Integrality of the therapeutic and pharmaceutical care: a necessary debate

Vieira, Fabiola Sulpino

doi:10.11606/S1518-8787.2017051000185

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Comments • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.11606/S1518-8787.2017051000185 copy

Integrality of the therapeutic and pharmaceutical care: a necessary debate

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The controversy surrounding the different interpretations on the integrality of therapeutic and pharmaceutical care has led to the delimitation of its scope by a law, but the issue has not been completely pacified. As a contribution to this debate, we aim to discuss the challenges to ensure the integrality of the therapeutic and pharmaceutical care, based on a conceptual approach on the meanings of integrality in the Brazilian Unified Health System (SUS). We identified important challenges to ensure the integrality of the therapeutic and pharmaceutical care in the SUS. These challenges are related to professional practices, the organization of actions and services, and the governmental response to health problems or to the treatment of specific population groups. For this end, governments need to carry out structuring actions and be efficient in using available resources so that existing problems can be overcome.

DESCRIPTORS
Pharmaceutical Services; Legislation & Jurisprudence; Integrality in Health; Unified Health System; Right to Health

Models of management of pharmaceutical care	Example	Access to drugs	Some possible difficulties from the perspective of the public administration
State public management	State public pharmaceutical care (most of the Brazilian municipalities)	It depends on the performance of the Health Department team in the management of the logistics component and the regular financing of the procurements	Management of procurement processes Difficulties in complying with distribution schedules Lack of drugs in health units
Integrated public and private mix	Management of health units, including pharmacies, by social organizations (OSS), but the global management of pharmaceutical care is under the responsibility of the public administration	It depends on the performance of the Health Department team in the management of the logistics component of pharmaceutical care and the routine financing of the procurements	The problems mentioned above may arise because the logistical component of pharmaceutical care falls under the responsibility of the public administration Difficulties in coordinating the actions of the technical component (the OSS is responsible for the management of the health unit and the pharmacists are hired by it)
Segmented public and private mix	Public or state public pharmaceutical care from the OSS coexisting with the Popular Pharmacy Program	It is facilitated by the supply of drugs by the private network of pharmaceutical establishments (drugstores)	Overlapping programs with different costs for the same paying source and induction of the market to ensure the offering only by the program that is more profitable Costs may be higher than in other models Difficulties in the regulation and control of expenses Disarticulation between the technical and logistic components of pharmaceutical care Pharmacotherapeutic monitoring by the public administration is impaired, unless mechanisms are created to link the health services of the SUS to the private network Fragmentation of the care may be greater

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[1] Correspondence: Fabiola Sulpino Vieira SBS, Quadra 1, Bloco J, Ed. BNDES, Sala 1413 70076-900 Brasília, DF, Brazil E-mail: fabiola.vieira@ipea.gov.br