1
|
Santo K, Santos RD, Girotto AN, Nieri J, Monfardini F, Raupp P, Pereira PM, Berwanger O, Machline-Carrion MJ. Statins use for primary prevention of cardiovascular disease: A population-based digitally enabled real-world evidence cross-sectional study in primary care in Brazil. J Clin Lipidol 2024; 18:e384-e393. [PMID: 38431498 DOI: 10.1016/j.jacl.2024.02.005] [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: 07/14/2023] [Revised: 12/20/2023] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Statins are the main strategy to reduce dyslipidemia-related cardiovascular risk. Nevertheless, there is scarce evidence on the real-world statins use in primary care settings in low-middle-income countries. OBJECTIVE We conducted a cross-sectional retrospective study using anonymized data routinely collected by community health workers in Brazil aimed to evaluate statin use and associated factors in a primary prevention population with cardiovascular risk enhancers. METHODS Study population consisted of adults with hypertension, diabetes, and/or dyslipidemia. The primary and secondary outcomes were the proportion of individuals self-reporting statins use on any dose and high-dose statins/high-intensity lipid-lowering therapy (LLT), respectively. RESULTS Of the 2,133,900 adult individuals in the database, 415,766 (19.5%) were included in the study cohort. From this cohort, 89.1% had hypertension, 28.9% diabetes, and 5.5% dyslipidemia. The mean age was 61.5 (standard deviation 14.5) years, 63.4% were female, and 61.0% were of mixed-race. Only 2.6% and 0.1% of individuals self-reported the use of statins and high-dose statins/high-intensity LLT, respectively. Older age (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.88, 2.05, p < 0.001), living in the South region of Brazil (OR 4.39; 95% CI 3.97, 4.85, p < 0.001), heart failure (OR 2.60; 95% CI 2.33, 2.89, p < 0.001), chronic kidney disease (OR 1.49; 95% CI 1.35, 1.64, p < 0.001), and anti-hypertensive medications use (OR 4.38; 95% CI 4.07, 4.71, p < 0.001) were independently associated with statin use. CONCLUSION In a real-world evidence study analyzing data routinely collected in a digitized primary care setting, we observed a very low use of statins in a primary prevention population with cardiovascular risk enhancers in Brazil. Socio-demographic factors and co-morbidities were associated with higher statins use rates.
Collapse
Affiliation(s)
- Karla Santo
- Hospital Israelita Albert Einstein, 755 Comendador Elias Jafet Street, room 408/409, Floor L4, Morumbi, São Paulo, SP, Postal Code 05653-000, Brazil (Santo, Santos, Nieri, Monfardini and Berwanger).
| | - Raul D Santos
- Hospital Israelita Albert Einstein, 755 Comendador Elias Jafet Street, room 408/409, Floor L4, Morumbi, São Paulo, SP, Postal Code 05653-000, Brazil (Santo, Santos, Nieri, Monfardini and Berwanger); Heart Institute (InCor), University of Sao Paulo Medical School, 44 Dr Enéas Carvalho de Aguiar Avenue, Cerqueira César, São Paulo, SP, Postal Code 05403-900, Brazil (Santos)
| | - Alysson Nathan Girotto
- epHealth Primary Care Solutions, 3339 Dr. Antônio Luiz Moura Gonzaga Road, Room 107 Block A, Rio Tavares, Florianópolis, SC, Postal Code 88048-300, Brazil (Girotto and Pereira)
| | - Josue Nieri
- Hospital Israelita Albert Einstein, 755 Comendador Elias Jafet Street, room 408/409, Floor L4, Morumbi, São Paulo, SP, Postal Code 05653-000, Brazil (Santo, Santos, Nieri, Monfardini and Berwanger)
| | - Frederico Monfardini
- Hospital Israelita Albert Einstein, 755 Comendador Elias Jafet Street, room 408/409, Floor L4, Morumbi, São Paulo, SP, Postal Code 05653-000, Brazil (Santo, Santos, Nieri, Monfardini and Berwanger)
| | - Priscila Raupp
- Novartis Biociências Brazil, 90 Professor Vicente Rao Avenue, Cidade Monções, São Paulo, SP, Postal Code 04706-900, Brazil (Raupp)
| | - Pedro Marton Pereira
- epHealth Primary Care Solutions, 3339 Dr. Antônio Luiz Moura Gonzaga Road, Room 107 Block A, Rio Tavares, Florianópolis, SC, Postal Code 88048-300, Brazil (Girotto and Pereira); epHealth UK, C/O Taylor Vinters, Floor 33 Tower 42, 25 Old Broad Street, London, EC2N 1HQ, United Kingdom (Pereira); Instituto epHealth, 2302 Consolação Street, CJ 21, Room 104, Consolação, Sao Paulo, SP, Postal Code 01302-001, Brazil (Pereira)
| | - Otavio Berwanger
- Hospital Israelita Albert Einstein, 755 Comendador Elias Jafet Street, room 408/409, Floor L4, Morumbi, São Paulo, SP, Postal Code 05653-000, Brazil (Santo, Santos, Nieri, Monfardini and Berwanger); The George Institute for Global Health, 4 Wood Ln, London, NW9 7PA, United Kingdom (Berwanger); Imperial College London, 80 Wood Ln, London, W12 7TA, United Kingdom (Berwanger)
| | - M Julia Machline-Carrion
- epHealth UK, C/O Taylor Vinters, Floor 33 Tower 42, 25 Old Broad Street, London, EC2N 1HQ, United Kingdom (Pereira); Instituto epHealth, 2302 Consolação Street, CJ 21, Room 104, Consolação, Sao Paulo, SP, Postal Code 01302-001, Brazil (Pereira)
| |
Collapse
|
2
|
Li C, Spencer G, Husain MJ, Nugent R, Auzenne D, Kostova D, Richter P. Barriers to accessibility of medicines for hyperlipidemia in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002905. [PMID: 38346061 PMCID: PMC10861044 DOI: 10.1371/journal.pgph.0002905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
Despite the high burden of hyperlipidemia and the effectiveness of treatment, evidence suggests that the accessibility of hyperlipidemia medicines can be low in many low- and middle-income countries (LMICs). The aim of this study was to identify common barriers to the accessibility of medicines for hyperlipidemia in LMICs. A multimethod analysis and multiple data sources were used to assess the accessibility and barriers of medicines for hyperlipidemia in selected LMICs. The overall median availability of statins for hyperlipidemia in public facilities was 0% and 5.4%, for originators and generics, respectively. In private facilities, median availability was 13.3% and 35.9%, for originators and generics, respectively. Statin availability was lowest in Africa and South-East Asia. Private facilities generally had higher availability than public facilities. Statins are less affordable in lower-income countries, costing around 6 days' wages per month. Originator statins are less affordable than generics in countries of all income-levels. The median cost for statin medications per month ranges from a low of $1 in Kenya to a high of $62 in Mexico, with most countries having a median monthly cost between $3.6 and $17.0. The key informant interviews suggested that accessibility to hyperlipidemia medicines in LMICs faces barriers in multiple dimensions of health systems. The availability and affordability of statins are generally low in LMICs. Several steps could be implemented to improve the accessibility of hyperlipidemia medicines, including private sector engagement, physician education, investment in technology, and enhancement of health systems.
Collapse
Affiliation(s)
- Chaoyang Li
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Garrison Spencer
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Muhammad Jami Husain
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Deon Auzenne
- Department of Psychology, Howard University, Washington, District of Columbia, United States of America
| | - Deliana Kostova
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patricia Richter
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
3
|
Machline-Carrion MJ, Girotto AN, Nieri J, Pereira PM, Monfardini F, Forestiero F, Raupp P, Roveda F, Santo K, Berwanger O, Santos RD. Assessing statins use in a real-world primary care digital strategy: a cross-sectional analysis of a population-wide digital health approach. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100534. [PMID: 37497398 PMCID: PMC10366451 DOI: 10.1016/j.lana.2023.100534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/28/2023]
Abstract
Background The digitization of the primary care system provides an opportunity to evaluate the current use of statins in secondary prevention populations (myocardial infarction or stroke). Methods We conducted a cross-sectional study (ClinicalTrials.gov, NCT05285085), analysing anonymised data routinely collected by community health workers (CHW) in Brazil between May 2016 and September 2021 to assess the proportion of self-reported statins use and associated factors. Findings From the 2,133,900 individuals on the database, 35,103 (1.6%), mean age 66.2 years (SD14.6), 49.5% (17,382/35,103) male sex, 50.5% (17,721/35,103) female sex, and 29.6% (10,381/34,975) Caucasians, had a previous myocardial infarction (MI) (n = 11,628; 33.1%) or stroke (n = 25,925; 73.9%). Approximately 50% (17,020/35,103) were from the Northeast region, 78.7% (27,605) from urban zones, and 39.4% (13,845) with social development index (SDI) >0.7. Overall, 6.7% (2346) and 0.6% (212) reported statins and high dose statins use, respectively. Age over 60 years old (OR 1.32 [95% CI 1.19-1.47), living in the Southern region (OR 4.53 [95% CI 3.66-5.60]), having a previous diagnosis of MI (OR 4.53 [95% CI 3.66-5.60]), heart failure (OR 2.29 [95% CI 1.13-1.47]), diabetes (OR 1.50 [95% CI 1.37-1.64]), dyslipidaemia (OR 2.90 [95% CI 2.55-3.29]), chronic kidney disease (OR 1.27 [95% CI 1.08-1.48]) and use of anti-hypertensives (OR 5.47 [95% CI 4.60-6.47]) were associated with statin use. Interpretation The analysis of a real-world database from a digitized primary care system, allowed us to identify a very low use of statins in secondary prevention Brazilian patients, mostly influenced by socio-demographic factors and co-morbidities. Funding Novartis Biociências, Brazil.
Collapse
Affiliation(s)
| | | | - Josué Nieri
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | | | - Frederico Monfardini
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | | | | | | | - Karla Santo
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Otávio Berwanger
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
- The George Institute for Global Health, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Raul D. Santos
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
- Lipid Clinic Heart Institute InCor University of Sao Paulo Medical School Hospital, São Paulo, SP, Brazil
| |
Collapse
|
4
|
Pedroso AF, Barreto SM, Telles RW, Machado LAC, Haueisen Sander Diniz MDF, Duncan BB, Figueiredo RC. Uncovering the Relationship Between Statins and Muscle Problems in the ELSA-Brasil MSK Cohort. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07476-7. [PMID: 37261675 DOI: 10.1007/s10557-023-07476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE To investigate the association between statins and muscle problems in a highly diverse sample of Brazilian civil servants. METHODS We conducted a cross-sectional data analysis at baseline of the ELSA-Brasil MSK cohort. Pain was identified through self-reported symptoms in large muscle groups (lower back and/or hips/thighs). Muscle strength was assessed using the five-times-sit-to-stand (FTSTS) and handgrip tests, with weakness defined as the lowest and highest quintiles of age- and sex-stratified handgrip strength and FTSTS performance time, respectively. Multivariable logistic regression analyses were conducted to investigate the association between statin use and muscle pain and weakness. Secondary analyses explored the impact of different types of statins and their duration of use on the response variables. RESULTS A total of 2156 participants (mean age 55.6 ± SD 8.9, 52.8% women) were included, of whom 21.1% were taking statins and 25.1% reported muscle pain. We found no significant association between statin use and muscle problems. Secondary analysis on different types of statins revealed an association between atorvastatin and muscle weakness, as measured by the five-times-sit-to-stand test (OR 1.94, 95% CI 1.12-3.37), but not by the handgrip test (OR 0.75, 95% CI 0.29-1.42). No evidence was found to support a link between the duration of statin treatment and muscle problems. CONCLUSIONS This study challenges previous claims of an efficacy-effectiveness gap between experimental and observational literature on statins. The findings indicate that statin use does not contribute to muscular problems.
Collapse
Affiliation(s)
- Aline Fernandes Pedroso
- Graduate Program of Health Sciences, Federal University of Sao Joao del-Rei, Bloco D, Sala 306, R. Sebastião Gonçalves Coelho, 400, Chanadour, Divinópolis, MG, 35501-296, Brazil
| | - Sandhi Maria Barreto
- Medical School and Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosa Weiss Telles
- Medical School and Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciana A C Machado
- Clinical Hospital, UFMG/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Roberta Carvalho Figueiredo
- Graduate Program of Health Sciences, Federal University of Sao Joao del-Rei, Bloco D, Sala 306, R. Sebastião Gonçalves Coelho, 400, Chanadour, Divinópolis, MG, 35501-296, Brazil.
| |
Collapse
|
5
|
Accorsi TAD, Nemoto RP, Nunes JT, de Azevedo AFB, Moreira FT, Kohler KF, Lima KDA, Amaral BDR, Morbeck RA, Pedrotti CHS. Clinical Features and Management of Patients Assessed by Cardiology Teleconsultation in the Brazilian Region with the Highest Number of Isolated Cities. Arq Bras Cardiol 2023; 120:e20220467. [PMID: 37162075 PMCID: PMC10263392 DOI: 10.36660/abc.20220467] [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: 07/06/2022] [Revised: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of adult mortality. Geographically remote and low-income Brazilian regions lack specialized consultations. The telemedicine management of this population by cardiologists is not fully known. OBJECTIVES To analyze cardiology teleconsultation in the Brazilian region with the highest number of isolated cities. METHODS From February 2020 to October 2021, patients from the North Region of Brazil evaluated by local general practitioners were referred for cardiological evaluation by telemedicine. Referral reasons, demographics, clinical history, physical examinations, tests, medications, and prescriptions pre- and post-telemedicine were analyzed (p<0.05 was considered statistically significant). RESULTS We analyzed 653 patients. The attendance rate was 85.7% (53.1% female, mean age: 54.2±6.5 years). The main reasons for referral were cardiovascular symptoms (58.1%) and risk factors among asymptomatic patients (13.3%). Only 12.6% had a diagnosed disease. Most patients had regular physical examinations and electrocardiograms. Few had recent complementary tests. The prescription of angiotensin receptor blockers (ARBs), calcium channel blockers and statins was significantly increased, while that of digoxin, noncardiac beta-blockers and acetylsalicylic acid (ASA) was decreased at the first teleconsultation. Most of the tests requested were of low complexity and cost: electrocardiogram (28.2%), chest X-ray (14%), echocardiogram (64.5%) and blood tests (71.8%). For 2.1% of patients, interventions were indicated, and 8% were discharged after the first consultation. CONCLUSION On-demand cardiology teleconsultation contributes to heart disease treatment optimization. Most patients were referred with syndromic diagnoses without previous complementary tests. The specialist workup requested was usually available locally and at a low cost but precluded early discharge. Local training could optimize the referral.
Collapse
Affiliation(s)
- Tarso Augusto Duenhas Accorsi
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Renato Paladino Nemoto
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Jairo Tavares Nunes
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | | | - Flavio Tocci Moreira
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Karen Francine Kohler
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Karine de Amicis Lima
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Bruna Dayanne Reges Amaral
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | - Renata Albaladejo Morbeck
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein – Telemedicine, São Paulo, SP – Brasil
| | | |
Collapse
|
6
|
Faria-Neto JR, Yarleque C, Vieira LF, Sakane EN, Santos RD. Challenges faced by patients with dyslipidemia and systemic arterial hypertension in Brazil: a design of the patient journey. BMC Cardiovasc Disord 2022; 22:237. [PMID: 35597901 PMCID: PMC9124411 DOI: 10.1186/s12872-022-02669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Non-communicable diseases like systemic arterial hypertension (SAH) and dyslipidemia are poorly studied in terms of patient journey aspects. This semi-systematic review provides evidence synthesis for the management of SAH and dyslipidemia in Brazil and also discusses challenges faced by patients at the local level along with a suggested care approach by local experts. METHODS A semi-systematic review using both structured literature databases (Embase and Medline) and unstructured scientific records (WHO, IPD, MOH and Google) on hypertension and dyslipidemia in the English language from 2010 to 2019 was performed by reviewers. After two-level screening based on pre-defined criteria, patient journey touchpoints and prevalence information were extracted from the included articles. Data gaps were bridged through the insights of local experts. RESULTS Prevalence of hypertension and dyslipidemia in Brazil were 23% and 40.8%, respectively. Awareness of dyslipidemia was found in a larger proportion (58.1%) than in SAH (22.2%). Similarly, screening for hypertension (97%) and dyslipidemia (55.4%) were found to be effective, while treatment was (62.9%) and (30.0%) for hypertension and dyslipidemia, respectively. CONCLUSION There were important gaps on patient awareness and treatment of dyslipidemia and hypertension. Limited patient education, regional disease distribution, and treatment allocation, along with limited resources for diagnosis and treatment are the key challenges.
Collapse
Affiliation(s)
- Jose Rocha Faria-Neto
- School of Medicine, Pontificial Catholic University of Parana (PUCPR), Curitiba, Brazil
| | - Carlos Yarleque
- Research, Development and Medical, Upjohn - A Division of Pfizer, Lima, Peru
| | | | | | - Raul D Santos
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, São Paulo, Brazil.
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| |
Collapse
|
7
|
Silva PRDS, Jannes CE, Oliveira TG, Krieger JE, Santos RD, Pereira AC. Pharmacological treatment with lipid-lowering agents after molecular identification of familial hypercholesterolemia: results from the Hipercol Brasil cohort. J Clin Lipidol 2022; 16:198-207. [DOI: 10.1016/j.jacl.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
|
8
|
Abstract
OBJECTIVES We aim to describe the frequency and type of adverse drug reactions (ADRs) in patients on statins in published studies from Latin American (LATAM) countries. DESIGN Scoping review. METHODS A literature search was conducted in three databases (PubMed, EMBASE and LILACS) in addition to a manual search in relevant journals from LATAM universities or medical societies. A snowballing technique was used to identify further references. Randomised controlled trials (RCTs) and observational studies between 2000 and 2020 were included. Studies were considered eligible if they included adults on statin therapy from LATAM and reported data on ADRs. Data on ADRs were abstracted and presented by study design. RESULTS Out of 8076 articles, a total of 20 studies were included (7 RCTs and 13 observational studies). We identified three head-to-head statin RCTs, two statin-versus-policosanol RCTs and only two placebo-controlled trials. The statin-related ADRs frequency ranged from 0% to 35.1% in RCTs and 0% to 28.4% in observational studies. The most common ADRs were muscle-related events including myalgia and elevated creatine phosphokinase. Other reported ADRs were gastrointestinal symptoms, headache and altered fasting plasma glucose. CONCLUSIONS We identified differences in the frequency of ADRs in both observational studies and RCTs from LATAM countries. This could be due to the absence of standard definitions and reporting of ADRs as well as differences among the study's interventions, population characteristics or design. The variability of ADRs and the absence of definitions are similar to studies from other geographical locations. Further placebo-controlled trials and real-world data registries with universal definitions should follow.
Collapse
Affiliation(s)
- Manuel Urina-Jassir
- Clinical Research Department, Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlantico, Colombia
| | - Tatiana Pacheco-Paez
- Evidence-Based Therapeutics Group, Clinical Pharmacology, Universidad de La Sabana, Chia, Colombia
| | - Carol Paez-Canro
- Sexually Transmitted Infections Group, Cochrane Collaboration, Universidad Nacional de Colombia, Bogota, Colombia
| | - Miguel Urina-Triana
- Clinical Research Department, Fundación del Caribe para la Investigación Biomédica, Barranquilla, Atlantico, Colombia
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Atlántico, Colombia
| |
Collapse
|
9
|
Pharmacogenomics of statins: lipid response and other outcomes in Brazilian cohorts. Pharmacol Rep 2021; 74:47-66. [PMID: 34403130 DOI: 10.1007/s43440-021-00319-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 01/20/2023]
Abstract
Statins are inhibitors of 3-hydroxy-3-methylglutaryl-CoA reductase, a key enzyme in cholesterol biosynthesis, that are highly effective in reducing plasma low-density lipoprotein (LDL) cholesterol and decreasing the risk of cardiovascular events. In recent years, a multitude of variants in genes involved in pharmacokinetics (PK) and pharmacodynamics (PD) have been suggested to influence the cholesterol-lowering response. However, the vast majority of studies have analyzed the pharmacogenetic associations in populations in Europe and the USA, whereas data in other populations, including Brazil, are mostly lacking. This narrative review provides an update of clinical studies on statin pharmacogenomics in Brazilian cohorts exploring lipid-lowering response, adverse events and pleiotropic effects. We find that variants in drug transporter genes (SLCO1B1 and ABCB1) positively impacted atorvastatin and simvastatin response, whereas variants in genes of drug metabolizing enzymes (CYP3A5) decreased response. Furthermore, multiple associations of variants in PD genes (HMGCR, LDLR and APOB) with statin response were identified. Few studies have explored statin-related adverse events, and only ABCB1 but not SLCO1B1 variants were robustly associated with increased risk in Brazil. Statin-related pleiotropic effects were shown to be influenced by variants in PD (LDLR, NR1H2) and antioxidant enzyme (NOS3, SOD2, MTHFR, SELENOP) genes. The findings of these studies indicate that statin pharmacogenomic associations are distinctly different in Brazil compared to other populations. This review also discusses the clinical implications of pharmacogenetic studies and the rising importance of investigating rare variants to explore their association with statin response.
Collapse
|
10
|
Watanabe LM, Navarro AM, Seale LA. Intersection between Obesity, Dietary Selenium, and Statin Therapy in Brazil. Nutrients 2021; 13:2027. [PMID: 34204631 PMCID: PMC8231251 DOI: 10.3390/nu13062027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 01/14/2023] Open
Abstract
Obesity is among the most alarming health concerns, impacting public health and causing a socioeconomic challenge, especially in developing countries like Brazil, where approximately one quart of the population presents obesity. As an established risk factor for numerous comorbidities with a multifactorial etiology, obesity is a consequence of energy-dense overfeeding, however with significant undernourishment, leading to excessive adipose tissue accumulation and dysfunction, dyslipidemia, and micronutrient deficiencies. About 60% of patients with obesity take statins, a cholesterol-lowering medication, to curb dyslipidemia, with ~10% of these patients presenting various myopathies as side effects. Statins act upon the rate-limiting enzyme of cholesterol biosynthesis in the liver, which is a pathway providing intermediates to the synthesis of selenoproteins, i.e., enzymes containing the micronutrient selenium. Statins have been postulated to negatively impact selenoprotein synthesis, particularly in conditions of selenium deficiency, and potentially implicated in the myopathies occurring as side effects of statins. The Brazilian population is prone to selenium deficiency, hence could be considered more susceptible to statin side effects. This review examines the specific consequences to the Brazilian population of the harmful intersection between obesity development and concomitant micronutrient deficiencies, particularly selenium, combined with statin treatment in the context of nutrition in Brazil.
Collapse
Affiliation(s)
- Ligia M. Watanabe
- Department of Health Sciences, Division of Nutrition and Metabolism, Ribeirão Preto Medical School, University of São Paulo—FMRP/USP, Ribeirão Preto 14040-900, SP, Brazil; (L.M.W.); (A.M.N.)
| | - Anderson M. Navarro
- Department of Health Sciences, Division of Nutrition and Metabolism, Ribeirão Preto Medical School, University of São Paulo—FMRP/USP, Ribeirão Preto 14040-900, SP, Brazil; (L.M.W.); (A.M.N.)
| | - Lucia A. Seale
- Pacific Biosciences Research Center, School of Ocean and Earth Science and Technology, University of Hawaii at Manoa, Honolulu, HI 96822, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Cerda A, Bortolin RH, Manriquez V, Salazar L, Zambrano T, Fajardo CM, Hirata MH, Hirata RDC. Effect of statins on lipid metabolism-related microRNA expression in HepG2 cells. Pharmacol Rep 2021; 73:868-880. [PMID: 33721286 DOI: 10.1007/s43440-021-00241-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Statins are potent cholesterol-lowering drugs that prevent cardiovascular events. microRNAs (miRNAs) modulate the expression of genes involved in metabolic pathways and cardiovascular functions post-transcriptionally. This study explored the effects of statins on the expression of miRNAs and their target genes involved in lipid metabolism in HepG2 cells. METHODS HepG2 cells were treated with atorvastatin or simvastatin (0.1-10 µM) for 24 h. The expression of 84 miRNAs and nine target genes, selected by in silico studies, was measured by qPCR Array and TaqMan-qPCR, respectively. RESULTS Five miRNAs were upregulated (miR-129, miR-143, miR-205, miR-381 and miR-495) and two downregulated (miR-29b and miR-33a) in atorvastatin-treated HepG2 cells. Simvastatin also downregulated miR-33a expression. Both statins upregulated LDLR, HMGCR, LRP1, and ABCG1, and downregulated FDFT1 and ABCB1, whereas only atorvastatin increased SCAP mRNA levels. In silico analysis of miRNA-mRNA interactions revealed a single network with six miRNAs modulating genes involved in lipogenesis and lipid metabolism. The statin-dysregulated miRNAs were predicted to target genes involved in cellular development and differentiation, regulation of metabolic process and expression of genes involved in inflammation, and lipid metabolism disorders contributing to metabolic and liver diseases. CONCLUSIONS Atorvastatin-mediated miR-129, miR-143, miR-205, miR-381, and miR-495 upregulation, and miR-29b, and miR-33a downregulation, modulate the expression of target genes involved in lipogenesis and lipid metabolism. Thus, statins may prevent hepatic lipid accumulation and ameliorate dyslipidemia.
Collapse
Affiliation(s)
- Alvaro Cerda
- Department of Basic Sciences, Center of Excellence in Translational Medicine, BIOREN, Universidad de La Frontera, Av. Alemania 0458, 4810296, Temuco, Chile.
| | - Raul Hernandes Bortolin
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, 05508-000, Brazil
| | - Victor Manriquez
- Department of Basic Sciences, Center of Excellence in Translational Medicine, BIOREN, Universidad de La Frontera, Av. Alemania 0458, 4810296, Temuco, Chile
| | - Luis Salazar
- Department of Basic Sciences, Center of Molecular Biology and Pharmacogenetics, BIOREN, Universidad de La Frontera, 4810296, Temuco, Chile
| | - Tomas Zambrano
- Department of Medical Technology, School of Medicine, Universidad de Chile, 8380456, Santiago, Chile
| | - Cristina Moreno Fajardo
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, 05508-000, Brazil
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, 05508-000, Brazil
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, 05508-000, Brazil
| |
Collapse
|
13
|
Lopes J, Santos P. Determinants of Non-Adherence to the Medications for Dyslipidemia: A Systematic Review. Patient Prefer Adherence 2021; 15:1853-1871. [PMID: 34465984 PMCID: PMC8403077 DOI: 10.2147/ppa.s319604] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Dyslipidemia is a major cardiovascular risk factor, and its control leads to less cardiovascular events. Many patients will need some medications to achieve ideal targets. Non-adherence to medications is a complex problem with high impact on their effectiveness. This study aims to identify the determinants of non-adherence to medications in patients with dyslipidemia. PATIENTS AND METHODS We conducted a systematic review. PubMed and Scopus databases were searched for original articles, published between 2000 and 2020, using the MeSH terms "Dyslipidemias" and "Medication Adherence". RESULTS From the initial 3502 identified articles, we selected 46 to include in the final qualitative synthesis. The determinants associated with non-adherence were lower age (≤50 years), female sex, African American ethnicity, smoking habits, being a new user of lipid-lowering medications, reporting or having concerns about lipid-lowering medication side effects and some comorbidities (chronic obstructive pulmonary disease, Alzheimer's disease/dementia, depression and diabetes). On the contrary, adherence is higher in older patients, alcohol drinking habits, taking β-blockers, having a higher number of comorbidities, having a history of cardiovascular events, cardiac interventions or revascularization procedures, having health insurance and having more provider follow-up visits. CONCLUSION There are important identifiable determinants of non-adherence in patients with dyslipidemia. These patients benefit from a specific approach to minimize the problem and maximize the potential benefit of the prescription.
Collapse
Affiliation(s)
- João Lopes
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- Correspondence: João Lopes Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, PortugalTel +351 220426600 Email
| | - Paulo Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| |
Collapse
|
14
|
Moreira T, Alvares-Teodoro J, Barbosa MM, Do Nascimento RCRM, Guerra Júnior AA, Acurcio FA. Polypharmacy among adult and older adult users of primary care services delivered through the Unified Health System in Minas Gerais, Brazil. Expert Rev Clin Pharmacol 2020; 13:1401-1409. [PMID: 33054470 DOI: 10.1080/17512433.2020.1836958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To estimate the prevalence of polypharmacy (≥5 drugs) among adults and to analyze related factors. METHODS Cross-sectional study with 1,159 interviewees distributed across 104 cities and 253 primary healthcare services delivered through the Brazilian Unified Health System. Polypharmacy-related factors were identified using logistic regression model. RESULTS 949 (81.8%) interviewees were using at least one medication and were included in this analysis. The prevalence of polypharmacy among them was 13.7% (95%CI:11.7-16.0%) in the general population and 33.3%(95%CI:26.1-41.4%) in older adults(≥65 years). Polypharmacy was positively associated with age (45 to 64 years, OR=2.02; 95%CI:1.03-3.94; ≥65 years, OR=4.17; 95%CI:1.92-9.17) and the following chronic diseases: stroke (OR=4.20; 95%CI:1.53-11.55); diabetes mellitus (OR=4.03; 95%CI:2.43-6.68); heart disease (OR=3.18; 95%CI:1.92-5.29); depression (OR=2.85; 95%CI:1.80-4.53); hypertension (OR=2.13; 95%CI:1.17-3.86); and dyslipidemia (OR=1.73; 95%CI:1.07-2.80). CONCLUSION This study revealed that polypharmacy is a real concern in primary health care and affects older and middle-aged adults alike. Groups of patients that are more likely to experience polypharmacy were identified. Our findings emphasize the relevance of an appropriate approach to polypharmacy driven by aging and multimorbidity.
Collapse
Affiliation(s)
- Thais Moreira
- Postgraduate Program in Public Health, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - J Alvares-Teodoro
- Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - M M Barbosa
- Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | | | - A A Guerra Júnior
- Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| | - F A Acurcio
- Postgraduate Program in Public Health, Federal University of Minas Gerais , Belo Horizonte, Brazil.,Department of Social Pharmacy, Federal University of Minas Gerais , Belo Horizonte, Brazil
| |
Collapse
|
15
|
de Souza Groia Veloso RC, Cruzeiro MGM, Dias BM, Reis AMM. Profile of use and access to statins in patients with coronary arterial disease in an outpatient clinic of a teaching hospital. Curr Med Res Opin 2020; 36:1427-1431. [PMID: 32634034 DOI: 10.1080/03007995.2020.1793313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of the study is to describe statin use pattern and access among individuals with coronary artery disease of a secondary care service of the Brazilian Unified Health System. METHODS This is a cross-sectional study carried out in a multi-professional outpatient cardiology clinic at a public, university, and general hospital in the state of Minas Gerais, Brazil. The level of adherence to the recommendations of intensity of the statin therapy of Brazilian and American dyslipidemia guidelines was established. The prescribed statin, adherence to treatment, access, and clinically relevant drug interactions with statins were identified. Access to statin was analyzed through the availability and acquisition capacity realms. RESULTS The sample consisted of 148 patients who were selected from April 2018 to February 2019. Approximately 90% of patients were under 75 years old. The most prevalent cardiovascular diagnoses were acute myocardial infarction with ST-segment elevation and without ST-segment elevation. All patients had a very high cardiovascular risk. Polypharmacy and cardiovascular polypharmacy were identified in 91.2% and 74.3% of patients, respectively. We identified that 90.6% of the patients used a moderate-intensity statin, and simvastatin was the most common stain used. The level of adherence to the recommendations of Brazilian and American dyslipidemia guidelines for statin use was 9.4% and 21.6%, respectively. Total free access to statins by the Unified Health System was 44.6%, with 52.1% of respondents reporting that they received statins at the health center, 25.7% through the popular pharmacy program via copayment, and 33.8% from a private pharmacy. CONCLUSION The level of adherence to the recommendations of U.S. and Brazilian guidelines of dyslipidemia for statin use was low. Most patients used a moderate intensity statin, despite having a high cardiovascular risk. Simvastatin was the most prescribed statin.
Collapse
Affiliation(s)
- Ronara Camila de Souza Groia Veloso
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | | | - Bianca Menezes Dias
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | | |
Collapse
|
16
|
Garcia MM, Azevedo PS, Mirelman A, Safatle LP, Iunes R, Bennie MC, Godman B, Guerra Junior AA. Funding and Service Organization to Achieve Universal Health Coverage for Medicines: An Economic Evaluation of the Best Investment and Service Organization for the Brazilian Scenario. Front Pharmacol 2020; 11:370. [PMID: 32351382 PMCID: PMC7175689 DOI: 10.3389/fphar.2020.00370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There are many health benefits since 31 years after the foundation of the National Health Service (NHS) in Brazil, especially the increase in life expectancy. However, family-income inequalities, insufficient funding, and suboptimal private sector-public sector collaboration are still areas for improvement. The efforts of Brazil to achieve universal health coverage (UHC) for medicines have resulted in increased public financing of medicines and their availability, reducing avoidable hospitalization and mortality. However, lack of access to medicines still remains. Due to historical reasons, pharmaceutical service organization in developing countries may have important differences from high-income countries. In some cases, developing countries finance and promote medicine access by using the public infrastructure of health care/medical units as dispensing sites and cover all costs of medicines dispensed. In contrast, many high-income countries use private community pharmacies and cover the costs of medicines dispensed plus a fee, which includes all logistic costs. In this study, we will undertake an economic evaluation to understand the funding needs of the Brazilian NHS to reduce inequalities in access to medicines through adopting a pharmaceutical service organization similar to that seen in many high-income countries with hiring/accrediting private pharmacies. METHODS We performed an economic evaluation of a model to provide access to medicines within public funds based on a decision tree model with two alternative scenarios public pharmacies (NHS, state-owned facilities) versus private pharmacies (NHS, agreements). The analysis assumed the perspective of the NHS. We identified the types of resources consumed, the amount, and costs in both scenarios. We also performed a budget impact forecast to estimate the incremental funding required to reduce inequalities in access to essential medicines in Brazil. FINDINGS The model without rebates for medicines estimated an incremental cost of US$3.1 billion in purchasing power parity (PPP) but with an increase in the average availability of medicines from 65% to 90% for citizens across the country irrespective of family income. This amount places the NHS in a very good position to negotiate extensive rebates without the need for external reference pricing for government purchases. Forecast scenarios above 35% rebates place the alternative of hiring private pharmacies as dominant. Higher rebate rates are feasible and may lead to savings of more than US$1.3 billion per year (30%). The impact of incremental funding is related to medicine access improvement of 25% in the second year when paying by dispensing fee. The estimate of the incremental budget in five years would be US$4.8 billion PPP. We have yet to explore the potential reduction in hospital and outpatient costs, as well as in lawsuits, with increased availability with the yearly expenses for these at US$9 billion and US$1.4 billion PPP respectively in 2017. INTERPRETATION The results of the economic evaluation demonstrate potential savings for the NHS and society. Achieving UHC for medicines reduces household expenses with health costs, health litigation, outpatient care, hospitalization, and mortality. An optimal private sector-public sector collaboration model with private community pharmacy accreditation is economically dominant with a feasible medicine price negotiation. The results show the potential to improve access to medicines by 25% for all income classes. This is most beneficial to the poorest families, whose medicines account for 76% of their total health expenses, with potential savings of lives and public resources.
Collapse
Affiliation(s)
- Marina Morgado Garcia
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
| | - Pamela Santos Azevedo
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
| | - Andrew Mirelman
- Centre for Health Economics, University of York, York, United Kingdom
| | - Leandro Pinheiro Safatle
- Department of Medicines Market Regulation - Brazilian Health Regulatory Agency (ANVISA), Brasília, Brazil
| | | | - Marion Clark Bennie
- Department of Pharmacoepidemiology, University of Strathclyde, Glasgow, United Kingdom
| | - Brian Godman
- Department of Pharmacoepidemiology, University of Strathclyde, Glasgow, United Kingdom
- Management School, University of Liverpool, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Augusto Afonso Guerra Junior
- Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Collaborating Centre for Health Technology Assessment and Excellence (CCATES), Belo Horizonte, Brazil
| |
Collapse
|
17
|
Garcia MM, Barbosa MM, Silva RM, Reis EA, Alvares J, Assis Acurcio FD, Godman B, Guerra Junior AA. Indicator of access to medicines in relation to the multiple dimensions of access. J Comp Eff Res 2019; 8:1027-1041. [DOI: 10.2217/cer-2019-0031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aim: Creation of a single indicator of access to medicines. Methods: Data collection was performed with individuals who obtained their medication from either public and/or private pharmacies. A Likert scale was used to measure the importance and satisfaction in relation to various access dimensions. Results: A total of 580 individuals were interviewed. Overall, participants attributed very similar importance scores to the dimensions of access to medicines. The results of the mean score of each dimension showed a statistically significant difference according to the type of pharmacy that the participant visited. Conclusion: This developed indicator will enable a review of access to medicines, making comparisons possible as well as improving decision making about public policies in the field of Pharmaceutical Services.
Collapse
Affiliation(s)
- Marina M Garcia
- Federal University of Minas Gerais, Department of Social Pharmacy, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Mariana M Barbosa
- Federal University of Minas Gerais, Department of Social Pharmacy, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Rondineli M Silva
- Sérgio Arouca National School of Public Health of the Oswaldo Cruz Foundation, Department of Drug Policy and Pharmaceutical Assistance, St Leopoldo Bulhões, Room 622–632, Rio de Janeiro, 21041-210, Brazil
| | - Edna A Reis
- Federal University of Minas Gerais, Department Institute of Exact Sciences, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Juliana Alvares
- Federal University of Minas Gerais, Department of Social Pharmacy, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Francisco de Assis Acurcio
- Federal University of Minas Gerais, Department of Social Pharmacy, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and 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, Ga-Rankuwa, Gauteng, South Africa
| | - Augusto A Guerra Junior
- Federal University of Minas Gerais, Department of Social Pharmacy, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| |
Collapse
|