Karen Sarmento Costa

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

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, Sao 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.

Disponibilidade de medicamentos nas unidades básicas de saúde e fatores relacionados: uma abordagem transversal

RESUMO Este estudo objetivou a caracterizacao da disponibilidade de medicamentos nas unidades basicas de saude (UBS) do Brasil e a identificacao de fatores organizacionais a ela asso ciados, utilizando banco de dados secundarios do Programa Nacional de Melhoria do Acesso e da Qualidade da Atencao Basica. O desfecho relacionado a disponibilidade de medicamentos, expresso de tres diferentes formas, foi explorado em relacao a variaveis explicativas relacionadas a caracteristicas da UBS e a assistencia farmaceutica. Encontrou-se disponibilidade media de 58,5%, que foi tambem baixa em todos os estratos populacionais; houve associacao estatisticamente significativa da variavel desfecho com todas as explicativas. Foi baixa a dis ponibilidade de medicamentos, mostrando-se inversamente associada com a organizacao geral da unidade de saude em geral e da assistencia farmaceutica em particular. PALAVRAS-CHAVE Atencao Primaria a Saude; Assistencia farmaceutica; Avaliacao de medicamentos; Politica nacional de medicamentos; Avaliacao em saude.

Automedicação em idosos residentes em Campinas, São Paulo, Brasil: prevalência e fatores associados

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.O objetivo foi avaliar a prevalencia e fatores associados a automedicacao em idosos e identificar os principais farmacos consumidos sem prescricao. Estudo transversal de base populacional, com amostra estratificada por conglomerados e em dois estagios realizado em Campinas, Sao Paulo, Brasil, em 2008-2009. Dos 1.515 idosos, 80,4% referiram uso de ao menos um medicamento nos tres dias anteriores a pesquisa. Desses, 91,1% relataram consumo exclusivo de medicamentos prescritos e o restante (8,9%), uso simultâneo de prescritos e nao prescritos. Apos ajuste, idade > 80 anos, hipertensao arterial, presenca de doencas cronicas, uso de servicos de saude, realizacao de consultas odontologicas e filiacao a plano medico de saude estiveram associadas negativamente, e renda per capita, positivamente a automedicacao. Os farmacos sem prescricao mais consumidos foram dipirona, AAS, diclofenaco, Ginkgo biloba, paracetamol e homeopaticos. Sobretudo entre idosos, a assistencia farmaceutica deve ser priorizada para evitar o uso incorreto de medicamentos e garantir o acesso aos farmacos necessarios ao tratamento.

HÓRUS: inovação tecnológica na assistência farmacêutica no sistema único de saúde

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.OBJETIVO: Analisar resultados do Sistema Horus, comparando elementos desse Sistema com algumas experiencias internacionais. METODOS: Horus e uma inovacao tecnologica introduzida em 2009 no sistema de informacoes para a Assistencia Farmaceutica do Sistema Unico de Saude. Em 2011, gestores locais e profissionais de saude de 1.247 municipios (16 estados) que aderiram ao Horus responderam a questionarios sobre a assistencia farmaceutica na atencao basica e sobre o Sistema Horus. Estudo descritivo e exploratorio, desenvolvido com emprego de metodo quali-quantitativo de pesquisa. Foram utilizados instrumentos multivariados de coleta de dados e suporte interpretativo da inferencia estatistica e da analise tematica. RESULTADOS: As principais mudancas identificadas apos a implantacao desse Sistema foram: melhoria do controle tecnico e cientifico da qualidade da assistencia farmaceutica, da dispensacao dos medicamentos e da atencao a saude; capacitacao dos recursos humanos e gestao do conhecimento; melhoria da relacao gestores de saude/usuarios de medicamentos; da gestao administrativa e maior gestao interfederativa; e melhoria da infraestrutura tecnologica. Em termos de sistemas de informacao em saude, essas categorias sao condizentes com avancos e obstaculos observados em experiencias internacionais. A maior lacuna identificada foi a falta de insercao do Horus a uma politica nacional de sistemas de informacao em saude, em processo de consolidacao no Pais. A base nacional de dados das acoes e servicos da Assistencia Farmaceutica no Sistema Unico de Saude possibilitara coletar, analisar e disseminar informacoes relativas a gestao integrada da Assistencia Farmaceutica no contexto da saude no Brasil. CONCLUSOES: O Sistema Horus e uma inovacao tecnologica viabilizadora da gestao da Assistencia Farmaceutica. A base nacional possibilitara a definicao e pactuacao de indicadores nacionais de Assistencia Farmaceutica, a fim de propiciar melhores condicoes de saude aos usuarios e produzir evidencias sobre a situacao da Politica Nacional de Assistencia Farmaceutica e suas tendencias.OBJETIVO: Analizar resultados del Sistema Horus, comparando sus elementos con algunas experiencias internacionales. METODOS: Horus es una innovacion tecnologica introducida en 2009 en el sistema de informaciones para el Servicio Farmaceutico del Sistema Unico de Salud Brasileno. En 2011, gestores locales y profesionales de salud de 1.247 municipios (16 estados) que adhirieron al Horus respondieron a cuestionarios sobre la asistencia farmaceutica en la atencion basica y sobre el sistema Horus. Estudio descriptivo es exploratorio, desarrollado con uso del metodo cuali-cuantitativo de investigacion. Se utilizaron instrumentos multivariados de colecta de datos y soporte interpretativo de la inferencia estadistica y del analisis tematico. RESULTADOS: Los principales cambios identificados posterior a la implantacion del Sistema fueron: mejoria del control tecnico y cientifico de la calidad de la asistencia farmaceutica, de la dispensacion de los medicamentos y de la atencion a la salud; capacitacion de los recursos humanos y gestion del conocimiento; mejoria de la relacion gestores de salud/usuarios de medicamentos; de la gestion administrativa y mayor gestion interfederativa; y mejoria de la infraestructura tecnologica. En terminos de sistemas de informacion en salud, tales categorias son condecentes con avances y obstaculos observados en experiencias internacionales. La mayor laguna identificada fue la falta de insercion del Horus a una politica nacional de sistemas de informacion en salud, en proceso de consolidacion en Brasil. La base nacional de datos de las acciones del Servicio Farmaceutico en el Sistema Unico de Salud Brasileno posibilitara colectar, analizar y diseminar informaciones relativas a la gestion integrada de la Asistencia Farmaceutica en el contexto de la salud en Brasil. CONCLUSIONES: El Sistema Horus es una innovacion tecnologica viabilizadora de la gestion del Servicio Farmaceutico. La base nacional posibilitara la definicion y pactuacion de indicadores nacionales de Servicio Farmaceutico, a fin de propiciar mejores condiciones de salud a los usuarios y producir evidencias sobre la situacion de la Politica Nacional de Servicio Farmaceutico Brasileno y sus tendencias.

Conhecimento e utilização do Programa Farmácia Popular do Brasil: estudo de base populacional no município de Campinas-SP

OBJETIVO:investigar a prevalencia e os fatores associados ao conhecimento e a utilizacao do Programa Farmacia Popular do Brasil (PFPB) em Campinas-SP, Brasil, em 2008.METODOS:estudo transversal de base populacional, com amostra probabilistica de individuos com 20 ou mais anos de idade.RESULTADOS:foram entrevistados 2.461 individuos, 32,8% (IC95%: 27,5-38,1) conheciam o PFPB e 11,0% (IC95%: 8,2-14,7) haviam utilizado medicamentos do Programa; o conhecimento do PFPB foi significativamente maior entre mulheres (43,2%), individuos com 30 ou mais anos de idade, renda familiar superior a 4 salarios minimos, 5 ou mais anos de estudo, que utilizavam 4 ou mais medicamentos (47,6%); a utilizacao foi maior entre mulheres (37,4%), individuos acima de 70 anos de idade (53,4%) e sem plano de saude (38,5%).CONCLUSAO:o conhecimento sobre o PFPB revelou-se restrito, porem superior nos segmentos de maior escolaridade, e sua utilizacao foi maior no segmento sem plano de saude.

Fontes de obtenção de medicamentos para tratamento de hipertensão arterial no Brasil: análise da Pesquisa Nacional de Saúde, 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.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.

Uso de medicamentos para tratamento de doenças crônicas não transmissíveis no Brasil: resultados da Pesquisa Nacional de Saúde, 2013

OBJETIVO:descrever a prevalencia do uso de medicamentos para o tratamento de doencas cronicas nao transmissiveis pela populacao brasileira segundo fatores demograficos.METODOS:estudo descritivo com dados da Pesquisa Nacional de Saude 2013.RESULTADOS:do total de hipertensos, 81,4% (IC95% 80,1-82,7) estavam em uso de medicamentos, com maior utilizacao na regiao Sul (83,6%; IC95%80,8-86,4), por mulheres (84,6%; IC95% 83,2-86,5) e individuos de mais 75 anos de idade (92,2%; IC95% 89,7-94,6); dos que referiram diabetes e depressao, 80,2% (IC95% 78,0-82,5) e 52,0% (IC95% 49,1-54,9) usavam medicamentos, respectivamente, com maior uso na regiao Sudeste para ambas doencas (84,6% e 55,0%); do total de pacientes que referiram asma, 81,5% (IC95% 77,4-85,6) usavam medicamentos, sem diferencas entre as macrorregioes do pais.CONCLUSOES:os resultados mostram elevada utilizacao de medicamentos para tratar as doencas cronicas investigadas, o que pode indicar um aumento do acesso ao tratamento para essas doencas, nao obstante algumas diferencas regionais.OBJECTIVE: to describe the prevalence of medication use by the Brazilian population to treat chronic noncommunicable diseases, according to demographic factors. METHODS: this was a descriptive study using 2013 National Health Survey data. RESULTS: 81.4% (95%CI 80.1-82.7) of those with hypertension were taking medication, with higher use in the South (83.6%; 95%CI 80.8-86.4), women (84.6%; 95%CI 83.2-86.5) and in individuals aged over 75 (92.2%; 95%CI 89.7-94.6); 80.2% (95%CI 78.0-82.5) of those reporting diabetes and 52.0% (95%CI 49.1-54.9) reporting depression used medication, with higher use in the Southeast (84.6% and 55.0%) for both diseases; 81.5% (95%CI 77.4-85.6) of patients reporting asthma used medication, there being no differences between the countrys regions. CONCLUSIONS: the results indicate high use of medication to treat the chronic diseases investigated, which may indicate increased access to their treatment, notwithstanding some regional differences.

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.

Organização dos serviços farmacêuticos no Sistema Único de Saúde em regiões de saúde

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.

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

The use of medicines is influenced by different factors. This study aimed to analyze the use of medicines and identify the sources for obtaining them and associated factors, using a population-based cross-sectional design with two-stage cluster sampling in Campinas, São Paulo State, Brazil, in 2008. Prevalence of use of at least one drug in the 3 previous days was 57.2% and prevalence of obtaining the drug from the Brazilian Unified National Health System (SUS) was 30%. 47.8% of individuals with no health insurance had to pay out-of-pocket for their medication, and 10.9% of individuals with insurance nevertheless obtained their medication from the SUS. Use of medicines obtained from the SUS was associated with older age, widowhood, black or brown skin color, lower schooling and income, and lack of insurance. Only 2.1% reported not being able to obtain the prescribed medication, and the main reasons were lack of availability in the public system and lack of money for out-of-pocket purchases. The study identified the subgroups that obtained most of their medicines in the SUS and showed that these were the subgroups with the lowest use of medicines in the system.The use of medicines is influenced by different factors. This study aimed to analyze the use of medicines and identify the sources for obtaining them and associated factors, using a population-based cross-sectional design with two-stage cluster sampling in Campinas, Sao Paulo State, Brazil, in 2008. Prevalence of use of at least one drug in the 3 previous days was 57.2% and prevalence of obtaining the drug from the Brazilian Unified National Health System (SUS) was 30%. 47.8% of individuals with no health insurance had to pay out-of-pocket for their medication, and 10.9% of individuals with insurance nevertheless obtained their medication from the SUS. Use of medicines obtained from the SUS was associated with older age, widowhood, black or brown skin color, lower schooling and income, and lack of insurance. Only 2.1% reported not being able to obtain the prescribed medication, and the main reasons were lack of availability in the public system and lack of money for out-of-pocket purchases. The study identified the subgroups that obtained most of their medicines in the SUS and showed that these were the subgroups with the lowest use of medicines in the system.