Análisis del proceso de valoración, selección, implementación y seguimiento de los medicamentos disponibles en la Caja Costarricense de Seguro Social vigente en 2020
Fecha
2023
Tipo
tesis de maestría
Autores
Jacobo Elizondo, Jeffrey Antonio
Título de la revista
ISSN de la revista
Título del volumen
Editor
Resumen
Este trabajo presenta un análisis del proceso de valoración, selección, implementación y seguimiento de los medicamentos aplicables en la Caja Costarricense de Seguro Social (CCSS) vigente al año 2020. Se encuadra con una metodología mixta de tipo secuencial explicativo, donde en una primera fase se realizó una revisión documental de la producción de la Dirección de Farmacoepidemiología, específicamente de los informes técnicos elaborados para la inclusión de medicamentos durante el año 2020 aplicando un análisis estadístico descriptivo básico, para luego ser contrastados los hallazgos en una segunda fase con un grupo focal, conformado por profesionales de la salud que laboran en la misma dependencia, para poder darle significado a los resultados obtenidos en la primera fase. Durante el periodo de estudio se contabilizaron un total de 17 oficios relacionados con la solicitud de inclusión de medicamentos nuevos para la CCSS con el fin ser incluidos en la Lista Oficial de Medicamentos (LOM), siendo un total de cinco medicamentos distintos: abiraterona, paracetamol endovenoso, Levonorgestrel de 1,5mg, octreótido y topiramato. Todos estos medicamentos fueron incluidos finalmente dentro de la LOM en ese mismo año. El grupo focal encontró que existen problemas en la estandarización del proceso de selección e inclusión de terapias, principalmente en la falta de claridad de las vías administrativas tanto dentro como fuera de la DFE. Además, se cuentan con recursos limitados, en especial porque el recurso humano capacitado es escaso y, a pesar de la carga de trabajo, no se ha fortalecido. Asimismo, se identificaron barreras de comunicación y una herramienta estandarizada para la elaboración de los informes técnicos de diferentes complejidades, al igual que se identificaron dificultades en la priorización de las solicitudes y el impacto del uso de medicamentos de alto costo en las finanzas institucionales, así como un área de mejora en el proceso de seguimiento y evaluación de los medicamentos una vez aprobados.
This paper presents an analysis of the process of assessment, selection, implementation, and monitoring of the medicines applicable in the Costa Rican Social Security Fund (CCSS) in force as of 2020. It is framed with a mixed methodology of an explanatory sequential type, where in a first phase a documentary review of the production of the Directorate of Pharmacoepidemiology was carried out, specifically of the technical reports prepared for the inclusion of drugs during the year 2020 applying a basic descriptive statistical analysis, to then be contrasted the findings in a second phase with a focus group. It is made up of health professionals who work in the same unit, in order to give meaning to the results obtained in the first phase. During the study period, a total of 17 trades related to the request for the inclusion of new drugs for the CCSS in order to be included in the Official List of Medicines (LOM) were counted, being a total of five different drugs: abiraterone, intravenous paracetamol, Levonorgestrel 1.5mg, octreotide and topiramate. All of these drugs were finally included in the LOM in the same year. The focus group found that there are problems in the standardization of the process of selection and inclusion of therapies, mainly in the lack of clarity of administrative channels both inside and outside the DFE. In addition, there are limited resources, especially since trained human resources are scarce and, despite the workload, have not been strengthened. Likewise, communication barriers and a standardized tool for the preparation of technical reports of different complexities were identified, as well as difficulties were identified in the prioritization of applications and the impact of the use of high-cost drugs on institutional finances, as well as an area for improvement in the process of monitoring and evaluation of medicines once approved.
This paper presents an analysis of the process of assessment, selection, implementation, and monitoring of the medicines applicable in the Costa Rican Social Security Fund (CCSS) in force as of 2020. It is framed with a mixed methodology of an explanatory sequential type, where in a first phase a documentary review of the production of the Directorate of Pharmacoepidemiology was carried out, specifically of the technical reports prepared for the inclusion of drugs during the year 2020 applying a basic descriptive statistical analysis, to then be contrasted the findings in a second phase with a focus group. It is made up of health professionals who work in the same unit, in order to give meaning to the results obtained in the first phase. During the study period, a total of 17 trades related to the request for the inclusion of new drugs for the CCSS in order to be included in the Official List of Medicines (LOM) were counted, being a total of five different drugs: abiraterone, intravenous paracetamol, Levonorgestrel 1.5mg, octreotide and topiramate. All of these drugs were finally included in the LOM in the same year. The focus group found that there are problems in the standardization of the process of selection and inclusion of therapies, mainly in the lack of clarity of administrative channels both inside and outside the DFE. In addition, there are limited resources, especially since trained human resources are scarce and, despite the workload, have not been strengthened. Likewise, communication barriers and a standardized tool for the preparation of technical reports of different complexities were identified, as well as difficulties were identified in the prioritization of applications and the impact of the use of high-cost drugs on institutional finances, as well as an area for improvement in the process of monitoring and evaluation of medicines once approved.
Descripción
Palabras clave
SEGURIDAD SOCIAL, MEDICAMENTO, POLÍTICA DE LA SALUD, EVALUACIÓN DE LA TECNOLOGÍA, COSTA RICA, ADMINISTRACIÓN DE LA CIENCIA, GERENTE, CIENCIAS MÉDICAS, RECURSOS FINANCIEROS, SALUD