Exploratory analysis of requests for authorization to dispense high-cost medication to COPD patients: the São Paulo 'protocol'
| Autor: | Lucas Yoshio Kido Navacchia, Gustavo Garcia Marques, Flavia Munhos Granja, Alberto Cukier, Frederico Leon Arrabal Fernandes, Telma de Cassia dos Santos Nery, Ingredy Tavares da Silva, Rafael Stelmach, Regina Maria Carvalho-Pinto |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Copd patients Vital Capacity Pulmonary disease chronic obstructive Health Services Accessibility Diseases of the respiratory system Special Article 03 medical and health sciences FEV1/FVC ratio 0302 clinical medicine Forced Expiratory Volume Doença pulmonar obstrutiva crônica medicine Humans 030212 general & internal medicine Aged Protocol (science) COPD RC705-779 β2 agonists business.industry Clinical protocols Authorization Tiotropium bromide Exploratory analysis Middle Aged Drug costs medicine.disease Bronchodilator Agents 030228 respiratory system Emergency medicine Protocolos clínicos Female Custos de medicamentos Brometo de tiotrópio business Brazil medicine.drug |
| Zdroj: | Jornal Brasileiro de Pneumologia v.45 n.6 2019 Jornal Brasileiro de Pneumologia Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) instacron:SBPT |
| ISSN: | 1806-3756 1806-3713 |
| DOI: | 10.1590/1806-3713/e20180355 |
| Popis: | Objective: A resolution passed by the government of the Brazilian state of São Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) São Paulo between 2011 and 2016. Methods: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. Results: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting β2 agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. Conclusions: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures. |
| Databáze: | OpenAIRE |
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