AUDIT OF THE COVERAGE DECISION MAKING PROCESS IN A GOVERNMENT AGENCY IN URUGUAY: FROM THE GUIDELINES TO PATIENTS

GARCIA MARTI S, ; ARUJ P,; GLUJOVSKY D; BARDACH A,; RODRÍGUEZ A.

VALUE IN HEALTH

WILEY-BLACKWELL PUBLISHING, INC

Lugar: Londres; Año: 2013

1098-3015

Objectives: The National Resources Fund (FNR) is a government agency devotedto provide coverage of high cost technologies in Uruguay. A particular characteristicof the FNR is being involved in the whole process of providing access to thesetechnologies, from its buying to its patient administration. To guide this process theFNR, has some clinical coverage guidelines that are used in the clinical coveragedecision with each individual patient. During 2009 and 2012 the FNR did an auditprocess of these guidelines and asked IECS (a non profit academic organization)from Argentina to implement it. To present the process were 12 of these guidelineswere audited (colorectal, kidney, CNS and breast cancer, leukemias, cystic fibrosis,hepatitis C, diabetes, palivizumab and rituximab, rheumatoid arthritis and multiplemieloma) and the coverage decision taken on patients with the corresponding diseases.Methods: Systematic bibliographic searches were performed to audit theguidelines and the clinical record of patients with the corresponding diseases wasaudited summarizing 200 patients in total. Results: Regarding the guidelines itwas observed that in general there were adequate in its clinical content and updatedwith the actual evidence promoting a better clinical decision coverage process. Onlysome reporting aspects as date of bibliographic searches not reported or not clearspecification of authors or methodology followed were mentioned. Regarding thepatients audit, in 198 cases the decision was in concordance with the guidelinebeing adequate in almost all the cases. Conclusions: An audit process of thecoverage decisions implemented in a government agency by an external organismas the one described in this study allows to identify potential improvements to theprocess, promotes transparency and at the end a better coverage decision-makingprocess and utilization of health resources