Lima-Dellamora Elisangela da Costa, Caetano Rosângela, Gustafsson Lars L, Godman Brian B, Patterson Ken, Osorio-de-Castro Claudia Garcia Serpa
School of Pharmacy, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Sergio Arouca National School of Public Health, Post-Graduate Program -Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Basic Clin Pharmacol Toxicol. 2014 Sep;115(3):268-76. doi: 10.1111/bcpt.12215. Epub 2014 Mar 14.
University teaching hospitals usually provide tertiary care and are subject to early adoption of new technologies, which may compromise healthcare systems when uncritically adopted. Knowledge on the decision-making process - drug selection by drug selection committees or DTCs - is crucial to improve the quality of care. There are no models for studying the selection of drugs in Brazilian healthcare services. This study aims to discuss DTC structure and the processes regarding adoption of medicines in tertiary university hospitals in Brazil and to propose an analytical structure for providing direction for the future. State of the art content regarding drug selection processes and DTC procedures was reviewed in three databases. Information on the medicine selection process in a Brazilian gold standard teaching hospital was collected through observations and a review of existing procedures. A structured discussion on medicine selection and DTC procedures in tertiary hospitals ensued. This discussion resulted in findings that were organized in three dimensions, composing an analytical framework for the application in tertiary Brazilian hospitals (i) motivations for the adoption of drugs; (ii) necessary structural and organizational aspects for decision-making; and (iii) criteria and methods employed by the decision-making process. We believe that the suggested framework is compatible with tertiary Brazilian hospitals, because a gold standard in the country was able to conduct all its procedures in the light of WHO and international recommendations. We hope to contribute in producing knowledge which may hopefully be adopted in tertiary hospitals across Brazil.
大学教学医院通常提供三级医疗服务，并且往往较早采用新技术，而不加批判地采用这些技术可能会对医疗系统造成损害。了解决策过程——药物选择委员会（DTC）的药物选择情况——对于提高医疗质量至关重要。在巴西的医疗服务中，尚无研究药物选择的模型。本研究旨在探讨巴西大学三级医院中DTC的结构以及药品采用流程，并提出一个分析框架，为未来提供指导。通过三个数据库对药物选择过程和DTC程序的最新内容进行了综述。通过观察和对现有程序的审查，收集了巴西一家金标准教学医院的药物选择过程信息。随后对三级医院的药物选择和DTC程序进行了结构化讨论。该讨论得出的结果从三个维度进行了组织，构成了一个适用于巴西三级医院的分析框架：（i）药物采用的动机；（ii）决策所需的结构和组织方面；（iii）决策过程中采用的标准和方法。我们认为，所建议的框架与巴西三级医院相兼容，因为该国的一家金标准医院能够根据世界卫生组织和国际建议开展其所有程序。我们希望能为知识的产生做出贡献，有望被巴西各地的三级医院采用。
