National Health Survey 2019: medication obtainment through the Brazilian Popular Pharmacy Program by adults being treated for hypertension and diabetes

OBJECTIVE

To describe the proportion of adults with hypertension and diabetes who obtained medication through the Brazilian Popular Pharmacy Program (Programa Farmácia Popular).

METHOD

Population-based descriptive study, using data from the 2019 Brazilian National Health Survey. The proportion of individuals who obtained at least one type of medication for hypertension and diabetes in the Program was analysed according to socioeconomic and demographic characteristics, by regions and federative units.

RESULTS

The proportion of individuals who obtained medication for hypertension was 45.1% (95%CI 43.7;46.5), and, for diabetes, 51.5% (95%CI 49.5;53.6). Respectively for both conditions, medication obtainment was higher in the South region (54.3%; 95%CI 51.3;57.2 and 59.1%; 95%CI 54.6;63.7) and lower in the higher strata level of education (30.9%; 95%CI 27.7;34.2 and 40.7%; 95%CI 35.1;46.3) and income (24.0%; 95%CI 19.7;28.2 and 28.9%; 95%CI 22.1;35.7).

CONCLUSION

Regional and socioeconomic inequalities were identified in obtaining medication for hypertension and diabetes through the Program.

Tendency of use and sources for obtaining oral antidiabetic drugs for treatment of diabetes in Brazil from 2012 to 2018: analysis of the Vigitel survey

OBJECTIVE

To estimate the prevalence of use of oral medications for the treatment of diabetes, as well as the distribution of sources for obtaining according to sociodemographic variables, in the Brazilian states' capitals and in the Federal District, and their evolution from 2012 to 2018.

METHODS

Cross-sectional and population-based study with individuals aged ≥ 20 years who reported a medical diagnosis of diabetes, interviewed through Vigitel from 2012 to 2018. We estimated the prevalence of use and the distribution of sources for obtaining according to sociodemographic variables (95%CI). We checked differences among proportions using the Pearson's χ2 test (Rao-Scott), with a significance level of 5%.

RESULTS

There was an increase in the prevalence of use of oral medications for the treatment of diabetes from 77.4 to 85.2% between 2012 and 2018, and a decrease in obtaining in the Health Unit Pharmacies of the Unified Health System (SUS), while there was an increase in obtaining in Popular Pharmacies.

CONCLUSIONS

In Brazil, SUS remained the main source for obtaining oral antidiabetic drugs, financing more than 70% of them in the country, considering the Health Unit Pharmacies and Popular Pharmacies, thereby showing the importance of public Pharmaceutical Policies in guaranteeing the access to medications by the Brazilian population, as well as in reducing inequities in the country. Nevertheless, the migration of obtaining by users from SUS Health Units to Popular Pharmacies suggests the weakening the responsibility of Primary Health Care in the provision oral antidiabetic drugs, thereby undermining the bond and the longitudinal care.

Use of medicines in São Paulo, Brazil, and State Health Care Coverage, 2003 and 2015

OBJECTIVES

To analyze the use and acquisition of medicines in São Paulo, Brazil, in 2003 and 2015, according to sociodemographic factors, socioeconomic status, and health conditions of the population.

METHODS

Data were obtained from population health surveys "ISA-Capital". Descriptive analysis, bivariate analysis, and logistic regression models were used to evaluate the use of medicines and coverage by the Brazilian Unified Health System (SUS) according to socioeconomic status and health conditions in two periods: 2003 and 2015.

RESULTS

From 2003 to 2015, the surveys showed an increase in the income and education level of the study population. There was no increase in the prevalence of chronic diseases and use of medicines from 2003 to 2015. The provision of medicines by SUS was higher in 2015 than in 2003, and the coverage by SUS was higher in the population with lower education level and income in both 2003 and 2015.

CONCLUSIONS

The use of medicines, mainly for chronic disease control, did not change over the years, and there was an increase in SUS coverage for medicines during 2003-2015 in all population groups, with a greater impact on the lower socioeconomic status population. The programs of the provision of medicines implanted since 2003 had influenced the greater SUS coverage for medicines and in the reduction of inequalities in access to medicines.

Use and sources of psychotropic drugs by Brazilian adults and seniors

The aim of the present study was to estimate the prevalence of psychotropic drug utilization among adults and seniors and determine associated factors, therapeutic classes and sources of acquisition. Data from the Brazilian National Survey on Access, Use and Promotion of the Rational Use of Medicines (2013-2014) were analyzed. The prevalence of use of at least one psychotropic drug in the overall sample (adults and seniors) was 8.7%. In the adjusted analyses, positive associations were found between the use of psychotropic drugs and the female sex, poorer self-rated health and chronic diseases (p < 0.05). The most frequently used therapeutic classes were antidepressants (55.3%) by the adults and anxiolytics (59.3%) by the seniors. Approximately 23.0% of psychotropic drugs were obtained exclusively from pharmacies of the public healthcare system and 77.0% were acquired from other sources. The findings reveal a low proportion of attaining psychotropic drugs through the Brazilian public healthcare system as well as the need for public policies that encourage the rational use of prescriptions and treatments to promote a better quality of life and ensure the population's right to health.

Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines

Objective

To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population.

Methods

This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined.

Results

The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval − 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors.

Conclusion

The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.

Avaliação dos usuários sobre as farmácias públicas no Brasil

Resumo O objetivo deste artigo é avaliar aspectos relacionados aos serviços prestados nas farmácias do SUS do Brasil, segundo a percepção dos usuários. Utilizou-se dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos, realizada entre 2013 e 2014. Analisou-se indivíduos que obtiveram algum medicamento nas farmácias públicas. Para o cálculo das estimativas de prevalências, foi usado como denominador o total de usuários de medicamentos com IC95%. A partir da faixa etária de 20 a 24 anos até 60 a 64 anos observa-se diferenças significativas entre homens e mulheres, em relação ao uso de farmácias públicas. Mais de 30% das pessoas de todas as classes socioeconômica que não obtiveram medicamentos nas farmácias do SUS, nunca pensaram nessa possibilidade. Não costumam esperar para obtenção dos medicamentos e avaliação positiva do horário de funcionamento tiveram uma associação mais forte em relação a avaliação positiva dos usuários das farmácias do SUS. O horário de funcionamento e o tempo de espera são potenciais barreiras nas farmácias do SUS. A avaliação dos usuários que utilizam o SUS é positiva, mas aponta diferenças regionais e a identificação da magnitude dessas pode contribuir na formulação de políticas mais eficazes e equânimes.

Prevalence of use and sources of antihypertensive medicine in Brazil: an analysis of the VIGITEL telephone survey

OBJECTIVE

The prevalence of hypertension in Brazil and worldwide has been increasing in recent decades, and drug therapy is one of the strategies used to control this condition. The objective of this study was to estimate the prevalence of use and identify the sources for obtaining antihypertensive drugs in Brazil, according to sociodemographic variables, comparing three periods: 2011, 2014 and 2017.

METHODS

Data from individuals aged ≥20 years who reported a medical diagnosis of hypertension, interviewed by Vigitel in 2011, 2014 and 2017 were used. Frequency and prevalence of drug use in addition to the sources for obtaining medication were estimated by sociodemographic variables, with 95% confidence intervals. The differences between proportions were verified by Pearson's chi-square test (Rao-Scott), with a significance level of 5%.

RESULTS

The prevalence of antihypertensive drug use remained stable (80%). Regarding the sources for obtaining these medicines, there was variation in the period, indicating a decrease in usage through the Brazilian Unified Health System (SUS) (44.2% in 2011; 30.5% in 2017). This decrease was accompanied with increase in PFPB (16.1% in 2011; 29.9% in 2017). The prevalence of other sources for obtaining medicine (private pharmacies/drugstores) showed stability in the period.

CONCLUSIONS

The prevalence of medication use remained high and there was a change in the pattern of use according to sources, demonstrating migration between SUS pharmacies to the PFPB, and suggesting a reduction in the availability of medicines from public pharmacies universally, and for free.

[Obtaining drugs for hypertension and diabetes through the Brazilian People's Pharmacy Program: results of the National Health Survey, 2013]

OBJECTIVE

to describe the proportion of hypertensive and diabetic patients who reported getting medicines to control these diseases via the Brazilian People's Pharmacy Program, according to sociodemographic factors.

METHODS

this was a population-based descriptive study using 2013 National Health Survey data on individuals aged over 18 years.

RESULTS

around one third of hypertensive individuals (35.9%; 95%CI 34.1-37.7) and more than half of those with diabetes (57.4%; 95%CI 54.2-60.2%) had got at least one kind of medication via the Program, there being some differences between the country's regions. Among patients with diabetes, higher rates of getting medication were found in black people (69.4%; 95%CI 60.8-77.9) and those with less schooling (0-8 years) (63.9%; 95%CI 60.2-67.7), with no significant differences between age groups or sex.

CONCLUSION

obtaining at least one kind of medication to treat hypertension and diabetes via the Program was high, especially among the underprivileged.

[Sources of medicines for chronic patients using the Brazilian Unified National Health System]

The article aimed to identify the sources of medicines for users of the Brazilian Unified National Health System (SUS) that reported chronic non-communicable diseases, characterizing the group according to demographic, socioeconomic, and health variables in the different regions of Brazil. Data were analyzed from the National Survey on Access, Use, and Promotion of Rational Use of Medicines in Brazil (PNAUM), a cross-sectional population-based study. The dependent variable was "source of medicines", and the associations were analyzed with demographic, socioeconomic, and health status variables. Users that obtained care and medicines solely in the SUS were designated here as SUS-exclusive. Some 39% of persons obtained their medicines from SUS pharmacies and 28.5% from other sources. The study found 42.9%, 41.8%, 40.2%, and 31% of exclusive SUS users in the Southeast, South, North, and Northeast regions of Brazil, respectively. SUS users have the SUS as their primary source of medicines, but there is also a relevant share from other sources, suggesting problems with access in the SUS. In the South and Southeast regions, the population relies less on private pharmacies than in the Northeast and North.

Access to medicines: relations with the institutionalization of pharmaceutical services

OBJETIVE

To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care.

METHODS

This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services 2015), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis.

RESULTS

Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: "management tools," "participation and social control," "financing," and "personnel structure," with significant associations in the bivariate analysis. The "pharmaceutical care" dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5).

CONCLUSIONS

Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies.

Polypharmacy: a challenge for the primary health care of the Brazilian Unified Health System

OBJECTIVE

To characterize the polypharmacy in primary health care patients and to identify its associated factors.

METHODS

This is a cross-sectional, exploratory, and evaluative study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). The variable of interest was polypharmacy, defined as the use of five or more medicines. We sought to identify the association of sociodemographic variables and indicators of health conditions to polypharmacy. For group comparison, the Pearson's Chi-square test was used. The association between polypharmacy and explanatory variables was evaluated by logistic regression model (p < 0.05). The quality of the adjustment was verified by Hosmer-Lemeshow test.

RESULTS

The prevalence of polypharmacy among medicine users was 9.4% (95%CI 7.8-12.0) in the general population and 18.1% (95%CI 13.6-22.8) in older adults above 65 years old. We found statistically significant association between polypharmacy and age above 45 years, lower self-perception of health, presence of chronic diseases, having health insurance, care in emergency services, and region of the Country. South users presented the highest chances to polypharmacy. The most used medicines were those of the cardiovascular system, being compatible with the national epidemiological profile.

CONCLUSIONS

Polypharmacy is a reality in the population met within the primary care of Brazilian Unified Health System and may be related to excessive or inappropriate use of medicines. The main challenge to qualify health care is to ensure that prescription of multiple medicines be appropriate and safe.

Conceptions on pharmaceutical services in Brazilian primary health care

OBJECTIVE

To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects.

METHODS

This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions.

RESULTS

Among the wide diversity of conceptions on pharmaceutical services (PS), we highlight the ones focused on 1) logistic control of medicines with activities concerning guidance or information on their use and 2) guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services.

CONCLUSIONS

The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified, in their reorientation process, a movement that reflects a gradual shift in the technical paradigm, from the focus on medicine logistics to a user-oriented approach of health services.

Technical issues and conservation conditions of medicines in the primary health care of the Brazilian Unified Health System

OBJECTIVE

To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance.

METHODS

This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines - Services)-, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21.

RESULTS

The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance.

CONCLUSIONS

The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of requirements essential to the conservation of medicines. We observed a disconnection between the efforts made in the Brazilian Unified Health System to promote access to medicines for all population and the organization and qualification of pharmaceutical services.

Management of pharmaceutical services in the Brazilian primary health care

OBJECTIVE

To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS).

METHODS

This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions.

RESULTS

We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators.

CONCLUSIONS

Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

Characterization of the selection of medicines for the Brazilian primary health care

OBJECTIVE

To characterize the process of selection of medicines for primary health care in the Brazilian regions.

METHODS

This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05.

RESULTS

The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands.

CONCLUSIONS

As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.

Financing of Pharmaceutical Services in the municipal management of the Brazilian Unified Health System

OBJECTIVE

To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System.

METHODS

The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil - Serviços (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone.

RESULTS

Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF - Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities.

CONCLUSIONS

We found serious deficiencies in the public financing of medicines, as well as little concern about the formality in the use of public resources, expenses that meet individual demands to the detriment of the community, insufficient resources allocated to the Basic Component of Pharmaceutical Services, and exhaustion of the financing model.

Characterization of the institutionalization of pharmaceutical services in Brazilian primary health care

OBJECTIVE

To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities.

METHODS

This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%), partial (35.0%-69.0%), and advanced (70.0%-100%), estimated based on the interviewees' answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of p<0.05.

RESULTS

Our results show a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazil, and an advanced stage in formal structures, such as the municipal health plans and the existence of a standardized list of medicines. The analysed variables in the "organization, structure, and financing" dimension configured stages that range from partial to advanced. The management presented partial institutionalization, positively showing the existence of computerized system, but also disparate results regarding the autonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences.

CONCLUSION

The study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional disparities. Variables related to the normative aspects of institutionalization were positively highlighted in all dimensions; however, it is necessary to conduct new studies to evaluate the institutionalization of pharmaceutical services' finalistic activities.

Access to medicines by patients of the primary health care in the Brazilian Unified Health System

OBJECTIVE

To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective.

METHODS

This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators.

RESULTS

For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines.

CONCLUSIONS

Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population.

Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM - Services data

OBJECTIVE

To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services.

METHODS

This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research.

RESULTS

The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2, while in 46.2% these areas were superior to 10m2. Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation.

CONCLUSION

Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities.

Main characteristics of patients of primary health care services in Brazil

OBJECTIVE

To characterize patients of primary health care services according to demographic and socioeconomic aspects, habits and lifestyle, health condition, and demand for health services and medicines.

METHODS

This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services), a cross-sectional study carried out between 2014 and 2015. Interviews were conducted with patients over the age of 17 years, with a standardized questionnaire, in primary health care services of a representative sample of cities, stratified by regions of Brazil. The analysis was performed for complex samples and weighted according to the population size of each region.

RESULTS

A total of 8,676 patients were interviewed, being 75.8% women, most of them aged from 18 to 39 years; 24.2% men, most of them aged from 40 to 59 years; 53.7% with elementary school; 50.5% reported to be of mixed race ethnicity, 39.7%, white, and 7.8%, black. Half of patients were classified as class C and 24.8% received the Bolsa Familia benefit. Only 9.8% had health insurance, with higher proportion in the South and lower in the North and Midwest. The proportion of men who consumed alcohol was higher than among women, as well as smokers. The self-assessment of health showed that 57% believed it to be very good or good, with lower proportion in the Northeast. The prevalence of chronic diseases/conditions, such as hypertension (38.6%), dyslipidemia (22.7%), arthritis/rheumatism (19.4%), depression (18.5%), diabetes (13.6%), and others are higher in these patients them among the general population. Medicines were predominantly sought in the health care service or in pharmacies of the Brazilian Unified Health System.

CONCLUSIONS

It was possible to characterize the profile of patients of Primary Health Care, but the originality of the research and its national scope hinders the comparison of results with official data or other articles.

Use of medicines by patients of the primary health care of the Brazilian Unified Health System

OBJECTIVE

To characterize the use of medicines by patients of the primary health care of the Brazilian Unified Health System (SUS).

METHODS

This is a cross-sectional, exploratory, and descriptive study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Interviews were carried out with patients present in the services by semi-structured questionnaires. Sociodemographic, clinical, and use of medicines variables were assessed and the use of medicines in the 30 days prior to the interview was also verified. The population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years or more. The differences between the age groups were verified using the Student’s t-test for continuous variables and chi-square test for the categorical ones. The complex samples analysis plan was employed. The medicines were classified according to the Anatomical Therapeutic Chemical Classification System.

RESULTS

Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used medicines in the 30 days prior to the interview. On average, each patient used 2.32 medicines, without difference between the sexes. Among medicine users, 18.2% were aged 65 years or more. Compared to the other age groups, older adults presented more comorbidities, used more medicines, and self-reported worse health conditions. They were also less educated, reported worse economic situation, and lived alone. The medicines that were mostly used were “other analgesics and antipyretics” (3^rd ATC level) and Losartan (5^th ATC level).

CONCLUSIONS

Most medicine users had lower education level and presented comorbidities. The most used medicines were the antihypertensive ones. Self-medication was higher among young people. Most patients reported to use generic medicines. The average number of medicines and the prevalence of use increased with age. Due to the characteristics observed and the difficulties in the use of medicines, older adults are in a situation of greater vulnerability.

Indicators related to the rational use of medicines and its associated factors

OBJECTIVE

To evaluate indicators related to the rational use of medicines and its associated factors in Basic Health Units.

METHOD

This is a cross-sectional study carried out in a representative sample of Brazilian cities included in the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The data were collected by interviews with users, medicine dispensing professionals, and prescribers; and described by prescription, dispensing, and health services indicators. We analyzed the association between human resources characteristics of pharmaceutical services and dispensing indicators.

RESULTS

At national level, the average number of medicines prescribed was 2.4. Among the users, 5.8% had antibiotic prescription, 74.8% received guidance on how to use the medicines at the pharmacy and, for 45.1% of users, all prescribed medicines were from the national list of essential medicines. All the indicators presented statistically significant differences between the regions of Brazil. The dispensing professionals that reported the presence of a pharmacist in the unit with a working load of 40 hours or more per week presented 1.82 more chance of transmitting information on the way of using the medicines in the dispensing process.

CONCLUSION

The analysis of prescription, dispensing, and health services indicators in the basic health units showed an unsatisfactory proportion of essential medicines prescription and limitations in the correct identification of the medicine, orientation to the patients on medicines, and availability of therapeutic protocols in the health services.

Medicine dispensing service in primary health care of SUS

OBJECTIVE

To characterize the medicine dispensing services in the primary health care network in Brazil and in its different regions, aiming to promote the access and rational use of medicines.

METHODS

This is a cross-sectional, quantitative study with data obtained from the Pesquisa Nacional sobre Acesso, Utilização e Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), 2015. Observation visits were carried out in 1,175 dispensing units, and interviews were held with 1,139 professionals responsible for the dispensation of medicines in the dispensing units and 495 municipal coordinators of pharmaceutical services.

RESULTS

More than half (53%) of the units presented a space smaller than 10 m2 for dispensing of medicines; 23.8% had bars or barriers between users and dispenser; 41.7% had computerized system; and 23.7% had counters for individual care. Among those responsible for dispensation, 87.4% said they always or repeatedly inform users how to use the medicines, and 18.1% reported developing some type of clinical activity. Isolated pharmacies presented a more developed physical and personal structure than those belonging to health units, but we found no significant differences regarding the information provided and the development of clinical activities.

CONCLUSIONS

There are major differences in the organization models of dispensation between cities, with regional differences regarding the physical structure and professionals involved. The centralization of medicine dispensing in pharmacies separated from the health services is associated with better structural and professional conditions, as in the dispensing units of the South, Southeast, and Midwest regions. However, the development of dispensation as health service does not prevail in any pharmacy or region of the Country yet.

Health-related quality of life of patients of Brazilian primary health care

OBJECTIVE

To analyze the Health-Related Quality of Life (HRQoL) of patients of the primary health care of the Brazilian Unified Health System (SUS) and its associated factors.

METHODS

This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D) instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors.

RESULTS

Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7%) and anxiety/depression (38.8%). About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services.

CONCLUSIONS

The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System.

Pharmaceutical services in the primary health care of the Brazilian Unified Health System: advances and challenges

This study is a synthesis of the main results of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), Evaluation Component of the Basic Pharmaceutical Services. Based on the critical narrative of the elements of Brazil's pharmaceutical policies, we discuss aspects related to the structure of the pharmaceutical services, the medicines' sanitary state, human resources, access to medicines, rational use and management. Despite the advances that reflect the commitment of the group of actors involved, the results of the Survey indicate challenges, such as equitable access to medicines, the structuring of pharmaceutical services, the improvement of logistics and administration, and the implementation of actions directed to pharmaceutical care in the health units.

Patient satisfaction with pharmaceutical services in Brazilian primary health care

OBJECTIVE

To evaluate patient satisfaction with pharmaceutical services in Brazilian primary health care.

METHODS

This is a cross-sectional, exploratory, and evaluative study on a representative sample from the five Brazilian geopolitical regions resulting from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). The outcome was the patient's satisfaction, obtained using the item response theory. Associations were tested using Pearson's Chi-square test with sociodemographic and health variables, and multiple logistic regression analyses were carried out. The Hosmer-Lemeshow test was used to verify the adequacy of the final model. Logistic regression results were presented as odds ratio.

RESULTS

The overall percentage of patients satisfied with these services was 58.4% (95%CI 54.4-62.3). The "opportunity/convenience" aspect had the lowest satisfaction percentage (49.5%; 95%CI 46.4-52.6) and "interpersonal aspects," the highest percentage (90.5%; 95%CI 88.9-91.8), significantly higher than other aspects. Sex, age group, limitations due to disease, and self-perception of health remained associated in the final multiple logistic model regarding general satisfaction.

CONCLUSIONS

Most of the interviewed users were satisfied with pharmaceutical services in Brazilian cities, and the satisfaction with the customer's service was determinant in the patient's overall satisfaction.

Availability of essential medicines in primary health care of the Brazilian Unified Health System

OBJECTIVE

To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS).

METHODS

This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename - National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed.

RESULTS

One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis.

CONCLUSIONS

The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer medicines in SUS confirm the general availability verified in this study. Among patients, about 60% said they obtain medicines in SUS units, data consistent with the lack of medicines reported by medicine dispensers and in line with physicians' evaluations.

Workforce in the pharmaceutical services of the primary health care of SUS, Brazil

OBJECTIVE

To characterize the workforce in the pharmaceutical services in the primary care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional and quantitative study, with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). For the analysis, we considered the data stratification into geographical regions. We analyzed the data on workers in the municipal pharmaceutical services management and in the medicine dispensing units, according to the country's regions. For the statistical association analysis, we carried out a Pearson correlation test for the categorical variables.

RESULTS

We analyzed 1,175 pharmacies/dispensing units, 507 phone interviews (495 pharmaceutical services coordinators), and 1,139 professionals responsible for medicine delivery. The workforce in pharmaceutical services was mostly constituted by women, aged from 18 to 39 years, with higher education (90.7% in coordination and 45.5% in dispensing units), having permanent employment bonds (public tender), being for more than one year in the position or duty, and with weekly work hours above 30h, working both in municipal management and in medicine dispensing units. We observed regional differences in the workforce composition in dispensing units, with higher percentage of pharmacists in the Southeast and Midwest regions.

CONCLUSIONS

The professionalization of municipal management posts in primary health care is an achievement in the organization of the workforce in pharmaceutical services. However, significant deficiencies exist in the workforce composition in medicine dispensing units, which may compromise the medicine use quality and its results in population health.

National Survey on Access, Use and Promotion of Rational Use of Medicines: methods

The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos -Serviços (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services) aimed to characterize the organization of pharmaceutical services in the Primary Health Care of the Brazilian Unified Health System (SUS). PNAUM - Services is a cross-sectional and evaluative study, with planned sample of 600 cities, held between 2014 and 2015, composed of a remote phase, with telephone interviews with health managers. Of these 600 cities, 300 were selected for a survey on health services. We selected the 27 capitals, the 0.5% largest cities of each region, and the remaining cities were drawn. The estimate of the representative national sample size considered three levels: cities, medicine dispensing services, and patients. The interviews were carried out with a structured questionnaire specific for: municipal secretaries of health, professionals responsible for pharmaceutical services in the city, professionals responsible for the dispensing of medicines, physicians, and patients. The secondary data were obtained in official databases, in the latest update date. PNAUM - Services was the first nationwide research aimed at the assessment and acquisition of national and regional indicators on access to medicines, as well as use and rational use, from the perspective of various social subjects.

Pharmaceutical care in Brazil's primary health care

OBJECTIVE

To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion.

METHODS

This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285) were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals.

RESULTS

From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were "pharmaceutical guidance" and "pharmaceutical care." The registration of activities is mainly made in the users' medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated.

CONCLUSIONS

Activities of clinical nature performed by pharmacists in Brazil are still incipient. The difficulties found point out to the professionals' improvisation and effort. The small participation in educational activities of health promotion indicates little integration of pharmacists with the health team and of pharmaceutical services with other health actions.

Sources for obtaining drugs for hypertension in Brazil: results from the National Health Survey, 2013

OBJECTIVE

To analyze the sociodemographic differences among adults with hypertension regarding the sources for obtaining drugs for hypertension treatment in Brazil.

METHODS

This is a secondary analysis of data from the National Health Survey 2013; the outcomes considered for the analysis were the sources for obtaining drugs for treating high blood pressure.

RESULTS

The great majority (74%) of patients with hypertension taking drugs use a single source for obtaining them, 7.3% (95%CI 6.4 - 8.4) reported getting all the drugs through private health plans, 22.7% (95%CI 21.0 - 24.4) by pharmacies of the public health system, 21.8% (95%CI 20.2 - 23.4) by the Popular Pharmacy Program, and about one-third (29.5%; 95%CI 27.7 - 31.4) exclusively by commercial pharmacies. Having the public health system as the single source for obtaining the drugs was found to decrease with age, was lower in white people, decreased strongly with increase in education, and was lower for residents in the North region. Exclusive obtainment through the Popular Pharmacy Program was lower for people with higher education. Obtainment in commercial pharmacies was positively associated with being male, with higher education level, being older, and having white skin color. Obtainment using more than one source was positively associated with increasing age and inversely associated with higher education levels.

CONCLUSIONS

The results allowed the identification of a trajectory of patients in obtaining drugs for the treatment of hypertension, aiming at explaining how the drugs are obtained and the impact of public policies in this sector in the country.

Coordinación entre servicios farmacéuticos para una farmacoterapia integrada: el caso de Cataluña

Resumen Las políticas farmacéuticas han sido consideradas como estratégicas para contribuir con la garantía de la coordinación asistencial y la integración clínica. El presente estudio tiene como objetivo describir los servicios farmacéuticos desarrollados en diferentes niveles asistenciales en la red de salud de Cataluña, así como identificar y analizar los mecanismos e instrumentos que actúan como facilitadores y/o barreras para la coordinación de la farmacoterapia. Se trata de un estudio descriptivo de 12 casos de los servicios farmacéuticos hospitalarios, atención primaria y oficinas de farmacia comunitarias. Se identifica avances que relacionan la percepción, formalización y la coordinación asistencial y clínica de los servicios farmacéuticos. Sin embargo, se identifican también fragilidades y situaciones mejorables en cuanto a la coordinación. Se concluyó que las diferentes herramientas e instrumentos implantados, parece facilitar una mayor posibilidad de integración entre servicios farmacéuticos y de éstos con la red de salud para contribuir con una farmacoterapia integrada.

Comments on "The organization of pharmaceutical services by 'health region' in Brazil's Unified Health System"

This study aimed to describe and characterize the pharmaceutical services provided in Brazil's Unified Health System (SUS) from the point of view of the healthcare networks that are organized by region in the QualiSUS-Rede Project. This was a cross-sectional study, with data collected from December 2013 to July 2015, in public health establishments that carried out delivery or warehousing of medications (n = 4,938), in 465 municipalites, and the Federal District, in 43'Health Regions'. The results show the existence of at least one management service supporting the health network, and warehousing of medications in all the regions (> 90%). It also showed the availability of at least one healthcare service, in healthcare locations, by pharmaceutical professionals is irregular between the Regions, being highest in the Southeastern Region (74.3%), and lowest in the Northeastern Region (43.3%). The results underpine the need for effective structuring of pharmaceutical assistance in the SUS networks, overcoming the current restrictive vision of its activities, which gives value almost exclusively to the logistical component of support to the network, to the detriment of the clinical component. It is also important to expand, and improve the quality of, the population's access to medical drugs, and improve the quality of the healthcare offered to users of the system.

Free access to medicines for the treatment of chronic diseases in Brazil

OBJECTIVE

To analyze the free access to medicines for the treatment of chronic diseases in the Brazilian population, according to demographic and socioeconomic factors. We also analyzed the most used pharmacological groups, according to funding source: free-of-charge or out-of-pocket paid.

METHODS

Analysis of data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based household survey, of cross-sectional design, based on probabilistic sample of the Brazilian population. We analyzed as outcome the prevalence of free access (free-of-charge) to all medicines for treatment of the reported chronic diseases, in the last 30 days. We studied the following independent variables: sex, age group, education in complete years of school, economic class, health plan, and geographical region of residence. We estimated the prevalences and 95% confidence intervals (95%CI) and applied the Pearson's Chi-squared test to assess the differences between the groups, considering a 5% significance level.

RESULTS

About half of adults and older adults who have had full access to the treatment of chronic diseases in Brazil obtained all needed medicines for free (47.5%; 95%CI 45.1-50.0). The prevalences of free access were higher among men (51.4%; 95%CI 48.1-54.8), age group of 40-59 years (51.1%; 95%CI 48.1-54.2), and in the poorest social classes (53.9%; 95%CI 50.2-57.7). The majority of medicines that act on the cardiovascular system, such as diuretics (C03) (78.0%; 95%CI 75.2-80.5), beta-blockers (C07) (62.7%; 95%CI 59.4-65.8), and the agents that work in the renin-angiotensin system (C09) (73.4%; 95%CI 70.8-75.8), were obtained for free. Medicines that act on the respiratory system, such as agents against obstructive airway diseases (R03) (60.0%; 95%CI 52.7-66.9) were mostly paid with own resources.

CONCLUSIONS

Free access to medicines for treatment of chronic diseases occurs to a considerable portion of the Brazilian population, especially for the poorest ones, indicating decreased socioeconomic inequalities, but with differences between regions and between some classes of medicines.

OBJETIVO

Analisar o acesso gratuito ao tratamento medicamentoso para doenças crônicas na população brasileira, segundo fatores socioeconômicos e demográficos. Analisaram-se também os grupos farmacológicos mais utilizados, segundo fonte de financiamento: gratuito ou pago do próprio bolso.

MÉTODOS

Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar de base populacional, de delineamento transversal, baseado em amostra probabilística da população brasileira. O desfecho analisado foi a prevalência de acesso gratuito (sem pagamento) a todos os medicamentos para tratamento das doenças crônicas referidas, nos últimos 30 dias. As variáveis independentes investigadas foram: sexo, faixa etária, escolaridade em anos completos de estudo, classe econômica, plano de saúde e região geográfica de residência. Foram estimadas as prevalências e calculados intervalos de 95% de confiança (IC95%) e aplicado o teste Qui-quadrado de Pearson para avaliação das diferenças entre os grupos, considerando nível de significância de 5%.

RESULTADOS

Cerca de metade dos adultos e idosos que tiveram acesso total ao tratamento de doenças crônicas no Brasil obtiveram todos os medicamentos que necessitavam gratuitamente (47,5%; IC95% 45,1-50,0). As prevalências de acesso gratuito foram maiores entre os homens (51,4%; IC95% 48,1-54,8), na faixa etária de 40-59 anos (51,1%; IC95% 48,1-54,2) e nas classes sociais mais pobres (53,9%; IC95% 50,2-57,7). Grande parte dos medicamentos que atuam no sistema cardiovascular, como os diuréticos (C03) (78,0%; IC95% 75,2-80,5), betabloqueadores (C07) (62,7%; IC95% 59,4-65,8) e os agentes que atuam no sistema renina-angiotensina (C09) (73,4%; IC95% 70,8-75,8) foram obtidos de forma gratuita. Os medicamentos que atuam no sistema respiratório como os agentes contra doenças obstrutivas das vias aéreas (R03) (60,0%; IC95% 52,7-66,9) foram na sua maioria pagos do próprio bolso.

CONCLUSÕES

O acesso gratuito aos medicamentos para tratamento das doenças crônicas ocorre para uma considerável parcela da população brasileira, principalmente para os mais pobres, indicando diminuição das desigualdades socioeconômicas, mas com diferenças regionais e entre algumas classes de medicamentos.

PNAUM: integrated approach to Pharmaceutical Services, Science, Technology and Innovation

This paper describes the development process of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines) based on an integrated approach to pharmaceutical services, science, technology and innovation. It starts by contextualizing health and development in Brazil and features elements of the National Policy for Science, Technology and Innovation in Health in Brazil and the National Policy for Pharmaceutical Services. On presenting pharmaceutical policy guidelines, it stresses the lack of nationwide data. This survey, commissioned by the Brazilian Ministry of Health, has two components: household survey and evaluation of pharmaceutical services in primary care. The findings point to perspectives that represent, besides the enhancement of public policy for pharmaceutical services and public health, results of government action aimed at developing the economic and industrial health care complex to improve the health conditions of the Brazilian population. RESUMO O artigo apresenta o processo de construção da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamento a partir de uma concepção integradora da Assistência Farmacêutica, Ciência, Tecnologia e Inovação. Inicia-se contextualizando a saúde e o desenvolvimento no País e apresenta elementos da Política Nacional de Ciência Tecnologia e Inovação em Saúde no Brasil e da Política Nacional de Assistência Farmacêutica. Ao apresentar as diretrizes das Políticas Farmacêuticas, destaca-se a carência de dados de abrangência nacional. A presente pesquisa, encomendada pelo Ministério da Saúde, foi estruturada em dois componentes: inquérito domiciliar e avaliação dos serviços de assistência farmacêutica na atenção básica. As perspectivas dos resultados representam, além do incremento das políticas públicas farmacêuticas e de saúde pública, resultados de ações governamentais voltadas ao desenvolvimento do complexo econômico-industrial da saúde, visando a melhoria das condições de saúde da população brasileira.

[Sources of medicines for hypertension and diabetes in Brazil: telephone survey results from Brazilian state capitals and the Federal District, 2011]

This study aimed to analyze differences between patients with diabetes and hypertension in drug treatment and their sources for obtaining medication. This was a cross-sectional study with data from the VIGITEL telephone survey in 2011 in Brazil's state capitals and Federal District. Some 72% of the 15,027 hypertensive patients and 78.2% of the 4,083 diabetics were on medication; 45.8% of the hypertensive patients obtained their medications from public health units, 15.9% from the Popular Pharmacy program, and 38.3% from drugstores, pharmacies, and other sources. The rates among diabetics were 54.4%, 16.2%, and 29.4%, respectively. In the public health units the percentages were highest among individuals with less schooling, black or brown skin, and without private health plans, while the percentages in the Popular Pharmacy program and drugstores/pharmacies and other sources were higher among individuals with more schooling, white skin, and private health plans. Access to different sources of medicines showed disparities between Brazil's regions and state capitals and between social segments of the population.

Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil

Resumo O uso de medicamentos é influenciado por diferentes fatores. O objetivo foi analisar esse uso e identificar as fontes de obtenção e fatores associados. Estudo transversal de base populacional, amostra por conglomerados, em dois estágios, em Campinas, São Paulo, Brasil, 2008. A prevalência de uso de ao menos um medicamento nos três dias prévios foi de 57,2%, a de obtenção no Sistema Único de Saúde (SUS) foi de 30%. Cerca de 47,8% dos indivíduos que não tinham plano precisaram desembolsar para adquirir os medicamentos e 10,9% dos que tinham obtiveram no SUS. Utilizaram com maior frequência os medicamentos do SUS os indivíduos com mais idade, viúvos, pretos/pardos, com menor escolaridade e renda, e que não tinham plano. Apenas 2,1% da população entrevistada referiram não ter conseguido obter o medicamento que lhe havia sido prescrito, e os principais motivos foram não ter no sistema público e a falta de recurso. O estudo identifica os segmentos com maior obtenção de medicamentos do SUS e revela que estes subgrupos apresentam porcentuais baixos de uso no sistema.

The use of medication and associated factors among adults living in Campinas, São Paulo, Brazil: differences between men and women

The objective of this study was to verify factors associated with the use of medication by adults, with emphasis on the differences between men and women. It was a population-based, cross-sectional study with cluster sampling conducted in two stages in Campinas in the state of São Paulo in 2008. Among the 2,413 individuals aged 20 or older, the prevalence of use of at least one drug in the three days before the research was 45.4% (95% CI: 41.3 - 49.4) in men and 64.6% (95% CI: 59.8 - 69.2) in women. For adult men over 40 years old who were not working, former smokers, with one or more chronic diseases, with two or more health problems and who sought health care or a health professional in the two weeks preceding the research showed higher prevalence of medication use. Among women, a higher prevalence of use was observed in females over 40, obese, former smokers, who reported a short sleep pattern, with one or more chronic diseases and two or more health problems, and who reported seeking a health care service or professional in the past 15 days. The findings showed some differences in the determinants of drug use in relation to gender, revealing the greater importance of health-related behavior among women.

[Horus: technological innovation in pharmaceutical assistance within the Brazilian unified health system]

OBJECTIVE

To analyze results of the Horus Information System, comparing elements of this system with some international experiences.

METHODS

Horus is a technological innovation introduced in 2009 in the Pharmaceutical management information system of the Sistema Único de Saúde (Brazilian Unified Health System). In 2011, local managers and health professionals of 1,247 municipalities (16 states) that adhered to Horus answered questionnaires on pharmaceutical assistance in primary care and about the Horus system. This is a descriptive and exploratory study, developed with the use of quantitative and qualitative methods of research. Multivariate tools were used for data collection and interpretative support of the statistical inference and thematic analysis.

RESULTS

The main changes identified after the implementation of this system were: improvement on technical and scientific quality control of Pharmaceutical Assistance, improvement on the supply of medications and health care; training of human resources and knowledge management; improvement on the relationship health managers/users; development in the administrative management and greater inter-state management; and improvement on the technological infrastructure. In terms of health information systems, these categories are consistent with programs and obstacles observed in international experiences. The biggest gap identified was the fact that Horus was not included in a national policy of health information systems, which is in a process of consolidation in Brazil. The national database of actions and services within the Pharmaceutical Assistance will enable the collection, analysis and dissemination of information regarding integrated pharmaceutical assistance in the Brazilian context.

CONCLUSIONS

The Horus System is a technological innovation that enables the management of the Pharmaceutical Assistance. The national base will enable the definition and agreement on national indicators of Pharmaceutical Assistance, aiming to produce evidence of better health conditions to the users and produce indications about the situation of the National Policy on Pharmaceutical Assistance and its trends.

[Self-medication in the elderly population of Campinas, São Paulo State, Brazil: prevalence and associated factors]

The aim of this study was to evaluate the prevalence and causative factors associated with self-medication in the elderly and identify the main drugs consumed without prescription. A cross-sectional population-based study with stratified clustered two-stage sampling was performed in Campinas, São Paulo, Brazil in 2008 and 2009. Of the 1,515 elderly studied, 80.4% reported using at least one drug during the three days preceding the survey. Of these, 91.1% reported the use of prescription drugs only and the remainder (8.9%) reported simultaneous use of prescribed and non prescribed drugs. After adjustment, a negative association between age ≥ 80 years, hypertension, chronic diseases, use of health services, dental consultations and adherence to a medical plan,and self-medication was found, whereas a positive association was found with per capita income. Dipyrone, acetylsalicylic acid, diclofenac, Ginkgo biloba, paracetamol and homeopathic medicines were among the most used non-prescribed drugs. Pharmaceutical assistance should be provided as a priority to the elderly, to avoid the misuse of medicines and ensure access to the correct drugs.

[Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil]

This article analyzes prevalence rates in the use of medication according to demographic, socioeconomic, and health-related behavioral variables through a population-based cross-sectional study of individuals 18 years and older (n=941) in Campinas, São Paulo State, Brazil. The study used multistage sampling, both stratified and cluster. Chi-square test was performed, and adjusted prevalence ratios were estimated by gender and age, both with 95% confidence intervals. A Poisson multiple regression model was developed, and the following factors were associated with use of medication: female gender, age 40 and over, reported illness in the previous two weeks, and number of chronic diseases. The most widely consumed drugs were for the cardiovascular and nervous systems, besides herbal remedies. Prevalence of medication in Campinas was lower than in most studies. Local health surveys could help identify drug use patterns and guarantee more appropriate interventions for pharmaceutical care policy.