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

BACKGROUND: The implementation of pharmaceutical services in hospitals contributes to the appropriate use of medicines and patient safety. However, the relationship of implementation with the legal framework and organizational practice has not been studied in depth. The objective of this research is to determine the role of these two factors (the legal framework and organizational practice) in the implementation of pharmaceutical services in public hospitals of the Ministry of Health of Mexico. METHODS: Semi-structured interviews were conducted with four groups of actors involved. The analysis focused on the legal framework, defined as the rules, laws and regulations, and on organizational practice, defined as the implementation of the legal framework by related individuals, that is, how they put it into practice. RESULTS: The main problems identified were the lack of alignment between the rules and the incentives for compliance. Decision-makers identified the lack of managerial capacity in hospitals as the main implementation barrier, while hospital pharmacists pointed to poor regulation and the lack of clarity of the legal framework as the problems to consider. CONCLUSIONS: Although the legal framework related to hospital pharmaceutical services in Mexico is inadequate, organizational factors (such as adequate skills of professional pharmacists and the support of the hospital director) have facilitated gradual implementation. To improve implementation, priority should be given to evaluation and modification of the current legislation along with the development of an official minimum standard for activities and services in hospital pharmacies.

Las reacciones adversas de las plantas medicinales y sus interacciones con medicamentos / The adverse reactions of the medicinal herbs and their interactions with medicines

Se informa sobre las reacciones adversas de 10 plantas medicinales, sus interacciones con medicamentos y el impacto producido. A los efectos se realizó una amplia revisión bibliográfica, para lo cual se seleccionaron aquellas especies vegetales muy bien documentadas en literaturas científicas. Se halló que muchas plantas medicinales provocan efectos indeseables e interactúan con medicamentos, de modo que en algunos casos atentan contra la vida del paciente o afectan la farmacocinética y farmacodinamia; ello justifica tener especial cuidado cuando se trata de niños, ancianos y embarazadas. Dichas interacciones se producen con medicamentos anticoagulantes, antihipertensivos, sedantes, antidepresivos, hipoglucemiantes y digitálicos. La divulgación de esta información es importante para los profesionales de la salud y la comunidad, dado que el consumo actual de las especies vegetales con fines terapéuticos se encuentra muy extendido en todas partes del mundo y muchas personas se automedican con estas, desconociendo sus acciones y convencidas de que resultan totalmente inocuas