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Lotfizadeh A, Palafox B, Takallou A, Balabanova D, McKee M, Murphy A. Factors associated with the availability and affordability of essential cardiovascular disease medicines in low- and middle-income countries: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000072. [PMID: 36962256 PMCID: PMC10021589 DOI: 10.1371/journal.pgph.0000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/24/2021] [Indexed: 11/19/2022]
Abstract
Despite their potential to prevent or delay the onset and progression of cardiovascular disease (CVD), medicines for CVD remain unavailable and unaffordable to many in low- and middle-income countries (LMICs). We systematically reviewed the literature to identify factors associated with availability and affordability of CVD medicines in LMICs. A protocol for this study was registered on the PROSPERO register of systematic reviews (CRD42019135393). We searched Medline, EMBASE, Global Health, Cumulative Index to Nursing and Allied Health Literature, EconLit, Social Policy and Practice, and Africa Wide Information for studies analyzing factors associated with the presence of medicines (availability) or the price of these medicines as it relates to ability to pay (affordability) in LMICs. We performed a narrative synthesis of the results using an access to medicines framework that examines influences at different levels of the health system. We did not conduct a meta-analysis because of the differences in analytic approaches and outcome measures in different studies. The search was conducted in accordance with PRISMA guidelines. Of 43 studies meeting inclusion criteria, 41 were cross-sectional. Availability and affordability were defined and measured in different ways. A range of factors such as sociodemographic characteristics, facility tier, presence of medicines on national essential medicine lists, and international subsidy programs were examined. The studies had variable quality and findings were often inconsistent. We find gaps in the literature on factors associated with availability and affordability of CVD medicines, particularly at the health program level. We conclude that there is a need for experimental and quasi-experimental studies that could identify causal factors and effective responses. Such studies would help further our understanding of how complex multifactorial influences impact these outcomes, which could inform policy decisions. Along with this, greater standardization of definitions and measurement approaches of availability and affordability are needed to allow for more effective comparisons.
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Affiliation(s)
- Ali Lotfizadeh
- PASHA, Los Angeles, California, United States of America
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Benjamin Palafox
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Armin Takallou
- School of Medicine, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Dina Balabanova
- Department of Global Health and Development, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adrianna Murphy
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
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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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Araújo LU, Santos DF, Bodevan EC, da Cruz HL, de Souza J, 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] [Key Words] [MESH Headings] [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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Vitorino LM, Low G, Lucchetti G. Is the Physical Environment Associated with Spiritual and Religious Coping in Older Age? Evidence from Brazil. JOURNAL OF RELIGION AND HEALTH 2019; 58:1648-1660. [PMID: 30927202 DOI: 10.1007/s10943-019-00796-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this cross-sectional Brazilian survey, we examined associations between aspects of physical environment (PE) and spiritual/religious coping (SRC) behaviors. Our studied sample was 77 nursing homes (NH) and 326 community-dwelling residents (CDRs). Aspects of the PE were measured using the environmental domain of the WHOQOL-BREF. SRC was assessed using the BRIEF SRC scale. The PE was significantly associated with positive SRC alone and differed between the two studied samples. "Feeling safe in daily life" and "having access to health services" were positively associated with positive SRC behaviors in NH residents. "Having access to information" and "adequate transport" were significant among CDRs. Positive SRC behaviors are influenced by PE and should be considered in geriatric and gerontology care.
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Affiliation(s)
- Luciano Magalhães Vitorino
- Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
- Faculty of Medicine of Itajubá, Av. Rennó Júnior, N° 368, São Vicente, Itajubá, Minas Gerais, 37502-138, Brazil.
| | - Gail Low
- Faculty of Nursing, 4rd Floor Edmonton Clinical Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Giancarlo Lucchetti
- School of Medicine, Federal University of Juiz de Fora, Luz Interior Street, N° 150, apt 601, Estrela Sul, Juiz de Fora, 36030-776, Brazil
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Opare-Addo MN, Buabeng KO, Marfo AF, Osei FA, Owusu-Dabo E, Ansong D, Anto BP, Boaheng JM, Nyanor I. Source of medicines and medicine information by self-reported persons living with hypertension and diabetes in rural and urban Ghana. Pharm Pract (Granada) 2018; 16:1151. [PMID: 30416620 PMCID: PMC6207351 DOI: 10.18549/pharmpract.2018.03.1151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 08/14/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives: This study was conducted to determine the source of medicines and medicine information of persons living with hypertension and diabetes in rural and urban Ghana and assessing if they are influenced by predisposing and enabling factors as defined by Andersen’s behavioural model. Methods: A population based cross sectional study was conducted in four (4) rural and four (4) urban districts in the Ashanti Region of Ghana. A multistage and proportional sampling method was used in enrolling participants aged 18 years and above. A pre-tested structured questionnaire was used to collect primary data from respondents. Data collected was exported to STATA for analysis. Descriptive analysis was performed. Chi-square tests/Fisher’s exact test and multinomial logistic regression models were used to establish association between variables. Results: A total of 336 self -reported persons with hypertension and diabetes were enrolled in the study with 199(59.23%) living in urban communities. The majority of participants with hypertension and diabetes living in the rural communities 77 (56.20%) were females contrasting with the male majority in urban communities 106 (53. 27%). In the rural communities, 49 (35.77%) of participants sourced medicines from the health centre while 45 (32.85%) and 35(25.55%) sourced medicines from the hospital and over the counter medicine shop (OTCMS) respectively. In the urban communities, 153 (76.88%) sourced medicines from the hospital while 33 (16.58%) sourced medicines from the pharmacy. The predisposing factor age (OR: 1.1, 95%CI 1.040-1.210) under OTCMS, age (OR 1.0, 95% CI: 1.002-1.066) under hospital and enabling factor socioeconomic status (OR: 0.3, 95%CI 0.085-0.855) under Hospital influenced participant’s source of medicine in the urban communities. The results also revealed that majority of participants in both rural 99 (72.26%), and urban 164 (82.41%) communities sourced medicine information mainly from public healthcare facilities, pre-disposing factors; age (OR 1.1 95%CI 1.032-1.270) under family member, age (OR 1.1, 95%CI 1.022-1.167) under friend health professional, age (OR 1.1, 95%CI 1.050-1.147) under nearest health institution, marital status (OR: 0.004, 95%CI 0.003-0.441) under friend health Professional were found to influence participants’ source of medicine information in the urban communities while in the rural communities the predisposing factor marital status (OR 10.6, 95%CI 1.044 -106.835), education (OR: 26.1, 95%CI 1.271-537.279) under friend health professional, age (OR 1.1, 95%CI 1.002-1.187), educational level (OR 30.6, 95%CI 1.718-546.668) under nearest health institution and enabling factor socio-economic status (OR 6.6, 95%CI 1.016 -43.510) under nearest health institution influenced one’s source of medicine information. Conclusions: Majority of inhabitants with hypertension and diabetes in both rural and urban communities, sourced medicines and medicine information from public health institutions though a larger proportion was recorded in the urban communities. More participants in the rural communities than in the urban communities sourced medicines and medicine information from community pharmacies. Participants’ source of medicine and medicine information was influenced by both predisposing and enabling factors.
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Affiliation(s)
- Mercy N Opare-Addo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology. Kumasi (Ghana).
| | - Kwame O Buabeng
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceu-tical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology. Kumasi (Ghana).
| | - Afia F Marfo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology. Kumasi (Ghana).
| | - Francis A Osei
- Kumasi Centre for Collaborative Research in Tropical Medicine. Kumasi, (Ghana).
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine. School of Public Health, College of Health Sciences Kwame Nkrumah University of Science and Technology, Kumasi (Ghana)
| | - Daniel Ansong
- School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology. Kumasi (Ghana).
| | - Berko P Anto
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology. Kumasi (Ghana).
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Meiners MMMDA, Tavares NUL, Guimarães LSP, Bertoldi AD, Pizzol TDSD, Luiza VL, Mengue SS, Merchan-Hamann E. Access and adherence to medication among people with diabetes in Brazil: evidences from PNAUM. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 20:445-459. [PMID: 29160437 DOI: 10.1590/1980-5497201700030008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/20/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe people with diabetes in Brazil and to compare their sociodemographic characteristics, access and self-reported adherence to diabetes prescribed drugs. METHODS Data analysis from the National Survey on Access, Use and Promotion of the Rational Use of Medicines, a household survey, with sampling by clusters, according to sex and age domains and national and macro-regional representativeness. Adults (≥ 20 years old) who reported having diabetes constituted the sample. The weighted frequencies of the variables in the sample were analyzed and the Pearson χ2 test was applied to evaluate the statistical significance of the differences between the strata for the data of access, form of financing and adherence to the drugs, considering the level of significance of 5%. RESULTS We found a higher proportion of women, people over 60 years and economy class C. Most participants reported having two or more comorbidities, in addition to diabetes, and taking five or more drugs. Regarding access, 97.8% say they have access to prescription drugs for diabetes and 70.7% say they get them totally free of charge. There was low adherence to anti-diabetic treatment, with significant macro-regional differences (p = 0,001), and greater vulnerability in the South and Northeast regions. CONCLUSION Better access to diabetes medicines in the country has been demonstrated. However, to improve the efficiency of health public spending, it is necessary to achieve higher rates of adherence to treatment.
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Affiliation(s)
| | - Noemia Urruth Leão Tavares
- Programa de Pós-graduação em Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília - Brasília (DF), Brasil
| | - Luciano Santos Pinto Guimarães
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas - Pelotas (RS), Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Vera Lucia Luiza
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Edgar Merchan-Hamann
- Programa de Pós-graduação em Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília - Brasília (DF), Brasil
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Oliveira MA, Luiza VL, Tavares NUL, Mengue SS, Arrais PSD, Farias MR, Pizzol TDSD, Ramos LR, Bertoldi AD. Access to medicines for chronic diseases in Brazil: a multidimensional approach. Rev Saude Publica 2016; 50:6s. [PMID: 27982382 PMCID: PMC5157920 DOI: 10.1590/s1518-8787.2016050006161] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 08/09/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyze the access to medicines to treat non-communicable diseases in Brazil according to socioeconomic, demographic, and health-related factors, from a multidimensional perspective. METHODS Analysis of data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM), household survey, sampling plan by conglomerates with representativeness of the Brazilian population and large areas of the country, according to sex and age domains. Data collected in 2013-2014 with sample of adults (≥ 20 years) who reported having non-communicable diseases and medical indication for use of medicines (n = 12,725). We assessed the prevalence of access to medicines for self-reported non-communicable diseases, considering four dimensions: availability, geographic accessibility, acceptability, and affordability. We applied Pearson's Chi-square test to assess the statistical significance of the differences between strata, considering the level of significance of 5%. We found prevalence of 94.3%, 5.2%, and 0.5% for full, partial, and null access, respectively. Higher prevalence was observed among seniors in the South compared to the Northeast; for those who reported having one non-communicable disease compared to those who reported having two or more; for those who needed one medicine compared to those who needed three or more; and for those who self-assessed their health as good or very good. Geographic accessibility was similar in the Unified Health System and in the private pharmacies (72.0%). Total availability of medicines was 45.2% in the Unified Health System, 67.4% in the Popular Pharmacy Program, and 88.5% in private pharmacies. Acceptability was 92.5% in the Unified Health System, 97.8% in the Popular Pharmacy Program, and 98.7% in private pharmacies. As to affordability, 2.6% of the individuals failed to take the medicines they should in the 30-day period prior to the interview due to financial difficulty. Prevalence of full access to medicines for non-communicable diseases in Brazil is high and presents significant differences for age group, region of the country, number of non-communicable diseases, and for medicines prescribed and self-assessment of health. The major barriers to access to medicines were identified in the dimensions analyzed. OBJETIVO Analisar o acesso a medicamentos para tratar doenças crônicas não transmissíveis no Brasil segundo fatores socioeconômicos, demográficos e de saúde, sob perspectiva multidimensional. MÉTODOS Análise de dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar, plano amostral por conglomerados com representatividade da população brasileira e grandes regiões do País, segundo domínios de sexo e idade. Dados coletados em 2013-2014 com amostra constituída por adultos (≥ 20 anos) que referiram ter doenças crônicas não transmissíveis e indicação médica para usar medicamentos (n = 12.725). Avaliou-se a prevalência de acesso aos medicamentos para doenças crônicas não transmissíveis autorreferidas, considerando quatro dimensões: disponibilidade, acessibilidade geográfica, aceitabilidade e capacidade aquisitiva. Aplicou-se teste Qui-quadrado de Pearson para avaliar a significância estatística das diferenças entre os estratos, considerando o nível de significância de 5%. RESULTADOS Foram encontradas prevalências de 94,3%, 5,2% e 0,5% para acesso total, parcial e nulo, respectivamente. Maiores prevalências ocorreram entre os idosos, na região Sul comparada à região Nordeste; naqueles que referiram ter uma doença crônica não transmissível comparados aos que referiram ter duas ou mais; naqueles que precisavam de um medicamento comparados aos que precisavam de três ou mais; e naqueles que autoavaliaram sua saúde como boa ou muito boa. A acessibilidade geográfica foi semelhante no Sistema Único de Saúde e nas farmácias privadas (72,0%). A disponibilidade total de medicamentos foi de 45,2% no Sistema Único de Saúde, 67,4% no Programa Farmácia Popular e 88,5% nas farmácias privadas. A aceitabilidade foi de 92,5% no Sistema Único de Saúde, 97,8% no Programa Farmácia Popular e 98,7% nas farmácias privadas. Quanto à capacidade aquisitiva, 2,6% dos indivíduos não tomou os medicamentos que deveria nos 30 dias anteriores à entrevista devido à dificuldade financeira. CONCLUSÕES A prevalência do acesso total aos medicamentos para doenças crônicas não transmissíveis no Brasil é alta e apresenta diferenças significativas por faixa etária, região do País, número de doenças crônicas não transmissíveis e de medicamentos prescritos e autoavaliação da saúde. Foram identificadas as principais barreiras ao acesso a medicamentos nas dimensões analisadas.
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Affiliation(s)
- Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
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