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State Pharmacy Brazil

name

Practicum in Health Administration

MHA 690

Pfeiffer University

November 7, 2013

Professor:

Table of Contents

Introduction ………………………………………………………………

Brazilian Health Care System………………………………………………………….14

The State Pharmacy Exceptional Drugs ……………………………………….…20

Activities…………………………………………………………………………………24

I. Participation in Activities Developed in Sector Screening and Social Services …………………………………………………………………33

II. Participation in the Passwords Distribution ………………………………………………………………34

III. Participation in the Activities of Pre-Dispensation:……………………………………………………………….35

IV. Participation in the Activities Performed in Pharmaceutical Care ……………………………………………………………36

V. Participation in the Activities of the Internal Pharmacy after the Service

Conclusion………………………………………………………………………38

Bibliography

………………………………………………………………….………….……..39

1. INTRODUCTION
The internship was in the State Pharmacy of Curitiba – Brazil. The internship aims to enter the student in daily SUS to analyze the role of the pharmacist in this system with the opportunity to combine theory with practice, to develop time responsibility and competence expected of the pharmacist, and improve theoretical, technical, ethical, and political understanding for the student.

Brazilian Health Care System

The public health system (SUS) is one of the largest public health systems in the world.  It ensures universal, comprehensive health care and it is free to the entire population of the country.  The public health system was created in 1988 by the Brazilian federal constitution to be the health care for all Brazilians.  Besides offering consultations, tests, and hospitalizations, the system also promotes vaccination campaigns, prevention, and sanitary surveillance.

The SUS was created to provide equal service and care, and promote the health of the entire population.  The system is a unique social project that materializes through health promotion, prevention, and Brazilians’ health care.

For nearly 22 years of existence, the National Health System (SUS) has established itself as a major public policy in Brazil promoting social inclusion and seeking to continuously strengthen their basic pillars of full health care, and universal and equal access. It is the only access to health services for 160 million Brazilians (80% of the population), SUS is developing mechanisms to improve management and expand its scope. In 2009, it performed 3 billion outpatient visits, 380 million medical visits, 280,000 heart surgeries, and 10 million procedures in radiotherapy and chemotherapy. In addition, SUS is one of the largest public organ transplant programs in the world, won international recognition for the success of mass vaccination campaigns, and is the only developing country to guarantee free comprehensive treatment for people with HIV (Brasil, pp 11-13).

The Unified Health System (SUS) was created from the Federal Constitution of 1988 stating that the entire population has access to the public health. Previously, National Institute of Medical Welfare (INAMPS) was in charge of healthcare. It was restricted to the employees who contributed to social security; others were attended to only through philanthropic services (Brasil, pp22).

Health posts, hospitals (including university laboratories), blood banks, services of Sanitary Surveillance, Epidemiological Surveillance, environmental monitoring, foundations, State Pharmacy and research institutes such as FIOCRUZ – Fundacao Oswaldo Cruz and the Instituto Vital Brazil, are part of the Sistema Unico de Saude (Brasil, pp 30-32).

The State Pharmacy

The State Pharmacy is the unit responsible for drug dispensing for exceptional users and the Metropolitan Region of Curitiba. Its main purpose is to ensure the necessary safety, efficacy, and quality of medicines, promoting the rational use of drugs, the universal access to essential medicines, and is an integrated part of the Pharmaceutical Care. (HEALTH-2008)

Pharmaceutical Care involves all activities related to medicines; being a fundamental part of health care services to the citizens. It involves the supply of medicines in all and each of its constituent steps, conservation and quality control, safety and therapeutic efficacy of drugs, monitoring and evaluation of the use, the gathering and distribution of information on medicines and continuing education for health professionals, patients, and the community to ensure the rational use of drugs. (BRAZIL-2001)

To ensure people’s access to medicines, CEMEPAR (Drug Center of Paraná) implemented the programs offered by the Ministry of Health-MS and the Ministry of Health of Paraná-SESA/PR. One of the programs is Exceptional Medicines. (HEALTH – 2008)

The Exceptional Drug Program was established by the Ministry of Health officially in 1982. It is responsible for providing drugs to treat specific diseases, which usually has a high unit value or requires chronic treatment; making it extremely expensive, precluding the population regardless of social class, to dispose of these drugs due to their high cost. (HEALTH – 2008)

Exceptional Drugs

The Exceptional Drug Program, which is managed by the Department of Health Care, covers drugs with high unit value or that the treatment of chronic diseases has become too expensive to be supported by the population. This policy has enormous reach in all social classes, since, if they were not distributed free of charge, such drugs would be accessible to many people due to the high cost of treatment. In operational terms, the funds for the acquisition of Exceptional Drugs are transferred by the Ministry of Health to the States every month and in advance; so then States can plan to purchase the drugs, and control the distribution and inventories according to the needs of the population.

The program has existed since 1993 and from that time until the current management of the Ministry, many inclusions and exclusions were made. In early 1999, Secretary of Health Service implemented new management which has been very effective and has generated good results grounded in expansion funding in nominal control of patients, and strict monitoring of the behavior of the pharmaceutical market that sets the value table for each medication and the proper management of the prescription and supply of medicines. Clinical Protocols and Therapeutic Guidelines were developed for each of the drugs, which rationalize their prescribing and dispensing.

The adopted management firm allowed the rationalization of expenditures, and expansion on the number of drugs available and patients covered by the program. Although medications were part of the table in practice until 1996, few drugs were actually dispensed to the population.

In 1997, the program had an increase in the supply of medicines and number of patients benefited. The growing trend of the program started in 1998, which registered a significant increase in the quantity of drugs dispensed.

From 1997 to 2001, many drugs were included in the program, as well as many diseases are being cured and an increase in the number of patients observed. In 2002, the program was significantly increased representing more than double of medications available in 2001.

The financial resources of the Ministry of Health are transferred monthly to the states, which are responsible for the planning, procurement, distribution, and dispensing of these drugs to patients registered in accordance with the Therapeutic Guidelines and Clinical Protocols-PCDT. They aims to establish criteria diagnosis of each disease, inclusion and exclusion of patients to treatment, the correct doses of prescription drugs, and control mechanisms, monitoring, and evaluation. (HEALTH – 2008)
 
The patient may only have access to these drugs if they are prescribed by a doctor during a consultation, thus avoiding self-medication as a drug administered improperly can not only decrease the effectiveness of treatment but can also cause serious injuries to the health of the patient. (HEALTH – 2008)

The State Pharmacy is located next to the building of 2nd Regional da Saude. At the entrance, there is a counter for the withdrawal password which will be the first evaluation of prescription and roles required for drug withdrawal. There are waiting chairs available so users can sit while for awaiting their password to be called. Just ahead is a panel showing the number of the password to be received. This panel will appear for normal and special passwords (for seniors, pregnant women, disabled, or people with a lap child), and a bathroom for male and female users is available. There are seven desks with computers, and there are chairs for the attendant who handles distribution of the medicine to the patients. In a separated part, there are twelve shelves and refrigerators to stock the medicines. In a locked shelf, there are all the controlled drugs which are supervised by the pharmacist. There is also, another room for the realization of pharmaceutical care.

2.2 ACTIVITIES
During the training period, I got trained to be able to develop all the activities of all sectors of the pharmacy, as indicated below.

2.2.1 Participation in Activities Developed in Sector Screening and Social Services

Screening and social service work is from 8:00 am to 5:00 pm. As their main functions, these two sectors guide and assist patients in the process of application of medicines, problems that prevent patients to withdraw from a drug, and function check and correct the documentation needed to start the process.

The documentation required to give input to the application of medicine are the Request for Exceptional Medicine(EMS), medical prescriptions, medical report, tests that prove the disease, copies of personal documents, RG, CPF, CNS(National Health Card), proof of address, and Informed Consent form signed by the doctor and patient. The whole process is evaluated by a physician auditor, and if it fits the clinical criteria established by the Ministry of Health then the patient is registered in the Program of Special Medication. Social service after learning of drug release connects the patient to attend the same sector of social welfare where you will receive guidance on how to proceed and the necessary documents in the days to withdraw the drug, expiration dates, and terms of revenues. Registration renewals are necessary to carry out each quarter.
2.2.2 Participation in the Passwords Distribution

When a patient arrives at the pharmacy, the user needs to wait their turn to be attended to. There are two rows arranged; the preferential queue (for the elderly, pregnant women, and disabled) or normal line. To be attended to the patient needs to show their photo ID, the prescription if it is a controlled drug, and the SME (Exceptional Drug Request) containing the internal number of the user.

The clerk sees the system if the documentation is up to date, and thus generates a password. With the automated system, the receipt with the number of the user’s password is sent straight to the pre-dispensation.
2.2.3 Participation in the Activities of Pre-Dispensation

In this sector, the intern prints receipts and engages them with the revenues. If the drug is controlled he/she fills these receipts according to the amount of drug released for each patient, and if the drug is controlled then revenue goes through a new evaluation performed by the intern. Soon, the drug is separated according to what is on the receipt, then leading to the booths to be excused.

In the area of ​​pre-dispensation, is where the trainee acquires many experiences and learns different types of medications which are not commonly seen at a retail pharmacy.

2.2.4 Participation in the activities developed in the Dispensation

In this section, the user is called to service after the appearance of its passphrase panel. He goes to the window, showing the clerk a photo ID and your EMS. If you are a family member or friend of the patient, then the patient should take a compulsory document described by the patient authorizing the person to withdraw the drug without his presence. Soon after the intern checks that the user documentation is up to date, there will be the realization of the dispensation of medicines.

Controlled drug after being separated is taken to the dispensation. The dispensation will be retained until the intern gets a signature from the pharmacist to check if the drug and the quantity are correct. If it is, then the drug can be dispensed.

The dispensation gives us the opportunity to have direct contact with users, offering them information and resolving their questions about the drugs. Therefore, only the day-to-day pharmacy can verify the reality of the NHS, its bureaucracy, large queues for the withdrawal of the drug.
2.2.5 Participation in the Activities Performed in Pharmaceutical Care

The first time that a patient is in the pharmacy to withdraw a drug, after dispensation, it must pass through the pharmacist where there will be pharmaceutical care. In a separate room with booths, the pharmacist or pharmacy intern (under the supervision of the technical manager) will talk with the patient by performing questions related to other medications used by the patient beyond those dispensed, establishing schedules for each drug, explaining how the patient should administer them and how they should handle storage and transportation of the drug in case the drug needs to be in refrigeration.

2.2.6 Participation in the Activities of the Internal Pharmacy after the Service

The Special Pharmacy is open to the public for distributing passwords until 5:00 pm, after this time the doors are closed leaving only the internal activities to be performed. After 5:00, some trainees who are still in attendance at the booth will fill out receipts for dispensation of the day. Another intern is responsible for counting the cabinet controlled; noting in spreadsheets the amount of medication dispensed on the day and conferring with the amount present in the inventory. All retained earnings are separated and numbered by the active. Dosage should then be recorded in the book of prescription drugs.

At the end of the day, the shelves are filled with more medicines, temperatures are checked for all the refrigerators, and the controlled drugs are counted to check if there are any mistakes that need to be fixed.

Bibliography

1) BRASIL. Secretaria Nacional dos Direitos da Cidadania e Justiça. Assistência Farmacêutica na Atenção Básica. Instruções técnicas para a sua organização. Brasília: Ministério da Saúde 2001.

2) SAÚDE. Secretaria de Saúde do Estado do Paraná. Assistência Farmacêutica. Disponível em:

www.saude.pr.gov.br

, acesso em 08/11/2008.

Brasil. Conselho Nacional de Secretários de Saúde.). Colecao para Entender a Gestao do SUS. Date accessed February 04, 2013. Pp17-18

BRASIL. Ministério da Saúde. Portaria 648, de 28 março de 2006. Date Accessed March 2, 2013.

CAMPOS, G.W.; BARROS, R.B.; CASTRO, A. M. Avaliação de política nacional de promoção da saúde. In: Ciência & Saúde Coletiva. 2004. v. 9, n. 3, pp 745-749

NOGUEIRA, V. M. R.; PIRES, D. E. P. Direito à saúde – convite à reflexão. Cadernos de Saude Pública. Rio de Janeiro: 2004. v. 20, n. 3, p. 753-760