Integration of Community pharmacy and pharmacists in primary health care policies in Argentina
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.
Instituto Nacional de Estadística y Censos (INDEC). [National population census, homes and houses 2010]. Available at: https://www.indec.gob.ar/ftp/cuadros/poblacion/censo2010_tomo1.pdf (accessed Aug 20, 2020).
Pan American Health Organization (PAHO). Integrated health service delivery networks: concepts, policy options and a road map for implementation in the Americas. Available at: https://iris.paho.org/handle/10665.2/31216 (accessed Aug 20, 2020).
Stolkiner A, Comes Y, Garbus P. [Scope and potential of Primary Healthcare in Argentina]. Cien Saude Colet. 2011;16(6):2807-2816. https://doi.org/10.1590/s1413-81232011000600019
Giovanella L, Fidelis de Almeida P, Vega Romero R, Oliveira S, Tejerina Silva H. [Overview of Primary Health Care in South America: conceptions, components and challenges]. Saúde Debate. 2015;39(105):300-322. https://doi.org/10.1590/0103-110420151050002002
Secretaría de Gobierno de Salud. [How much does Argetina spends in health?] Available at: http://www.msal.gob.ar/images/stories/bes/graficos/0000001756cnt-cuanto-gasta-argentina-en-salud.pdf (accessed Aug 20, 2020).
Uema S, Solá N. [The pharmacist in the decentralization of health-care system: Pharmaceutical Legislation analysis and diagnosis in the province of Córdoba, Argentina]. Acta Farm Bonaerense. 2000;19(1):65-68.
República Argentina. [Law of the promotion and use of generic names of drugs]. Available at: http://servicios.infoleg.gob.ar/infolegInternet/anexos/75000-79999/77881/norma.htm (accessed Aug 25, 2020).
Food and Drug Administration. Orange Book Preface. Available at: https://www.fda.gov/drugs/development-approval-process-drugs/orange-book-preface (accessed Sep 15, 2020).
Ministerio de Salud. Remediar. Available at: https://www.argentina.gob.ar/salud/remediar (accessed Aug 25, 2020).
Ministerio de Salud. [The president and the health ministry re-launched Remediar program with more free medications]. Available at: https://www.argentina.gob.ar/noticias/el-presidente-y-el-ministro-de-salud-relanzaron-el-programa-remediar-con-mas-medicamentos (accessed Aug 25, 2020).
Ministerio de Salud. [Essential drugs guideline at primary care level] Available at: https://www.argentina.gob.ar/salud/remediar/guia-medicamentos-esenciales-pna (accessed Aug 25, 2020).
Pan American Health Organization (PAHO). Renewing primary health care in the Americas: a position paper of the Pan American Health Organization/World Health Organization (PAHO/WHO). Available at: https://iris.paho.org/handle/10665.2/31083 (accessed Aug 20, 2020).
Organización Panamericana de la Salud (OPS). [Pharmaceutical services based on primary healthcare]. Available at: https://www.paho.org/hq/dmdocuments/2013/SerieRAPSANo6-2013.pdf (accessed Aug 20, 2020).
Tobar F. [Healthcare]. Available at: www.salud.gob.ar/dels/entradas/la-atencion-de-la-salud (accessed Aug 20, 2020).
Ministerio de Salud. [Mission, vision and objectives]. Available at: https://www.argentina.gob.ar/salud/mision (accessed Aug 20, 2020).
Ministerio de Salud y Seguridad Social. [Organization of healthcare at the Cordoba province by the risk of conditions and the complexity of determinants]. Resolution 1248/1997, Dec 6, 1997.
Poder Legislativo, Provincia de Córdoba. [Provincial Law 9133 of healthy guarantees].
Bertolotto A, Fuks A, Rovere M. [Primary Health Care in Argentina: disordered proliferation and conflicting models]. Saúde Debate. 2012;36(94):362-374. https://doi.org/10.1590/S0103-11042012000300009
Ministerio de Salud. LEGISALUD. Available at: http://leg.msal.gov.ar/ (accessed Aug 25, 2020).
Secretaría de Regulación y Gestión Sanitaria. [List of pharmacies]. Available at: https://datos.gob.ar/dataset/salud-listado-establecimientos-farmacias (accessed Aug 18, 2020).
Argentina.gob.ar. [Technical report about the situation of competence in the drug market]. Available at: https://www.argentina.gob.ar/sites/default/files/im._4_-_medicamentos_-_disposicion_y_anexo.pdf (accessed Aug 20, 2020).
Infonegocios [Main pharmacy chains already posses 68 shops in Cordoba (out of a total of 818 shops in the city)]. Available at: https://infonegocios.info/nota-principal/las-principales-cadenas-de-farmacias-ya-poseen-68-bocas-en-cordoba-sobre-un-total-de-818-establecimientos-en-la-ciudad (accessed Aug 20, 2020).
Uema S, Armando P, Solá N. [Change proposal for drug dispensing in community pharmacy]. Medicamentos y Salud. 2003;4(1):28-33.
Mirada Profesional. [The fight for profitability: every three months, two pharmacies close in San Juan by economic issues]. Available at: https://miradaprofesional.logueos.com/ampliarpagina?id=18665 (accessed Aug 20, 2020).
Maceira D. [Drug Market chain: incentives, global trends, and the Argentinian experience]. Available at: https://www.danielmaceira.com.ar/wp-content/uploads/2018/06/Doc_t128-Cadena-de-Comercializacio%CC%81n-de-medicamentos.pdf (accessed Aug 20, 2020).
Confederación Farmacéutica Argentina. [Who we are]. Available at: http://www.cofa.org.ar/?p=29 (accessed Aug 20, 2020).
FEFARA. [Institutional]. Available at: https://www.fefara.org.ar/institucional/ (accessed Aug 20, 2020).
FACAF [History and objectives]. Available at: http://www.facaf.org.ar/la-institucion/historia-y-objetivos/ (accessed Aug 20, 2020).
Afmsra.net. [History]. Available at: http://www.afmsra.net/institucional_historia.shtml (accessed Aug 20, 2020).
Fontana D, Uema S, Vega E. [The pharmacists in the healthcare system]. In: [Module 1: Continuous training program for pharmacists]. Cordoba: Universidad Nacional de Córdoba; 2008. ISBN: 978-950-33-0636-9.
Confederación Farmacéutica Argentina. [Continuous professional development certification system: General regulations].. Available at: http://servicios.cofa.org.ar/cnc/Documentos/CNC-RGCyR.pdf (accessed Aug 20, 2020).
FEFARA. [Certification: Federal system for professional updating, certification and re-certification]. Available at: https://www.fefara.org.ar/sistema-de-recertificacion/certificacion/ (accessed Aug 20, 2020).
Ministerio de Salud y Acción Social. [Definitions and regulatory framework of professional certification and re-certification]. Available at: http://servicios.infoleg.gob.ar/infolegInternet/anexos/55000-59999/59096/norma.htm (accessed Aug 25, 2020).
Confederación Farmacéutica Argentina. [COFA joined the Brasilia letter for the renewing of pharmaceutical services based on PHC]. Available at: http://www.cofa.org.ar/?p=34364 (accessed Aug 20, 2020).
República Argentina. [National Law of higher education]. Available at: http://servicios.infoleg.gob.ar/infolegInternet/anexos/25000-29999/25394/texact.htm (accessed Aug 25, 2020).
Ministerio de Educación, Ciencia y Tecnología. [Identity or equivalence of the pharmacy degree and basic curricular contents of the pharmacy degree]. Available at: http://servicios.infoleg.gob.ar/infolegInternet/anexos/95000-99999/95802/texact.htm (accessed Aug 25, 2020).
Ministerio de Educación. [Dimension of the degree]. Available at: http://servicios.infoleg.gob.ar/infolegInternet/anexos/310000-314999/310461/texact.htm (accessed Aug 25, 2020).
Uema S, Armando P, Vega EM, Fontana D, Correa Salde V. [From theory to practice: contribution for the progressive development of concrete activities in pharmaceutical care]. Pharm Care Esp. 2008;10(2):76-80.
Colegio de Farmacéuticos de Córdoba. [Advising to symtoms as pharmacist professional service]. Available at: https://colfacor.educativa.com (accessed Aug 20, 2020).
Armando P, Uema S, Solá N. [Assessing patient satisfaction in pharmacotherapy follow-up]. Seguim Farmacoter. 2005;3(4):205-212.
Colegio Oficial de Farmacéuticos y Bioquímicos de la Capital Federal. [Fees for pharmaceutical services: new amounts approved by the Pharmacy section]. Available at: http://www.cofybcf.org.ar/noticia_anterior.php?n=2207 (accessed Aug 20, 2020).
PAMI. [2020 flu national vaccination campaign]. Available at: https://www.pami.org.ar/vacunacion (accessed Aug 20, 2020).
[Flu vaccine for PAMI affiliated: timeline and registered pharmacies]. Available at: https://www.pagina12.com.ar/257014-vacuna-antigripal-para-afiliados-del-pami-el-cronograma-y-la (accessed Aug 20, 2020).
Colegio de Farmacéuticos de La Pampa. [2020 Vaccination campaign: general conditions]. Available at: http://www.colfarlp.org.ar/normas/20200508modulo23d.pdf (accessed Aug 20, 2020).
Colegio de Farmacéuticos de Entre Ríos. [Pharmacy services in primary healthcare: guide for control of hypertension]. Available at: https://www.cofaer.org.ar/userfiles/Guia%20Hipertension_2018.pdf (accessed Aug 20, 2020).
Confederación Farmacéutica Argentina [SAHA presented the results of Know and Control your blood pressure campaign: more than 50% Argentinians have hypertension]. Available at: http://www. http://www.cofa.org.ar/?p=33088 (accessed Aug 20, 2020).
Armando P, Sonzini LJ, Tenllado MI, Uema SAN, FACCOR Committee. [Effects of pharmaceutical intervention in patients with high blood pressure and no pharmacological treatment at community pharmacies in the province of Cordoba]. Rev Salud Pública (Cordoba). 2017;21(3):35-44. https://doi.org/10.31052/1853.1180.v21.n3.17739
Uema S, Vega E, Correa Salde V, Paraje M. [Outcomes obtained using clinical protocols for minor ailments by pharmacy’s students duringtheir professional practices]. Acta Farmacéutica Bonaerense. 2006;25(2):296-301.
Armando P, Vega E, Uema S. [Community pharmacies' professional image: causes and improvement strategies by applying qualitative research techniques]. Rev Salud Publ. (Bogotá). 2011;13(2):274-87
Uema S, Olivera ME. [Pharmacoepidemiology applied to public programs for diabetic patients in Alta Gracia (Córdoba, Argentina)]. Rev Salud Pública (Cordoba). 2011;XV(1):29-39. https://doi.org/10.31052/1853.1180.v15.n1.7009
Brusa A, Armando P, Uema S. [Diabetic patients without health coverage: drug use, adherence and complications arising from their underlying disease]. Rev Salud Pública (Cordoba). 2013;XVII(2):52-63. https://doi.org/10.31052/1853.1180.v17.n2.6836
Chiapella LC, Montemarani Menna J, Mamprin ME. Assessment of polypharmacy in elderly patients by using data from dispensed medications in community pharmacies: analysis of results by using different methods of estimation. Int J Clin Pharm. 2018;40(5):987-990. https://doi.org/10.1007/s11096-018-0663-3
Chiapella LC, Menna JM, Mamprin ME. Potentially Inappropriate Medications in Elderly Ambulatory Patients: A Comparative Study between a Primary Health Care Center and a Community Pharmacy. Value Health Reg Issues. 2018;17:119-125. https://doi.org/10.1016/j.vhri.2017.12.009
Chiapella LC, Montemarani Menna J, Marzi M, Mamprin ME. Prevalence of potentially inappropriate medications in older adults in Argentina using Beers criteria and the IFAsPIAM List. Int J Clin Pharm. 2019;41(4):913-919. https://doi.org/10.1007/s11096-019-00858-8
Uema SAN, Olivera ME. [Importance of the information systems in public health programs: diabetic patients databases]. Rev Facultad Cienc Med (Cordoba). 2012;69(1):25-32.
Badesso RE, Solá Uthurry NH, Armando P. [Effect of pharmacotherapy follow-up to type 2 diabetes mellitus patients at a primary health care service in Córdoba (Argentina)]. Pharm Care Esp. 2013;15(1):2.
Dupotey Varela NM, Sedeño Argilagos C, Ramalho de Oliveira D, Rojas Vázquez EI, Fernández Sánchez E, Reyes Hernández I, et al. [Comprenhensive approach in Pharmaceutical Care: Comprehensive Medication Therapy Management Services]. Rev Mex Cienc Farm. 2017;48(4):28-42.
International Federation of Pharmacy, World Health Organization. Joint Guidelines on Good Pharmacy Practice - Standards for Quality Services. Available at: https://www.fip.org/file/1476 (accessed Aug 25, 2020).
Copyright (c) 2020 Pharmacy Practice and the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.