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Estudo do impacto global dos Cuidados Farmacêuticos de farmácia comunitária nos ganhos em saúde na Diabetes Mellitus
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Introdução: Detetar problemas de saúde pública como a diabetes mellitus (DM) para os poder controlar, requer intervenções multidisciplinares, de tal forma ativas e dinâmicas que garantam a equidade e o acesso a cuidados de saúde de qualidade, aplicando-as a situações emergentes no mundo contemporâneo, como a atual crise em saúde na Europa. Adaptar os serviços farmacêuticos (SF) de gestão da doença, no contexto dos cuidados farmacêuticos, personalizando-os e enquadrando-os ao ambiente digital é uma das possíveis soluções, potenciando a colaboração da farmácia comunitária e do farmacêutico com a rede de cuidados de saúde primários. Porém, a exequibilidade desta implementação implica ultrapassar barreiras conceptuais, legais e políticas.
Objetivos: A tese propõe-se a avaliar a evolução do modelo português de prestação serviços de farmácia (SC) para a DM, mediante uma análise comparativa desta prática na União Europeia e Reino Unido (EUK), no período 2008-2022.
Métodos: A tese constitui a compilação de um estudo observacional de corte transversal proveniente de uma revisão sistemática, para conceptualizar temporal e espacialmente os SC para a DM, na EUK; de um estudo exploratório de natureza descritiva igualmente assente numa revisão sistemática e num questionário, para avaliar o arcabouço normativo da prática de SC para a DM2, na EUK; e de uma revisão narrativa, para analisar a exequibilidade técnica do SF designado por teleconsulta farmacêutica, em Portugal, com base em modelos de consulta internacionais.
Resultados: Identificaram-se elementos determinantes do presente e futuro dos SF e dos SC, detancando-se o papel do farmacêutico e da farmácia comunitária na sua prestação, na capacidade de alocar recursos a nível do seu máximo desempenho e custo-efetivamente e na possibilidade de inovar e desenvolver serviços transversais a outras áreas, que não a do medicamento. A evolução da implementação de SC foi evidente ao longo do tempo, tendo sido representada por treze subtipos de SC, coexistentes na sua totalidade, na Alemanha e do Reino Unido. O serviço “blood glucose measurement” surgiu em 15 países e o de “diabetes management” em 13. Algumas farmácias portuguesas demonstraram compreender ambos os serviços, tendo permitido desenvolver um quadro teórico de apoio ao desenho e plano de uma teleconsulta farmacêutica. Por sua vez, a Bélgica, a Dinamarca, a Eslováquia, os Países Baixos e Portugal, demonstraram constituir a estrutura regulamentar e normativa de SC para a DM, mais bem estabelecida da EUK.
Conclusão: Na maioria dos países da EUK, a expansão do conjunto de SC e SF para âmbitos patológicos mais específicos e da saúde digital, interpretou a necessidade de responder a necessidades em saúde como a DM, de uma forma pertinente e exequível, ainda que, com barreiras e limitações potencialmente ultrapassáveis mediante a aceitabilidade social e um compromisso político responsabilizado por garantir uma evolução constante, a nível da alocação de recursos e a sustentabilidade dos sistemas de saúde. Quanto a Portugal, a robustez organizacional e a alocação simétrica de recursos alavancariam a exequibilidade dos SF, ao potenciarem o desempenho das farmácias comunitárias, no âmbito dos cuidados de saúde primários.
Introduction Detecting public health problems such as diabetes mellitus (DM) and controlling them requires active and dynamic multidisciplinary interventions that guarantee equity and access to quality health care, to be applied in emerging situations in the contemporary world, such as the current situation of health crisis in Europe. Adapting Pharmaceutical Assistance (SF) services for disease management, in the pharmaceutical care context, personalizing them and framing them in the digital environment is one of the possible solutions, to enhance the collaboration of community pharmacy and pharmacists with the primary health care network (CSP). However, the feasibility of this implementation requires overcoming conceptual, legal and political barriers. Objectives: The thesis aims to evaluate the evolution of the Portuguese model of providing pharmacy services (SC) for DM through a comparative analysis of this practice in European Union and the United Kingdom (EUK) in 2008-2022. Methods: The thesis constitutes the compilation of a cross-sectional observational study resulting from a systematic review to temporally and spatially conceptualize SC for DM in EUK; an exploratory study of a descriptive nature, also based on a systematic review and a questionnaire, to evaluate the normative framework for the practice of SC for DM2, in EUK; and a narrative review, to analyse the technical feasibility of the SF called pharmaceutical teleconsultation, in Portugal, based on international consultation models. Results: We identified determining elements of the present and future of SF and SC, highlighting the role of the pharmacist and community pharmacy in their provision, in the ability to allocate resources at maximum performance and cost-effectiveness, and in the possibility of innovating and developing cross-cutting services also in areas non-medicines related. The evolution of SC’ implementation was evident over time, represented by thirteen subtypes, which coexisted in their entirety in Germany and the United Kingdom. The “blood glucose measurement” service was implemented in 15 countries, and the “diabetes management” service was implemented in 13. Some Portuguese pharmacies demonstrated that they offer both services, allowing the development of a theoretical framework to support the design and planning of pharmaceutical teleconsultations. In turn, Belgium, Denmark, Slovakia, the Netherlands, and Portugal demonstrated that they constitute the most well-established SC regulatory and normative structure for DM in the EUK. Conclusion: In most EUK countries, the expansion of the set of SC and SF to more specific pathological areas and digital health interpreted the need to respond to health needs, such as DM, in a pertinent and feasible way, even though with barriers and limitations potentially surmountable through social acceptability and a political commitment responsible for ensuring constant evolution in terms of resource allocation and the sustainability of health systems. As for Portugal, organizational robustness and the symmetrical allocation of resources would leverage the feasibility of SF by enhancing the performance of community pharmacies within the scope of CSP.
Introduction Detecting public health problems such as diabetes mellitus (DM) and controlling them requires active and dynamic multidisciplinary interventions that guarantee equity and access to quality health care, to be applied in emerging situations in the contemporary world, such as the current situation of health crisis in Europe. Adapting Pharmaceutical Assistance (SF) services for disease management, in the pharmaceutical care context, personalizing them and framing them in the digital environment is one of the possible solutions, to enhance the collaboration of community pharmacy and pharmacists with the primary health care network (CSP). However, the feasibility of this implementation requires overcoming conceptual, legal and political barriers. Objectives: The thesis aims to evaluate the evolution of the Portuguese model of providing pharmacy services (SC) for DM through a comparative analysis of this practice in European Union and the United Kingdom (EUK) in 2008-2022. Methods: The thesis constitutes the compilation of a cross-sectional observational study resulting from a systematic review to temporally and spatially conceptualize SC for DM in EUK; an exploratory study of a descriptive nature, also based on a systematic review and a questionnaire, to evaluate the normative framework for the practice of SC for DM2, in EUK; and a narrative review, to analyse the technical feasibility of the SF called pharmaceutical teleconsultation, in Portugal, based on international consultation models. Results: We identified determining elements of the present and future of SF and SC, highlighting the role of the pharmacist and community pharmacy in their provision, in the ability to allocate resources at maximum performance and cost-effectiveness, and in the possibility of innovating and developing cross-cutting services also in areas non-medicines related. The evolution of SC’ implementation was evident over time, represented by thirteen subtypes, which coexisted in their entirety in Germany and the United Kingdom. The “blood glucose measurement” service was implemented in 15 countries, and the “diabetes management” service was implemented in 13. Some Portuguese pharmacies demonstrated that they offer both services, allowing the development of a theoretical framework to support the design and planning of pharmaceutical teleconsultations. In turn, Belgium, Denmark, Slovakia, the Netherlands, and Portugal demonstrated that they constitute the most well-established SC regulatory and normative structure for DM in the EUK. Conclusion: In most EUK countries, the expansion of the set of SC and SF to more specific pathological areas and digital health interpreted the need to respond to health needs, such as DM, in a pertinent and feasible way, even though with barriers and limitations potentially surmountable through social acceptability and a political commitment responsible for ensuring constant evolution in terms of resource allocation and the sustainability of health systems. As for Portugal, organizational robustness and the symmetrical allocation of resources would leverage the feasibility of SF by enhancing the performance of community pharmacies within the scope of CSP.
Descrição
Palavras-chave
Saúde pública Políticas de saúde Farmacologia clínica Diabetes mellitus tipo 2 Farmácia