Noemia Urruth Leão Tavares

Is the Brazilian pharmaceutical policy ensuring population access to essential medicines

BackgroundTo evaluate medicine prices, availability and affordability in Brazil, considering the differences across three types of medicines (originator brands, generics and similar medicines) and different types of facilities (private pharmacies, public sector pharmacies and “popular pharmacies”).MethodsData on prices and availability of 50 medicines were collected in 56 pharmacies across six cities in Southern Brazil using the World Health Organization / Health Action International methodology. Median prices obtained were divided by international reference prices to derive the median price ratio (MPR).ResultsIn the private sector, prices were 8.6 MPR for similar medicines, 11.3 MRP for generics and 18.7 MRP for originator brands, respectively. Mean availability was 65%, 74% and 48% for originator brands, generics and similar medicines, respectively. In the public sector, mean availability of similar medicines was 2–7 times higher than that of generics. Mean overall availability in the public sector ranged from 68.8% to 81.7%. In “popular pharmacies”, mean availability was greater than 90% in all cities.ConclusionsAvailability of medicines in the public sector does not meet the challenge of supplying essential medicines to the entire population, as stated in the Brazilian constitution. This has unavoidable repercussions for affordability, particularly amongst the lower socio-economic strata.

Capacidade aquisitiva e disponibilidade de medicamentos para doenças crônicas no setor público

OBJETIVO: Avaliar a capacidade aquisitiva do trabalhador para pagar medicamentos utilizados no tratamento de doencas cronicas e a disponibilidade desses medicamentos na forma de referencia, similar ou generica para fornecimento gratuito no setor publico. METODOS: Utilizou-se metodologia preconizada pela Organizacao Mundial da Saude (OMS) e Health Action International (HAI) para coleta padronizada de informacoes sobre precos de venda no setor privado e disponibilidade no setor publico de medicamentos em seis cidades do Rio Grande do Sul, Brasil. A coleta de dados ocorreu de novembro de 2008 a janeiro de 2009. A capacidade aquisitiva foi estimada como o numero de dias do salario que um trabalhador com rendimento de 1 salario minimo nacional necessita trabalhar para adquirir, em uma farmacia privada, a quantidade necessaria de medicamento para 1 mes de tratamento. A disponibilidade foi avaliada verificando-se a presenca dos medicamentos nas farmacias do setor publico. RESULTADOS: A pesquisa incluiu 22 estabelecimentos publicos e 30 farmacias privadas. Dos 21 medicamentos utilizados no tratamento de sete doencas cronicas, apenas nove eram disponibilizados gratuitamente nos seis municipios pesquisados. O percentual medio da disponibilidade variou de 83,3% (Sao Leopoldo) a 97,6% (Caxias do Sul). A capacidade aquisitiva variou de 0,4 a 10,5 dias de salario para medicamentos de referencia; de 0,2 a 8,4 dias de salario para medicamentos similares; e de 0,3 a 3,8 dias de salario para medicamentos genericos. CONCLUSOES: A disponibilidade geral dos medicamentos pesquisados foi superior aos 80% recomendados pela OMS; porem, alguns tratamentos nao estavam disponiveis, ou apresentaram uma disponibilidade limitada no setor publico. A capacidade aquisitiva dos trabalhadores nos municipios estudados indicou um comprometimento de dias do salario que pode afetar a continuidade dos tratamentos com medicamentos para doencas cronicas.

Prescrição de antimicrobianos em unidades de saúde da família no Sul do Brasil

This paper describes antimicrobial prescription, clinical indications, and seasonal characteristics in primary health care. We performed a cross-sectional study in family health units in Bagé, Rio Grande do Sul State, Brazil, in July 2005 and January 2006. All medical prescriptions (n = 2,877) were analyzed, and the prevalence rates for antimicrobial prescription in winter and summer were 30.4% (95%CI: 28.5-32.4) and 21% (95%CI: 19.1-22.9), respectively. The most frequently prescribed antimicrobials were amoxicillin and sulfamethoxazole-trimethoprim. The main clinical indications for antimicrobial prescription were non-specific upper respiratory tract infections (22.5%), throat infections (20.8%), urinary tract infections (13.3%), otitis (8.5%), and sinusitis (7.5%). We observed differences between summer and winter in prescriptions for the same diseases. Seasonal differences between treatment profiles for the same diseases show the absence of a consistent antimicrobial prescription pattern in primary health care, contrary to World Health Organization guidelines, which advocate the establishment of protocols for antimicrobial use at all levels of care, as a strategy to prevent inadequate usage and the occurrence of strains that are resistant to available antimicrobials.

Therapeutic procedures and use of alternating antipyretic drugs for fever management in children

OBJECTIVEnThe evidence on the effectiveness of alternating antipyretics in fever management is scarce and indicates clinically negligible differences. The present study aimed to describe therapeutic procedures and the use of alternating antipyretics in children, and to evaluate associated factors.nnnMETHODSnThis was a cross-sectional study with 692 children aged 0 to 6 years, living in Southern Brazil. Household interviews of the childrens caregivers were conducted through cluster sampling using a structured questionnaire. A descriptive analysis was carried out, and the association between the use of alternating antipyretics and sociodemographic factors was evaluated. A total of 630 cases were analyzed (91.0%), corresponding to children with a history of fever.nnnRESULTSnApproximately 73% of caregivers reported that the first measure adopted during the last fever episode was the administration of medication. The mean temperature considered as fever by caregivers was 37.4°C, and as high fever, 38.7°C. The use of alternating antipyretic therapy was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical indication, in most cases. The drugs most often used were dipyrone and paracetamol. Children whose primary caregiver was a parent with higher socioeconomic status and higher educational level received more alternating medications. Approximately 70% of the doses used were below the minimum recommended dose for the treatment of fever.nnnCONCLUSIONSnThe use of medication to control fever is a common practice, including alternating antipyretic regimens. Most caregivers consider as fever temperatures lower than those established and they reported lack of response to monotherapy and medical indication as the main reasons for alternating medication.

Utilização de medicamentos entre crianças de zero a seis anos: um estudo de base populacional no sul do Brasil

The scope of this article was to estimate the prevalence of medication use in children between zero and six years old, analyzing the associated socio-demographic characteristics, and evaluating the adequacy of the medication with respect to pediatric recommendations and restrictions per age group. A cross-sectional study was conducted by means of cluster sampling on a sample comprised of children aged six or under, residents of a city in the south of Brazil. A standardized questionnaire about medication use 15 days prior to the interview was applied. A descriptive analysis was carried out, and the association between medication use and socio-demographic factors was evaluated, as well as the analysis of the pediatric adequacy of the most prevalent medication. Of the 687 children evaluated, 52% used at least one drug in the period. Associations between medication use and socio-demographic characteristics were not found, with the exception of per capita monthly income. The most prevalent medication was paracetamol (17.1%), followed by amoxicillin (9.5%) and dipyrone (8.4%). Among the ten drugs most used in children, six had pediatric restrictions for the age group. The results indicate significant use of medication, including medication with age restrictions, particularly for children under two years of age.

Medicine use among adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

The aim of this study was to investigate medicine use and associated factors among adolescents. This was a prospective cohort study including 4,452 adolescents born in Pelotas, Rio Grande do Sul State, Brazil, in 1993. Information on medicine use in the 15 days prior to the interviews was collected from the mothers. Overall prevalence of medicine use was 30.9%, and 64.7% of the medicines had been prescribed by a physician. The most frequently used pharmacological groups were medicines for the nervous (35.9%) and respiratory systems (25.7%). Medicine use was directly associated with socioeconomic status, maternal schooling, complications during pregnancy or delivery, and neonatal problems resulting in the need for intensive care. Underweight and obese adolescents were more likely to use medicines as compared to those with normal body mass index. A direct association was observed between maternal use of hypnotic drugs and sedatives and adolescent medicine use. It is essential to implement educational policies aimed at promoting rational use of medicines by adolescents.

Avanços e desafios da assistência farmacêutica na atenção primária no Sistema Único de Saúde

I Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil II Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, Brasil III Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil IV Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil V Prefeitura Municipal de Florianópolis. Florianópolis, SC, Brasil VI Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil VII Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil VIII Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil

Original articleTherapeutic procedures and use of alternating antipyretic drugs for fever management in childrenCondutas terapêuticas e uso alternado de antipiréticos no manejo da febre em crianças

Objective nThe evidence on the effectiveness of alternating antipyretics in fever management is scarce and indicates clinically negligible differences. The present study aimed to describe therapeutic procedures and the use of alternating antipyretics in children, and to evaluate associated factors.

Therapeutic conducts and alternating antipyretics in the management of fever in children

OBJECTIVES: To describe therapeutic conducts and the alternate use of antipyretics in children, and to evaluate factors associated with this use. METHODS: Cross-sectional study with 692 children from 0 to 6 years, living in southern Brazil. Through cluster sampling, we carried out household interviews with caregivers, using a structured questionnaire. A descriptive analysis was performed and the association between sociodemographic factors and the alternate use of antipyretics was evaluated. We analyzed 630 cases (91.0%), corresponding to children with history of fever. RESULTS: Around 73% of the caregivers answered that their first action with respect to a rising temperature was to medicate the child. The mean temperature considered fever by the caregivers was 37.4 °C and high fever, 38.7 °C. The use of alternate antipyretics was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical advice, in most cases. The most widely used drugs were dipyrone and paracetamol. Children whose main caregiver was a parent, with better economic conditions and higher educational level were more likely to use alternating therapy. Around 70% of the doses used were below the minimum recommended. CONCLUSIONS: The administration of medication to control fever is a common practice, including alternating antipyretics. Most caregivers consider fever some temperatures below those recommended, and pointed out non-response and medical advice as the main reasons for alternating antipyretics.