Avaliação de viabilidade de técnicas de visitação médica para detalhamento acadêmico na artrite reumatoide

Abstract

According to the World Health Organization, more than 50% of all medicines are incorrectly prescribed, dispensed and sold; and more than 50% of patients use them incorrectly. For a prescriptive habit of better quality, prescribers need up-to-date information, reliable sources, easy access, and simple understanding. Representatives from the pharmaceutical industry who conduct these visits are welltrained agents, provide detailed information about their products, and work with specific marketing materials to shape their prescriptive profile. As an evidence-based alternative and according to established guidelines, the practice of academic detailing began in the 1980s at Harvard University. This strategy is used in several countries, but in some, such as Australia, Canada and the United States, there are permanent programs of academic detailing. In Brazil, there is a deficiency in strategies for dissemination of clinical protocols and therapeutic guidelines of the Ministry of Health, and academic detail has the potential to fill this gap. With this, it is opportune to evaluate the feasibility of medical visitation techniques for academic details about medications made available in SUS for rheumatoid arthritis, a systemic autoimmune pathology characterized by severely debilitating chronic joint inflammation that affects about 0.5 to 1,0% of the world population. To develop and execute an academic detailing program for rheumatoid arthritis with prescribers working in the city of Belo Horizonte, we selected academics or health professionals with a communicative profile and knowledge of SUS to be the facilitators. 43 prescribers were visited, with a total of 79 visits. The facilitators reported how very difficult the marking of the visits in 52% of the times and difficult in 32,9%. An average of 1.4 attempts were required to mark the visit. They also reported an average time in the waiting room of 36 minutes and 12.2 minutes duration of the visit with the doctor. The facilitators reported that the physicians were receptive (31.5%) or very receptive (52%) in the visits and were shown interested (25.7%) or very interested (51.3%) in the presented content. They reported that it was possible to present all the planned information in 91.7% of visits. There were 28 telephone contacts where 70.4% of the doctors said they were very satisfied with the visit, agreeing with the relevance of the content presented in 85.7% of the time. About 57% of the doctors visited understood that the visits added some knowledge and that there was nothing they did not like about 82%. They also reported that they believe that academic detailing is equally effective in deepening knowledge compared to participation in events, such as conferences in approximately 44% of contacts. A total of R $ 14,185 was spent to carry out the program. Despite the geographical limitation of the study, the 43 prescribers visited represent a large number of deferrals for CEAF drug applications. Therefore, the total amount spent on the implementation of this program of academic detail and its potential for improving access to these drugs can have a positive impact on the targeting of public expenditures avoiding the judicial process, representing an effective strategy in the dissemination of Clinical Protocols and Therapeutic Guidelines.