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Estratégias de racionalidade terapêutica com vista à sustentabilidade do SNS
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Perante o crescente desafio de garantir a sustentabilidade do Serviço Nacional de Saúde, esta monografia explora as estratégias de racionalidade terapêutica como instrumentos essenciais para a utilização eficiente e segura dos medicamentos, avaliando o seu impacto na otimização dos recursos públicos e nos resultados em saúde. São abordados conceitos estruturantes como racionalidade terapêutica, sustentabilidade do SNS, medicamentos genéricos e biossimilares, bem como alternativas terapêuticas definidas pela Comissão Nacional de Farmácia e Terapêutica. Analisa-se ainda o papel do INFARMED e da CNFT na definição e monitorização do Formulário Nacional de Medicamentos, assumido como ferramenta central na racionalização da utilização de fármacos.
O trabalho aprofunda um conjunto de estratégias específicas que promovem a racionalidade terapêutica, nomeadamente o financiamento público, as compras centralizadas, o posicionamento terapêutico, a monitorização da prescrição e do uso de medicamentos, e a consultadoria farmacêutica, avaliando o seu impacto na eficácia clínica, segurança do doente, adesão terapêutica e sustentabilidade económica do sistema. São igualmente analisadas experiências internacionais, com destaque para casos de referência como a Escócia e a Dinamarca, que oferecem perspetivas comparativas úteis para o contexto português.
Por fim, apresentam-se aplicações práticas para o exercício farmacêutico em Portugal, incluindo a criação de indicadores de monitorização e exemplos de intervenção clínica em áreas como os anticoagulantes orais diretos e a terapêutica antirretroviral no VIH. Estes exemplos ilustram o papel central do farmacêutico na implementação de estratégias que garantem um uso racional, seguro e equitativo do medicamento, contribuindo para um SNS mais eficiente, sustentável e centrado no doente.
In light of the growing challenge of ensuring the sustainability of the Portuguese National Health Service, this dissertation explores therapeutic rationality strategies as essential tools for the efficient and safe use of medicines, assessing their impact on the optimization of public resources and on patients’ health outcomes. It addresses key concepts such as therapeutic rationality, health system sustainability, generic and biosimilar medicines, as well as therapeutic alternatives defined by the National Commission of Pharmacy and Therapeutics. The roles of INFARMED and the CNFT in defining and monitoring the National Medicines Formulary are also examined, as this instrument serves as a central tool for rationalizing the use of medicines. The study further develops a set of specific strategies that promote therapeutic rationality, namely public financing mechanisms, centralized procurement, therapeutic positioning, prescription and medicine-use monitoring, and pharmaceutical consultancy. Each strategy is analysed in terms of its contribution to clinical effectiveness, patient safety, therapeutic adherence, and the economic sustainability of the health system. International experiences, particularly those of reference countries such as Scotland and Denmark, are also discussed, providing comparative insights for the Portuguese context. Finally, practical applications for pharmaceutical practice in Portugal are presented, including the development of monitoring indicators and examples of clinical intervention in areas such as direct oral anticoagulants and antiretroviral therapy in HIV. These examples highlight the pharmacist’s central role in implementing strategies that ensure the rational, safe, and equitable use of medicines, thereby contributing to a more efficient, sustainable, and patient-centred National Health Service.
In light of the growing challenge of ensuring the sustainability of the Portuguese National Health Service, this dissertation explores therapeutic rationality strategies as essential tools for the efficient and safe use of medicines, assessing their impact on the optimization of public resources and on patients’ health outcomes. It addresses key concepts such as therapeutic rationality, health system sustainability, generic and biosimilar medicines, as well as therapeutic alternatives defined by the National Commission of Pharmacy and Therapeutics. The roles of INFARMED and the CNFT in defining and monitoring the National Medicines Formulary are also examined, as this instrument serves as a central tool for rationalizing the use of medicines. The study further develops a set of specific strategies that promote therapeutic rationality, namely public financing mechanisms, centralized procurement, therapeutic positioning, prescription and medicine-use monitoring, and pharmaceutical consultancy. Each strategy is analysed in terms of its contribution to clinical effectiveness, patient safety, therapeutic adherence, and the economic sustainability of the health system. International experiences, particularly those of reference countries such as Scotland and Denmark, are also discussed, providing comparative insights for the Portuguese context. Finally, practical applications for pharmaceutical practice in Portugal are presented, including the development of monitoring indicators and examples of clinical intervention in areas such as direct oral anticoagulants and antiretroviral therapy in HIV. These examples highlight the pharmacist’s central role in implementing strategies that ensure the rational, safe, and equitable use of medicines, thereby contributing to a more efficient, sustainable, and patient-centred National Health Service.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
Racionalidade terapêutica Sustentabilidade Serviço Nacional de Saúde