Suchergebnisse

From a political and governance perspective Spain is a decentralized country with 17 states [comunidades autónomas] resulting in a governmental structure similar to a federal state. The various state regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced.

Community pharmacy is part of the health care system which is currently under economic pressure and facing changes in demands from consumers and government. In response, the pharmacy profession is becoming more patient orientated and implementing cognitive pharmaceutical services (CPS). CPS in various countries has similar objectives with different emphasis, definitions, labels and using different tools. However, they can be classified using a broad hierarchical model based on clinical decision making and the extent of change required (Box 1). The challenges faced by the profession are related the development of a new patient orientated model of pharmacy which affects health care policy, education and research, the evolution of the market, the individual and organisational approaches to change and the implementation of CPS. These issues and previous research conducted in pharmacy practice have been synthesised to provide a platform for change that can guide a holistic and integrated approach to CPS implementation. Implementation can be conceptually framed in six levels: clinical, service provision, community pharmacy, professional organisation, government and stakeholder (Figure 1). Past experience with service implementation has seen the application of programs that include one or two of these levels in practice rather than a holistic approach. A concentric model was developed to illustrate the implementation of CPS and the holistic and integrated approach required to support change. A program (conSIGUE) being conducted in Spain has attempted to integrate all six levels to support the implementation and evaluation of a medication management service (Seguimiento Farmacoterapéutico) ; La Farmacia Comunitaria forma parte del sistema de salud. Este sistema actualmente se encuentra sometido a presiones económicas y debe afrontar cambios en la demanda tanto de los consumidores como de los gobiernos. La respuesta de la profesión farmacéutica está dirigida a orientar su práctica hacia el paciente y a implantar servicios cognitivos farmacéuticos (CPS). En distintos países estos servicios tiene objetivos similares aunque presentan diferencias en el énfasis de los servicios, en sus definiciones, denominaciones y en la utilización de diferentes herramientas. Sin embargo, todos ellos pueden clasificarse utilizando un amplio modelo jerárquico que se basa en la toma de decisiones clínicas y en la amplitud del cambio requerido. (Box 1). Los retos que debe afrontar la profesión están relacionados con el desarrollo de un nuevo modelo de farmacia orientado al paciente que afecta a las políticas de salud, a la formación e investigación, a la evolución de los mercados, a los abordajes del cambio tanto a nivel individual como organizacional, y a la implantación de CPS. Estos temas y la investigación en práctica farmacéutica que se ha venido realizando con anterioridad han sido sintetizados para proporcionar una plataforma para el cambio que pueda guiar un planteamiento holístico e integrado de implantación de CPS. Conceptualmente la implantación de CPS puede enmarcarse en seis niveles: clínico, provisión de servicios, farmacia comunitaria, organización profesional, gobierno y agentes implicados (Figura 1). La experiencia reciente relacionada con la implantación de servicios ha mostrado la aplicación de programas de implantación que han incluido uno o dos de estos niveles en lugar de haber utilizado un abordaje holístico. Por ello se ha desarrollado un modelo concéntrico para ilustrar la implantación de CPS dentro del planteamiento integrado y holístico necesario para apoyar el cambio En España se ha desarrollado un programa (conSIGUE) que pretende integrar los seis niveles con el objetivo de apoyar la implantación y evaluación de un CPS, el servicio de seguimiento farmacoterapéutico.

Introducción: La necesidad de estándares de calidad de los servicios farmacéuticos, para garantizar el uso seguro, responsable y efectivo del medicamento, ha hecho que a través de los años se produzcan una serie de cambios en los sistemas sanitarios. Existe además, una lucha para posicionar a la farmacia y a farmacéuticos como ejes potenciales para promulgar la protección de la salud. Fruto de estos cambios, se evidencian diferencias estructurales en los modelos de farmacia entre países desarrollados y países en vías de desarrollo. El presente estudio realiza un análisis comparativo del modelo de oficina farmacia entre los países de Ecuador y España, diferenciando las legislaciones alusivas al funcionamiento de las farmacias y comparando los modelos de oficina de farmacia. Método: Estudio comparativo basado en investigación documental, en lo referente a normativas y legislación de las farmacias comunitarias de Ecuador y España Resultados: En el presente trabajo se analizan la legislación vigente que regula la farmacia española y ecuatoriana, en referencia al establecimiento de nuevas farmacias, propiedad farmacéutica, prohibición de cadenas de farmacia, así como la calidad de la formación del farmacéutico comunitario Conclusiones: En países de Latinoamérica, como en el caso de Ecuador, la farmacia adopta un modelo más liberal, refiriendo a la desregularización de la apertura de nuevas farmacias, temas de propiedad, sistema de planificación territorial, así como la no presencia del profesional farmacéutico; dando lugar a un sistema con un fuerte enfoque comercial; incidiendo de esta forma sobre la función ideal que debe llevar a cabo la farmacia comunitaria. ; Introduction: The need for quality standards in pharmaceutical services, that provides a safety, responsible and effectiveness use of medication, has led several changes in health systems over the years. There is also a struggle to position the pharmacy and pharmaceutical professionals as potential axes to enact health care. As a result of these changes, there are structural differences in pharmacy models between developed and developing countries. The present study sets out to provide a comparative analysis of Ecuador and Spain pharmacy office model, differentiating legislations concerning the functioning of pharmacies and comparing the pharmacy office models. Method: Documentary based research and a comparative study, regarding regulations and legislation of community pharmacies in Ecuador and Spain. Results: In this paper, the current legislation that regulates the Spanish and Ecuadorian pharmacy is analyzed, in reference to the establishment of new pharmacies, pharmaceutical ownership, prohibition of pharmacy chains, as well as the quality of the training of community pharmacists. Conclusions: In Latin American countries, as in the case of Ecuador, the pharmacy adopts a more liberal model, referring to the deregulation of the opening of new pharmacies, property issues, territorial planning system, as well as the non-presence of the professional pharmacist; resulting in a system with a strong commercial focus; thus emphasizing the ideal role to be played by the community pharmacy.

Introducción: La necesidad de estándares de calidad de los servicios farmacéuticos, para garantizar el uso seguro, responsable y efectivo del medicamento, ha hecho que a través de los años se produzcan una serie de cambios en los sistemas sanitarios. Existe además, una lucha para posicionar a la farmacia y a farmacéuticos como ejes potenciales para promulgar la protección de la salud. Fruto de estos cambios, se evidencian diferencias estructurales en los modelos de farmacia entre países desarrollados y países en vías de desarrollo. El presente estudio realiza un análisis comparativo del modelo de oficina farmacia entre los países de Ecuador y España, diferenciando las legislaciones alusivas al funcionamiento de las farmacias y comparando los modelos de oficina de farmacia. Método: Estudio comparativo basado en investigación documental, en lo referente a normativas y legislación de las farmacias comunitarias de Ecuador y España Resultados: En el presente trabajo se analizan la legislación vigente que regula la farmacia española y ecuatoriana, en referencia al establecimiento de nuevas farmacias, propiedad farmacéutica, prohibición de cadenas de farmacia, así como la calidad de la formación del farmacéutico comunitario Conclusiones: En países de Latinoamérica, como en el caso de Ecuador, la farmacia adopta un modelo más liberal, refiriendo a la desregularización de la apertura de nuevas farmacias, temas de propiedad, sistema de planificación territorial, así como la no presencia del profesional farmacéutico; dando lugar a un sistema con un fuerte enfoque comercial; incidiendo de esta forma sobre la función ideal que debe llevar a cabo la farmacia comunitaria. ; Introduction: The need for quality standards in pharmaceutical services, that provides a safety, responsible and effectiveness use of medication, has led several changes in health systems over the years. There is also a struggle to position the pharmacy and pharmaceutical professionals as potential axes to enact health care. As a result of these changes, there are structural differences in pharmacy models between developed and developing countries. The present study sets out to provide a comparative analysis of Ecuador and Spain pharmacy office model, differentiating legislations concerning the functioning of pharmacies and comparing the pharmacy office models. Method: Documentary based research and a comparative study, regarding regulations and legislation of community pharmacies in Ecuador and Spain. Results: In this paper, the current legislation that regulates the Spanish and Ecuadorian pharmacy is analyzed, in reference to the establishment of new pharmacies, pharmaceutical ownership, prohibition of pharmacy chains, as well as the quality of the training of community pharmacists. Conclusions: In Latin American countries, as in the case of Ecuador, the pharmacy adopts a more liberal model, referring to the deregulation of the opening of new pharmacies, property issues, territorial planning system, as well as the non-presence of the professional pharmacist; resulting in a system with a strong commercial focus; thus emphasizing the ideal role to be played by the community pharmacy.