Abstract
Background: In the last decades, litigation has been increasingly used to access medicines in Brazil. This phenomenon has led to the development of diverse strategies to reduce its negative impact on the organization of pharmaceutical services. In spite of that, managers still face difficulties dealing with lawsuits. Objective: This study aims to report the planning and implementation of strategies to approach medicines litigation in a municipality located in the southeast region of Brazil. Methods: Mixed methods were employed through an action research cycle. A network coordination team included researchers from university and municipal managers. The scenario analysis comprised the characterization of pharmaceutical services and the profile of medicines lawsuits. Afterward, strategies were planned to deal with the central problem identified. The action plan involved educational outreach visits and distribution of printed materials for health professionals, evaluated through opinion survey. Group conversations were conducted with the users of the public health system, followed by thematic analysis of reports. Results: The characterization of pharmaceutical services in the municipality revealed that treatments supplied were in accordance with the National Medicines Policy. In addition, a sector was implemented to attend demands for non-incorporated medicines. In spite of the services available, the characterization of lawsuits indicated that the main claimants were users of the public health system, requiring non-incorporated medicines, with therapeutic alternatives available. Thus, educational outreach visits were held in 14 health units (23 physicians in total). Everyone who answered the evaluation declared that they were very satisfied with the approach. Group conversations with the users of the health system reached 227 participants in total. In regard to users’ perception about pharmaceutical services, thematic analysis of reports identified three main categories including aspects related to medicines provided, users assisted, and quality of service. Conclusion: The study described the first cycle of an action research project to develop strategies to approach medicines litigation at the municipal level. The application of educational outreach visits for health professionals and group conversations with health system users is a promising approach to improve access to information about pharmaceutical services in Brazil.
Highlights
The lawsuits for access to medicines impact the structure, financing, and organization of healthcare services as they neglect the priorities established through public policies and force reallocation of financial and human resources with the potential to widen inequality (Wang, 2015)
The study site was a municipality in the southeastern region of Brazil, located in the state of Rio de Janeiro with a population of 230,000 inhabitants (IBGE, 2016)
Organization of Pharmaceutical Services In Brazil, medicines funded by SUS are divided into three groups, called components, namely, basic, specialized, and strategic
Summary
The lawsuits for access to medicines impact the structure, financing, and organization of healthcare services as they neglect the priorities established through public policies and force reallocation of financial and human resources with the potential to widen inequality (Wang, 2015). Health system managers had to remodel and structure new services to address the increasing demand of lawsuits to access medicines (Catanheide et al, 2016). In Brazil, the institutional response of the judicial branch included the Recommendation 31/2010 (Conselho Nacional de Justiça, 2010) issued by the National Council of Justice, which advises courts to implement actions to support judges These included the requirement of detailed medical reports to support decision-making, encouraging judicial workers to visit health units, and the establishment of interinstitutional agreements to provide health workers support in assessing the clinical issues presented by the claimants. Litigation has been increasingly used to access medicines in Brazil This phenomenon has led to the development of diverse strategies to reduce its negative impact on the organization of pharmaceutical services. Managers still face difficulties dealing with lawsuits
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