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Luz TCB, de Castro AKS, Marques IC, Cota BB, Alves JDC, Law MR. Performance of a pharmaceutical services regionalization strategy policy in Minas Gerais, Brazil: Pre-post analysis from ERAF project. Front Pharmacol 2022; 13:953990. [PMID: 36120343 PMCID: PMC9478725 DOI: 10.3389/fphar.2022.953990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In 2016, the Brazilian state of Minas Gerais (∼20 million people), implemented the ERAF policy (“Regionalization Strategy of Pharmaceutical Services”) in an effort to improve medicine procurement and distribution within primary care. We evaluated the impact of the policy on three main goals: price reductions, volume increases, and expansion of therapeutic options. Methods: We analyzed the procurement data from the Integrated System of Management of Pharmaceutical Services database in 2012 and 2018. We estimated the volume, drug mix, and expenditure indicators for all major therapeutic classes, and, in detail, for cardiovascular and nervous system drugs. We evaluated the expenditure drivers using decomposition analyses. Results: Overall, the expenditure increased by 14.5%, drug mix almost doubled, while the volume decreased by a third. Cardiovascular and neurological system drugs followed similar patterns. Decomposition analyses showed that prices and drug mix had positive effects while the volume had negative effects, resulting in an overall increase in expenditure. Conclusion: Our findings suggest that the ERAF policy cannot be considered effective as it has not fulfilled its intended purposes so far. Strategies to address the identified problems and to build a platform for a more sustainable long-lasting policy should be put in place by the government.
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Affiliation(s)
- Tatiana Chama Borges Luz
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow, United Kingdom
- *Correspondence: Tatiana Chama Borges Luz, ,
| | - Ana Karine Sarvel de Castro
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Isabela Cristina Marques
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Betania Barros Cota
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Jèssica de Castro Alves
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil
| | - Michael Robert Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, CO, Canada
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A broad view of pharmaceutical services in multidisciplinary teams of public Primary Healthcare Centers: a mixed methods study in a large city in Brazil. Prim Health Care Res Dev 2022; 23:e31. [PMID: 35593129 PMCID: PMC9247684 DOI: 10.1017/s1463423622000160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM This study aims to describe how the pharmaceutical services are performed in Primary Healthcare Centers of the Brazilian Public Health System in a large city. Background: There is extensive international discussion about the role of pharmacists in health care teams, particularly in Primary Health Care (PHC). However, in Brazil, there is still no consensus on what services the pharmacist should perform in multidisciplinary teams in PHC. METHODS This study used mixed methods research, and it was conducted with 200 pharmacists who work in PHC Centers of the public health system in São Paulo. The study was conducted using a focus group and an online survey, and qualitative and quantitative data were obtained. FINDINGS The analysis of the data from the focus group showed two central themes: (i) pharmaceutical services go beyond medicines and (ii) the contributions of the pharmacist to a multidisciplinary team work in PHC. The survey explored 29 services provided by pharmacists, 7 of which were provided daily. It is important to emphasize that pharmacists do not differentiate the relevance attributed to services considered clinical from those that are managerial or more related to access to medicines. This is an opportunity to develop their teamwork skills. Hence, it is necessary to consolidate the professional identity of the pharmacist and to organize their work processes in a multidisciplinary team. PHC is a space that allows a wide development of pharmaceutical services.
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Peixoto RT, Campos MR, Luiza VL, Mendes LV. O farmacêutico na Atenção Primária à Saúde no Brasil: análise comparativa 2014-2017. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O farmacêutico tem importante papel nas unidades de saúde da Atenção Primária à Saúde (APS). No entanto, ainda são escassos no Brasil estudos que abordem a influência do farmacêutico na rede assistencial de saúde. O artigo tem como objetivo verificar em que medida a inserção dos farmacêuticos nas Unidades Básicas de Saúde (UBS) do País está associada à ampliação de aspectos estruturais das farmácias e à disponibilidade de medicamentos. Trata-se de estudo transversal, retrospectivo e analítico, que utilizou dados secundários do 2º (2014) e 3º (2017) ciclos da avaliação externa do Programa de Melhoria de Acesso e da Qualidade da Atenção Básica (PMAQ-AB) e do Cadastro Nacional de Estabelecimentos de Saúde (CNES). Os resultados mostraram importante centralização na dispensação de medicamentos ao longo do 2º e 3ºs ciclos PMAQ-AB. Em contrapartida, identificou-se melhora nos aspectos estruturais nas farmácias das UBS e incremento tanto na disponibilidade média de medicamentos como no total de UBS com disponibilidade de medicamentos ≥80%. Tais avanços foram ainda maiores na existência de farmacêutico cadastrado na UBS. Evidenciou-se a relevância do farmacêutico na APS no Sistema Único de Saúde, uma vez que sua presença potencializa tanto a disponibilidade de medicamentos como também propicia melhores condições estruturais dos serviços de farmácia da APS.
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Peixoto RT, Campos MR, Luiza VL, Mendes LV. The pharmacist in the Brazilian Primary Health Care: a comparative analysis between 2014 and 2017. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213308i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The pharmacist play a vital role in PHC. However, studies addressing how pharmacists influence the health care network are still scarce. We aim to verify to what extent the inclusion of pharmacists in PHC Units (UBS) in the country is associated with the expanded structural aspects of pharmacies and drug availability in Brazil. This cross-sectional, retrospective, and analytical study employed secondary data from cycles 2 (2014) and 3 (2017) of the external evaluation of the Improvement of Access and Quality of Primary Care Program (PMAQ-AB) and the National Register of Health Facilities (CNES) databases. The results showed an essential centralization in drug dispensing over PMAQ-AB cycles 2 and 3. In contrast, we identified an improvement in the structural aspects of the UBS pharmaceutical services and an increase in the mean drug availability and the total UBS with drug availability ≥ 80%. Such advances were even more significant in the presence of registered pharmacists at the UBS. We conclude by stating that the presence of pharmacists in the PHC of the Unified Health System (SUS) enhances drug availability and provides better structural conditions for PHC pharmacy services.
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Barros DSL, Silva DLMD, Leite SN. Clinical pharmaceutical services of primary health care of the Federal District: A discussion based on the SWOT matrix. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e18593] [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
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Lorenzoni AA, Buendgens FB, Manzini F, Rech N, Leite SN. A Comprehensive Understanding of the Use of e-Learning in Continuing Education: Experiences of Pharmacists in a Public Health System. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059977. [PMID: 34995148 PMCID: PMC8753235 DOI: 10.1177/00469580211059977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The health and education sectors have experienced rapid technological development. In this scenario, the use of Internet technology has grown as an option for the expansion of continuing education (CE), as it allows professionals to develop educational activities with flexibility, autonomy, and convenience. E-learning has gained popularity and currently, thousands of online courses are being offered. However, studies of e-learning in professional training have presented only a few specific foci of study. OBJECTIVE to develop a comprehensive approach to understand both the experience and the complex scenario of the use of e-learning in the CE for pharmacists. METHOD Field research in 10 Brazilian states through interviews and focus groups with alumni of a CE e-learning specialization course for pharmacists in public health. Data analysis used the model of socio-technical systems and was based on a framework with the components Objectives, People, Processes, Culture, Technology, Infrastructure, and Scenario. RESULTS The People and Culture components indicated the assimilation and normalization of technologies in the educational process. Although the infrastructure (technical and organizational) was deficient in some regions, the Technology component suggested that the characteristics of the course design, associated with the personal characteristics of the students, provided ways to overcome obstacles. The objectives of the use of distance education seem to be related to the possibility of greater accessibility and autonomy. The Processes component, in turn, revealed the burden that a e-learning course puts on the pharmacist. CONCLUSION E-learning proved to be useful to enable and expand access to education, providing pharmacists with an opportunity for CE. On the other hand, e-learning contributes to the normalization of the precarious working conditions of pharmacists, attributing to individuals the sole responsibility for the CE even in an institutional CE program, which results in work overload.
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Affiliation(s)
| | | | - Fernanda Manzini
- Pharmaceutical Sciences Department, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Norberto Rech
- Pharmaceutical Sciences Department, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Silvana Nair Leite
- Pharmaceutical Sciences Department, Federal University of Santa Catarina, Florianópolis, Brazil
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Manzini F, Diehl EE, Farias MR, Dos Santos RI, Soares L, Rech N, Lorenzoni AA, Leite SN. Analysis of a Blended, In-Service, Continuing Education Course in a Public Health System: Lessons for Education Providers and Healthcare Managers. Front Public Health 2020; 8:561238. [PMID: 33324594 PMCID: PMC7725868 DOI: 10.3389/fpubh.2020.561238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: To train pharmacists working in the public health system, the Brazilian Ministry of Health developed a specialization course called Pharmaceutical Service and Access to Medicine Management (PSAMM) between 2010 and 2016. The course was free of charge and used e-learning as its main approach. In the end, 2,500 pharmacists were trained. The purpose of this study was to identify and analyze the strengths, weaknesses, opportunities, and threats of an in-service and e-learning course for pharmacists working in a public health system. Materials and Methods: Three workshops involving 67 participants were conducted at the conclusion of the course to analyze the perspective of the PSAMM course's faculty (tutors, regional coordinators, professors, and management committee) and students (pharmacists). Strengths, weaknesses, opportunities, and threats analysis and qualitative analysis methods were used. Results and Discussion: The strength dimension had the greatest number of items. The qualitative analysis resulted in six categories: the category “E-learning in continuing education” had the most cited items. Internal elements such as in-service hands-on activities directly related to the professionals' roles, course contents, faculty, and the methods to offer the course (the mixed methods and materials) were positively assessed. Nonetheless, external elements were considered critical for the course's outcomes such as investments in the infrastructure of pharmaceutical services, access to the internet, local managers' support for continuing education and innovation implementation, practice of interprofessional collaboration, and political stability. The continuing education course in the public health system was affected by internal elements such as its project and structure as well as external elements such as the sociopolitical scenario. Continuing education investment must be accompanied by infrastructure investment and coordination of services.
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Affiliation(s)
- Fernanda Manzini
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Eliana Elisabeth Diehl
- Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Mareni Rocha Farias
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil.,Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Luciano Soares
- Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Norberto Rech
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil.,Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Silvana Nair Leite
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil.,Department of Pharmacy Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
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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.
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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).
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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.
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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).
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Araújo LU, Santos DF, Bodevan EC, Cruz HLD, Souza JD, Silva-Barcellos NM. Patient safety in primary health care and polypharmacy: cross-sectional survey among patients with chronic diseases. Rev Lat Am Enfermagem 2019; 27:e3217. [PMID: 31826159 PMCID: PMC6896818 DOI: 10.1590/1518-8345.3123.3217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 08/08/2019] [Indexed: 01/20/2023] Open
Abstract
Objective: to characterize and determine the polypharmacy prevalence in patients with chronic diseases and to identify the factors associated, in order to improvement of pharmaceutical care focused on patient safety. Methods: cross-sectional study included 558 patients, covered by primary health care, using a household and structured questionnaire. We analyzed the data on polypharmacy and its clinical and socioeconomic factors. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio. Results: the results showed that polypharmacy (consumption of four or more drugs) was of 37.6%. The prevalence ratio analyses identified independent variables associated with polypharmacy: age (3.05), economic strata (0.33), way of medication acquisition through a combination of out-of-pocket and Brazilian public health system (1.44), diabetes and hypertension (2.11), comorbidities (coronary artery disease 2.26) and hospital admission (1.73). In the analyses, inappropriate medication use of the 278 patients (≥ 65 years) was associated with polypharmacy (prevalence ratio 4.04). Conclusion: polypharmacy study becomes an opportunity to guide the strategies for the patient safety to promote the medication without harm in chronic diseases.
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Affiliation(s)
- Lorena Ulhôa Araújo
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Farmácia, Diamantina, Minas Gerais, Brazil
| | - Delba Fonseca Santos
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Farmácia, Diamantina, Minas Gerais, Brazil
| | - Emerson Cotta Bodevan
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Matemática e Estatística, Diamantina, Minas Gerais, Brazil
| | - Hellen Lilliane da Cruz
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Farmácia, Diamantina, Minas Gerais, Brazil
| | - Jacqueline de Souza
- Universidade Federal de Ouro Preto, Escola de Farmácia, Ouro Preto, Minas Gerais, Brazil
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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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