Consultorios adyacentes a farmacias privadas en México: infraestructura y características del personal médico y su remuneración

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Abstract

Objetivo. Analizar las características del personal médico y su remuneración, así como la infraestructura, apego a la regulación y servicios ofrecidos en consultorios adyacentes a farmacias (CAF), y compararlos con consultorios médicos independientes (CMI). Material y métodos. Cuestionario aplicado a 239 médicos generales en 18 entidades federativas, incluido el Distrito Federal, en México en 2012. Resultados. Los médicos en CAF tenían menor experiencia profesional (5 vs 12 años), menos estudios de posgrado (61.2% vs 81.8%) y menor salario base promedio mensual (MXN 5500 vs MXN 8500) que en CMI. En CAF hubo menor cumplimiento de la regulación en relación con la historia clínica y la receta médica. Conclusiones. Los aspectos laborales explorados de médicos en CAF son más precarios que en CMI. Es necesario fortalecer la aplicación de la regulación vigente para consultorios y generar políticas a partir del monitoreo de su funcionamiento, particularmente, pero no de forma exclusiva, en CAF.

Translated abstract

Objective. To analyze and compare the physicians' characteristics, their remuneration, the compliance with regulation and the services offered between clinics adjacent to pharmacies (CAF) and independent medical clinics (CMI). Materials and methods. Questionnaire applied to 239 physicians in 18 states including the Federal District, in Mexico in 2012. Results. Physicians in CAF had less professional experience (5 versus 12 years), less postgraduate studies (61.2 versus 81.8%) and lower average monthly salaries (USD 418 versus USD 672) than their peers in CMI. In CAF there was less compliance in relation to medical record keeping and prescribing. Conclusions. The employment situation of physicians in CAF is more precarious than in CMI. It is necessary to strengthen the enforcement of existing regulations and develop policies according to the monitoring of its performance, particularly, but not exclusively, in CAF.

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Sistema de salud de México

Octavio Gómez Dantés, Sergio Sesma, Victor M. Becerril … (2011)

En este trabajo se describe el sistema mexicano de salud. En la primera parte se discuten las condiciones de salud de la población mexicana, con énfasis en los padecimientos emergentes que constituyen las principales causas de muerte: diabetes, enfermedades isquémicas del corazón, padecimientos cerebrovasculares y cáncer. En la segunda parte se describe la estructura básica del sistema: las instituciones que lo conforman, la población a la que cubre, los beneficios que reciben los afiliados de las distintas instituciones, las fuentes de financiamiento del sistema, los niveles de protección financiera alcanzados, los recursos físicos, materiales y humanos con los que cuenta y las principales tareas de rectoría que desarrollan la Secretaría de Salud y otros actores. También se describen los mecanismos de participación de los ciudadanos en la vigilancia y evaluación del desempeño del sistema y su nivel de satisfacción con los servicios recibidos. La tercera parte se dedica a discutir las innovaciones más recientes y su impacto en la operación del sistema. Destaca la discusión del recién creado Sistema de Protección Social en Salud y su brazo operativo, el Seguro Popular de Salud. El trabajo concluye con un análisis de los principales retos que enfrenta en el corto y mediano plazo el sistema mexicano de salud.

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Antibiotic use following a Korean national policy to prohibit medication dispensing by physicians.

Jonathan A. Finkelstein, Sylvia Park, Stephen B Soumerai … (2005)

This study investigated whether a Korean national policy prohibiting doctors from dispensing drugs as of 2000 selectively reduced inappropriate antibiotic prescribing in viral illness compared with bacterial illness. We assessed the proportions of episodes prescribed an antibiotic and the number of different antibiotics prescribed for patients with viral and bacterial illness episodes before and after the policy. The nationally representative sample consisted of 50,999 episodes (18,656 viral and 7758 bacterial pre-policy, 16,736 viral and 7849 bacterial post-policy) from 1372 primary care clinics. We used generalized estimating equations to investigate changes in antibiotic prescribing after the policy, and multiple linear regression to determine provider factors associated with reductions in inappropriate antibiotic prescribing for viral illness. After the dispensing restriction, antibiotic prescribing declined substantially for patients with viral illness (from 80.8 to 72.8%, relative risk (RR) = 0.89, [95% confidence interval: 0.86, 0.91], p<0.001), and only minimally for patients with bacterial illness (from 91.6 to 89.7%, RR = 0.98, [0.97, 0.99], p = 0.017). Reductions in antibiotic prescribing were significantly larger (RR = 0.90, [0.87, 0.93], p<0.001) for patients with viral illness. The number of different antibiotics prescribed per episode also decreased significantly after the policy, but there were no significant differences in these reductions between viral and bacterial illness. The dispensing restriction also reduced prescribing of non-antibiotic drugs, with no difference by diagnosis. Provider factors found to be associated with reduced inappropriate antibiotic prescribing were younger age and practice location in an urban area. Prohibiting doctors from dispensing drugs reduced prescribing overall, both of antibiotics and other drugs, and selectively reduced inappropriate antibiotic prescribing in viral illness.