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Avaliação do impacto económico do receituário devolvido para as farmácias comunitárias: contribuição da DCI, do CNPEM e das justificações técnicas
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Abstract(s)
Introdução: Em Portugal, as farmácias comunitárias vêem-se envolvidas pelos tentáculos da crise que abala não só o país, a Europa mas o globo inteiro. A Farmácia sofreu inúmeras alterações nos últimos anos, fruto das sucessivas alterações legislativas, das quais se destacam: a implementação da prescrição por Denominação Comum Internacional (DCI) e através do Código Nacional para a Prescrição Eletrónica de Medicamentos (CNPEM), o recurso a justificações técnicas pelos prescritores, entre outras. A devolução do receituário às farmácias, por parte do Centro de Conferência de Faturas (CCF), constitui mais um obstáculo à gestão financeira das próprias farmácias. O objetivo do estudo passa por avaliar a extensão na qual a implementação das medidas referidas tem afetado o processo de dispensa do medicamento e contribuído para a devolução do receituário às farmácias.
Metodologia: Através de um estudo descritivo-correlacional longitudinal, foi entregue um questionário a cada uma das cinquenta farmácias pertencentes ao concelho de Coimbra. O questionário foi enviado para a morada do autor, através de envelope sem remetente, de modo a assegurar o anonimato dos dados. Software: Microsoft Excel 2010® e SPSS 20.0®. Testes estatísticos: Friedman, Rho de Spearman, Wilcoxon e U de Mann-Whitney (nível de significância=0,05).
Resultados: A taxa de resposta foi de 58%. As diferenças detetadas entre os meses em análise revelaram um maior impacto das devoluções em setembro de 2013, que se deve, principalmente, à menção das justificações técnicas, mas também à recente implementação do CNPEM. As exceções têm aumentado o número de medicamentos pagos por inteiro pelo utente. A redução da média do valor não processado pelo CCF, verificado em março de 2013, pode querer dizer que a DCI veio reduzir o impacto das devoluções. Os valores médios não processados pelo CCF apresentam um impacto significativo para a gestão financeira das respetivas farmácias. No entanto, as farmácias conseguem recuperar grande parte do valor não processado, após a correção e o reenvio das prescrições devolvidas. Porém, é de assinalar o tempo despendido pelos profissionais durante este procedimento. Os erros mencionados com maior frequência como origem de devoluções, ao longo dos três meses analisados, foram: o C024 e o D999, ambos relacionados com o preço dos medicamentos e associados a diferenças de interpretações quanto às regras de dispensa, por parte das farmácias e do CCF. Nenhum dos erros colocou em risco a saúde dos utentes.
Conclusão: A DCI poderá estar na origem da redução do número de prescrições devolvidas. O CNPEM, dada a recente implementação, contribuiu para o aumento do número de devoluções. No entanto, esta influência inicial poderá deixar de ter tradução no futuro. A menção de justificações técnicas tem criado dificuldades ao processo de dispensa de medicamentos e tem contribuído ativamente para o aumento do impacto económico provocado pela devolução do receituário. Todavia, prevê-se também a redução do impacto do receituário devolvido devido à menção de justificações técnicas.
Introduction: Portuguese community pharmacies were already involved by the tentacles of the crisis that affects not only the country, but also Europe and the entire globe. Pharmaceutical sector have experienced numerous changes in recent years, as a result of successive legislative amendments, which can be noted: the implementation of International Non-Proprietary Name (INN) prescription, the introduction of prescription by National Code for the Eletronic Prescription of Medicines (NCEPM) and the use of technical justifications by physicians. The return of prescriptions to pharmacies, by the Conference Center of Bills (CCB), represents an additional obstacle on the financial management of the pharmacies. The objective of the study involves assessing the extent in which the implementation of the measures referred have affected the drug dispensing process and contributed to the return of prescriptions to pharmacies. Methodology: Through a longitudinal descriptive-correlational study, a questionnaire was delivered to each one of the fifty pharmacies belonging to the municipality of Coimbra. The questionnaire was sent to the address of the writer, by blank envelope, to ensure data confidentiality. Software: Microsoft Excel 2010® and SPSS 20.0®, for Windows. Statistical tests: Friedman, Spearman's Rho, Wilcoxon and Mann-Whitney (significance level=0.05). Results: The response rate was 58%. The differences detected between the months under analysis showed a bigger impact of returns in September 2013, which was mainly due to the indication of technical justifications, but also to the recent implementation of NCEPM. The mention of exceptions have increase the number of drugs paid entirely by the user. The reduction in the mean value not paid by CCB, recorded in March 2013, could mean that INN prescription has reduced the impact of returns. Mean values not processed by CCF have a significant impact on financial management of pharmacies. However, pharmacies can recover much of the value not processed by CCB, after correction and resend of returned prescriptions. Nonetheless, it should be noted the time spent by professionals during this procedure. The errors most frequently mentioned as a source of returns over the three months analysed were: C024 and D999, both related to drug’s prices. Patient’s health was not affected by the errors. Conclusions: INN prescription may have caused the reduction of the number of returned prescriptions. NCEPM, due to recent implementation, contributed to increase the number of returns. However, this influence may have no consequences in the future. Indication of technical justifications has created difficulties in medicines dispensing process and has actively contributed to increase the economic impact caused by the return of prescriptions to the pharmacies. Nevertheless, it is also expected the reduction of the impact of returned prescriptions due to the mention of technical justifications.
Introduction: Portuguese community pharmacies were already involved by the tentacles of the crisis that affects not only the country, but also Europe and the entire globe. Pharmaceutical sector have experienced numerous changes in recent years, as a result of successive legislative amendments, which can be noted: the implementation of International Non-Proprietary Name (INN) prescription, the introduction of prescription by National Code for the Eletronic Prescription of Medicines (NCEPM) and the use of technical justifications by physicians. The return of prescriptions to pharmacies, by the Conference Center of Bills (CCB), represents an additional obstacle on the financial management of the pharmacies. The objective of the study involves assessing the extent in which the implementation of the measures referred have affected the drug dispensing process and contributed to the return of prescriptions to pharmacies. Methodology: Through a longitudinal descriptive-correlational study, a questionnaire was delivered to each one of the fifty pharmacies belonging to the municipality of Coimbra. The questionnaire was sent to the address of the writer, by blank envelope, to ensure data confidentiality. Software: Microsoft Excel 2010® and SPSS 20.0®, for Windows. Statistical tests: Friedman, Spearman's Rho, Wilcoxon and Mann-Whitney (significance level=0.05). Results: The response rate was 58%. The differences detected between the months under analysis showed a bigger impact of returns in September 2013, which was mainly due to the indication of technical justifications, but also to the recent implementation of NCEPM. The mention of exceptions have increase the number of drugs paid entirely by the user. The reduction in the mean value not paid by CCB, recorded in March 2013, could mean that INN prescription has reduced the impact of returns. Mean values not processed by CCF have a significant impact on financial management of pharmacies. However, pharmacies can recover much of the value not processed by CCB, after correction and resend of returned prescriptions. Nonetheless, it should be noted the time spent by professionals during this procedure. The errors most frequently mentioned as a source of returns over the three months analysed were: C024 and D999, both related to drug’s prices. Patient’s health was not affected by the errors. Conclusions: INN prescription may have caused the reduction of the number of returned prescriptions. NCEPM, due to recent implementation, contributed to increase the number of returns. However, this influence may have no consequences in the future. Indication of technical justifications has created difficulties in medicines dispensing process and has actively contributed to increase the economic impact caused by the return of prescriptions to the pharmacies. Nevertheless, it is also expected the reduction of the impact of returned prescriptions due to the mention of technical justifications.
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Keywords
Farmácia comunitária Denominações comuns internacionais para as substâncias farmacêuticas Prescrições Receituário Justificações técnicas