Regional governance arrangements of the Brazilian Unified National Health System: provider diversity and spacial inequality in service provision

"Opportunities and responsibilities": how do pharmacists assess their professionalism?

INTRODUCTION

Professionalism is fundamental to the existence of professions. In pharmacy, interest in this theme improved with events that examined the resocialization of pharmacists in care. With this, evaluating professionalism can help the operationalization of the theme and, consequently, the development of strategies for pharmacy consolidation before its challenges. Therefore, this study aimed to evaluate the professionalism of Brazilian pharmacists.

METHODS

To meet the objective, a cross-sectional study was conducted between March 2022 and August 2023. Data were collected using the Brazilian version of the "Modification of Hall's Professionalism Scale for Use with Pharmacists". The scale has 39 items grouped into the domains: autonomy, vocation, professional council, self-regulation, continuing education, and altruism. Data were analyzed using descriptive statistics and an ANOVA analysis of variance with post-hoc Hochberg or Games-Howell tests with Bootstrapping was conducted to verify differences between groups.

RESULTS

600 pharmacists participated in this study. The majority (69%) was female and carried out their professional activities in community pharmacies (50%). Professionalism scores ranged between 14 and 29 points, with an average of 22.8 points. Pharmacists working in outpatient clinics had higher scores in most factors, namely, altruism, continuing education, professional council, vocation, and autonomy. This indicates that the inclination of pharmacists to occupy areas focused on care can be significant to assess professionalism.

CONCLUSIONS

The data obtained indicate that pharmacists working in outpatient clinics had higher professionalism scores compared to others. This corroborates the worldwide trend experienced by pharmacy in recent decades, which is the execution of increasingly patient-centered practice models.

Structure and process in primary health care for children and spatial distribution of infant mortality

OBJECTIVE

To identify the spatial patterns of the quality of the structure of primary health care services and the teams' work process and their effects on infant mortality in Brazil.

METHODS

An ecological study of spatial aggregates, using the 5,570 municipalities in Brazil as the unit of analysis. Secondary databases from the Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB - National Program for Improving Access and Quality of Primary Care), the Mortality Information System (SIM), and the Live Birth Information System (SINASC) were used. In 2018, the infant mortality rate was the outcome of the study, and the exposure variables were the proportion of basic health units (BHU) with adequate structure and work processes. Global and local Moran's indices were used to evaluate the degree of dependence and spatial autocorrelation. Spatial linear regression was used for data analysis.

RESULTS

In 2018, in Brazil, the infant mortality rate was 12.4/1,000 live births, ranging from 10.6/1,000 and 11.2/1,000 in the South and Southeast, respectively, to 14.1/1,000 and 14.5/1,000 in the Northeast and North regions, respectively. The proportion of teams with an adequate work process (β = -3.13) and the proportion of basic health units with an adequate structure (β = -0.34) were associated with a reduction in the infant mortality rate. Spatial autocorrelation was observed between smoothed mean infant mortality rates and indicators of the structure of primary health care services and the team's work process, with higher values in the North and Northeast of Brazil.

CONCLUSIONS

There is a relationship between the structure of primary health care services and the teams' work process with the infant mortality rate. In this sense, investment in the qualification of health care within the scope of primary health care can have an impact on reducing the infant mortality rate and improving child health care.

Comparison of 1-year survival between patients initiating chronic hemodialysis under public and private health insurance: register-based data analysis from Brazil

PURPOSE

Brazil has one of the world's highest numbers of patients on hemodialysis (HD). Most dialysis centers are private and perform HD for patients with private and public health insurance. We compared 1-year survival between patients initiating chronic HD with public and private health insurance.

METHODS

This is an HD register-based retrospective cohort. Adult patients starting HD from January 2011 to December 2021 were included. Survival analysis was stratified according to the period entered in the HD register. Multivariate Cox regression focused on 1-year survival differences between private and public patients.

RESULTS

In the final sample (n = 5114), 68.5% of participants had public and 31.3% to private health insurance, with overall 1-year survival of 92.8% and 89.9%, respectively (p = 0.002). Crude analysis showed a slightly higher survival rate among patients with public health insurance than those with private health insurance (91 vs. 87%, p = 0.030) in the first period (2019-21). However, the adjusted hazard ratio (HR) did not remain significantly higher for patients with private health insurance compared to those with public health insurance (HR = 1.07; 95% CI 0.80-1.41; p = 0.651), even after propensity score matching of the groups by several baseline features.

CONCLUSION

Brazilian chronic HD patients funded by either private health plans or the public system have a similar 1-year mortality risk after controlling for several sociodemographic and clinical parameters.

Economic burden of depression in Brazil: a cost-of-illness study based on productivity losses and healthcare costs between 2010 to 2018

BACKGROUND

Depression is disabling disorder and cause functional impairments, and high costs for the health and social security system.

OBJECTIVE

The direct and indirect costs of depression from the societal perspective were estimated for the period 2010 to 2018.

METHODS

This cost-of-illness study in adults is based on prevalence, with a top-down approach, from the societal perspective. Direct (hospital and outpatient) and indirect (absenteeism) costs were included. Data were extracted from the Hospital and Outpatient Information Systems and the National Social Security Institute.

RESULTS

The cost of depression was Int$ 2,288,511,607.39 in the analyzed period, with an average annual cost of Int$ 254,279,067.49. From 2014 to 2018, had a sharp and persistent decrease in the cost of depression (-44.24%), mainly in indirect costs (-55.83%). In the period investigated, indirect costs represented 74.85% of the total cost. Over time, outpatient surpassed hospital cost. In 2017 and 2018, outpatient costs represented 43.22% and 39.57% of total costs. In all the years and cost components analyzed, women predominated.

CONCLUSIONS

Depression is a disease with a high economic burden for the healthcare system. Investments are still needed, such as higher coverage of services, multidisciplinary teams, and training of health professionals for psychosocial care.

Epidemiology of inflammatory bowel diseases in the state of Rio Grande do Sul, Brazil

BACKGROUND

This is the first study on the epidemiology of inflammatory bowel diseases (IBDs) in Rio Grande do Sul (RS), the southernmost state of Brazil with the country’s fifth largest population. Crohn’s disease (CD) and ulcerative colitis (UC) are collectively termed IBDs. They have high incidence and prevalence rates in high-income countries, although in recent years there has been a change in the classic geographical distribution of IBDs, with growing rates in traditionally low-incidence regions.

AIM

To estimate the incidence and prevalence of IBDs in the RS state, Brazil, between 2014 and 2019.

METHODS

This is a cross-sectional descriptive observational study. Patients with IBD who had initiated treatment and met the inclusion criteria of the RS state free drug distribution program were included. Data were obtained from registration or renewal records of the RS state specialty pharmacy. The male, female, and total populations were estimated according to mid-year data from the Brazilian Institute of Geography and Statistics, which served as a reference for calculating the incidence and prevalence rates of IBDs during the study period. Results were described using mean, standard deviation, and range.

RESULTS

We included 1082 patients with IBD, of whom 57.5% were female and 42.5% were male. Patients with CD accounted for 72.45% of the sample, and those with UC accounted for 27.54%. IBD prevalence during the study period was 9.51 per 100000 population, of which 6.89 corresponded to people with CD and 2.62, to people with UC. Incidence rates per 100000 population/year were 2.54 in 2014, 2.61 in 2015, 1.91 in 2016, 0.80 in 2017, 0.83 in 2018, and 0.96 in 2019. The mean IBD incidence rate per 100000 population was 1.61, of which 1.17 corresponded to CD and 0.44, to UC. The mean age was 41 years, and patients were mostly aged 30-40 years. Prevalence by region was higher in the state capital metropolitan area: 12.69 per 100000 population.

CONCLUSION

Our results demonstrated an IBD prevalence of 9.51% and incidence of 1.61 per 100000 population. The patients were predominantly female, and CD was more prevalent than UC.