1
|
Soares LSDS, Mata JAIDL, Santana RS, Galato D. Evaluation of pharmaceutical care in Brazilian primary health services settings: expanding objects and approaches. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902020000318733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
2
|
de Jesus SM, Santana RS, Leite SN. Comparative analysis of the use and control of thalidomide in Brazil and different countries: is it possible to say there is safety? Expert Opin Drug Saf 2021; 21:67-81. [PMID: 34232089 DOI: 10.1080/14740338.2021.1953467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION One of the biggest drug disasters in history has not prevented thalidomide from being used to treat various clinical conditions. Currently, Brazil has a worrying scenario: high consumption of the drug and, cases of pregnant women using thalidomide, even after adopting restrictive legislation. AREAS COVERED This review of the literature and legislation sought to comparatively analyze the monitoring of thalidomide use in Brazil and other countries that use this drug. Finally, we discuss the differences between the countries. EXPERT OPINION This analysis allows us to think beyond the safe use of thalidomide, but the safety provided by any type of monitoring system. It seems that out-patients that use unsafe drugs are exposed to some degree of risk. To improve safety, more extensive improvements are needed than monitoring systems related to the use of thalidomide. Its safe use depends on a drastic reduction in the incidence of leprosy and Erythema Nodosum Leprosum in the world; investment in research and development of safe and effective therapeutic alternatives to thalidomide; improvement of health systems and their health surveillance systems, particularly in primary health care; awareness of health professionals and patients for greater responsibility in the use of medicines, especially thalidomide.
Collapse
Affiliation(s)
- Soraya Machado de Jesus
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Silvana Nair Leite
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
3
|
Abstract
The drug thalidomide has resurged in the world market under restrictive conditions for marketing and use. In Brazil, there are still cases of pregnant women using thalidomide even after the implementation of laws that regulate the control of use (Law No. 10.651/2003 and Collegiate Board Resolution No. 11/2011). The objective of this study was to discuss the control of thalidomide use in Brazil, based on a scoping review of the scientific literature, documents, and data from the Ministry of Health. A total of 51 studies and documents related to the following subthemes were selected: (1) organization of access and use of thalidomide in the health system; (2) epidemiological and population characteristics of people affected by leprosy; and (3) occurrence of pregnancy and cases of embryopathy with the use of thalidomide. The results showed that Brazil has no unified information database about thalidomide patients. Furthermore, there is inconsistency in the accreditation of public health centers that dispense this medicine, in a country that has a high consumption of thalidomide in the Unified Health System. A large part of this amount of dispensed medicine is intended for the treatment of erythema nodosum leprosum, mainly in the North, Northeast, and Central-West regions of the country, which are endemic for leprosy. This disease is the only one among the clinical indications of the medicine approved in Brazil that does not have a Clinical Protocol and Therapeutic Guidelines. The control of thalidomide use in Brazil presents historical regulatory failures. These are currently linked to the organization and structure of primary healthcare in the country, as well as to the lack of leadership of the Ministry of Health and National Health Surveillance Agency when it comes to managing the process of control of this use.
Collapse
Affiliation(s)
- Soraya Machado de Jesus
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Silvana Nair Leite
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
4
|
Santana RS, de Oliveira Lupatini E, Zanghelini F, de March Ronsoni R, Rech N, Leite SN. The different clinical guideline standards in Brazil: High cost treatment diseases versus poverty-related diseases. PLoS One 2018; 13:e0204723. [PMID: 30332422 PMCID: PMC6192575 DOI: 10.1371/journal.pone.0204723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/13/2018] [Indexed: 01/09/2023] Open
Abstract
Each year, evidence-based clinical guidelines gain more space in the health professionals' practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations.
Collapse
Affiliation(s)
| | | | - Fernando Zanghelini
- Postgraduate Program in Therapeutic Innovation, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Norberto Rech
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Silvana Nair Leite
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
5
|
Santana RS, Lupatini EDO, Leite SN. The regulation and adoption of health technologies under Brazil's Unified Health System: barriers to access to medicines for diseases of poverty? Cien Saude Colet 2018; 22:1417-1428. [PMID: 28538914 DOI: 10.1590/1413-81232017225.32762016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/01/2016] [Indexed: 11/22/2022] Open
Abstract
The study aimed to examine the regulation and adoption of health technologies for the diseases of poverty in the Brazil's Unified Health System (SUS). An exploratory, descriptive study was conducted between January and May 2016 consisting of the search and analysis of relevant documents on the websites of Brazil's National Health Surveillance Agency, the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), the National Commission for the Adoption of Technologies by the SUS, and Saúde Legis (the Ministry of Health's Legislation System). The 2014 version of the Brazilian National List of Essential Medicines (RENAME, acronym in Portuguese) contained 132 medicines for diseases of poverty. Over one-third of these (49) had only one national producer, while 24 were not registered in the country. The number of medicines contained in the RENAME dedicated to this group of diseases increased by 46% between 2006 and 2014. Despite advances in the regulation and incorporation of technologies by the SUS, given the lack of market interest and neglect of diseases of poverty, the government has a vital role to play in ensuring access to the best available therapies in order to reduce health inequalities. It therefore follows that Brazil needs to improve the regulation of medicines that do not attract market interest.
Collapse
Affiliation(s)
- Rafael Santos Santana
- Departamento de Assistência Farmacêutica e Insumos Estratégicos, Ministério da Saúde. Esplanada dos Ministérios Bloco G, Zona Cívico-Administrativa. 70058900 Brasília DF Brasil.
| | - Evandro de Oliveira Lupatini
- Departamento de Assistência Farmacêutica e Insumos Estratégicos, Ministério da Saúde. Esplanada dos Ministérios Bloco G, Zona Cívico-Administrativa. 70058900 Brasília DF Brasil.
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
| |
Collapse
|
6
|
Santana RS, Leite SN. [Priorities of clinical drug trials in Brazil and neglected diseases of poverty]. Rev Panam Salud Publica 2016; 40:356-362. [PMID: 28076585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/11/2016] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To identify clinical drug trials performed in Brazil between 2012 and 2015, with emphasis on those focusing on neglected diseases of poverty. METHOD Two clinical trial registries, ReBEC (Brazilian registry) and ClinicalTrials.gov were surveyed. The following aspects were investigated: distribution of clinical trials in relation to the burden of disease in Brazil, distribution of trials regarding their focus on diseases of poverty vs. diseases not linked to poverty, phase of trials, performing institution, and type of funding (private, public, or mixed). RESULTS The search revealed 866 eligible trials, 88 registered in ReBEC and 778 in ClinicalTrials.gov. Of these, 73 (8.5%) were phase I trials, 610 (70.5%) were phase II and III trials, and 183 (21%) were phase IV trials. There were 38 trials (4%) focusing on neglected diseases of poverty. Regarding the burden of disease, 734 (84.8%) trials focused on noncommunicable diseases, which in fact represent the largest burden of disease in Brazil. Most trials were carried out by pharmaceutical companies (55.3%), with predominance of private funding (57.1%); however, if only the diseases of poverty are considered, 63.1% were financed by public resources. CONCLUSIONS The clinical drug trials carried out in Brazil in the study period are in agreement with the proportional burden of disease for the country. However, the neglected diseases of poverty were not prioritized. More effective action is necessary to redirect clinical research on drug development to meet national needs.
Collapse
Affiliation(s)
| | - Silvana Nair Leite
- Universidade Federal de Santa Catarina, Departamento de Ciências Farmacêuticas, Florianópolis (SC), Brasil
| |
Collapse
|
7
|
Santana RS, Catanheide ID. [The Brazilian National List of Medicines: a work in progress]. CAD SAUDE PUBLICA 2015; 31:647-8. [PMID: 25859730 DOI: 10.1590/0102-311xca010315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/14/2015] [Indexed: 11/21/2022] Open
|
8
|
Santana RS, Viana ADC, Santiago JDS, Menezes MS, Lobo IMF, Marcellini PS. The cost of excessive postoperative use of antimicrobials: the context of a public hospital. Rev Col Bras Cir 2014; 41:149-54. [DOI: 10.1590/s0100-69912014000300003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/23/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: To evaluate the improper use of antimicrobials during the postoperative period and its economic impact. METHODS: We conducted a prospective cohort study by collecting data from medical records of 237 patients operated on between 01/11/08 and 31/12/08. RESULTS: from the 237 patients with the information collected, 217 (91.56%) received antimicrobials. During the postoperative period, 125 (57.7%) patients received more than two antimicrobials. On average, 1.7 ± 0.6 antimicrobials were prescribed to patients, the most commonly prescribed antibiotic being cephalothin, in 41.5% (154) of cases. The direct cost of antimicrobial therapy accounted for 63.78% of all drug therapy, this large percentage being attributed in part to the extended antimicrobial prophylaxis. In the case of clean operations, where there was a mean duration of 5.2 days of antibiotics, antimicrobials represented 44.3% of the total therapy cost. CONCLUSION: The data illustrate the impact of overuse of antimicrobials, with questionable indications, creating situations that compromise patient safety and increasing costs in the assessed hospital.
Collapse
|
9
|
Santana RS, Jesus EMSD, Santos DGD, Lyra Júnior DPD, Leite SN, Silva WBD. [Indicators for drug selection in health systems: an integrative review]. Rev Panam Salud Publica 2014; 35:228-234. [PMID: 24793871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 01/11/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To produce a panel of the main drug selection indicators by performing an integrative literature review. METHODS After the elaboration of a review protocol, searches were conducted in LILACS, MEDLINE, Embase, and SciELO databases. The following search terms were used: "indicators"; "criteria"; "drug selection"; "pharmacy and therapeutics committee"; and "medication form"; with the applicable variations in English and Spanish. Sixteen original articles published between January 1996 and March 2012 were retrieved and reviewed to compose a panel of indicators. RESULTS Forty-five quantitative and qualitative indicators were identified. These indicators were grouped according to conceptual similarities in three categories: 1) assessment of pharmacy and therapeutics committee structure; 2) evaluation of the general processes of drug selection; and 3) evaluation of the results of drug selection. CONCLUSIONS The indicators identified reveal relative uniformity in the established patterns for drug selection. The group of indicators established in this study should serve as reference for the development and consolidation of drug selection in public health services.
Collapse
Affiliation(s)
| | | | | | | | - Silvana Nair Leite
- Departamento de Farmácia, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | | |
Collapse
|