Implementation of clinical guidelines in Brazil : should academic detailing be used?

Objective: The Brazilian National Health System provides high cost medicines through the Specialized Component of Pharmaceutical Assistance in accordance with adherence to agreed Clinical Guidelines. However, physician compliance to these Guidelines, as well as the barriers and facilitators related to them and the influence on the subsequent quality of care provided is unknown. Consequently, the objectives of this paper are to undertake a review of international experiences and scientific publications of a strategy to disseminate and communicate guidelines to physicians through Academic Detailing. Subsequently use the findings to develop and conduct a pilot Academic Detailing Program in Brazil targeting specialists who prescribe medicines for patients with Alzheimer’s disease, which are part of the Specialized Component of Pharmaceutical Assistance. Methods: Review international experiences and scientific publications relating to academic detailing based on a thorough review of available literature including publications known to the co-authors. Develop and monitor physician acceptance of academic detailing for patients with Alzheimer’s Disease and the impact on future prescribing. Key findings: Based on the lessons learnt from the international experience and review, coupled with the initial experiences in Brazil, we conclude that conducting academic detailing to enhance the implementation and dissemination of clinical protocols and therapeutic guidelines in Brazil is worthwhile. We will be closely monitoring the outcome of the pilot academic detailing programme as a basis for developing future programmes to further improve the quality of prescribing in Brazil. Conclusion: Findings from the experiences are encouraging. This will be further explored to provide a basis for this approach in the future

Development and content validity of the perceived barriers with antiretroviral treatment scale.

Introdu??o: Pessoas vivendo com HIV (PVHA) devem ser devidamente orientadas para iniciar a terapia antirretroviral (TARV), sendo importante identificar as dificuldades de PVHA com o tratamento, no intuito de realizar interven??es para prevenir uma poss?vel falha terap?utica. Objetivos: Desenvolver uma escala para avaliar a percep??o de dificuldades de PVHA com a TARV e analisar sua validade de conte?do. M?todos: Uma escala contendo 47 itens foi proposta a partir de um estudo qualitativo pr?vio e, entre junho e agosto de 2015, foi aplicada em 27 PVHA em tratamento no Hospital Eduardo de Menezes para avaliar a compreens?o dos itens pela popula??o alvo (an?lise sem?ntica). Os itens foram modificados e avaliados por tr?s ju?zes quanto ? relev?ncia, adequa??o e dimensionalidade, utilizando-se o coeficiente de validade do conte?do e coeficiente kappa. Resultados: Ap?s an?lise sem?ntica os itens foram reduzidos para 40. Nenhum item foi exclu?do ap?s an?lise de ju?zes, uma vez que todos foram considerados relevantes. Apenas 30% dos itens foram modificados ap?s serem considerados inadequados. A maior dificuldade dos ju?zes foi classificar itens sobre a adequa??o do medicamento ? rotina entre as dimens?es. Conclus?es: Os resultados apontaram a adequa??o da escala ao conte?do que ela pretende avaliar. A vers?o piloto da escala est? sendo testada empiricamente e poder? ser usada no servi?o de sa?de, em n?vel individual, identificando os casos nos quais ? necess?rio prover educa??o e aconselhamento ao paciente, bem como instrumento de pesquisa, em n?vel coletivo, para o planejamento de interven??es e de pol?ticas p?blicas.Introduction: People living with HIV (PLHIV) should be properly informed when starting antiretroviral therapy (ART). It is important to identify the difficulties of PLHIV, in order to implement interventions to prevent a possible treatment failure. Objectives: To develop a scale to measure the perceived difficulty of PLHIV with ART and analyze its content validity. Methods: A scale containing 47 items was proposed from previous qualitative study. Between June and August 2015, it was applied to 27 PLHIV under treatment at Eduardo de Menezes Hospital to assess the comprehension of items by the target population (semantic analysis). The items were modified and evaluated by three judges regarding the relevance, appropriateness and dimensionality, using the validity of the content and kappa coefficients. Results: After semantic analysis the items were reduced to 40. No items were excluded after analysis of judges, since all were considered relevant. Only 30% of the items were modified after being considered unsuitable. The main difficulty of judges was to evaluate items on their appropriateness of the medication use between dimensions. Conclusions: Results indicated the suitability of the scale to the content that it intends to evaluate. The scale of the pilot version is being tested empirically and can be used in the health service at the individual level, identifying cases where it is necessary to provide education and counseling to the patient, as well as a research tool, at the collective level, to plan interventions and public policies

Acceptability and consumer willingness to pay for a hypothetical HIV vaccine in Northern Brazil : a cross-sectional study and the implications

The Human Immunodeficiency Virus (HIV) is considered one of the greatest public health chal-lenges given its impact on morbidity and mortality and, there is currently no vaccine available. The costs for any vaccine have to be weighed against current preventative measures as well as its impact in reducing future infections. This was the rationale behind conducting a willingness to pay (WTP) study to guide future funding decisions. A cross-sectional study was conducted involving residents of Northern Brazil regarding their WTP for a hypothetical vaccine against HIV with 70% effectiveness. 634 individuals were interviewed and 94% accepted to use this hypothetical vaccine. The WTP was US$ 47.54 (200.00BRL). We believe these findings can contribute to decision-making about pricing once a HIV vaccine becomes available in Brazil and in discussions with its acceptability

Acesso aos medicamentos para tratamento da doença de Alzheimer fornecidos pelo Sistema Único de Saúde em Minas Gerais, Brasil

Resumo: Avaliou-se as barreiras de acesso ao tratamento da doença de Alzheimer com base nos processos administrativos de medicamentos inibidores da colinesterase (IChE), enviados à Secretaria de Estado de Saúde de Minas Gerais, Brasil, entre 2012 e 2013. Utilizando-se informações de 165 processos selecionados aleatoriamente, abordaram-se as dimensões de acesso: acessibilidade geográfica, acomodação, aceitabilidade, disponibilidade e capacidade aquisitiva. O trâmite administrativo para o fornecimento dos IChE levou em média 39 dias e foi influenciado por características do trajeto percorrido pelo usuário. A maioria dos prescritores cumpriu menos de 80% dos critérios exigidos pelo Protocolo Clínico e Diretrizes Terapêuticas (PCDT) da doença de Alzheimer. Como resultado, 38% dos processos não foram deferidos. A capacidade aquisitiva para o tratamento privado mensal com IChE foi de cerca de 21 dias de salário mínimo. Conclui-se que a burocracia do trâmite administrativo e a dificuldade de seguimento do PCDT pelos prescritores prejudicam o acesso ao tratamento da doença de Alzheimer e constituem uma grande carga para o orçamento dos pacientes