Diagnóstico e propostas para prevenção de perdas de medicamentos – um estudo de caso sobre o estoque da Secretaria de Estado de Saúde do Rio de Janeiro

Abstract

In the scope of the Unified Health System, the execution of comprehensive therapeutic assistance actions, including pharmaceutical assistance, is included. The essential input for a large part of health actions and services is medication, which goes through a set of stages from manufacturing to dispensing to the patient. Due to the possible impact of logistical activity on population assistance, the present study was planned to provide a customized contribution to loss prevention. This work analyzed expired medications in the stock of the Rio de Janeiro State Health Secretary between May 2016 and December 2023 based on (1) the description of the stock management procedures adopted; (2) the survey of expired items during the study period (May 2016 to December 2023); (3) the analysis of expired medications based on multiple variables such as status, occurred/possible outcome, entity responsible for acquisition, levels of the Anatomical Therapeutic Chemical Classification (1, 3, 4, and 5), average price per pharmaceutical unit, health program, and diseases. The study was descriptive, retrospective, observational, exploratory, and based on document analysis. The analysis of the obtained data set and documents indicating the supply planning and replenishment methods allowed the understanding of how these activities can contribute to stock imbalances and the accumulation of expired medications. A significant concentration of expired medications in the SES-RJ stock was evidenced in items acquired by the Ministry of Health and transferred to the state level. The strategy of requiring a replacement commitment when stock entry occurs after more than 15% of the shelf life has elapsed was responsible for recovering an average of 84.44% of potential losses between 2016 and 2023. The main items present in the expired medications in stock were vaccines, cisatracurium/ rocuronium/ dobutamine (used in COVID-19 response actions), interferon/ sofosbuvir/ daclatasvir/ simeprevir/ glecaprevir + pibrentasvir/ ledipasvir + sofosbuvir (hepatitis treatment), cinacalcet (mineral bone disorder in chronic kidney disease) and brinzolamide/ bimatoprost/ travoprost (glaucoma). The study provided an opportunity to improve the work process based on gaps observed in the acquisition planning information routinely included in loss prevention instruments. As a byproduct of the research, a technical note was created to propose improvements in the tools used