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To select clinical situations that can be used as risk indicators of preventable morbidity caused by drugs at the community pharmacies, and to study their acceptability, in terms of pertinence and relevance.We used the Delphi technique, in 2 rounds, by a panel of 14 medical doctors and pharmacists experts, to study the relevance of 68 types of clinical situations as risk indicators of preventable morbidity related to drug utilization used by health professionals in community pharmacies, with scientific evidence of foreseeable adverse result, frequent situations in ambulatory care and with controllable cause and result.43 of the 68 indicators were considered usable and pertinent. The indicators referred three areas: drug type (medications of narrow therapeutic margin, with individualized dose and adverse reactions frequent and severe), health problem (chronic problems, especially asthma, cardiac, thyroid and prostate illness, and pain), and patient (old or with several medications. Pharmacists systematically overvalued some indicators in relation to the doctors, but differences were not significant.Forty-three indicators were selected as valuable to identify situations of preventable morbidity related to drug utilization. more...

ResumenLas páginas siguientes pretenden identificar organización y gestión de la atención primaria necesarios para desarrollar una estrategia de marketing social, consistente y viable. Algunos elementos claves que han de modificarse son: 1. Esquemas administrativos y de gestión centralizados y rigidos. Presupuestos retrospectivos. 2. Estructura de incentivos centralizada y disociada de la cadena de mando. 3. Unidades de dirección y gestión en atención primaria, inmersas en el conflicto político. 4. Carencia de márgenes de elección del usuario. 5. Inexistencia de una estrategia de marketing interno.Se discuten distintas formas de simular mercados como instrumentos para la eficiencia, asi como elementos necesarios del «cambio interno», tales como la modificación del marco jurd ico del In-salud, SAS, etc. en una dirección desreguladora. De todos «los cambios internos» esbozados, tres se consideran esenciales: a) Sistemas de retribución en atención primaria, b) Modificación del marco laboral, c) La reforma del proceso presupuestario. Se proponen estrategias concretas en cada una de estas áreas enfatizando su indispensable interdependencia y congruencia entre si.SummaryThe article desired organizational an managerial changes in Primary Health Care, so as to develop a sound and feasible social marketing strategy. Key elements that should be changed are: 1. Rigid and centralized administrative structures and procedures. 2. Incentives system centralized and dissociated from the managerial structure. 3. Primary Health Care management units immersed in political conflict. 4. Absence of alternative in the margin. Users cannot choose. 5. Lack of an internal marketing strategy.Several ways of internal markets simulation are assessed as potential means for internal change. The need for an administration reform leading to a less normativist system in the spanish national and regional health services in reviewed too. Three changes are considered essential:a) Payment systems in Primary Health Care, b) Modifications in the personnel contracts, c) Reform of the budgeting processes. Specific strategies in each of these issues are suggested, making emphasizing the need of their interrelationship and coherence. more...