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  • 1
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    Use of medicines by patients of the primary health care of the Brazilian Unified Health System
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 18s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 18s-
    Abstract: 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” (3rd ATC level) and Losartan (5th 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
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007144
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 2
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    Online Resource
    Availability of essential medicines in primary health care of the Brazilian Unified Health System
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 10s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 10s-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007062
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 3
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    Online Resource
    Characterization of the institutionalization of pharmaceutical services in Brazilian primary health care
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 7s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 7s-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007135
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 4
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    Patient satisfaction with pharmaceutical services in Brazilian primary health care
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 21s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 21s-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007145
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 5
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    National Survey on Access, Use and Promotion of Rational Use of Medicines : methods
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 4s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 4s-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007027
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 6
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    Online Resource
    Main characteristics of patients of primary health care services in Brazil
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 17s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 17s-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007070
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 7
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    Online Resource
    Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System : Analysis of PNAUM – Services data
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 13s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 13s-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007120
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 8
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    Medicine dispensing service in primary health care of SUS
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 11s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 11s-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007121
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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  • 9
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    Online Resource
    Disponibilidade de medicamentos nas unidades básicas de saúde e fatores relacionados: uma abordagem transversal
    GN1 Sistemas e Publicacoes Ltd. ; 2014
    In:  Saúde em Debate Vol. 38, No. special ( 2014)
    Details
    In: Saúde em Debate, GN1 Sistemas e Publicacoes Ltd., Vol. 38, No. special ( 2014)
    Type of Medium: Online Resource
    ISSN: 0103-1104
    URL: Article
    DOI: 10.5935/0103-1104.2014S009
    Language: English
    Publisher: GN1 Sistemas e Publicacoes Ltd.
    Publication Date: 2014
    SSG: 7,36
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  • 10
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    Pharmaceutical care in Brazil’s primary health care
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2017
    In:  Revista de Saúde Pública Vol. 51 ( 2017-09-22), p. 6s-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 51 ( 2017-09-22), p. 6s-
    Abstract: 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
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2017051007109
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2017
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