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Micelli ML, Sequeira G, Fara N, Abbas L, Estrella N, Acevedo M, Kerzberg E. Description of the resources for rheumatology training and speciality certification and recertification requirements in Argentina. Rheumatol Int 2020; 40:243-249. [PMID: 31894352 DOI: 10.1007/s00296-019-04505-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
The objective of the study was to analyse resources for rheumatology training, and speciality certification and recertification requirements in Argentina. Information was gathered regarding vacancies, entry requirements, duration and validity of the specialist degree in every residency and postgraduate course in adult rheumatology. The following aspects were analysed: monitoring authority, certification and recertification requirements, and mandatory recertification. Six out of 36 universities offer rheumatology postgraduate courses. Out of 65 vacancies, 36 (55%) are implemented by a National Public University in the Autonomous City of Buenos Aires (CABA), and 46 (70%) are in CABA. There are 32 vacancies for rheumatology residencies in 7 out of 24 districts, 16 of them (50%) in CABA. There are 2- to 3-year postgraduate courses; entry requirements range from 1-year experience in internal medicine to either complete residency or specialist degree in internal medicine. Training formats vary from full-time university residency to either university-based courses with part-time dedication in a rheumatology service without residency or non-university courses with part-time dedication. Not every specialist degree is automatically homologated in every jurisdiction. Provincial governments and colleges of physicians are the certification and recertification authorities; medical school was included in one district. Recertification is mandatory in only 8 districts; 40-50% of the process is achieved by merely practising as a rheumatologist. Most of the training resources are concentrated in CABA. Although there are various options, not all of them are automatically homologated. Recertification is not mandatory nationwide, and a significant part of the process involves practising as a rheumatologist.
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Affiliation(s)
- Marina Laura Micelli
- Servicio de Reumatologia. Hospital J. M. Ramos Mejia, Urquiza 609, 1221, Ciudad Autonoma de Buenos Aires, Argentina
| | - Gabriel Sequeira
- Servicio de Reumatologia. Hospital J. M. Ramos Mejia, Urquiza 609, 1221, Ciudad Autonoma de Buenos Aires, Argentina.
| | - Nauan Fara
- Clínica La Pequeña Familia, Provincia de Buenos Aires, Junín, Argentina
| | - Leila Abbas
- Asociación Mutual Obreros Y Empleados Municipales de La República Argentina, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | - Eduardo Kerzberg
- Servicio de Reumatologia. Hospital J. M. Ramos Mejia, Urquiza 609, 1221, Ciudad Autonoma de Buenos Aires, Argentina
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da Silva MRR, Dos Santos JBR, Almeida AM, Alvares-Teodoro J, Kakehasi AM, Acurcio FDA. Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation. Adv Rheumatol 2019; 59:48. [PMID: 31727164 DOI: 10.1186/s42358-019-0091-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 10/21/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pharmaceutical Assistance (PA) is a dynamic and multidisciplinary process that aims to supply health systems, programs or services with quality medicines, enabling access and health care, in an efficient and timely manner. The objective of the study was to evaluate the profile of administrative processes for the treatment of PsA, identify the time elapsed in the flow of processes and its associated factors. METHODS A cross-sectional study of medication requests for the treatment of PsA was carried out between November 2014 and December 2016. Linear regression was used to verify the factors associated with time to delivery. RESULTS A total of 218 cases containing 250 drugs were analyzed. The median time between the medical appointment and the first dispensation was 66 days (interquartile range, 44-90). The State proceedings, which includes requesting the drug until the authorization of treatment, was the stage that most contributed to the total time spent. The factors associated with the longer time to delivery of medications were prescriptions coming from clinics and specialty centers, from dermatologists, non-authorized processes and non-persistent patients in the treatment in 12 months. CONCLUSION The median time to receive medicines for the PsA treatment in Belo Horizonte health region after a medical prescription was higher than 2 months. The time between the solicitation of the medicines and the authorization of the treatment in the SUS (State administrative procedure) was the main component of the total time spent.
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Affiliation(s)
- Michael Ruberson Ribeiro da Silva
- College of Pharmacy, Federal University of Minas Gerais, President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil. .,Department of Pharmacy and Nutrition, Federal University of Espírito Santo, Alto Universitário, s/nº - Guararema, Alegre, Espírito Santo, CEP 29500-000, Brazil.
| | - Jéssica Barreto Ribeiro Dos Santos
- College of Pharmacy, Federal University of Minas Gerais, President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Alessandra Maciel Almeida
- College of Pharmacy, Federal University of Minas Gerais, President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Juliana Alvares-Teodoro
- College of Pharmacy, Federal University of Minas Gerais, President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Adriana Maria Kakehasi
- Medicine School, Federal University of Minas Gerais, Alfredo Balena Avenue, 6627, Health Campus, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Francisco de Assis Acurcio
- College of Pharmacy, Federal University of Minas Gerais, President Antônio Carlos Avenue, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.,Medicine School, Federal University of Minas Gerais, Alfredo Balena Avenue, 6627, Health Campus, Belo Horizonte, Minas Gerais, 30130-100, Brazil
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da Silva MRR, Dos Santos JBR, Almeida AM, Guerra Júnior AA, Alvares Teodoro J, Acurcio FDA. Biological therapy in the treatment of psoriatic arthritis: economic and epidemiological considerations. Expert Rev Clin Immunol 2019; 15:879-887. [PMID: 31192746 DOI: 10.1080/1744666x.2019.1631798] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Biological therapies have a significant economic and clinical burden but, in general, lose their effectiveness over time. This study evaluated the medication persistence and costs associated to use of anti-TNF agents for psoriatic arthritis (PsA) treatment. Methods: A historical cohort composed of individuals in Brazil with PsA diagnosis was developed during the period between 2010 and 2015. The difference among the anti-TNF agents was verified by the log-rank test. The predictors of medication non-persistence were identified by Cox regression. The costs were compared by variance analysis with Bonferroni correction. Results: 11,008 patients were analyzed. Adalimumab (51%) was the most used anti-TNF agent. Individuals using adalimumab presented higher medication persistence as compared to etanercept and infliximab. The costs with anti-TNF agents corresponded to 90% of the total costs and were similar among anti-TNF agents. The non-persistence predictors were female sex, younger patients, to live in the Northeastern and Northern regions of Brazil, to use infliximab and etanercept, and have more comorbidities. Conclusion: The direct costs with anti-TNF agents were the main component of total costs. Outpatient and inpatient costs increase when medication persistence decreases. A considerable price reduction of anti-TNF agents has been observed over the years.
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Affiliation(s)
- Michael Ruberson Ribeiro da Silva
- a Postgraduate Program in Medicines & Pharmaceutical Services, College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil
| | - Jéssica Barreto Ribeiro Dos Santos
- a Postgraduate Program in Medicines & Pharmaceutical Services, College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil
| | - Alessandra Maciel Almeida
- b College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil.,c Institute of Research and Postgraduate in Medical Sciences, Faculty of Medical Sciences of Minas Gerais , Minas Gerais , Brasil
| | | | | | - Francisco de Assis Acurcio
- b College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil.,d Department of Social and Preventive Medicine, School of Medicine, Federal University of Minas Gerais , Minas Gerais , Brazil
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Rocha FAC, Landim JIVD, da Rocha LN. Advances in rheumatology practice in Brazil. Rheumatol Int 2018; 39:1125-1134. [PMID: 30506466 DOI: 10.1007/s00296-018-4211-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/21/2018] [Indexed: 02/07/2023]
Abstract
Despite resilient inequities, Brazil has seen progressive improvement in health care in the last 25 years. Infectious diseases rendered place to chronic non-communicable diseases as a major cause of death. Existence of traditional schools of medicine and training services in rheumatology helped form a reasonable number of specialists, though irregular distribution due to the economic issues favoring their clustering in major cities. The Brazilian Society of Rheumatology provides continued medical education, helps training rheumatologists, family physicians and other health professionals and has worked to publish national recommendations for the diagnosis and treatment of major rheumatic diseases. Access to medications and health care facilities is provided for most patients, free of direct charge, including biologics. Specialized services for autoimmune and rare diseases, including pediatric rheumatology and autoinflammatory diseases, have improved, particularly in developed centers of the southern best developed parts of the country. A major unmet need is the lack of access to non-pharmacological treatment modalities. In this article, we will summarize some of the strengths and points that need improvement to enhance access to the rheumatological health care in Brazil.
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Affiliation(s)
- Francisco Airton Castro Rocha
- Laboratório de Investigação em Osteoartropatias, Department of Internal Medicine, Liga de Reumatologia e Doenças Autoimunes, Instituto de Biomedicina, Faculdade de Medicina, Federal University of Ceará, Rua Cel. Nunes de Melo, 1315, 1°. Andar, Rodolfo Teófilo, Fortaleza, CE, 60430-270, Brazil.
| | - Joaquim Ivo Vasques Dantas Landim
- Laboratório de Investigação em Osteoartropatias, Department of Internal Medicine, Liga de Reumatologia e Doenças Autoimunes, Instituto de Biomedicina, Faculdade de Medicina, Federal University of Ceará, Rua Cel. Nunes de Melo, 1315, 1°. Andar, Rodolfo Teófilo, Fortaleza, CE, 60430-270, Brazil
| | - Leila Nascimento da Rocha
- Laboratório de Investigação em Osteoartropatias, Department of Internal Medicine, Liga de Reumatologia e Doenças Autoimunes, Instituto de Biomedicina, Faculdade de Medicina, Federal University of Ceará, Rua Cel. Nunes de Melo, 1315, 1°. Andar, Rodolfo Teófilo, Fortaleza, CE, 60430-270, Brazil
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