Access to antipsychotic in Brazil: using risk management to assess changes in pharmaceutical services

The treatment of schizophrenia is essential for patients' quality of life and relies on the continuous use of antipsychotics provided by the Brazilian Unified Health System (SUS). This study aimed to compare the processes that affect access to antipsychotics across different components of pharmaceutical services (PS) using risk management. The risk management methodology applied establishes risk levels, from very low to very high, based on the combination of probability and impact scales, following consecutive stages from context understanding to risk treatment. A total of 20 risk events were identified within the stages of the PS cycle. Both components show high and very high risks that need to be mitigated, with 12 in the basic component (60%), 11 in the specialized component (55%), and seven shared between the two. The component comparison indicates that both require risk mitigation and have opportunities for improvement; thus, the maintenance or transition of antipsychotics between components should be guided by the capacity to mitigate PS management risks, along with other local context criteria. Risk management proved useful in discussing medication access and guiding decision-making in PS management.