Felipe Ferré

Médicos, advogados e indústria farmacêutica na judicialização da saúde em Minas Gerais, Brasil

OBJETIVO: Descrever as relacoes entre medico prescritor, advogado e industria farmaceutica em acoes judiciais contra o Estado. METODOS: Estudo descritivo retrospectivo com base nas informacoes dos expedientes administrativos dos processos judiciais com demandas por medicamentos contra o Estado de Minas Gerais movidos entre outubro de 1999 e outubro de 2009. As variaveis estudadas foram: sexo, idade e doenca dos beneficiarios das acoes, origem do atendimento medico (publico ou privado), medico prescritor, tipo de representacao juridica e medicamento solicitado. Foi realizada analise descritiva das variaveis com a distribuicao de frequencias. RESULTADOS: Foram analisadas 2.412 acoes judiciais referentes a 2.880 medicamentos solicitados, com 18 farmacos diferentes. Entre esses, 12 sao fornecidos pelas politicas de assistencia farmaceutica do Sistema Unico de Saude (SUS). Os medicamentos mais solicitados foram adalimumabe, etanercepte, infliximabe e insulina glargina. As principais doencas dos beneficiarios foram artrite reumatoide, espondilite anquilosante, diabetes mellitus e doencas pulmonares obstrutivas cronicas. Houve predominio de representacao por advogados particulares e atendimento por medicos do setor privado. Entre as acoes representadas pelo escritorio A, 43,6% tiveram um unico medico prescritor para o adalimumabe e 29 medicos foram responsaveis por 40,2% dos pedidos do mesmo farmaco. Apenas um medico foi responsavel por 16,5% das prescricoes de adalimumabe, solicitado por apenas um escritorio particular de advocacia, em 44,8% dos pedidos. CONCLUSOES: A maior representatividade de medicos do setor privado e advogados particulares pode trazer prejuizo a equidade. Os dados sugerem associacao entre medicos e escritorios de advocacia nas solicitacoes dos medicamentos. Esse quadro e um indicio de que a Justica e a medicina tem sido utilizadas para atender aos interesses da industria farmaceutica.OBJECTIVE To describe the relationship between the prescribing doctor, lawyer and pharmaceutical industry in lawsuits against the state. METHODS Retrospective descriptive study based on data from administrative files, relating to lawsuits involving medicine demands, in the state of Minas Gerais, Southeastern Brazil, from October 1999 to October 2009. RESULTS A total of 2,412 lawsuits were analyzed with 2,880 medicine requests, including 18 different drugs, 12 of them provided through Pharmaceutical Policies of the Brazilian National Health System (SUS). The most frequent medicines requested included were adalimumab, etanercept, infliximab, insulin glargine and tiotropium bromide. The main diseases were rheumatoid arthritis, ankylosing spondylitis, diabetes mellitus, and chronic obstructive pulmonary disease. Private lawyers and doctors were predominant. The results revealed the association between doctors and law offices on drug requests. Among the lawsuits filed by the office A, 43.6% had a single prescriber to adalimumab, while 29 doctors were responsible for 40.2% of the same drug prescriptions. A single doctor was responsible for 16.5% of the adalimumab prescriptions, being requested through lawsuits filed by a single private law office in 44.8% of legal proceedings. CONCLUSIONS A greater representation of doctors and lawyers from the private sector can hinder equity in health. The results revealed the association between doctors and law offices on drug requests. This is an indication that justice and medical practice have been used, at certain times, to serve the interests of the pharmaceutical industry.

Potentially inappropriate medication use in a city of Southeast Brazil

Potentially inappropriate medication use by the Diamantina (Minas Gerais State) population was investigated by analyzing medicine consumption, self-medication, polypharmacy and drug interactions of medicines prescribed among those interviewed. Level of knowledge about rational drug use and its relationship to socio-economic variables was also evaluated using a semi-structured questionnaire. This survey was based on stratified sampling of 423 individuals selected randomly. The prevalence of prescription drug consumption was 42.32% (n=179) and cardiovascular drugs were the most prescribed. Drug interactions were found in 45.81% (n=82) of prescriptions and 92.68% (n=76) of these interactions were moderate, with co-administration of cardiovascular drugs occurring in more than half of the cases. The inappropriate use of medication, according to Beers criteria, occurred in 44.73% of prescriptions to the elderly. The prevalence of self-medication was 63.34% (n=268) while 21.99% (n=91) of individuals administered medications to their children without formal prescriptions, where this practice was associated to analgesic/antipyretic consumption. The population showed a high prevalence of inappropriate use of drugs across all strata of society, representing an issue requiring effective actions to promote rational use of medicines.

Doctors, lawyers and pharmaceutical industry on health lawsuits in Minas Gerais, Southeastern Brazil

OBJETIVO: Descrever as relacoes entre medico prescritor, advogado e industria farmaceutica em acoes judiciais contra o Estado. METODOS: Estudo descritivo retrospectivo com base nas informacoes dos expedientes administrativos dos processos judiciais com demandas por medicamentos contra o Estado de Minas Gerais movidos entre outubro de 1999 e outubro de 2009. As variaveis estudadas foram: sexo, idade e doenca dos beneficiarios das acoes, origem do atendimento medico (publico ou privado), medico prescritor, tipo de representacao juridica e medicamento solicitado. Foi realizada analise descritiva das variaveis com a distribuicao de frequencias. RESULTADOS: Foram analisadas 2.412 acoes judiciais referentes a 2.880 medicamentos solicitados, com 18 farmacos diferentes. Entre esses, 12 sao fornecidos pelas politicas de assistencia farmaceutica do Sistema Unico de Saude (SUS). Os medicamentos mais solicitados foram adalimumabe, etanercepte, infliximabe e insulina glargina. As principais doencas dos beneficiarios foram artrite reumatoide, espondilite anquilosante, diabetes mellitus e doencas pulmonares obstrutivas cronicas. Houve predominio de representacao por advogados particulares e atendimento por medicos do setor privado. Entre as acoes representadas pelo escritorio A, 43,6% tiveram um unico medico prescritor para o adalimumabe e 29 medicos foram responsaveis por 40,2% dos pedidos do mesmo farmaco. Apenas um medico foi responsavel por 16,5% das prescricoes de adalimumabe, solicitado por apenas um escritorio particular de advocacia, em 44,8% dos pedidos. CONCLUSOES: A maior representatividade de medicos do setor privado e advogados particulares pode trazer prejuizo a equidade. Os dados sugerem associacao entre medicos e escritorios de advocacia nas solicitacoes dos medicamentos. Esse quadro e um indicio de que a Justica e a medicina tem sido utilizadas para atender aos interesses da industria farmaceutica.OBJECTIVE To describe the relationship between the prescribing doctor, lawyer and pharmaceutical industry in lawsuits against the state. METHODS Retrospective descriptive study based on data from administrative files, relating to lawsuits involving medicine demands, in the state of Minas Gerais, Southeastern Brazil, from October 1999 to October 2009. RESULTS A total of 2,412 lawsuits were analyzed with 2,880 medicine requests, including 18 different drugs, 12 of them provided through Pharmaceutical Policies of the Brazilian National Health System (SUS). The most frequent medicines requested included were adalimumab, etanercept, infliximab, insulin glargine and tiotropium bromide. The main diseases were rheumatoid arthritis, ankylosing spondylitis, diabetes mellitus, and chronic obstructive pulmonary disease. Private lawyers and doctors were predominant. The results revealed the association between doctors and law offices on drug requests. Among the lawsuits filed by the office A, 43.6% had a single prescriber to adalimumab, while 29 doctors were responsible for 40.2% of the same drug prescriptions. A single doctor was responsible for 16.5% of the adalimumab prescriptions, being requested through lawsuits filed by a single private law office in 44.8% of legal proceedings. CONCLUSIONS A greater representation of doctors and lawyers from the private sector can hinder equity in health. The results revealed the association between doctors and law offices on drug requests. This is an indication that justice and medical practice have been used, at certain times, to serve the interests of the pharmaceutical industry.

Medication Persistence of Disease‐Modifying Antirheumatic Drugs and Anti–Tumor Necrosis Factor Agents in a Cohort of Patients With Rheumatoid Arthritis in Brazil

To assess the use and persistence of anti–tumor necrosis factor (anti‐TNF) versus disease‐modifying antirheumatic drug (DMARD) therapies in patients with rheumatoid arthritis (RA) in Brazil.

Legal and health variations in drug litigation injunctions granted in Minas Gerais

OBJECTIVE To investigate the factors related to the granting of preliminary court orders [injunctions] in drug litigations. METHODS A retrospective descriptive study of drug lawsuits in the State of Minas Gerais, Southeastern Brazil, was conducted from October 1999 to 2009. The database consists of 6,112 lawsuits, out of which 6,044 had motions for injunctions and 5,167 included the requisition of drugs. Those with more than one beneficiary were excluded, which totaled 5,072 examined suits. The variables for complete, partial, and suppressed motions were treated as dependent and assessed in relation to those that were independent – lawsuits (year, type, legal representation, defendant, court in which it was filed, adjudication time), drugs (level five of the anatomical therapeutic chemical classification), and diseases (chapter of the International Classification of Diseases). Statistical analyses were performed using the Chi-square test. RESULTS Out of the 5,072 lawsuits with injunctions, 4,184 (82.5%) had the injunctions granted. Granting varied from 95.8% of the total lawsuits in 2004 to 76.9% in 2008. Where there was legal representation, granting exceeded 80.0% and in lawsuits without representation, it did not exceed 66.9%. In public civil actions (89.1%), granting was higher relative to ordinary lawsuits (82.8%) and injunctions (80.1%). Federal courts granted only 68.6% of the injunctions, while the state courts granted 84.8%. Diseases of the digestive system and neoplasms received up to 87.0% in granting, while diseases of the nervous system, mental and behavioral disorders, and diseases of the skin and subcutaneous tissue received granting below 78.6% and showed a high proportion of suspended injunctions (10.9%). Injunctions involving paroxetine, somatropin, and ferrous sulfate drugs were all granted, while less than 54.0% of those involving escitalopram, sodium diclofenac, and nortriptyline were granted. CONCLUSIONS There are significant differences in the granting of injunctions, depending on the procedural and clinical variances. Important trends in the pattern of judicial action were observed, particularly, in the reduced granting [of injunctions] over the period.

Gastos publicos com medicamentos para o tratamento da osteoporose na pos-menopausa

OBJETIVO: Analizar los gastos con medicamentos para el tratamiento de la osteoporosis en la post-menopausia y los factores asociados al gasto promedio per capita. METODOS: Pareamiento probabilistico-deterministico a partir de las bases de las Autorizaciones de Procedimientos de Alta Complejidad con el Sistema de Informacion sobre Mortalidad, resultando en cohorte historica de pacientes que utilizaron medicamentos de alto costo para el tratamiento de la osteoporosis en la post-menopausia de 2000 a 2006. El gasto promedio mensual con medicamentos fue estratificado por grupos etarios y descrito de acuerdo con las caracteristicas demograficas, clinicas y tipo de medicamento usado. Se utilizo modelo de regresion linear para evaluar el impacto de las caracteristicas socio demograficas y clinicas sobre el gasto promedio mensual per capita con los medicamentos. RESULTADOS: Se identificaron 72.265 mujeres que recibieron medicamentos para el tratamiento de la osteoporosis en la post-menopausia. El gasto promedio mensual per capita en el primer ano de tratamiento fue de R

Public spending on drugs for the treatment of osteoporosis in post-menopause

90,00 (de R

Medication persistence of DMARDs and anti‐TNF agents in a cohort of patients with rheumatoid arthritis in Brazil

144,49). La mayoria de las mujeres tenia de 60 a 69 anos de edad, iniciaron tratamiento en 2000, eran residentes en la region Sureste, tenian fracturas osteoporoticas previas, y el alendronato de sodio fue el medicamento mas utilizado en el inicio del tratamiento. La mayoria de los pacientes permanecio en uso del mismo principio activo durante el tratamiento. Se identificaron 6.429 obitos entre las participantes. Mas de un tercio de las mujeres permanecieron en el programa por 12 meses. Raloxifeno y calcitonina sintetica fueron las alternativas con mayor impacto sobre el gasto promedio mensual con medicamentos, teniendo como patron de referencia el alendronato de sodio. CONCLUSIONES: Dado el alto impacto del tipo de medicamento utilizado en el gasto por parte del SUS, se recomienda establecer criterios para prescripcion y dispensacion, priorizando aquellos con menores costos y mayor efectividad. Esto puede optimizar el proceso de asistencia farmaceutica y la provision de mayor numero de unidades farmaceuticas para la poblacion.OBJETIVO: Analizar los gastos con medicamentos para el tratamiento de la osteoporosis en la post-menopausia y los factores asociados al gasto promedio per capita. METODOS: Pareamiento probabilistico-deterministico a partir de las bases de las Autorizaciones de Procedimientos de Alta Complejidad con el Sistema de Informacion sobre Mortalidad, resultando en cohorte historica de pacientes que utilizaron medicamentos de alto costo para el tratamiento de la osteoporosis en la post-menopausia de 2000 a 2006. El gasto promedio mensual con medicamentos fue estratificado por grupos etarios y descrito de acuerdo con las caracteristicas demograficas, clinicas y tipo de medicamento usado. Se utilizo modelo de regresion linear para evaluar el impacto de las caracteristicas socio demograficas y clinicas sobre el gasto promedio mensual per capita con los medicamentos. RESULTADOS: Se identificaron 72.265 mujeres que recibieron medicamentos para el tratamiento de la osteoporosis en la post-menopausia. El gasto promedio mensual per capita en el primer ano de tratamiento fue de R

Potentially inappropriate medication use among institutionalized elderly individuals in southeastern Brazil

90,00 (de R

Treatment persistence in patients with rheumatoid arthritis and ankylosing spondylitis

144,49). La mayoria de las mujeres tenia de 60 a 69 anos de edad, iniciaron tratamiento en 2000, eran residentes en la region Sureste, tenian fracturas osteoporoticas previas, y el alendronato de sodio fue el medicamento mas utilizado en el inicio del tratamiento. La mayoria de los pacientes permanecio en uso del mismo principio activo durante el tratamiento. Se identificaron 6.429 obitos entre las participantes. Mas de un tercio de las mujeres permanecieron en el programa por 12 meses. Raloxifeno y calcitonina sintetica fueron las alternativas con mayor impacto sobre el gasto promedio mensual con medicamentos, teniendo como patron de referencia el alendronato de sodio. CONCLUSIONES: Dado el alto impacto del tipo de medicamento utilizado en el gasto por parte del SUS, se recomienda establecer criterios para prescripcion y dispensacion, priorizando aquellos con menores costos y mayor efectividad. Esto puede optimizar el proceso de asistencia farmaceutica y la provision de mayor numero de unidades farmaceuticas para la poblacion.OBJECTIVE To analyze expenditure on treatment for postmenopausal osteoporosis and associated factors on mean per capita expenditure. METHODS A probabilistic-deterministic linkage between the database of Authorizations for Highly Complex Procedures and the mortality information system was constructed, resulting in a historical cohort of patients using high-cost medications for the treatment of postmenopausal osteoporosis, between 2000-2006. Mean monthly spending on medicines was stratified by age group and described according to demographic and clinical characteristics and the type of drug used. A linear regression model was used to assess the impact of demographic and clinical characteristics on per capita mean monthly expenditure on medicines. RESULTS We identified 72,265 women who received drugs for the treatment of postmenopausal osteoporosis. The average monthly expenditure per capita in the first year of treatment was