8 anos.
Através da análise qualitativa dos dados subjetivos, foram identificadas categorias que
apontaram como metodologia preferencial o blister automatizado semanal. Contudo, o
custo de investimento é demasiado elevado para a sua implementação na prática
considerando o número de potenciais utentes. Para além disso, foi unânime que a PIM tem
um impacto muito positivo em termos de segurança e adesão à terapêutica, sendo que a
esmagadora maioria considera ainda que esse impacto também é verificado na redução de
desperdício. Existem vários modelos que podem ser seguidos e que merecem uma análise
mais aprofundada em articulação com as principais entidades envolvidas.
Conclusão: Com este trabalho, foi possível recolher os dados disponíveis acerca da
implementação da PIM em Portugal e caracterizar este serviço numa amostra de farmácias
comunitárias. O impacto aparentemente é muito positivo nas componentes de segurança,
adesão à terapêutica e desperdício. Relativamente à associação com DDU, existem várias
limitações que devem ser analisadas novamente e de uma forma aprofundada, sendo que
isso não invalida o estudo acerca de outros modelos de modo a aumentar a adesão ao serviço
para quem dele necessita, que foram alvo de reflexão crítica nesta dissertação.
Introduction: The lack of medication adherence is defined by the World Health Organization as the extent to which a person’s behaviour concerning taking medication, following a diet, and/or executing lifestyle changes corresponds to the recommendations from a health care provider. It can be divided into intentional or non-intentional, if it results from deliberate action or not, respectively. The lack of medication adherence comes with medical and psychosocial issues due to the complications from ongoing diseases and a huge waste of medical resources. Dose Administration Aid Service (DAAS) and Unit Dose Dispensing (UDD) arise as possible solutions of practical interventions. DAAS consists of a service that delivers the medicine accordingly to the dosage prescribed on appropriate dose administration aids. It is important to emphasize that the most recent systematic reviews admit the possibility of a positive impact of this service on adhesion, safety, clinical outcomes, and reduction of waste. In Portugal, the literature is scarce; however, the 4 studies on this area showed very positive outcomes. UDD consists of a system of single-dose prescribing and distributing specifically associated with DAAS. Main objective: to characterize and assess the implementation of DAAS and UDD in Portugal. Specific objectives: to characterize the implementation of DAAS in Portugal; to assess the impact of DAAS as an instrument for medication adherence, for reducing waste and increasing safety, considering the possibility of associating therapeutic review; to assess the impact of linking UDD with the introduction of a pre-sale DAAS system and individualized medical prescription; to critically reflect on the different models towards the future of DAAS; to identify the limitations of introducing a pre-sale DAAS system and the possible solutions to overcome them; to know the public position of stakeholders and entities directly involved. Methodology: A descriptive observational study was conducted based on the collection of objective and subjective data from pharmaceutical sector associations and through semistructured interviews with the stakeholders (patients, pharmacists and pharmacy owners) and decision-makers (professional orders representatives, sector associations, and political parties). The subjective data was reported using the consolidated criteria for reporting qualitative research (COREQ) checklist. Results: According to objective data provided by the National Association of Pharmacies, there are 366 pharmacies registered to provide DAAS, which represents an increase of 47% compared to 2016. Considering the number of pharmacies established in Portugal, the implementation of DAAS is estimated at around 10%. The average price for the service considering the last 4 years is €4.57 per week. In the sample of 18 community pharmacies, the average weekly cost to the user was €3.23 and the average cost to the pharmacy was €8.74 per month. DAAS was available in these pharmacies on average for 4.8 years. Using qualitative content analysis, we identified categories that revealed that automated weekly methodology is the preferred methodology; however, the investment cost is too high considering the number of potential users for implementation in practice. Furthermore, participants were unanimous in recognizing that DAAS has a very positive impact in terms of safety and medication adherence, and the majority agreed that it also helped reducing medication waste. Several models can be followed and deserve further analysis with the main entities involved. Conclusion: With this work, it was possible to collect available data about the implementation of DAAS in Portugal and characterize this service in a sample of community pharmacies. The impact is apparently very positive in terms of safety, medication adherence, and waste. Regarding the association with UDD, several limitations were identified and should be analyzed in depth. However, this does not invalidate the study of other models to increase DAAS provision for those who need it, this being the target of the critical reflection presented in this dissertation.
Introduction: The lack of medication adherence is defined by the World Health Organization as the extent to which a person’s behaviour concerning taking medication, following a diet, and/or executing lifestyle changes corresponds to the recommendations from a health care provider. It can be divided into intentional or non-intentional, if it results from deliberate action or not, respectively. The lack of medication adherence comes with medical and psychosocial issues due to the complications from ongoing diseases and a huge waste of medical resources. Dose Administration Aid Service (DAAS) and Unit Dose Dispensing (UDD) arise as possible solutions of practical interventions. DAAS consists of a service that delivers the medicine accordingly to the dosage prescribed on appropriate dose administration aids. It is important to emphasize that the most recent systematic reviews admit the possibility of a positive impact of this service on adhesion, safety, clinical outcomes, and reduction of waste. In Portugal, the literature is scarce; however, the 4 studies on this area showed very positive outcomes. UDD consists of a system of single-dose prescribing and distributing specifically associated with DAAS. Main objective: to characterize and assess the implementation of DAAS and UDD in Portugal. Specific objectives: to characterize the implementation of DAAS in Portugal; to assess the impact of DAAS as an instrument for medication adherence, for reducing waste and increasing safety, considering the possibility of associating therapeutic review; to assess the impact of linking UDD with the introduction of a pre-sale DAAS system and individualized medical prescription; to critically reflect on the different models towards the future of DAAS; to identify the limitations of introducing a pre-sale DAAS system and the possible solutions to overcome them; to know the public position of stakeholders and entities directly involved. Methodology: A descriptive observational study was conducted based on the collection of objective and subjective data from pharmaceutical sector associations and through semistructured interviews with the stakeholders (patients, pharmacists and pharmacy owners) and decision-makers (professional orders representatives, sector associations, and political parties). The subjective data was reported using the consolidated criteria for reporting qualitative research (COREQ) checklist. Results: According to objective data provided by the National Association of Pharmacies, there are 366 pharmacies registered to provide DAAS, which represents an increase of 47% compared to 2016. Considering the number of pharmacies established in Portugal, the implementation of DAAS is estimated at around 10%. The average price for the service considering the last 4 years is €4.57 per week. In the sample of 18 community pharmacies, the average weekly cost to the user was €3.23 and the average cost to the pharmacy was €8.74 per month. DAAS was available in these pharmacies on average for 4.8 years. Using qualitative content analysis, we identified categories that revealed that automated weekly methodology is the preferred methodology; however, the investment cost is too high considering the number of potential users for implementation in practice. Furthermore, participants were unanimous in recognizing that DAAS has a very positive impact in terms of safety and medication adherence, and the majority agreed that it also helped reducing medication waste. Several models can be followed and deserve further analysis with the main entities involved. Conclusion: With this work, it was possible to collect available data about the implementation of DAAS in Portugal and characterize this service in a sample of community pharmacies. The impact is apparently very positive in terms of safety, medication adherence, and waste. Regarding the association with UDD, several limitations were identified and should be analyzed in depth. However, this does not invalidate the study of other models to increase DAAS provision for those who need it, this being the target of the critical reflection presented in this dissertation.
Description
Keywords
Adesão à Terapêutica Desperdício Dispensa em Dose Unitária Farmácia Comunitária Preparação Individualizada da Medicação Segurança