Armando Pedro D, Uema Sonia A, Vega Elena M
PhD, MPharm. Faculty of Chemical Sciences. National University of Córdoba. Córdoba (Argentina).
PhD, MPharm. Faculty of Chemical Sciences, National University of Córdoba. Córdoba (Argentina).
Pharm Pract (Granada). 2020 Oct-Dec;18(4):2173. doi: 10.18549/PharmPract.2020.4.2173. Epub 2020 Oct 22.
Argentina is a federal republic with approximately 44 million people, divided into 23 provinces and an autonomous city, Buenos Aires. The health system is segmented into public, social security and private subsystems. The social security and private sectors cover more than 60% of the population. Total health expenditure in 2017 was 9.4% of gross domestic product. Primary health care (PHC) was considered as the principal strategy for universal coverage policy for health system reform in Latin America at the end of 20th century. The most remarkable characteristics of the Argentinian health system are its fragmentation and disorganization. An increase of public sector demands, due to a socioeconomic crisis, led to the subsequent collapse of the system, caused primarily by a sustained lack of investment. First care level decentralization to the Integral Health Service Delivery Networks (IHSDN) becomes the cornerstone of a PHC-based system. Pharmacists and community pharmacies are not formally mentioned in PHC policies or IHSDN. However, pharmacies are recognized as healthcare establishments as part of the first care level. Community pharmacists are the only health care professional whose profit comes from the margin on product sales. Contracts with social security and private insurances provide small margins which reduce the viability of community pharmacies. There is a preference by community pharmacies to diversify product sales instead of providing professional services. This is driven by marketing and economic pressures rather than patient care and health policies. Dispensing is the main professional activity followed by management of minor illness and associated product recommendations. Currently, there are no national practice guidelines or standard operating procedures for the provision of pharmaceutical services and there is no nationally agreed portfolio of services. National pharmacy organizations appear to have no official strategic statements or plans which would guide community pharmacies. There are some isolated experiences in community pharmacies and in public first care level pharmacies that demonstrate the possibilities and opportunities for implementing pharmaceutical services under the PHC approach. There is a real lack of integration of community pharmacies and pharmacists in the healthcare system.
阿根廷是一个联邦共和国，人口约4400万，分为23个省和一个自治市布宜诺斯艾利斯。卫生系统分为公共、社会保障和私营子系统。社会保障和私营部门覆盖了超过60%的人口。2017年卫生总支出占国内生产总值的9.4%。20世纪末，初级卫生保健（PHC）被视为拉丁美洲卫生系统改革普及覆盖政策的主要战略。阿根廷卫生系统最显著的特点是其分散性和无序性。由于社会经济危机导致公共部门需求增加，随后该系统崩溃，主要原因是持续缺乏投资。将一级护理权力下放到综合卫生服务提供网络（IHSDN）成为基于初级卫生保健系统的基石。初级卫生保健政策或IHSDN中未正式提及药剂师和社区药房。然而，药房被视为一级护理层面的医疗机构。社区药剂师是唯一其利润来自产品销售差价的医疗保健专业人员。与社会保障和私人保险的合同提供的差价很小，这降低了社区药房的生存能力。社区药房倾向于使产品销售多样化，而不是提供专业服务。这是由市场和经济压力驱动的，而非患者护理和卫生政策。配药是主要的专业活动，其次是处理小病和提供相关产品建议。目前，没有关于提供药学服务的国家实践指南或标准操作程序，也没有全国统一认可的服务组合。国家药房组织似乎没有指导社区药房的官方战略声明或计划。在社区药房和公共一级护理药房有一些孤立的经验，展示了在初级卫生保健方法下实施药学服务的可能性和机会。社区药房和药剂师在医疗保健系统中确实缺乏整合。
