Organization and practices of pharmaceutical services in oncology within the Brazilian National Health System

This study, based on the Giddens’ Structuration Theory, aimed to analyze organization and pharmaceutical services practices for oncology care in five brazilian municipalities by a multiple-case study design, having breast cancer as a marker condition. Oncology care-certified facilities were established as analysis sub-units. In-depth interviews were conducted with ten managers and fifteen health professionals. Research strategy also involved document analysis and direct observation of practices. Results were analyzed according to four main themes: organizational structure, financing, technologies and work process. We found little interaction of pharmaceutical services with levels of care, structural problems within facilities, insufficient funding, belated technology assessment and technology adoption, and shortfalls in work processes. These aspects contribute to precarious functioning of the cancer-care system.

本研究以吉登斯结构化理论（Structuration Theory）为指导框架，采用多案例研究设计（multiple-case study design），针对巴西五个市镇的肿瘤护理场景，以乳腺癌作为标志性指征病症，分析其组织结构与药学服务实践模式。本研究将肿瘤护理认证机构设定为分析子单元，共对10名管理者与15名卫生专业人员开展深度访谈，同时辅以文献分析与实践现场直接观察的研究手段。研究结果从四大核心主题展开剖析：组织结构、经费保障、技术应用与工作流程。经分析发现，药学服务与各级照护体系的互动严重不足，机构内部存在结构性弊端，经费供给匮乏，技术评估与采纳滞后，且工作流程存在诸多短板，上述问题共同导致癌症照护体系的运转状态不佳。