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Luz TCB, Tavares NUL, Marques IC, de Castro AKS, Cota BB. An analysis of the essential medicines policy in primary care: Findings from MedMinas project. Front Pharmacol 2022; 13:953329. [DOI: 10.3389/fphar.2022.953329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Essential Medicines Policy (EMP) has been adopted in Brazil to improve the provision and use of pharmaceuticals. This mixed methods study aims to bring evidence of the EMP implemented in municipalities in the context of primary care in Minas Gerais (20,997,560 inhabitants), Southeast Brazil.Methods: We analysed the core output of the EMP, i.e., the municipal essential medicines lists (MEML) and the effects of the policy on the procurement and availability of medicines. Data sources included a sample of 1,019 individuals (patients, health managers and health professionals), 995 prescriptions, 2,365 dispensed medicines and policy documents from 26 municipalities. Data were collected between April and October 2019. Document analysis and thematic content analysis were performed, and four availability indexes were estimated.Results: The findings suggest an overall lack of standardised and methodologically sound procedures to elaborate the MEML. Funding and public purchasing processes were found to be the major obstacles to medicine procurement. Only 63% of medicines were available at public community pharmacies and just 46.2% of patients had full access to their pharmaceutical treatment.Conclusion: This study reveals weaknesses in the implementation of EMP and a clear disconnection between medicines selection, procurement, and availability, the three core elements of the supply system. These findings contribute to informing future policy improvement actions to strengthen this system. Other countries aiming to advance towards universal health coverage may learn from the challenges that primary care in Brazil still needs to address.
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Lima VG, Silva MT, Galvão TF. Medication use by adults in greater Manaus: a population-based cross-sectional study, 2015. BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902020000318756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Vanessa Gomes Lima
- Universidade Federal do Amazonas, Brazil; Secretaria Estadual de Saúde do Amazonas, Brazil
| | | | - Taís Freire Galvão
- Universidade Federal do Amazonas, Brazil; Universidade Estadual de Campinas, Brazil
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Ming Y, Huang R, Zhou W, Wang B, Yu H, Zhang J. Is age and socioeconomic status associated with preference for birth mode in nulliparous women in China? Arch Gynecol Obstet 2019; 300:33-40. [PMID: 31053947 DOI: 10.1007/s00404-019-05140-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the association between sociodemographic factors and preference for birth mode in nulliparous women in China. METHODS A total of 4606 women before or in early pregnancy were recruited from 2013 to 2016 in the Shanghai Birth Cohort Study. Generalized linear regression was used to examine the association of sociodemographic characteristics with preferred birth mode and actual cesarean section (CS) without clinical indications in 2713 nulliparous women, and the changes from preference of vaginal birth to actual CS without clinical indications in 2369 nulliparous women. RESULTS After controlling for potential confounders, preference for CS was associated with older maternal age [31-34 years: adjusted risk ratio (ARR) 2.73, 95% confidence interval (CI) 1.56-4.78; ≥ 35 years: 6.27, 3.28-12.01, p for trend < 0.0001] and lower level of education (below junior college vs college or above: 1.51, 1.10-2.09). Older maternal age (≥ 35 years: 3.37, 1.74-6.50), born in city or township (city vs countryside: 3.18, 1.93-5.24; township vs countryside: 1.97, 1.06-3.66), and lower level of education (below junior college vs college or above: 1.38, 1.01-1.88) were significantly associated with a CS without clinical indications. Women who preferred vaginal birth but had an actual CS without clinical indications were more likely to be older (≥ 35 years: 4.30, 1.44-12.83) and born in city (city vs countryside: 2.89, 1.33-6.30). CONCLUSIONS Older age, lower education level, and being born in city or township were risk factors for CS without clinical indication in China.
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Affiliation(s)
- Yanhong Ming
- School of Public Health, Guilin Medical University, Guilin, Guangxi, China.,Department of Obstetrics and Gynecology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Huang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Wei Zhou
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Wang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongping Yu
- School of Public Health, Guilin Medical University, Guilin, Guangxi, China. .,Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China. .,Department of Epidemiology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Jun Zhang
- School of Public Health, Guilin Medical University, Guilin, Guangxi, China.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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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
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