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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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Tavares GA, Ribeiro JB, Almeida-Santos MA, Sousa ACS, Barreto-Filho JAS. Cardiovascular health control in the family health strategy. Front Cardiovasc Med 2022; 9:933972. [PMID: 36061539 PMCID: PMC9433642 DOI: 10.3389/fcvm.2022.933972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction In Brazil, the Unified Health System (SUS) controls and oversees public health care, and the Family Health Strategy (FHS) is its primary access, with 60% of the population registered in it. The surveillance of risk factors for cardiovascular diseases (CVD) is the responsibility of the FHS. In 2010, the American Heart Association (AHA) proposed the evaluation of seven metrics (smoking, Body Mass Index (BMI), physical activity, diet, total cholesterol, blood pressure and blood glucose) with an aim to monitoring cardiovascular health (CVH). However, the results of the FHS regarding the CVH of the Brazilian population are unascertained. Objective Evaluate the control of CVH among adult patients treated by the FHS in the city of Aracaju, Sergipe, Brazil. Material and methods A cross-sectional study was conducted using the seven metrics recommended by the AHA to evaluate CVH among patients treated by the FHS. The city of Aracaju has a population of 571,149 inhabitants, with 394,267 > 20 years of age; therefore, it was admitted that in a simple random sample, sampling error of 5% with 95% CI, 329 individuals would be needed. Results Among 400 patients, only 32.5% had controlled CVH. In a univariate analysis, the adjusted multivariate analysis found that being female (aOR: 2.07 IC: 1.20 to 3.60 p: 0.006) under 45 years old (aOR: 1.61 IC: 1.15 to 2.28 p: 0.006) and with the habit of following health advice from family members and neighbors (aOR: 1.28 IC: 1.15 to 2.28 p: 0.040) were associated with control of CVH. On the other hand, those ones who had a greater number of children (aOR: 0.91 IC: 0.84 to 0.95 p: 0.020) were associated with less control of CVH. Conclusions The study showed that only 32.5% of patients have controlled CVH. Being a woman, young and following health advice from family members and neighbors have a positive influence in controlling CVH. More children reduced controlling these metrics.
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Affiliation(s)
- Gilberto Andrade Tavares
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- Department of Medicine Lagarto, Federal University of Sergipe, Aracaju, Brazil
| | - Joathan Borges Ribeiro
- Postgraduate Program in Adult Health Nursing, University of São Paulo, São Paulo, Brazil
- Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Marcos Antonio Almeida-Santos
- Postgraduate Program in Health and Environment, Tiradentes University, Aracaju, Brazil
- São Lucas Clinic and Hospital / Rede D‘Or São Luiz, Aracaju, Brazil
| | - Antônio Carlos Sobral Sousa
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- São Lucas Clinic and Hospital / Rede D‘Or São Luiz, Aracaju, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Department of Internal Medicine, Federal University of Sergipe, Aracaju, Brazil
| | - José Augusto Soares Barreto-Filho
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
- São Lucas Clinic and Hospital / Rede D‘Or São Luiz, Aracaju, Brazil
- Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, Brazil
- Department of Internal Medicine, Federal University of Sergipe, Aracaju, Brazil
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Ribeiro VRT, Marins LMS, Vieira ACV, Geraldo DS, Costa GG, Araujo RBD, Silva RPND, Guaraldo L, Torres TS. Guidelines for organization, operation and evaluation of clinical trials pharmacies in Brazil: a scope review. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022278.04052022en] [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 development of new drugs depends on several scientific steps, which culminate in clinical trials. The clinical trials pharmacy (CTP) is the place for receiving, preparing, storing and dispensing the investigational product or study drug. Therefore, it must have infrastructure and procedures that guarantee participant safety and quality of research data. This study aimed to systematize guidelines for CTP in Brazil. We conducted a scope review and organized the results using the Ishikawa Method (6Ms). In total, 51 publications were selected for each “M”, 39 laws, regulations or guidelines and 12 scientific articles: 25 publications for pharmaceutical services (pharmacy procedures to ensure participant safety from investigational product ordering to final disposition), 14 for Quality Indicators, 12 for Human Resources, 11 for Infrastructure, 11 for Material Resources and 5 for Investigational Product. Our results synthesize information for the organization, operation and evaluation of CTP in Brazil, emphasizes the inclusion of the pharmacist within the clinical trials context, and contributes to preparation for monitoring, auditing, and inspections conducted by regulatory agencies.
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Ribeiro VRT, Marins LMS, Vieira ACV, Geraldo DS, Costa GG, Araujo RBD, Silva RPND, Guaraldo L, Torres TS. Guidelines for organization, operation and evaluation of clinical trials pharmacies in Brazil: a scope review. CIENCIA & SAUDE COLETIVA 2022; 27:3103-3116. [PMID: 35894322 DOI: 10.1590/1413-81232022278.04052022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
The development of new drugs depends on several scientific steps, which culminate in clinical trials. The clinical trials pharmacy (CTP) is the place for receiving, preparing, storing and dispensing the investigational product or study drug. Therefore, it must have infrastructure and procedures that guarantee participant safety and quality of research data. This study aimed to systematize guidelines for CTP in Brazil. We conducted a scope review and organized the results using the Ishikawa Method (6Ms). In total, 51 publications were selected for each "M", 39 laws, regulations or guidelines and 12 scientific articles: 25 publications for pharmaceutical services (pharmacy procedures to ensure participant safety from investigational product ordering to final disposition), 14 for Quality Indicators, 12 for Human Resources, 11 for Infrastructure, 11 for Material Resources and 5 for Investigational Product. Our results synthesize information for the organization, operation and evaluation of CTP in Brazil, emphasizes the inclusion of the pharmacist within the clinical trials context, and contributes to preparation for monitoring, auditing, and inspections conducted by regulatory agencies.
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Affiliation(s)
- Valeria Rita Teixeira Ribeiro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Luana Monteiro Spindola Marins
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Ana Carolina Vitorino Vieira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Debora Santana Geraldo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Giovanna Giannini Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Renata Bastos de Araujo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Robson Pierre Nascimento da Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Lusiele Guaraldo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
| | - Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Av. Brasil 4365, Manguinhos. 21040-360 Rio de Janeiro RJ Brasil.
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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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Luz TCB, Tavares NUL, de Castro AKS, Marques IC, Dos Santos EM, Cota BB. MedMinas project: design and use of mixed methods in the evaluation of pharmaceutical services in primary health care in Minas Gerais, Brazil. BMC Med Res Methodol 2022; 22:80. [PMID: 35346045 PMCID: PMC8962222 DOI: 10.1186/s12874-022-01568-y] [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] [Received: 07/02/2021] [Accepted: 02/25/2022] [Indexed: 11/27/2022] Open
Abstract
Background The main purposes of primary care-based pharmaceutical services (PHCPS) in Brazil are to provide free access to medicines and pharmaceutical care to patients. Several obstacles hinder achieving their goals; thus, MedMinas Project aimed to evaluate the PHCPS, the supply system, and the use of medicines. This paper reflects on our experience designing, planning, and conducting the project, describing the issues yielded in the field and lessons learned. Methods This work consists of a mixed-methods study conducted in Minas Gerais, Southeastern Brazil. We adopted the principles of Rapid Evaluation Methods, employing a multistage stratified sampling for the quantitative and a purposeful sampling for the qualitative components, respectively, and a documentary research. Data sources included individuals (patients and professionals), prescriptions, dispensed medicines, and policy documents collected between April and October 2019. The quantitative data described in this paper were analysed by descriptive statistics and the qualitative by Thematic Content Analysis. Results A total of 26 municipalities varying from 37,784 to 409,341 inhabitants were included. The field team spent, on average, 16 days in each location. We interviewed 1019 respondents, of which 127 were professionals and 892 patients. The participation rate varied from 92 to 100%, depending on the respondent subgroup. Most interviews lasted between 45 min and one hour. Fieldwork challenges included participants’ enrolment, field team, interview processes, and project budget. The participants provided positive feedback and five main themes emerged from the interview experience (self-awareness, sense of gratitude, research value, access to findings, and benefits of the research). Additionally, we collected copies of 1072 documents and 2070 pieces of data from prescriptions filled and medicines dispensed at the PCP. Conclusion We demonstrated the viability of conducting the MedMinas Project in an extensive geographic area within effective time frames that provided meaningful, high-quality data from multiple actors. The methods and lessons learned are valuable for researchers across various disciplines in similar urban settings in Brazil and other countries of low- and middle-income (LMIC).
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Affiliation(s)
- Tatiana Chama Borges Luz
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), Rene Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), 1715 Augusto de Lima Ave, Barro Preto, Belo Horizonte, Minas Gerais, 30190-009, Brazil. .,Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), University of Strathclyde, Glasgow, G4 0RE, UK.
| | - Noemia Urruth Leão Tavares
- Department of Pharmacy, Faculty of Health Sciences, University of Brasília, Darcy Ribeiro University Campus, Asa Norte, Brasília, Distrito Federal, 70910-90, Brazil
| | - Ana Karine Sarvel de Castro
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), Rene Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), 1715 Augusto de Lima Ave, Barro Preto, Belo Horizonte, Minas Gerais, 30190-009, Brazil
| | - Isabela Cristina Marques
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), Rene Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), 1715 Augusto de Lima Ave, Barro Preto, Belo Horizonte, Minas Gerais, 30190-009, Brazil
| | - Elizabeth Moreira Dos Santos
- LASER (Laboratório de Avaliação de Situações Endêmicas Regionais), National School of Public Health Sérgio Arouca (ENSP), Oswaldo Cruz Foundation (FIOCRUZ), 1480 Leopoldo Bulhões St, Manguinhos, Rio de Janeiro, 21041-210, Brazil
| | - Betania Barros Cota
- GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), Rene Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), 1715 Augusto de Lima Ave, Barro Preto, Belo Horizonte, Minas Gerais, 30190-009, Brazil
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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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Barros DSL, Silva DLMD, Leite SN. Clinical pharmaceutical services in primary health care of the Federal District: Performance frequency and conditioning factors. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Cruz MM, Heringer KODSC, Lyrio C, Brasil GA, Lima EMD, Endringer DC, Lenz D, Rezende AMB, Andrade TUD. Pharmaceutical services in primary health care: dissatisfaction among users, managers and pharmacists. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902020000318849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Pereira NC, Luiza VL, Campos MR, Chaves LA. Implementation of pharmaceutical services in Brazilian primary health care: a cross-sectional study. BMC FAMILY PRACTICE 2021; 22:170. [PMID: 34433429 PMCID: PMC8390232 DOI: 10.1186/s12875-021-01516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND In the Brazilian public health system, primary health care (PHC) is provided by the municipalities and is considered the entry level of the Unified Health System (SUS). Governmental pharmaceutical services (PharmSes) are part of the SUS, including PHC, and are the most significant way in which patients access medicine and services. Considering the diversity of the country, the municipalities have the autonomy to decide how PharmSes are implemented. Even though policies and procedures should be implemented as expected by policy makers and experts, municipality characteristics may interfere with implementation fidelity. Therefore, this study evaluated the degree to which the PharmSes in PHC were delivered as intended in Brazilian municipalities. METHODS We analysed data from a secondary database originating from a cross-sectional nationwide study carried out by the Ministry of Health and the World Bank from 2013 to 2015. Data on 465 municipalities and the Federal District were collected from 4939 governmental PharmSes. A rating system comprising 43 indicators was developed and applied to the dataset to obtain the implementation degree (ID) of each PharmSe. Additionally, the IDs of the two PharmSes dimensions and the nine components were measured. RESULTS Overall, the ID of the PharmSes in Brazilian PHC was evaluated as critical. The ID was critical in 81% of the municipalities (n = 369), incipient in 14% (n = 65) and unsatisfactory in 4.8% (n = 22). Regarding the PharmSes dimensions, the 'medicine management' (MM) ID was considered critical (Mean = 46%), while the 'care management' (CM) ID was incipient (Mean = 22%). In terms of the PharmSes components, the highest ID was achieved by 'forecasting' (58%). In contrast, 'continuing education and counselling' showed the lowest figure (ID = 11%) in the whole sample, followed by 'information and communication' and 'teamwork'. CONCLUSIONS The degree to which PharmSes were implemented was critical (ID< 50%). This analysis demonstrated that PharmSes were implemented with low fidelity, which may be related to the low availability of medicine in PHC. Although the care management component requires more attention, considering their incipient ID, all components must be reviewed. Municipalities must increase their investment in PharmSes implementation in order to maximize the benefits of these services and guarantee the essential right of access to medicine.
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Affiliation(s)
- Nathália Cano Pereira
- Department of Medicines Policy and Pharmaceutical Service, National School of Public Heath Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Vera Lucia Luiza
- Department of Medicines Policy and Pharmaceutical Service, National School of Public Heath Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mônica Rodrigues Campos
- Social Science Department, National School of Public Heath Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Yamauti SM, Barreto JOM, Barberato-Filho S, Lopes LC. Strategies Implemented by Public Institutions to Approach the Judicialization of Health Care in Brazil: A Systematic Scoping Review. Front Pharmacol 2020; 11:1128. [PMID: 32848747 PMCID: PMC7406659 DOI: 10.3389/fphar.2020.01128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
Background The judicialization of health care is a social claim concerning the right to the access to health care. It usually occurs due to gaps in public policy or failures in its application. In Brazil, several public institutions have implemented strategies to approach this phenomenon. However, these strategies have not yet been systematized into functional categories. Objective To categorize and analyze the strategies implemented by public institutions in Brazil to approach the judicialization of health care. Method A systematic scoping review was developed following the method proposed by the Joanna Briggs Institute. The descriptor ‘judicialization of health’ was used to conduct the searches for studies in 18 electronic databases and other types of documents in the gray literature until March 2019. Documents containing the reports of strategies implemented in public institutions to approach the judicialization of health care in Brazil were included. Two independent reviewers assessed the eligibility of the documents and extracted the data. The strategies identified were categorized using definitions from the World Health Organization and existing Brazilian legislation. Results Seventy eight implemented strategies were identified and organized into nine categories: i. Technical support to the judiciary; ii. State health committees; iii. Organization of assistance; iv. Compliance with court orders, v. Computerized information systems; vi. Administrative proceeding; vii. Defense of the public authority; viii. Pharmacy and therapeutics committee; ix. Alternative dispute resolution. These categories are not mutually exclusive and often act in concert or complement each other’s activities. They represent services either existing or provided for in legal provisions by the public administration to meet various types of demands. Conclusions The categories proposed to approach the judicialization of health care represent some of the recommendations for qualifying public administration or are provided for in Brazilian legislation, or both. The existence of recommendations and legislation facilitate, but do not guarantee, the implementation of strategies by public institutions.
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Affiliation(s)
- Sueli Miyuki Yamauti
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Sorocaba, Brazil
| | | | | | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Science, University of Sorocaba, Sorocaba, Brazil
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De Almeida Lima C, Souto Moreira K, Nogueira Guimarães de Abreu MH, De Melo Alvarenga Vieira D, De Lima Mangueira SA, Vieira MA, De Melo Costa S. Qualidade do cuidado: Avaliação da disponibilidade de insumos, imunobiológicos e medicamentos na Atenção Básica em município de Minas Gerais, Brasil. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2019. [DOI: 10.5712/rbmfc14(41)1900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Avaliar a Atenção Básica quanto aos insumos, imunobiológicos e medicamentos disponibilizados nos serviços de saúde da família de município de Minas Gerais, Brasil. Métodos: Trata-se de pesquisa transversal, analítica, conduzida em 2014, a partir de instrumento ministerial intitulado Autoavaliação para Melhoria do Acesso e da Qualidade da Atenção Básica, de equipes de saúde da família. Oito itens foram considerados, com valores entre zero a 10 pontos, da total inadequação à total adequação da Unidade Básica de Saúde (UBS), ao item avaliado. Classificaram-se as unidades em padrões de qualidade “muito insatisfatório” a “muito satisfatório” e analisou-se conforme localização rural e urbana, nível de significância p<0,05. Resultados: Participaram 75 equipes, que apresentaram expressiva inadequação nos itens: UBS dispor todas as vacinas exigidas no calendário básico, 5,95 (±4,003); possuir insumos e medicamentos para abordagem inicial de urgência/emergência, 2,33 (±2,500); apresentar os medicamentos básicos com regularidade, 3,68 (±3,146). A classificação foi regular para 45,3% das unidades e insatisfatória para 29,3%, sem diferenças quanto à localização urbana ou rural (p=0,479). Conclusão: Evidenciou-se avaliação insatisfatória, com inadequações relativas às vacinas, à abordagem inicial nas situações de urgência e emergência e à disponibilidade dos medicamentos. Tal situação prejudica o elenco de ações e a resolutividade dos serviços, afetando a capacidade da equipe para atender, efetivamente, as demandas de saúde da população
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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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