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Medina-Ranilla J, Espinoza-Pajuelo L, Mazzoni A, Roberti J, García-Elorrio E, Leslie HH, García PJ. A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys. Health Policy Plan 2023; 38:1225-1241. [PMID: 37803966 DOI: 10.1093/heapol/czad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Abstract
High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.
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Affiliation(s)
- Jesús Medina-Ranilla
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Laura Espinoza-Pajuelo
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Agustina Mazzoni
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Javier Roberti
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Ezequiel García-Elorrio
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Hannah Hogan Leslie
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th St., Floor 4, San Francisco, CA 94143, United States
| | - Patricia Jannet García
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
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de Freitas EL, Calil-Elias S, Erbisti RS, Grinberg-Weller B, Miranda ES. Consumption of drugs for Alzheimer's disease on the Brazilian private market. Rev Saude Publica 2023; 57:83. [PMID: 37971177 PMCID: PMC10631752 DOI: 10.11606/s1518-8787.2023057005128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/26/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To analyze the consumption of drugs for Alzheimer's disease on the Brazilian private market and its geographical distribution from 2014 to 2020. METHODS National data from the Brazilian National System of Controlled Product Management were used, regarding sales of donepezil, galantamine, rivastigmine, and memantine from January 2014 to December 2020. Sales data were used as a proxy for drug consumption and expressed as defined daily dose/1,000 inhabitants/year at national, regional, federative unit and microregion levels. RESULTS Drug consumption went from 5,000 defined daily doses/1,000 inhabitants, in 2014, to more than 16,000/1,000 inhabitants, in 2020, and all federative units showed positive variation. The Brazilian Northeast had the highest cumulative consumption in the period but displayed microregional disparities while the North region had the lowest consumption. Donepezil and memantine were the most consumed drugs, with the highest growth in consumption from 2014 to 2020. CONCLUSION The consumption of medicines indicated to treat Alzheimer's disease tripled in Brazil between 2014 and 2020, which may relate to the increase in the prevalence of the disease in the country, greater access to health services, and inappropriate use. This challenges managers and healthcare providers due to population aging and the increased prevalence of chronic-degenerative diseases.
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Affiliation(s)
- Evani Leite de Freitas
- Universidade Federal FluminenseFaculdade de FarmáciaPrograma de Pós-graduação em Administração e Gestão da Assistência FarmacêuticaNiteróiRJBrazil Universidade Federal Fluminense . Faculdade de Farmácia . Programa de Pós-graduação em Administração e Gestão da Assistência Farmacêutica . Niterói , RJ , Brazil
| | - Sabrina Calil-Elias
- Universidade Federal FluminenseFaculdade de FarmáciaDepartamento de Farmácia e Administração FarmacêuticaNiteróiRJBrazil Universidade Federal Fluminense . Faculdade de Farmácia . Departamento de Farmácia e Administração Farmacêutica . Niterói , RJ , Brazil
| | - Rafael Santos Erbisti
- Universidade Federal FluminenseInstituto de Matemática e EstatísticaDepartamento de EstatísticaNiteróiRJBrazil Universidade Federal Fluminense . Instituto de Matemática e Estatística . Departamento de Estatística . Niterói , RJ , Brazil
| | - Branca Grinberg-Weller
- Universidade Federal FluminenseFaculdade de FarmáciaNiteróiRJBrazil Universidade Federal Fluminense . Faculdade de Farmácia . Niterói , RJ , Brazil
| | - Elaine Silva Miranda
- Universidade Federal FluminenseFaculdade de FarmáciaDepartamento de Farmácia e Administração FarmacêuticaNiteróiRJBrazil Universidade Federal Fluminense . Faculdade de Farmácia . Departamento de Farmácia e Administração Farmacêutica . Niterói , RJ , Brazil
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Hemmeda L, Koko AEA, Mohamed RF, Mohammed YIA, Elabid AOM, Omer AT, Hamida AARAH, Haiba AM, Ali EM, Abdelgadir II, Al Fanob RM, Almahadi SSM, Ali S, Mahgoub SAA. Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs' dispensaries assessment and patients' perspectives. Int J Equity Health 2023; 22:216. [PMID: 37848939 PMCID: PMC10583350 DOI: 10.1186/s12939-023-02009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Access to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn't well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients' perceived affordability of essential medicines, and accommodation and acceptability of the public facility. METHODS A cross-sectional study was carried out at 30 primary healthcare facilities' drug dispensaries across three districts in Khartoum state. Within each Centre's dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan's national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26. RESULTS Participants' ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets. CONCLUSION Patients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients' access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients' satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan.
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Affiliation(s)
- Lina Hemmeda
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Radia F Mohamed
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | | | - Alaa T Omer
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Aya M Haiba
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Eithar M Ali
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
| | | | - Reem M Al Fanob
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Sara Ali
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Alves JC, Law MR, Luz TCB. Prevalence and Factors Associated With Out-of-Pocket Pharmaceutical Expenditure Among Primary Healthcare Patients: Evidence From the Prover Project. Value Health Reg Issues 2022; 30:83-90. [PMID: 35306468 DOI: 10.1016/j.vhri.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed to determine the prevalence and associated factors of out-of-pocket pharmaceutical expenditure (OOPPE) among primary healthcare patients. METHODS The study is part of the Prover Project, an exit survey conducted in 2017 in a large city (population 234 937) in Minas Gerais State, Brazil. A representative sample of patients (n = 1219) from pharmaceutical services based on primary healthcare was selected. Three components of OOPPE were assessed: the general prevalence, the types of medicines purchased (medicines for the treatment of chronic diseases, medicines for the treatment of acute diseases, or herbal medicines), and coverage by the National Health System. The factors associated with OOPPE were examined applying a modified Andersen's behavioral model of health services use. Data were analyzed using descriptive statistics and logistic regression. RESULTS The overall prevalence of OOPPE was 77%. Most patients who had OOPPE purchased medicines to treat chronic diseases (94%). In addition, these patients purchased medicines covered by public insurance but were out of stock (85%). OOPPE was associated with enabling factors, such as higher personal income (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.02-3.62), holding health insurance (OR 1.40; 95% CI 1.01-1.95), and higher neighborhood trust (OR 1.34; 95% CI 1.01-1.79), and with need factors, that is, poorer perception of health (OR 1.63; 95% CI 1.20-2.21), multiple comorbidities (OR 1.70; 95% CI 1.18-2.46), and higher number of prescribed medicines (OR 2.84; 95% CI 1.90-4.26). CONCLUSIONS We found a high prevalence of OOPPE, identifying individuals more likely to incur these expenses. These findings are useful to inform policy makers from the healthcare system to plan and implement the needed interventions to protect primary care patients from this financial burden.
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Affiliation(s)
- Jéssica C Alves
- Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente, Fiocruz Minas, Belo Horizonte, Brazil
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tatiana C B Luz
- Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente, Fiocruz Minas, Belo Horizonte, Brazil; Strathclyde Institute of Pharmacy and Biomedical Sciences, The University of Strathclyde, Glasgow, Scotland, UK.
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Bueno MAM, Simões TC, Luz TCB. Differences in prescribed medicine availability in Primary Health Care: evidence from the Prover Project. CIENCIA & SAUDE COLETIVA 2022; 27:1191-1203. [PMID: 35293455 DOI: 10.1590/1413-81232022273.38782020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 03/05/2021] [Indexed: 01/02/2023] Open
Abstract
This is a cross-sectional study on the availability of prescribed medicines in Primary Health Care (PHC), with a probabilistic sample of 1,221 users of public pharmacies in a health pole municipality in Minas Gerais, in 2017. Medicine availability indicators were estimated, and a hierarchical logistic regression was performed, according to the behavioral model of health service use. Only 39.3% of patients received all medicines in the prescribed quantities. The most and the least available medicines were, respectively, those for the digestive system/metabolism, and for blood and hematopoietic organs. Full availability of the prescribed treatment was associated with higher schooling (≥ 8 years OR: 1.7; 95% CI: 1.3-2.4); proximity to the pharmacy (≤15 min OR: 1.7; 95% CI: 1.2-2.3); absence of out-of-pocket expenditure on medicines (OR: 2.2; 95% CI: 1.7-2.9), and a smaller number of prescription drugs (≤ 2 OR: 3.2; 95% CI: 2.3-4.4; 3/4 OR: 1.6; 95% CI: 1.2-2.1). These results showed differences in medicine availability within the Brazilian Unified Health System (SUS), and highlighted the need to reorganize the dispensing services network and pharmaceutical procurement planning, as well as to develop public policies to protect the vulnerable population.
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Affiliation(s)
- Maria Angélica Martins Bueno
- Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente, Instituto René Rachou, Fundação Oswaldo Cruz. Av. Augusto de Lima 1715 Anexo, Barro Preto. 30190-002 Belo Horizonte MG Brasil.
| | - Taynãna César Simões
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz. Belo Horizonte MG Brasil
| | - Tatiana Chama Borges Luz
- Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente, Instituto René Rachou, Fundação Oswaldo Cruz. Av. Augusto de Lima 1715 Anexo, Barro Preto. 30190-002 Belo Horizonte MG Brasil. .,Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Scotland
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Soares AQ, Melo MA, Silva PID, Chagas VO, Provin MP, Silva MMD, Vila VDSC, Amaral RG. "A lack of information keeps us from medicine, well-being, harmony…": a mixed method study with plaintiffs requesting medicines in administrative cases. CIENCIA & SAUDE COLETIVA 2022; 27:1205-1221. [PMID: 35293456 DOI: 10.1590/1413-81232022273.04122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/22/2021] [Indexed: 11/22/2022] Open
Abstract
The need to request public health managers to ensure the right of access to medicines characterizes an administrative case and the method to do so is called the administrative route. This mixed method study aimed to analyze the perceptions of plaintiffs requesting medications by the administrative route about barriers to access medicines in the Brazilian public health sector. Data were gathered through focus groups and questionnaires. The results point to the interdependence of pharmaceutical services with the interfacing areas to ensure access. The barriers related to individuals reflect the commitment to develop citizenship, justifying the cost of the medicine to motivate the demand. Barriers to service provision include irregular availability of medicines, insufficient resources, and unsatisfactory quality of services. The difficulty in obtaining medical consultations and prescriptions originating in the public sector are barriers to the health sector. The barriers above the health sector are compliance with administrative procedures, corruption, and clientelism. The administrative route intensifies inequities in access to healthcare in Brazil.
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Affiliation(s)
- Amanda Queiroz Soares
- Hospital das Clínicas, Universidade Federal de Goiás. Setor de Farmácia Hospitalar, 1ª Avenida s/n, Setor Leste Universitário, 74605-020. Goiânia GO Brasil.
| | | | - Pedro Ivo da Silva
- Hospital Municipal de Aparecida, Secretaria Municipal de Aparecida de Goiânia. Aparecida de Goiânia GO Brasil
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Ó DMSOD, Santos RCD, Sousa FDOS, Albuquerque PCD, Santos MOSD, Gurgel IGD. Barreiras de acessibilidade à atenção básica em assentamento em Pernambuco, Brasil, sob a ótica de camponesas, profissionais de saúde e gestão. CAD SAUDE PUBLICA 2022; 38:e00072322. [DOI: 10.1590/0102-311xpt072322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/08/2022] [Indexed: 12/23/2022] Open
Abstract
São inegáveis as iniquidades envolvidas diretamente nos modos de nascer, viver, adoecer e morrer da população do campo. Para analisar a acessibilidade ao cuidado em saúde desse povo, consideramos quatro barreiras pertinentes à acessibilidade aos serviços de atenção básica: as geográficas, organizacionais, financeiras e de informação. O estudo objetivou evidenciar as barreiras de acessibilidade à atenção básica pela população de um assentamento em Pernambuco, Brasil, sob a perspectiva de assentadas, profissionais e gestão. Trata-se de uma pesquisa descritiva, transversal, qualitativa, do tipo caso único realizada em um assentamento de reforma agrária pernambucano e na unidade de saúde da família responsável pela assistência desse território. Um representante da gestão municipal em atenção básica foi entrevistado e dois grupos focais foram realizados, um com as assentadas e outro com os profissionais de saúde da equipe de saúde da família. Para a análise dos dados utilizou-se o método do Discurso do Sujeito Coletivo. As barreiras de acessibilidade geográfica evidenciaram distância entre unidade e assentamento sem a garantia de um transporte; as barreiras organizacionais expuseram alta demanda de usuários e estrutura física precária; as barreiras financeiras demonstraram ameaças do novo financiamento e condições socioeconômicas precárias da população; e as barreiras de informação revelaram a escassez da educação permanente e o preconceito associado às lacunas de comunicação entre profissionais e assentados. Ante às inúmeras barreiras de acessibilidade e suas consequências para a população do estudo, cabe avançar na adequação da atenção básica, com vistas a ampliar o acesso às necessidades de saúde evidenciadas.
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Fernandes BD, Foppa AA, Almeida PHRF, Lakhani A, Lima TDM. Application and utility of geographic information systems in pharmacy specific health research: A scoping review. Res Social Adm Pharm 2021; 18:3263-3271. [PMID: 34836813 DOI: 10.1016/j.sapharm.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/25/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Geographic Information Systems (GIS) are considered essential tools to analyze spatially referenced health data. OBJECTIVES The purpose of this scoping review is to describe how GIS is used in pharmacy specific health research. METHODS During July 2020, the following databases were searched: EMBASE, MEDLINE (PubMed), Web of Science and Scopus. The search strategy included terms relating to spatial analysis and pharmacy. Studies were considered eligible if they involved the use of GIS and focused on pharmacies. A narrative and tabular synthesis of the results was carried out, structured around the spatial analysis methods utilized across studies, as well as the characteristics of pharmacies evaluated in studies. RESULTS After a review of 6967 sources, 48 studies were included in this review. Twenty-nine studies were conducted in the United States (60.4%) and thirty-six focused on accessibility (75.0%; n = 36). Twenty-two studies investigated the relationship between sociodemographic aspects of the population and the accessibility and availability of pharmacies (45.8%). Twelve studies (25.0%) performed distance analysis and six studies (12.5%) performed geostatistical analysis. Community pharmacies were the setting evaluated most frequently, with over-the-counter selling products being the most evaluated pharmacy variable (13.3%; n = 6). Population density (58.3%; n = 28), income indicators (43.8%; n = 21) and minority community composition rates (41.7%; n = 20) were the most used population variables. CONCLUSIONS GIS have been increasingly used in pharmacy specific health research. Generally, research has sought to identify potential barriers to access and their effects on the population. Future research may benefit by utilizing robust spatial methods and applications across countries outside of the United States. Doing so could help to confirm the impact of sociodemographic characteristics on the availability and/or accessibility of pharmacies globally.
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Affiliation(s)
- Brígida Dias Fernandes
- Department of Pharmaceutical Sciences, Federal University of Espirito Santo (UFES), Avenida Marechal Campos, 1468, Bonfim, Vitória, Espirito Santo, 29047105, Brazil.
| | - Aline Aparecida Foppa
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Paulo Henrique Ribeiro Fernandes Almeida
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Ali Lakhani
- School of Psychology and Public Health, La Trobe University, 360 Collins St, Melbourne, Victoria, Australia, 3000; The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Logan Campus, University Drive, Meadowbrook, Queensland, Australia, 4131.
| | - Tácio de Mendonça Lima
- Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro (UFRRJ), Brazil.
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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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Barbosa MM, Moreira TA, Nascimento RC, Nascimento MM, Acurcio FA, Godman B, Guerra AA, Alvares-Teodoro J. Access to medicines in the Brazilian Unified Health System's primary health care: assessment of a public policy. J Comp Eff Res 2021; 10:869-879. [PMID: 34032143 DOI: 10.2217/cer-2021-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In 2008, the Programa Rede Farmácia de Minas (RFM, literally translated: 'Minas Gerais Pharmacy Network' program) was created as a strategy to expand access to medicines. Aim: Measure access to medicines in public pharmacies through comparison between municipalities that joined or not the RFM. Materials & methods: Cross-sectional, evaluative study, gathering information from a representative sample of the municipalities in Minas Gerais between July 2014 and May 2015. The Poisson regression results were obtained by calculating the prevalence ratios. Results: Adequate access to medicines in Minas Gerais was 69.9%, being 75.8% in municipalities with and 69.2% without the RFM. The municipalities with the RFM showed statistically higher percentages in the Availability, Adequacy/Accommodation, and Acceptability dimensions. Conclusion: RFM appears an efficient strategy for promoting access to medicines.
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Affiliation(s)
- Mariana M Barbosa
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Thais A Moreira
- School of Medicine, Postgraduate Program in Public Health Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Renata Crm Nascimento
- School of Pharmacy, Department of Pharmacy, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Mariana Mg Nascimento
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Francisco A Acurcio
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Augusto A Guerra
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- School of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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11
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Rocha WH, Teodoro JÁ, Assis Acurcio FD, Guerra AA, Gomes Moura IC, Godman B, Kurdi A, Rezende Macedo do Nascimento RC, Almeida AM. Influence of pharmaceutical services organization on the availability of essential medicines in a public health system. J Comp Eff Res 2021; 10:519-532. [PMID: 33739138 DOI: 10.2217/cer-2020-0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To evaluate the influence of organizational structure and technical-management activities on the availability of essential medicines in the primary healthcare. Materials & methods: Cross-sectional, exploratory and evaluative study. The availability was evaluated according to parameters established by the WHO. Results: The average availability of standardized essential medicines was 83.3 and 73.3% for medicines purchased centrally by the Brazilian government. Among the therapeutic groups evaluated, the lowest average availability were for the tuberculostatics (24.1%) and psychotropic/special control medicines (30.3%). Conclusion: The availability of essential medicines was positively influenced by the presence of the pharmacist and by the computerized system deployed, and negatively associated with essential medicines purchased centrally by the federal government, especially in the smaller municipalities.
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Affiliation(s)
- Wenderson Henrique Rocha
- Faculty of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Juliana Álvares Teodoro
- Faculty of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,School of Pharmacy, SUS Collaborating Centre for Technology Assessment & Excellence in Health, UFMG, Belo Horizonte, MG, Brazil
| | - Francisco de Assis Acurcio
- Faculty of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,School of Pharmacy, SUS Collaborating Centre for Technology Assessment & Excellence in Health, UFMG, Belo Horizonte, MG, Brazil
| | - Augusto Afonso Guerra
- Faculty of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,School of Pharmacy, SUS Collaborating Centre for Technology Assessment & Excellence in Health, UFMG, Belo Horizonte, MG, Brazil
| | - Isabel Cristina Gomes Moura
- Faculty of Medical Sciences of Minas Gerais, Postgraduate Program in Health Sciences, Belo Horizonte, MoG, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, 161 Cathedral St. G4 0RE. Glasgow, UK.,Division of Clinical Pharmacology, Karolinska Institutet. Karolinska University Hospital Huddinge. SE-141 86, Stockholm, Sweden.,Division of Public Health Pharmacy & Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, 0208, South Africa
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, 161 Cathedral St. G4 0RE. Glasgow, UK.,Department of Pharmacology & Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | | | - Alessandra Maciel Almeida
- Faculty of Pharmacy, Postgraduate Program in Medicines & Pharmaceutical Services, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Faculty of Medical Sciences of Minas Gerais, Postgraduate Program in Health Sciences, Belo Horizonte, MoG, Brazil
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12
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Tiguman GMB, Silva MT, Galvão TF. Consumption and Lack of Access to Medicines and Associated Factors in the Brazilian Amazon: A Cross-Sectional Study, 2019. Front Pharmacol 2020; 11:586559. [PMID: 33123016 PMCID: PMC7573467 DOI: 10.3389/fphar.2020.586559] [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: 07/23/2020] [Accepted: 09/14/2020] [Indexed: 01/20/2023] Open
Abstract
Objective We aimed to investigate the consumption and lack of access to medicines in the adult population of Manaus, Amazonas. Methods A population-based study was conducted in Manaus in 2019. Individuals aged ≥18 years were selected by probabilistic sampling performed in three stages. Study outcomes included the consumption of medicines in the previous fortnight and the lack of access to treatments in those who used any medicine. We calculated the prevalence ratios (PR) for the outcomes with 95% confidence intervals (CI) by Poisson regression with robust variance, considering the complex sampling design. Results Out of the 2,321 participants, 53.2% (95%CI 50.7-55.7%) consumed medicines, of which 14.4% (95% CI 11.9-16.8%) could not obtain appropriate treatments. Analgesics were the most used medicines (557/2,702; 21.4%), whereas antibiotics were the most inaccessible treatments (18/228; 7.9%). Lack of financial resources was the main reason for not accessing treatments (104/228; 45.6%). Consumption was significantly associated with older age (≥60 years: PR = 1.27; 95%CI 1.09-1.49), lower social class (D/E: PR = 0.84; 95%CI 0.72-0.99), lower educational level (p = 0.039), poor health status (PR = 1.30; 95%CI 1.11-1.52), use of health care services (PR = 1.37; 95%CI 1.26-1.49), and chronic diseases (PR = 1.36; 95%CI 1.22-1.52). Lack of access was higher in people with poor health status (PR = 2.46; 95%CI 1.50-4.04) and chronic diseases (PR = 1.84; 95%CI 1.16-2.92). Conclusion Half of Manaus' population used medicines, which was higher in socially privileged and sicker individuals. Among those, 14 in every 100 could not access drug therapies, which was more frequent in people with poor health and with chronic diseases.
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Affiliation(s)
| | - Marcus Tolentino Silva
- Post-Graduate Program of Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - Taís Freire Galvão
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Brazil
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13
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Costa KS, Zaccolo AV, Tavares NUL, Arrais PSD, Luiza VL, Oliveira MA, Mengue SS, Bertoldi AD, Ramos LR, Farias MR, Pizzol TDSD. Avaliação dos usuários sobre as farmácias públicas no Brasil. CIENCIA & SAUDE COLETIVA 2020; 25:3163-3174. [DOI: 10.1590/1413-81232020258.00202018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 11/27/2018] [Indexed: 11/21/2022] Open
Abstract
Resumo O objetivo deste artigo é avaliar aspectos relacionados aos serviços prestados nas farmácias do SUS do Brasil, segundo a percepção dos usuários. Utilizou-se dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos, realizada entre 2013 e 2014. Analisou-se indivíduos que obtiveram algum medicamento nas farmácias públicas. Para o cálculo das estimativas de prevalências, foi usado como denominador o total de usuários de medicamentos com IC95%. A partir da faixa etária de 20 a 24 anos até 60 a 64 anos observa-se diferenças significativas entre homens e mulheres, em relação ao uso de farmácias públicas. Mais de 30% das pessoas de todas as classes socioeconômica que não obtiveram medicamentos nas farmácias do SUS, nunca pensaram nessa possibilidade. Não costumam esperar para obtenção dos medicamentos e avaliação positiva do horário de funcionamento tiveram uma associação mais forte em relação a avaliação positiva dos usuários das farmácias do SUS. O horário de funcionamento e o tempo de espera são potenciais barreiras nas farmácias do SUS. A avaliação dos usuários que utilizam o SUS é positiva, mas aponta diferenças regionais e a identificação da magnitude dessas pode contribuir na formulação de políticas mais eficazes e equânimes.
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14
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Pinto IVL, Lima MG, Pantuzza LLN, Ceccato MDGB, Silveira MR, Reis AMM. Free access to medicines among older adults in primary care: a cross-sectional study. SAO PAULO MED J 2020; 138:235-243. [PMID: 32578745 PMCID: PMC9671230 DOI: 10.1590/1516-3180.2019.0541.r1.19022020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Access to medicines is an important indicator of healthcare system quality and capacity to resolve problems. The healthcare system needs to ensure free access to medicines for elderly people, in order to provide greater effectiveness of disease control, thus reducing morbidity and mortality, and improving health and quality of life. OBJECTIVES To analyze the frequency of free access to medication among older adults within primary care and determine the factors associated with free access. DESIGN AND SETTING Cross-sectional study at two primary care units. METHODS Free access was defined as provision of all medicines through pharmacies within the Brazilian National Health System and through the Brazilian program for free medicines in private pharmacies. We investigated the sociodemographic, clinical, functional and pharmacotherapeutic characteristics of older adults. Multivariate logistic regression was performed to identify factors associated with free access to medicines. RESULTS This study included 227 older adults, among whom 91 (40.1%) had free full access to prescription drugs. A direct association with age ≤ 70 years and indirect associations with polypharmacy and multimorbidity (P < 0.05) were found. CONCLUSIONS Age ≤ 70 years increases the likelihood of having free full access to medicines, and older adults with multimorbidity and polypharmacy use have a lower likelihood of access. Identification of factors associated with free access to medicines among elderly people provides elements to guide the Brazilian National Health System in implementing access improvement actions.
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Affiliation(s)
- Isabela Vaz Leite Pinto
- MSc. Pharmacist, Municipal Health Department, Municipal Government of Belo Horizonte, Belo Horizonte (MG), Brazil.
| | - Marina Guimarães Lima
- PhD. Associate Professor and Pharmacist, School of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Laís Lessa Neiva Pantuzza
- MSc. Doctoral Student and Pharmacist, School of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Maria das Graças Braga Ceccato
- PhD. Associate Professor and Pharmacist, School of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Micheline Rosa Silveira
- PhD. Associate Professor and Pharmacist, School of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Adriano Max Moreira Reis
- PhD. Associate Professor and Pharmacist, School of Pharmacy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
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15
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Souza ACS, Bezerra ALQ, Caixeta CC, Pinho ES, Paranaguá TTDB, Teixeira CC. Perception of professionals about patient safety in psychosocial care. Rev Bras Enferm 2020; 73 Suppl 1:e20180831. [PMID: 32428172 DOI: 10.1590/0034-7167-2018-0831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 03/27/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To understand the professionals' perception of risks and factors related to patient safety incidents in psychosocial care. METHODS Descriptive-exploratory study, with a qualitative approach, carried out with 31 professionals in type III Psychosocial Health Care Centers, between October 2016 and April 2017. Data collection was mediated by the Experiential Learning Cycle. Content analysis was performed. RESULTS The professionals revealed risks and factors related to safety incidents in their daily practices, associated with the institution's physical and organizational structure, with the configuration of the clinical process, with clinical administration and organizational management. Final considerations: Continuous efforts are needed on the part of senior managers and professionals to improve the work process and organizational structure in psychosocial care, contributing to the development of the patient's autonomy and social rehabilitation, avoiding institutionalization and, especially, ensuring the safety of this type of care.
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16
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Salas M, Lopes LC, Godman B, Truter I, Hartzema AG, Wettermark B, Fadare J, Burger JR, Appenteng K, Donneyong M, Arias A, Ankrah D, Ogunleye OO, Lubbe M, Horne L, Bernet J, Gómez-Galicia DL, Del Carmen Garcia Estrada M, Oluka MN, Massele A, Alesso L, Herrera Comoglio R, da Costa Lima E, Vilaseca C, Bergman U. Challenges facing drug utilization research in the Latin American region. Pharmacoepidemiol Drug Saf 2020; 29:1353-1363. [PMID: 32419226 DOI: 10.1002/pds.4989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/20/2019] [Accepted: 02/03/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The International Society of Pharmacoepidemiology (ISPE) in collaboration with the Latin America Drug Utilization Research Group (LatAm DURG), the Medicines Utilization Research in Africa (MURIA) group, and the Uppsala Monitoring Center, is leading an initiative to understand challenges to drug utilization research (DUR) in the Latin American (LatAm) and African regions with the goal of communicating results and proposing solutions to these challenges in four scientific publications. The purpose of this first manuscript is to identify the main challenges associated with DUR in the LatAm region. METHODS Drug utilization (DU) researchers in the LatAm region voluntarily participated in multiple discussions, contributed with local data and reviewed successive drafts and the final manuscript. Additionally, we carried out a literature review to identify the most relevant publications related to DU studies from the LatAm region. RESULTS Multiple challenges were identified in the LatAm region for DUR including socioeconomic inequality, access to medical care, complexity of the healthcare system, limited investment in research and development, limited institutional and organization resources, language barriers, limited health education and literacy. Further, there is limited use of local DUR data by decision makers particularly in the identification of emerging health needs coming from social and demographic transitions. CONCLUSIONS The LatAm region faces challenges to DUR which are inherent in the healthcare and political systems, and potential solutions should target changes to the system.
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Affiliation(s)
- Maribel Salas
- Daiichi Sankyo, Inc, Basking Ridge, USA.,CCEB/CPeRT, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Luciane C Lopes
- Pharmaceutical Science graduate Course, Universidade de Sorocaba UNISO, Sao Paulo, Brazil
| | - Brian Godman
- Karolinska Institute, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Gainesville, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, South Africa
| | | | - Bjorn Wettermark
- Clinical epidemiology & Clinical pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Pharmacy, Disciplinary Domain of Medicine and Pharmacy, Uppsala University
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa
| | - Kwame Appenteng
- Department of Epidemiology, Astellas Pharma US, Northbrook, IL
| | - Macarius Donneyong
- Pharmacy Practice and Science, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Ariel Arias
- Centre for Biologics Evaluation, Health Canada, Ottawa, ON and Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | | | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Martha Lubbe
- Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa
| | - Laura Horne
- Department of Epidemiology, Daiichi Sankyo, Inc, Basking Ridge, NJ
| | - Jorgelina Bernet
- School of Medicine, Cordoba National University, Cordoba, Argentina
| | - Diana L Gómez-Galicia
- Facultad de Farmacia, Universidad Autónoma del Estado de Morelos, Cuernavaca, México
| | | | | | - Amos Massele
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Luis Alesso
- School of Medicine, Cordoba National University, Cordoba, Argentina
| | | | - Elisangela da Costa Lima
- Observatorio de Vigilancia e Uso de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Cidade Universitária, Rio de Janeiro, RJ
| | - Carmen Vilaseca
- Colegio de Bioquimica y Farmacia, La Paz, Bolivia, Plurinational State
| | - Ulf Bergman
- Departments of Clinical Pharmacology and Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Huddinge
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17
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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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