OBJECTIVE: The aim of this article is to provide an outcome evaluation model for preparedness of pharmaceutical services (PS) in disaster situations. METHODS: A five-step evaluation model development was conducted. The first step was a search of disaster preparedness and PS literature. The second step consisted of a description of the political and organizational aspects, external context, implementation, and performance of PS in disaster preparedness. A theoretical model on PS preparedness in disaster situations, encompassing pharmaceutical services variables and measures of preparedness, was developed as the third step. The fourth step produced a comprehensive theoretical model for evaluating PS preparedness, combining the two approaches used in steps two and three. The fifth and final step examined the development of the indicator framework. RESULTS: The results of this methodological approach are presented in the logic model of PS preparedness and the indicator framework, both of which were developed based on the disaster preparedness and PS literature and organized to provide a structured evaluation approach. CONCLUSIONS: PS was conceptualized as a program that can be evaluated by measurable effects. These effects can only be measured based on documented, on-site conditions before and after an event recognized as a disaster situation. This conceptual approach is context-modulated and therefore only applicable where the logistic cycle has been adopted as the rationale for PS.

OBJETIVO: Proporcionar un modelo de evaluación de resultados relativos al estado de preparación de los servicios farmacéuticos (SF) para situaciones de desastre. MÉTODOS: Se elaboró un modelo de evaluación en cinco pasos. El primer paso fue una búsqueda bibliográfica sobre preparativos para situaciones de desastre y SF. El segundo consistió en una descripción de los aspectos políticos y técnicos, el contexto externo, la implementación y el desempeño de los SF en la preparación para situaciones de desastre. El tercer paso fue la elaboración de un modelo teórico sobre el estado de preparación de los SF para situaciones de desastre, que comprendía variables relativas a los SF y medidas del estado de preparación. El cuarto paso consistió en la creación de un modelo teórico integral para evaluar el estado de preparación de los SF, mediante la combinación de los enfoques usados en los pasos dos y tres. El quinto y último paso fue el análisis de la elaboración del marco de indicadores. RESULTADOS: Se presentan los resultados de este enfoque metodológico en el modelo lógico del estado de preparación de los SF y el marco de indicadores, ambos elaborados con base en la bibliografía sobre preparativos para casos de desastre y SF, y organizados para poder proporcionar un método estructurado de evaluación. CONCLUSIONES: A efectos de la elaboración de este marco conceptual se consideró a los SF como un programa que podría ser evaluado a partir de sus efectos cuantificables. Estos efectos solo pueden ser medidos sobre la base de condiciones documentadas en el lugar de los hechos antes y después del evento considerado una situación de desastre. Este enfoque conceptual está modulado en función del contexto y por lo tanto se considera aplicable solamente donde se haya adoptado el ciclo logístico como fundamento de los SF.

OBJECTIVES: The spread of HIV/AIDS challenges governments to provide antiretroviral (ARV) treatment at affordable prices, and various initiatives have been developed with that intent. In Latin America and the Caribbean, four subregional negotiations were conducted during 2002-2005 to reduce drug prices and thus broaden access to ARVs. Studies were carried out to monitor the negotiations, and the development of a monitoring methodology was recommended. The objective of the current study was to develop and describe a potential methodology for monitoring ARV price negotiations. METHODS: The study, carried out in 2006-2007, consisted of a design phase and validation phase. The design phase included an extensive literature review and development of a theoretical framework. Validation was performed using health professional consensus and pilot studies in three countries-Barbados, Honduras, and Peru-representing the Caribbean, Central American, and Andean subregions. RESULTS: The results included a detailed logic model and a 40-indicator framework. Both were tested in the field. Indicators were evaluated for feasibility, pertinence, and sensitivity, based on the outcome of the pilot study. CONCLUSIONS: This monitoring methodology is designed to help countries self-evaluate progress toward implementation of ARV price negotiations. The results of the pilot study indicate that its implementation in the field helped elucidate the ARV price negotiation process by identifying local conditions and indirectly measuring countries' negotiating capacities.

OBJETIVO: La diseminación del VIH/sida exige de los gobiernos suministrar el tratamiento antirretroviral (ARV) a precios asequibles y se han desarrollado varias iniciativas con ese fin. En América Latina y el Caribe se han realizado cuatro negociaciones subregionales entre 2002 y 2005 para reducir los precios de los medicamentos y así ampliar el acceso a los ARV. Se han realizado estudios para monitorear las negociaciones y se ha propuesto crear una metodología de monitoreo. El objetivo del presente trabajo fue desarrollar y describir una posible metodología para el monitoreo de las negociaciones de los precios de los ARV. MÉTODOS: El estudio, realizado en 2006-2007, constó de las fases de diseño y validación. En la fase de diseño se hizo una extensa revisión de la literatura y se desarrolló un marco teórico. La validación se realizó mediante un análisis de consenso de profesionales de la salud y un estudio piloto en tres países -Barbados, Honduras y Perú- en representación del Caribe, América Central y la subregión andina. RESULTADOS: Se obtuvo un detallado modelo logístico y un marco conceptual de 40 indicadores. Ambos se probaron en el terreno. Se evaluaron la factibilidad, pertinencia y sensibilidad de los indicadores según los resultados del estudio piloto. CONCLUSIONES: Esta metodología de monitoreo se diseñó para ayudar a los países a autoevaluar sus progresos en la implementación de la negociación de precios de los ARV. Los resultados del estudio piloto indican que su implementación en el terreno ayudó a esclarecer el proceso de negociación de los precios de los ARV mediante la identificación de las condiciones locales y la medición indirecta de la capacidad de negociación de los países.

O texto apresenta uma visão crítica da interação entre prescritores, dispensadores e pacientes, vislumbrando, na informação, um dos fatores-chave para o desenvolvimento qualitativo dessa complexa relação. Descreve, além do aporte de informações por parte desses profissionais de saúde, as fontes às quais possivelmente terão acesso e alguns fatores envolvidos na transformação da informação em conhecimento. Relata os papéis dos profissionais que exercem o ato da prescrição e da dispensação, as expectativas do paciente como alvo dos serviços prestados e as conseqüências das ações de saúde envolvidas no processo.

The article presents a critical view of the interaction between prescribers, dispensers, and patients, considering information one of the key issues in enhancing the qualitative aspects involved in this complex relationship. It describes the acquisition of information by health professionals, possible sources of this information, and the process involved in transforming it into knowledge. Briefly discussed are the physician's and pharmacist's roles, the patient's expectations as recipient, and consequences of pertinent health interventions.

O texto apresenta uma visão crítica da interação entre prescritores, dispensadores e pacientes, vislumbrando, na informação, um dos fatores-chave para o desenvolvimento qualitativo dessa complexa relação. Descreve, além do aporte de informações por parte desses profissionais de saúde, as fontes às quais possivelmente terão acesso e alguns fatores envolvidos na transformação da informação em conhecimento. Relata os papéis dos profissionais que exercem o ato da prescrição e da dispensação, as expectativas do paciente como alvo dos serviços prestados e as conseqüências das ações de saúde envolvidas no processo.

The article presents a critical view of the interaction between prescribers, dispensers, and patients, considering information one of the key issues in enhancing the qualitative aspects involved in this complex relationship. It describes the acquisition of information by health professionals, possible sources of this information, and the process involved in transforming it into knowledge. Briefly discussed are the physician's and pharmacist's roles, the patient's expectations as recipient, and consequences of pertinent health interventions.