The pharmacy workforce in public primary healthcare centers: promoting access and information on medicines

The financing of medicines in Brazilian municipalities: whose responsibility is it?

OBJECTIVE

To analyze the investments made in medicines by the federated entities and the asymmetries in these investments from 2016 to 2020, which may have an impact on the supply of and access to these medicines in the SUS.

METHODS

This is an exploratory, retrospective study to identify who are the main entities responsible for investment in Primary Care medicines in municipalities, the evolution, counterparts, and regional differences of this investment between 2016 and 2020.

RESULTS

The amounts spent on medicines by Brazilian municipalities were higher than the contribution to the CBAF from the MS or the MS + State in all the years analyzed. The average percentages of federal funds transferred and municipal spending varied according to the region of Brazil. The average per capita amount invested in medicines by municipalities increased between 2016 and 2020 (deflation applied), with a greater impact for municipalities with lower MHDI. The Farmácia Popular program mainly reaches municipalities with the largest populations and the highest MHDI and is therefore not enough to address the inequalities in access pointed out.

CONCLUSIONS

There has been a widening of inequalities in the capacity of municipalities to ensure access to medicines, especially among the most vulnerable municipalities, accumulating even more risks of illnesses and deaths from primary care-sensitive diseases.

Drug dispensing in public community pharmacies: evidence from the MedMinas project

BACKGROUND

Drug dispensing is a service provided by pharmacists to ensure the supply of medications and other health-related products. However, despite the importance of dispensing services, Public Community Pharmacies (PCP) in Brazil still focus on the control and distribution of medicines and supplies. Thus, this paper aims to evaluate how the pharmacists in charge conduct and the challenges they encounter in dispensing services in PCP.

METHODS

This is a mixed methods study, with a representative sample of 26 municipalities (whose populations vary between 37,784 and 409,341 inhabitants) in the state of Minas Gerais, Brazil. Data collection took place between April and October 2019 and included interviews and documentary research. Quantitative data analysis was carried out using descriptive statistics and qualitative data was subjected to thematic content analysis.

RESULTS

24 dispensing services were analyzed. The PCP had, on average, two active pharmacists and operated full-time (40 h per week). In relation to dispensing services, the most frequently mentioned steps were checking the adequacy of the prescription received, followed by providing counseling to the user about the medicines, mainly regarding administration, storage and disposal. The results highlighted a need for improvements in terms of infrastructure, workforce and the pharmacist's work process.

CONCLUSION

It is necessary to invest and to design improvement strategies in dispensing services, especially regarding physical infrastructure, human resources and work processes.

Impact of a Pharmacy Management Course for Pharmacists Working Within Brazil's Public Health System

Objective. To assess the impact of a continuing education course that focused on the development of management competencies on pharmacists working in Brazil's public health system.Methods. A specialization blended in-service course (360 hours) entitled Pharmaceutical Service and Access to Medicine Management was offered to pharmacists working within the Brazilian public health system. Data on course outcomes were collected through individual interviews with pharmacists who worked in the Brazilian public health system, as well as from focus groups and records of researchers' observations. The analysis was based on models of learning and training evaluation theory.Results. The findings showed proximal outcomes on students' knowledge, skills, and attitudes; behavioral changes; and programmatic outcomes in the organization and management of health services, promoting the recognition and integration of the "pharmaceutical services division" - a dedicated sector within the health departments in municipalities and states. The inputs (course content, structure, and in-service hands-on activities) were directly linked to the outcomes reported by participants and helped them to overcome some of the barriers to using knowledge and skills in the workplace.Conclusion. A well-structured course including leaning activities to intervene in the workplace had a positive impact on pharmacists' behavior and contributed to the capacity building of the organizations in which they operate.

Pharmacist Workforce at Primary Care Clinics: A Nationwide Survey in Taiwan

Although dispensing is usually separated from prescribing in healthcare service delivery worldwide, primary care clinics in some countries can hire pharmacists to offer in-house dispensing or point-of-care dispensing for patients’ convenience. This study aimed to provide a general overview of pharmacists working at primary care clinics in Taiwan. Special attention was paid to clarifying the relationship by location, scale, and specialty of clinics. The data source was the Government’s open database in Taiwan. In our study, a total of 8688 pharmacists were hired in 6020 (52.1%) 11,546 clinics. The result revealed significant differences in the number of pharmacists at different specialty clinics among levels of urbanization. Group practices did not have a higher probability of hiring pharmacists than solo practices. There was a higher prevalence of pharmacists practicing in clinics of non surgery-related specialties than in surgery-related specialties. Although the strict separation policy of dispensing and prescribing has been implemented for 2 decades in Taiwan, most primary care clinics seem to circumvent the regulation by hiring pharmacists to maintain dominant roles in dispensing drugs and retaining the financial benefits from drugs. More in-depth analyses are required to study the impact on pharmacies and the quality of pharmaceutical care.

Attending a Blended In-Service Management Training in a Public Health System: Constraints and Opportunities for Pharmacists and Health Services

Management and public health are important domains of competency for pharmacists. In about 90% of Brazilian health departments, pharmacists manage the selection and purchase of medicines. The Pharmaceutical Services and Access to Medicines Management Course (PSAMM) was offered to pharmacists working in the public health system. The aim of this study is to analyze the impacts of the course as perceived by the students (pharmacists). Two thousand five hundred pharmacists completed the course. It is a mixed-methods study, including subscribing forms (n = 2500), evaluation questionnaire (n = 1500), focus groups (n = 10), and semi-structured interviews (n = 31). Participants reported a high level of satisfaction with the course; they considered to have developed competencies related to leadership and management, competencies needed to enhance and sustain their practices in health services. Data analyses showed important barriers to complete the course: high course workload, poor quality of Internet access, lack of support from the health services. Participants highlighted crucial features of the course that helped them develop key competencies: practical in-service activities, useful and realistic contents, tutoring. These features helped participants overcome some important constraints described by them. The educational model described in this study was perceived as having a long-term impact on their behaviors and management practices in health services.