Lynn Dee Silver

Evaluation of pharmaceutical assistance in public primary care in Brasília, Brazil

OBJECTIVE Pharmaceutical assistance is essential in health care and a right of citizens according to Brazilian law and drug policies. The study purpose was to evaluate aspects of pharmaceutical assistance in public primary health care. METHODS A cross-sectional study using WHO drug indicators was carried out in Brasilia in 2001. From a random sample of 15 out of 62 centers thirty exiting patients per center were interviewed. RESULTS Only 18.7% of the patients fully understood the prescription, 56.3% could read it, 61.2% of the prescribed drugs were actually dispensed, and mean duration of pharmaceutical dispensing was 53.2 seconds. Each visit lasted on average 9.4 minutes. Of prescribed and non-dispensed drugs, 85.3% and 60.6% were on the local essential drug list (EDL) respectively. On average 83.2% of 40 essential drugs were in stock, and only two centers had a pharmacist in charge of the pharmacy. The mean number of drugs per prescription was 2.3, 85.3% of prescribed drugs were on the EDL, 73.2% were prescribed using the generic denomination, 26.4% included antibiotics and 7.5% were injectables. The most prescribed groups were: cardiovascular drugs (26.8%), anti-infective drugs (13.1%), analgesics (8.9%), anti-asthmatic drugs (5.8%), anti-diabetic drugs (5.3%), psychoactive drugs (3.7%), and combination drugs (2.7%). CONCLUSIONS Essential drugs were only moderately available almost 30 years after the first Brazilian EDL was formulated. While physician use of essential drugs and generic names was fairly high, efficiency was impaired by the poor quality of pharmaceutical care, resulting in very low patient understanding and insufficient guarantee of supply, particularly for chronic diseases.

Planejamento familiar: a autonomia das mulheres sob questão

OBJECTIVES: to investigate womens access to contraceptive methods. METHODS: inquiry through a self-applied survey of a random sample (divided into geographic regions and population size). The study comprised all 5507 Brazilian municipalities. RESULTS: an outstanding number of municipalities place a high priority on family planning in relation to geographic region and size. As for contraception availability, 79.5% of 5358 municipalities do not provide diaphragms, and only 6.6% meet over 75% of the demand. In contrast, more than 75% of the demand for injectable contraceptives is met in 13.4% of 5314 municipalities. Seventy two and nine percent (72.9%) of all Brazilian municipalities does not offer fertility treatment, and only 5.9% of the municipalities provide contraceptives to over 75% of the women seeking this service. CONCLUSIONS: findings indicate inconsistency between education and routines of family planning, quantitative and qualitative access restrictions to contraceptive methods and insufficient care for infertility. This scenario limits women freedom of choice.

Perfil sociodemográfico e estado de saúde auto-referido entre idosas de uma localidade de baixa renda

Os objetivos foram elaborar diagnostico sociodemografico e identificar a auto-percepcao quanto ao estado de saude de mulheres idosas de uma localidade de baixa renda do municipio do Rio de Janeiro, Brasil. Trata-se de estudo descritivo, de corte seccional, desenvolvido em tres momentos: grupos focais exploratorios; Censo da Populacao Idosa e inquerito domiciliar com as idosas identificadas no Censo. Os sujeitos foram 369 idosas, correspondendo a 83,5% da populacao elegivel. As mulheres corresponderam a 62,8% do total de idosos da comunidade, apresentando uma condicao social nada favoravel (49,3% sao analfabetas, 44,7% estao viuvas, 62,3% tem renda mensal de ate um salario minimo e 22,0% declararam nao ter renda). Apesar de 62,0% afirmarem que tem uma boa saude, 80,5% referiram apresentar algum problema de saude. Pela sua propria condicao (idosa, mulher e pobre), o grupo ja se encontra potencialmente numa situacao de risco e de desvantagem social em relacao a outros grupos.

O uso de medicamentos na gravidez

O uso de medicamentos na gravidez e cada vez mais intenso, enquanto a pratica medica volta-se para a incorporacao do conceito de risco. Embora a tragedia da talidomida tenha marcado o inicio da reflexao sobre a ocorrencia de efeitos adversos de medicamentos usados durante a gestacao, as percepcoes dos prescritores, no âmbito da terapeutica medicamentosa na gravidez, ainda oscilam entre a certeza de que tudo e nocivo e a relativa crenca de que tudo e seguro ate que se prove o contrario. Faz-se necessaria a producao de evidencias que substanciem as condutas clinicas. O ensaio clinico randomizado e considerado a pedra angular do paradigma da medicina baseada em evidencias. Sugerem-se os contextos nos quais a aplicacao dos diversos tipos de pesquisa clinica seriam apropriados na gestacao e ainda o emprego ampliado da farmacoepidemiologia para a construcao de evidencias nessa populacao, por meio de estudos analiticos, em especial a coorte. Entende-se que estes estudos, desde que executados com rigor metodologico, possam oferecer informacao balizada, geradora de hipoteses, essenciais para a pratica clinica.

Retail prices of essential drugs in Brazil: an international comparison

OBJECTIVES Price is a key obstacle for consumer access to essential drugs, especially in developing countries. This study sought to compare the retail prices of essential drugs on the private market in Brazil with that of two international pricing standards. METHODS The retail price of all drugs on Brazils Essential Drugs List, July 2000 edition, were compared to the retail price of the same drugs on the Swedish market and on a referential bulk-price indicator from low-cost suppliers on the international market. Ratios of Brazils prices to Swedens prices and Brazils prices to the international bulk mean price-per-unit for each drug were calculated. Using linear regression analysis, the ratios were also studied in relation to the number of manufacturers. RESULTS For the 132 drugs that were listed on both Brazils and Swedens lists, unitary retail prices in Brazil were 1.9 times higher. Of the 94 drugs found on both Brazils list and the international unit-price indicator, Brazils national mean unit prices were 13.1 more expensive. No relationship was found between the number of manufacturers for each product and the ratios of prices. CONCLUSIONS Average retail prices of essential drugs in Brazil are significantly higher than in Sweden. Furthermore, international bulk prices indicate that drugs are brought to market by Brazils private pharmacies at prices that may be excessively high in relation to production costs, creating high profit margins. The expected price-lowering effects of competition were not identified.

Apoio social entre idosas de uma localidade de baixa renda no Munícipio do Rio de Janeiro

Objective: To identify the perceived availability and provision of informal and formal social support among elderly women in a low income area of the municipality of Rio de Janeiro. Methods: This is descriptive and cross-sectional study; done by using household survey with 369 (83.5%) elderly in the community. Results: Elderly women had an adverse social condition (49.3% were illiterate, 71.3% had no partner, 62.3% reported a monthly income of up to minimum wage and 22.0% had no income.) The most common informal types of support were: money, personal care and companionship for locomotion. However, they relied on the care of grandchildren, housing and money. Only 20% reported receiving support from the state or institutions, most of them as basic food. The three main sources of formal supports were: the municipal government, the church and, the state government. Conclusion: The trade of relations had more weight on the side of the older, because the when the elderly cares for their grandchildren, the parents could work and thus increase the household income. Descriptors: Health of the elderly; Social support; Aging; Cross-sectional studies; Women’s health

Orientação farmacêutica para DST: uma proposta de sistematização

As DST se constituem num grave problema de saude publica. Diante da baixa notificacao de casos, a OMS estima que 70% dos portadores de DST no Brasil nao busquem tratamento em unidades de saude. Em todo o mundo a farmacia comunitaria e um importante local de busca por atendimento primario de saude e os farmaceuticos sao numerosos e se constituem nos profissionais de saude mais acessiveis para o publico em geral. A dificuldade de acesso a servicos de saude, a falta de orientacao para o uso racional de medicamentos ao usuario e a automedicacao sao uma realidade no Brasil, onde se convive, de um lado, com a falta de acesso de grande parcela da populacao a medicamentos essenciais, e de outro, com o uso abusivo e irracional pelos segmentos que tem poder de compra. As farmacias devem, portanto, ser consideradas locais de intervencao para o estabelecimento de parcerias no sentido de divulgar e disseminar praticas educativas quando se pensa em campanhas educativas e prevencao de doencas como as DST. Propoe-se, entao, uma sistematizacao da orientacao farmaceutica com relacao as DST, na tentativa de concretizar um melhor atendimento aos possiveis portadores que procuram a resolucao de seu problema de saude na farmacia e contribuir para o enfraquecimento da cadeia de transmissao dessas doencas.

Impacto de um programa de avaliação da qualidade da imagem nos serviços de mamografia do Distrito Federal

OBJECTIVE: The present study was aimed at evaluating the quality and the impact of an intervention involving inspection and education in mammography centers of the Federal District, Brazil. MATERIALS AND METHODS: Forty one mammography centers in the Federal District were studied in the period between 2000 and 2002. The intervention involved an initial inspection followed by a training activity and notification of mammography centers by the Federal District Sanitary Vigilance authority. The imaging quality was compared before and after the intervention. RESULTS: None of the 36 centers which completed the study reached more than 90% compliance with the standard imaging quality prior to the interventions, whereas ten were above 90% afterwards. Major improvements were observed in chassis maintenance, breast compression and visualization of microcalcifications. CONCLUSION: Despite the availability of a great number of mammography centers in the Federal District, most of them did not meet the required quality standards. The intervention has shown to be effective for improving the imaging quality, however a continued action is required to solve the remaining problems and increase the impact of the program.

Social support among elderly women in a low income area in the municipality of Rio de Janeiro

Objective: To identify the perceived availability and provision of informal and formal social support among elderly women in a low income area of the municipality of Rio de Janeiro. Methods: This is descriptive and cross-sectional study; done by using household survey with 369 (83.5%) elderly in the community. Results: Elderly women had an adverse social condition (49.3% were illiterate, 71.3% had no partner, 62.3% reported a monthly income of up to minimum wage and 22.0% had no income.) The most common informal types of support were: money, personal care and companionship for locomotion. However, they relied on the care of grandchildren, housing and money. Only 20% reported receiving support from the state or institutions, most of them as basic food. The three main sources of formal supports were: the municipal government, the church and, the state government. Conclusion: The trade of relations had more weight on the side of the older, because the when the elderly cares for their grandchildren, the parents could work and thus increase the household income. Descriptors: Health of the elderly; Social support; Aging; Cross-sectional studies; Women’s health

Apoyo social entre ancianas de una localidad de baja renta en el Municipio de Rio de Janeiro

Objective: To identify the perceived availability and provision of informal and formal social support among elderly women in a low income area of the municipality of Rio de Janeiro. Methods: This is descriptive and cross-sectional study; done by using household survey with 369 (83.5%) elderly in the community. Results: Elderly women had an adverse social condition (49.3% were illiterate, 71.3% had no partner, 62.3% reported a monthly income of up to minimum wage and 22.0% had no income.) The most common informal types of support were: money, personal care and companionship for locomotion. However, they relied on the care of grandchildren, housing and money. Only 20% reported receiving support from the state or institutions, most of them as basic food. The three main sources of formal supports were: the municipal government, the church and, the state government. Conclusion: The trade of relations had more weight on the side of the older, because the when the elderly cares for their grandchildren, the parents could work and thus increase the household income. Descriptors: Health of the elderly; Social support; Aging; Cross-sectional studies; Women’s health