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Table 4 Recommendations to improve the implementation of hospital pharmaceutical services through the approach of emerging bottlenecks

From: The implementation of pharmaceutical services in public hospitals in Mexico: an analysis of the legal framework and organizational practice

Rule Current situation Proposal for change Possible implications
Legal framework
General Health Law/regulation of health products - The figure of the health manager is not suitable for the implementation of HPS
- The legal framework does not differentiate between retail and hospital pharmacies
- Establish the figure of the pharmacy chief to replace the health manager
- Prepare a NOM for activities and services in (at least) hospital pharmacies
- Possible resistance to change by hospital staff
- Having a competent full-time pharmacy chief will increase HPS implementation
Standards for hospital certification - They are only harmonized with the international standards of the Joint Commission; however, their implementation is not mandatory - The critical medication management and use system can be considered as a basis for the elaboration of a NOM, from which the accreditation criteria of the Ministry of Health and the COFEPRIS pharmacy verification certificate are developed - Having a norm based on international standards will help increase the quality of pharmacy services
The FEUM Supplement - Absence of some pharmaceutical services
- Lack of clarity in the concepts of the last edition
- It is not a binding rule /
a low-key law
- Establish minimum standards for all pharmaceutical services that are developed in Mexico
- Review concepts based on scientific literature
- Make standards binding and promote compliance
- The FEUM Supplement is the norm mostly related to the HPS, its revision, strengthening, alignment and adoption at the national level is one of the best strategies to achieve the implementation of HPS
Accreditation and certificates of medical care establishments/hospitals - Conceptual and process discrepancies with the CSG and FEUM supplement standards
- Weak enforcement of compliance
- Pharmacy verification by COFEPRIS or its state offices is sometimes performed by untrained personnel for HPS evaluation
- Review, correct, evaluate and align the verification card following the appropriate standards - A suitable regulation tool for the HPS will allow to increase the quality in the provision of these services
- Make it mandatory
National Model of Hospital Pharmacy - It is voluntary
- It is not updated
- It is necessary to update and promote it - A new effort to update it can help put the issue on the national political agenda
- A NOM is recommended due to its mandatory nature
Organizational practice
Health system level - Compliance with the legal framework is encouraged, but not required
- Problems in supervising the assignment and fulfillment of the functions of the health manager
- Corruption problems in different instances
- Decentralization and fragmentation of the health system complicate the standardized implementation of new service delivery models
- Lack of hospital pharmacists at various levels of decision-making
- Lack of financing for the implementation of some services
- Increase the mechanisms of compliance with the legal framework related to HPS. It may be necessary to increase the number of trained verifiers
- Transparency of the mechanisms for assigning contracts for health managers
- Promote the educational training of pharmacists with the necessary skills
- Allocation of financial resources for the implementation of HPS
- Taking the impact of NOM 220 on hospital practice as an example, we consider that developing a NOM (s) for HPS will promote its implementation
Hospital level - The implementation and permanence of HPS may be subject to the decision of the hospital director
- Historically the pharmacy service has belonged to the areas of material resources or the administrative area of the hospital
- Inadequate levels of recruitment and wages for pharmacists
- Resistance to change by members of the health team and hospital managers
- Problems of prioritization of services and activities between pharmacy staff and hospital authority
- Raise awareness among hospital directors, area managers, and health personnel about the benefits of HPS
- The pharmacy service must be linked to both the medical and administrative areas
- Increase the number of trained pharmacists in hospital pharmacies and assess their labor rights
- Increase in HPS implemented with the consequent decrease in costs and increase in the quality of care