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Primary Health Care Policy and Vision for Community Pharmacy and Pharmacists in Colombia

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Primary Health Care Policy and Vision for Community Pharmacy and Pharmacists in Colombia Amariles P, Ceballos M, González-Giraldo C. Primary health care policy and vision for community pharmacy and pharmacists in Colombia. Pharmacy Practice 2020 Oct-Dec;18(4):2159. https://doi.org/10.18549/PharmPract.2020.4.2159 International Series: Integration of community pharmacy in primary health care Primary health care policy and vision for community pharmacy and pharmacists in Colombia Pedro AMARILES , Mauricio CEBALLOS , Cesar GONZÁLEZ-GIRALDO. Published online: 23-Nov-2020 Abstract Colombia is a decentralized republic with a population of 50 million, constituted by 32 departments (territorial units) and 1,204 municipalities. The health system provides universal coverage and equal access to health care services to 95% of the population. Primary health care is seen as a practical approach that guarantees the health and well-being of whole-of-society. The National Pharmaceutical Policy (NPP, 2012) goal is "to develop strategies that enable the Colombian population equitable access to effective medicines, through quality pharmaceutical services (PS)”. There are 4,351 providers certified to deliver PS: 3,699 (85%) ambulatory and 652 (15%) hospital care. The goals for PS are: a) promoting healthy lifestyles; b) preventing risk factors arising from medication errors; c) promoting rational use of medicines; and d) implementing Pharmaceutical Care. There are a number of ways that ambulatory patients access medications: through intermediary private companies, public and private hospitals pharmacies, and retail establishments (drugstores and pharmacies). Intermediary private companies are similar to Pharmaceutical Benefits Management in the U.S. health system, and act as intermediaries between health insurers, pharmaceutical laboratories, and patients. Pharmacists are ) license being employed by these companies and in health insurance companies managing, auditing and delivering rational use of medicines .0 4 programs. In 2014 there were approximately 20,000 pharmacies and drugstores, (private establishments) where a significant number ND of prescription-only medicines are sold without medical prescription. Colombian laws allow personal without pharmacy education to - be a “director” in these establishments, so the training and education of persons working in drugstores and pharmacies is an important NC - challenge. There about 8,000 registered pharmaceutical chemists with 25% to 30% working in patient care. Since the 90´s, there are more favorable conditions for pharmacist’s participation and contribution to health system and patient’s health outcome. These CC BY environmental facilitators include: a) laws and regulations regarding pharmaceutical services (2005-2007), b) establishment of a NPP (2012), and c) opportunities associated with the consolidation of private health management companies providing health services with an interest in pharmaceutical services (since 1995). Finally, telepharmacy, comprehensive care routes for pharmaceutical services, and further strengthen of postgraduate training in pharmacy practice are future strategies to improve the pharmacy profession in .0 Unported ( Colombia. They provide an opportunity to influence the recognition and value of the pharmacist as the health care professional. 4 Keywords Pharmacies; Primary Health Care; Delivery of Health Care, Integrated; Ambulatory Care; Community Health Services; Pharmacists; NoDerivs NoDerivs - Community Pharmacy Services; Professional Practice; Colombia INTRODUCTION and the “subsidized”, where lower socio-economic groups are financed by the State. Both subsystems provide Colombia is a decentralized republic constituted by 32 NonCommercial universal coverage, equal access to medicines, surgical - departments (territorial units) and 1,204 municipalities procedures, medical and dental services through a basic which develop and implement the national government's and mandatory benefit package (identified as POS, by its policies for public health, and the provision and Spanish acronym).2,3 management of health services. It is a middle-income country with 50 million inhabitants.1 In 2019, Colombia was reported to have highest universal health coverage in Latin America, with coverage for 95% of Colombia's health system the population. However, 70% of people stated that they Since 1993, Law 100: General System of Social Security in were dissatisfied with the quality of service indicating Health (SGSSS by its Spanish acronym) established the limitations to timely, equitable, and effective access to current health system in Colombia. This Law guarantees health care services despite this extensive health equity in health services and mandates the compulsory coverage.4 It is estimated that only 31% of people had enrolment of the population. Health equity focuses on access on the same day or the day after they sought providing equal access and quality health services to all the ambulatory or first-level health care services. This is lower Colombia inhabitants, regardless of their ability to pay.2 than the average of 51% for Latin America and the SGSSS is composed of two subsystems: the “contributory”, Caribbean region.4 paid by workers, retired workers, self-employed workers Enrollment in the SGSSS is administered through public or with incomes equal to or greater than the legal minimum private health insurance entities (EPS by its Spanish wage (300 USD per month in 2020) and their beneficiaries, Article distributed the under Creative Commons Attribution acronym), which collect and distribute the premium payments to the SGSSS Resource Managers. The Resource Pedro AMARILES. PhD, MPharm, BPharm. Professor. University of Manager provides reimbursement on a monthly basis to Antioquia. Medellín (Colombia). [email protected] each of the EPS. The reimbursement, known as of Mauricio CEBALLOS. MSc, BPharm. Professor. University of Capitation Payment Units (UPC by its Spanish acronym), is a Antioquia. Medellín (Colombia). [email protected] Cesar GONZÁLEZ-GIRALDO. MSc, BPharm. Director predetermined capitation fee for each unit of service and Medicamentos POS (DEMPOS). Medellín (Colombia). patient characteristics per enrolled persons (workers and [email protected] their beneficiaries covered by the scheme). The UPC is fixed www.pharmacypractice.org (eISSN: 1886-3655 ISSN: 1885-642X) 1 Amariles P, Ceballos M, González-Giraldo C. Primary health care policy and vision for community pharmacy and pharmacists in Colombia. Pharmacy Practice 2020 Oct-Dec;18(4):2159. https://doi.org/10.18549/PharmPract.2020.4.2159 annually by the Ministry of Health, and it depends mainly Law 1438 improved and reinforced PHC as the strategy for on the characteristics of the population (age, sex, and place achieving equity, comprehensiveness of access, and of residence) and probability of use of services. Each EPS integrated care.11 In Colombia PHC is seen as a practical has the responsibility to finance and deliver health care to approach that guarantees the health and well-being of their respective population in any location in Colombia. EPS whole-of-society, contributing to reducing health contracts are agreed with one or more public or private inequalities and protecting health as a fundamental right. It institutions providing health services (IPS, by its Spanish is integrated through three interdependent components: acronym). Each EPS contracts a structured network at three health services, inter-sector strategies for health, and social level of care that provides and guarantees access to health and community participation. From the pharmacy's services and medications included in a determined the perspective, the Ministry of Health and Social Protection’s health plan [Plan Obligatorio Salud] (POS by Spanish guidelines on PHC include pharmaceutical services (PS). acronym). For medications and medical devices, networks However, they do not specify the functions or of pharmacies are contracted by the EPS and patients must responsibilities of pharmacists or community pharmacy. use those pharmacies to have their prescriptions Pharmacists are included only in specialized healthcare or dispensed.3 The private sector is used to complement the support services networks in the PHC model. public system by people who can afford and purchase Comprehensive access to health care and integrated care private health insurance and who may be able to pay for are delivered by the provision of the public health any out-of-pocket health expenditures. Approximately 5- 2,3,5 programs (mainly by Ministry of Health and Social 10% of population have private health insurance. Protection) and health promotion, disease prevention, and In 2018, 75% of health expenditure was attributed to public diagnosis, treatment, and rehabilitation (mainly by EPS and sources and the remaining 25% to private.6 In 2019, the IPS) through integrated health services networks (Figure out-of-pocket patient payments in Colombia were 20.6% of 1).11 the health spending, compared to 42.7% in the Latin 7 The Ten-year Public Health Plan: 2012-2021 America region. Overall, per capita health care spending is considered to be low, USD 960 per person in 2017 (7.2% of The Ten-year Health Plan Public (PHP), to coordinate with 311,80 billion USD of Colombia’s gross domestic product- the Colombian socio-economic development, was 8 GDP). Interestingly, the health care budget increased by developed through a process of participation of all country 9 8.12% in 2020. sectors, including Colombians of all ages, family organizations, health
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