1
|
Leal AADF, Rodrigues Galvão MH, Medeiros ADA, Roncalli ÂG. Access to medicines among the Brazilian population based on the 2019 National Health Survey. PLoS One 2023; 18:e0280599. [PMID: 36662881 PMCID: PMC9858017 DOI: 10.1371/journal.pone.0280599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Access to medicines is a challenge, especially in developing countries, highlighting the need of population-based research to evaluate access and related factors. OBJECTIVE This study aimed to assess access to medicines and identify associated factors using data from the 2019 Brazilian National Health Survey (PNS). METHODS This population-based cross-sectional study used data from the 2019 PNS and considered access to prescription medicines as the primary outcome. The sample included 24,753 individuals aged 15 years or older who looked for medical care in the last 15 days and received a medicine prescription. Andersen's behavioral model was used to select independent variables. After descriptive analysis, a multinomial logistic regression multilevel analysis was performed using the independent variables with a significance level lower than 0.20 in the bivariate analysis. RESULTS The lowest chances of getting access to medicines were observed in individuals aged between 40 and 59 years, women, with complete middle and high school, with lower-income families, who attended public services, with worse self-assessed health, and those who looked for health care for disease prevention and health promotion. CONCLUSIONS Access to medicines among the Brazilian population is associated with social, economic, and health perception factors. Our findings may update and guide the development of public policies on medication and pharmaceutical care, facilitating medication purchases by the care user and promoting health equity.
Collapse
Affiliation(s)
| | | | - Arthur de Almeida Medeiros
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Health Integrated Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Ângelo Giuseppe Roncalli
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| |
Collapse
|
2
|
Torres NPB, Alvares-Teodoro J, Júnior AAG, Horizonte PDB, Acurcio FDA. Social and economic factors associated with antidepressant use: results of a national survey in primary care. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
3
|
Silva WLFD, Matos DMD, Felicíssimo JM, Jardim ACB, Cruz DTD, Cazarim MDS, Mendonça AED, Silvério MS. Profile of pharmaceutical interventions of a pharmacotherapeutic follow-up model for diabetic patients in a community pharmacy. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
4
|
Curado DDSP, Gomes DF, Silva TBC, Almeida PHRF, Tavares NUL, Areda CA, da Silva EN. Direct cost of systemic arterial hypertension and its complications in the circulatory system from the perspective of the Brazilian public health system in 2019. PLoS One 2021; 16:e0253063. [PMID: 34111216 PMCID: PMC8191920 DOI: 10.1371/journal.pone.0253063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Systemic arterial hypertension (SAH), a global public health problem and the primary risk factor for cardiovascular diseases, has a significant financial impact on health systems. In Brazil, the prevalence of SAH is 23.7%, which caused 203,000 deaths and 3.9 million DALYs in 2015. OBJECTIVE To estimate the cost of SAH and circulatory system diseases attributable to SAH from the perspective of the Brazilian public health system in 2019. METHODS A prevalence-based cost-of-illness was conducted using a top-down approach. The population attributable risk (PAR) was used to estimate the proportion of circulatory system diseases attributable to SAH. The direct medical costs were obtained from official Ministry of Health of Brazil records and literature parameters, including the three levels of care (primary, secondary, and tertiary). Deterministic univariate analyses were also conducted. RESULTS The total cost of SAH and the proportion of circulatory system diseases attributable to SAH was Int$ 581,135,374.73, varying between Int$ 501,553,022.21 and Int$ 776,183,338.06. In terms only of SAH costs at all healthcare levels (Int$ 493,776,445.89), 97.3% were incurred in primary care, especially for antihypertensive drugs provided free of charge by the Brazilian public health system (Int$ 363,888,540.14). Stroke accounted for the highest cost attributable to SAH and the third highest PAR, representing 47% of the total cost of circulatory diseases attributable to SAH. Prevalence was the parameter that most affected sensitivity analyses, accounting for 36% of all the cost variation. CONCLUSION Our results show that the main Brazilian strategy to combat SAH was implemented in primary care, namely access to free antihypertensive drugs and multiprofessional teams, acting jointly to promote care and prevent and control SAH.
Collapse
Affiliation(s)
| | - Dalila Fernandes Gomes
- Graduate Program in Public Health, University of Brasilia, Brasilia, Federal District, Brazil
| | | | | | | | - Camila Alves Areda
- Faculty of Ceilandia, University of Brasilia, Brasilia, Federal District, Brazil
| | - Everton Nunes da Silva
- Graduate Program in Public Health, University of Brasilia, Brasilia, Federal District, Brazil
- Faculty of Ceilandia, University of Brasilia, Brasilia, Federal District, Brazil
| |
Collapse
|
5
|
Faraco EB, Guimarães L, Anderson C, Leite SN. The pharmacy workforce in public primary healthcare centers: promoting access and information on medicines. Pharm Pract (Granada) 2020; 18:2048. [PMID: 33224324 PMCID: PMC7672483 DOI: 10.18549/pharmpract.2020.4.2048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/25/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Only few studies have analyzed the pharmaceutical workforce in primary
healthcare centers, and a global recommendation calls for better
understanding of the trends that shape workforce development and
capacity. Objective: To analyze the distribution of the pharmaceutical workforce in primary
healthcare centers in the national health system [Sistema Único de
Saúde (SUS)] in Brazil. Methods: The study was conducted using data from the National Survey on Access, Use
and Promotion of Rational Use of Medicines in Brazil. Secondary data
referring to the socioeconomic indicators of each municipality were obtained
from national public databases. Data stratification in geographic regions
was considered, and data on workers in the management of the municipal
pharmaceutical services and medicines dispensing centers were analyzed.
Crude and adjusted prevalence ratios were calculated by Poisson regression
in the study investigating the factors associated with low and high-density
pharmacists per 10,000 inhabitants. Results: The results showed that most Brazilian municipalities have a rate of 1 or
more pharmacist per 10,000 inhabitants in primary healthcare public
facilities, with a higher concentration of pharmacists in small
municipalities. Even in Brazilian municipalities with lower economic
capacity, the conditions of access to medicines and pertinent information on
medicines were directly related to the number of pharmacists available in
these centers. Conclusions: This study showed a high number of pharmacists in the public health system.
The higher density of pharmacists in primary healthcare public facilities
correlated to increased access to medicines information and better municipal
social development.
Collapse
Affiliation(s)
- Emilia B Faraco
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina. Florianópolis, SC (Brasil).
| | - Luciano Guimarães
- Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul. Porto Alegre, RS (Brasil).
| | - Claire Anderson
- Professor of Social Pharmacy. Division of Pharmacy Practice and Policy, University of Nottingham. Nottingham (United Kingdom).
| | - Silvana N Leite
- Professor. Postgraduate Program in Pharmacy, Federal University of Santa Catarina. Florianópolis, SC (Brasil).
| |
Collapse
|
6
|
Faraco EB, Guimarães L, Anderson C, Leite SN. The pharmacy workforce in public primary healthcare centers: promoting access and information on medicines. Pharm Pract (Granada) 2020; 18:2048. [PMID: 33224324 DOI: 10.18549/pharmpract.2020.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/25/2020] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Only few studies have analyzed the pharmaceutical workforce in primary healthcare centers, and a global recommendation calls for better understanding of the trends that shape workforce development and capacity. OBJECTIVE To analyze the distribution of the pharmaceutical workforce in primary healthcare centers in the national health system [Sistema Único de Saúde (SUS)] in Brazil. METHODS The study was conducted using data from the National Survey on Access, Use and Promotion of Rational Use of Medicines in Brazil. Secondary data referring to the socioeconomic indicators of each municipality were obtained from national public databases. Data stratification in geographic regions was considered, and data on workers in the management of the municipal pharmaceutical services and medicines dispensing centers were analyzed. Crude and adjusted prevalence ratios were calculated by Poisson regression in the study investigating the factors associated with low and high-density pharmacists per 10,000 inhabitants. RESULTS The results showed that most Brazilian municipalities have a rate of 1 or more pharmacist per 10,000 inhabitants in primary healthcare public facilities, with a higher concentration of pharmacists in small municipalities. Even in Brazilian municipalities with lower economic capacity, the conditions of access to medicines and pertinent information on medicines were directly related to the number of pharmacists available in these centers. CONCLUSIONS This study showed a high number of pharmacists in the public health system. The higher density of pharmacists in primary healthcare public facilities correlated to increased access to medicines information and better municipal social development.
Collapse
Affiliation(s)
- Emilia B Faraco
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina. Florianópolis, SC (Brasil).
| | - Luciano Guimarães
- Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul. Porto Alegre, RS (Brasil).
| | - Claire Anderson
- Professor of Social Pharmacy. Division of Pharmacy Practice and Policy, University of Nottingham. Nottingham (United Kingdom).
| | - Silvana N Leite
- Professor. Postgraduate Program in Pharmacy, Federal University of Santa Catarina. Florianópolis, SC (Brasil).
| |
Collapse
|
7
|
Lutz BH, Miranda VIA, Silveira MPT, Dal Pizzol TDS, Mengue SS, da Silveira MF, Domingues MR, Bertoldi AD. Medication Use among Pregnant Women from the 2015 Pelotas (Brazil) Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030989. [PMID: 32033282 PMCID: PMC7037701 DOI: 10.3390/ijerph17030989] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 11/16/2022]
Abstract
Background: Medication use during pregnancy is a common practice that has been increasing in recent years. The aim of this study is to describe medication use among pregnant women from the 2015 Pelotas (Brazil) Birth Cohort Study. Methods: This paper relies on a population-based cohort study including 4270 women. Participants completed a questionnaire about the antenatal period, including information about medication use. We performed descriptive analyses of the sample and the medications used and adjusted analyses for the use of medications and self-medication. Results: The prevalence of medication use was 92.5% (95% CI 91.7-93.3), excluding iron salts, folic acid, vitamins, and other minerals. The prevalence of self-medication was 27.7% (95% CI 26.3-29.1). In the adjusted analysis, women who had three or more health problems during pregnancy demonstrated higher use of medicines. Self-medication was higher in lower income groups and among smokers and multiparous women (three pregnancies or more). Acetaminophen, scopolamine, and dimenhydrinate were the medications most commonly used. Conclusions: This study describes the pattern of drug use among pregnant women in a population-based cohort study, with a high prevalence of self-medication. Greater awareness of the risks of self-medication during pregnancy is required, focusing on groups more prone to this practice, as well as ensuring qualified multidisciplinary prenatal care.
Collapse
Affiliation(s)
- Bárbara Heather Lutz
- Faculty of Medicine, Department of Social Medicine & Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil
- Correspondence: ; Tel.: +55-53-3309-2400
| | - Vanessa Iribarrem Avena Miranda
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil; (V.I.A.M.); (M.F.d.S.); (A.D.B.)
| | - Marysabel Pinto Telis Silveira
- Institute of Biology, Department of Physiology and Pharmacology & Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil;
| | - Tatiane da Silva Dal Pizzol
- Post-Graduate Program in Epidemiology, Federal University of Porto Alegre, Av. Ipiranga, 2752, Sala 203, Porto Alegre CEP 90610-000, RS, Brazil; (T.d.S.D.P.); (S.S.M.)
| | - Sotero Serrate Mengue
- Post-Graduate Program in Epidemiology, Federal University of Porto Alegre, Av. Ipiranga, 2752, Sala 203, Porto Alegre CEP 90610-000, RS, Brazil; (T.d.S.D.P.); (S.S.M.)
| | - Mariângela Freitas da Silveira
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil; (V.I.A.M.); (M.F.d.S.); (A.D.B.)
| | - Marlos Rodrigues Domingues
- Post Graduate Program in Physical Education & Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil;
| | - Andréa Dâmaso Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil; (V.I.A.M.); (M.F.d.S.); (A.D.B.)
| |
Collapse
|
8
|
do Nascimento RCRM, Guerra AA, Alvares J, Gomes IC, Godman B, Bennie M, Kurdi AB, de Acurcio FA. Statin use in Brazil: findings and implications. Curr Med Res Opin 2018. [PMID: 29528246 DOI: 10.1080/03007995.2018.1451312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION AND OBJECTIVES Statins have become an integral part of treatment to reduce cardiac events in patients with cardiovascular disease. However, their use within the public healthcare system in Brazil is unknown. Consequently, we sought to determine and characterize statin use in primary healthcare delivered by the public health system (SUS) in Brazil and evaluate associated patient factors to improve future use. METHODS Cross-sectional study with a national representative sample from five Brazilian regions, derived from the National Survey on Access, Use and Promotion of Rational Use of Medicines using a multi-stage complex sampling plan. Patients over 18 years old were interviewed from July 2014 to May 2015. The prevalences of statin use and self-reported statin adherence were determined amongst medicine users. The associations between statin use and sociodemographic/health condition variables were assessed using logistic regression. RESULTS A total of 8803 patients were interviewed, of whom 6511 were medicine users. The prevalence of statin use was 9.4% with simvastatin (90.3%), atorvastatin (4.7%) and rosuvastatin (1.9%) being the most used statins. Poor adherence was described by 6.5% of patients. Statin use was significantly associated with age ≥65 years old, higher educational level, residence in the South, metabolic and heart diseases, alcohol consumption and polypharmacy. CONCLUSIONS This is the first population based study in Brazil to assess statin use in SUS primary healthcare patients. Addressing inequalities in access and use of medicines including statins is an important step in achieving the full benefit of statins in Brazil, with the findings guiding future research and policies.
Collapse
Affiliation(s)
- R C R M do Nascimento
- a Post-graduated Program of Medicines and Pharmaceutical Assistance, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
| | - A A Guerra
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - J Alvares
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - I C Gomes
- d Faculdade de Ciências Médicas , Belo Horizonte , Minas Gerais , Brazil
| | - B Godman
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
- f Division of Clinical Pharmacology , Karolinska Institutet , Stockholm , Sweden
- g Health Economics Centre , Liverpool University Management School , Liverpool , UK
| | - M Bennie
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - A B Kurdi
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - F A de Acurcio
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| |
Collapse
|
9
|
de Barros RD, Costa EA, dos Santos DB, Souza GS, Álvares J, Guerra AA, Acurcio FDA, Guibu IA, Costa KS, Karnikowski MGDO, Soeiro OM, Leite SN. Access to medicines: relations with the institutionalization of pharmaceutical services. Rev Saude Publica 2017; 51:8s. [PMID: 29160462 PMCID: PMC5676401 DOI: 10.11606/s1518-8787.2017051007138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 02/08/2017] [Indexed: 11/25/2022] Open
Abstract
OBJETIVE To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services 2015), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis. RESULTS Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: "management tools," "participation and social control," "financing," and "personnel structure," with significant associations in the bivariate analysis. The "pharmaceutical care" dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5). CONCLUSIONS Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies.
Collapse
Affiliation(s)
| | - Ediná Alves Costa
- Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | | | | | - Juliana Álvares
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Augusto Afonso Guerra
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Ione Aquemi Guibu
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil
| | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Medicina. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | | | - Orlando Mario Soeiro
- Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| |
Collapse
|
10
|
Karnikowski MGDO, Galato D, Meiners MMMDA, da Silva EV, Gerlack LF, Bós ÂJG, Leite SN, Álvares J, Guibu IA, Soeiro OM, Costa KS, Costa EA, Guerra AA, Acurcio FDA. Characterization of the selection of medicines for the Brazilian primary health care. Rev Saude Publica 2017; 51:9s. [PMID: 29160450 PMCID: PMC5676384 DOI: 10.11606/s1518-8787.2017051007065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 01/30/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To characterize the process of selection of medicines for primary health care in the Brazilian regions. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. RESULTS The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. CONCLUSIONS As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.
Collapse
Affiliation(s)
| | - Dayani Galato
- Curso de Farmácia. Faculdade de Ceilândia. Universidade de Brasília. Brasília, DF, Brasil
| | | | | | - Letícia Farias Gerlack
- Programa de Pós-graduação em Ciências e Tecnologias em Saúde. Faculdade de Ceilândia. Universidade de Brasília. Brasília, DF, Brasil
| | | | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Juliana Álvares
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Ione Aquemi Guibu
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil
| | - Orlando Mario Soeiro
- Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil
| | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Ediná Alves Costa
- Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | - Augusto Afonso Guerra
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| |
Collapse
|
11
|
Álvares J, Guerra AA, de Araújo VE, Almeida AM, Dias CZ, Ascef BDO, Costa EA, Guibu IA, Soeiro OM, Leite SN, Karnikowski MGDO, Costa KS, Acurcio FDA. Access to medicines by patients of the primary health care in the Brazilian Unified Health System. Rev Saude Publica 2017; 51:20s. [PMID: 29160463 PMCID: PMC5676371 DOI: 10.11606/s1518-8787.2017051007139] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 01/23/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients' perspective. METHODS This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Services, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS For the "availability" dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For "accessibility," 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For "accommodation," UBS was evaluated as very good/good for the items "comfort" (74.2%) and "cleanliness" (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For "acceptability," 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units' service was very good/good. For "affordability," 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS Results show 70%-90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population.
Collapse
Affiliation(s)
- Juliana Álvares
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Augusto Afonso Guerra
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | | | | | - Carolina Zampirolli Dias
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Bruna de Oliveira Ascef
- Programa de Pós-Graduação em Saúde Pública. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Ediná Alves Costa
- Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | - Ione Aquemi Guibu
- Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil
| | - Orlando Mario Soeiro
- Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | | | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| |
Collapse
|
12
|
Costa CMFN, Silveira MR, Acurcio FDA, Guerra AA, Guibu IA, Costa KS, Karnikowski MGDO, Soeiro OM, Leite SN, Costa EA, do Nascimento RCRM, de Araújo VE, Álvares J. Use of medicines by patients of the primary health care of the Brazilian Unified Health System. Rev Saude Publica 2017; 51:18s. [PMID: 29160464 PMCID: PMC5676385 DOI: 10.11606/s1518-8787.2017051007144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/17/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student's t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System. RESULTS Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were "other analgesics and antipyretics" (3rd ATC level) and Losartan (5th ATC level). CONCLUSIONS Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the prevalence of use increased with age. Due to the characteristics observed and the difficulties in the use of medicines, older adults are in a situation of greater vulnerability.
Collapse
Affiliation(s)
- Clarisse Melo Franco Neves Costa
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Micheline Rosa Silveira
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Augusto Afonso Guerra
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Ione Aquemi Guibu
- Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil
| | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | | | - Orlando Mario Soeiro
- Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Ediná Alves Costa
- Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | | | - Vânia Eloísa de Araújo
- Instituto de Ciências Biológicas da Saúde. Pontifícia Universidade Católica de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Juliana Álvares
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| |
Collapse
|
13
|
Lima MG, Álvares J, Guerra AA, Costa EA, Guibu IA, Soeiro OM, Leite SN, Karnikowski MGDO, Costa KS, Acurcio FDA. Indicators related to the rational use of medicines and its associated factors. Rev Saude Publica 2017; 51:23s. [PMID: 29160461 PMCID: PMC5676378 DOI: 10.11606/s1518-8787.2017051007137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 01/30/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate indicators related to the rational use of medicines and its associated factors in Basic Health Units. METHOD This is a cross-sectional study carried out in a representative sample of Brazilian cities included in the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). The data were collected by interviews with users, medicine dispensing professionals, and prescribers; and described by prescription, dispensing, and health services indicators. We analyzed the association between human resources characteristics of pharmaceutical services and dispensing indicators. RESULTS At national level, the average number of medicines prescribed was 2.4. Among the users, 5.8% had antibiotic prescription, 74.8% received guidance on how to use the medicines at the pharmacy and, for 45.1% of users, all prescribed medicines were from the national list of essential medicines. All the indicators presented statistically significant differences between the regions of Brazil. The dispensing professionals that reported the presence of a pharmacist in the unit with a working load of 40 hours or more per week presented 1.82 more chance of transmitting information on the way of using the medicines in the dispensing process. CONCLUSION The analysis of prescription, dispensing, and health services indicators in the basic health units showed an unsatisfactory proportion of essential medicines prescription and limitations in the correct identification of the medicine, orientation to the patients on medicines, and availability of therapeutic protocols in the health services.
Collapse
Affiliation(s)
- Marina Guimarães Lima
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Juliana Álvares
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Augusto Afonso Guerra
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Ediná Alves Costa
- Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | - Ione Aquemi Guibu
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil
| | - Orlando Mario Soeiro
- Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | | | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| |
Collapse
|
14
|
Akerman M, de Freitas O. National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM): evaluation of pharmaceutical services in the primary health care. Rev Saude Publica 2017; 51:1s. [PMID: 29160468 PMCID: PMC5676376 DOI: 10.11606/s1518-8787.201705100supl2ed] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Marco Akerman
- Departamento de Política, Gestão e Saúde. Faculdade de Saúde Pública. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Osvaldo de Freitas
- Departamento de Ciências Farmacêuticas. Faculdade de Ciências Farmacêuticas. Universidade de São Paulo. Ribeirão Preto, SP, Brasil
| |
Collapse
|