Vera Lúcia Edais Pepe

A interação entre prescritores, dispensadores e pacientes: informação compartilhada como possível benefício terapêutico

The article presents a critical view of the interaction between prescribers, dispensers, and patients, considering information one of the key issues in enhancing the qualitative aspects involved in this complex relationship. It describes the acquisition of information by health professionals, possible sources of this information, and the process involved in transforming it into knowledge. Briefly discussed are the physicians and pharmacists roles, the patients expectations as recipient, and consequences of pertinent health interventions.

Judicialização da saúde, acesso à justiça e a efetividade do direito à saúde

Este artigo busca analisar os vinculos entre acesso a justica e a efetividade de um dos aspectos do direito a saude: o acesso aos medicamentos. Inicialmente, apresenta os desafios e as dificuldades na conceituacao de saude e do direito a saude. Em seguida, analisa processos judiciais individuais que reivindicam dos entes publicos o fornecimento de medicamentos, no periodo de junho de 2007 a julho de 2008, no Tribunal de Justica do Estado do Rio de Janeiro. Constata-se que a prescricao medica individual, a hipossuficiencia economica e a urgencia dos demandantes ao acesso aos medicamentos sao os principais respaldos das decisoes judiciais analisadas, que determinam o fornecimento de medicamento conforme requerido pelos autores. Conclui-se que a efetividade do direito a saude requer um conjunto de respostas politicas e acoes governamentais mais amplas, e nao meramente formais e restritas as ordens judiciais. As demandas judiciais nao podem ser consideradas como principal instrumento deliberativo na gestao da assistencia farmaceutica no SUS, mas admitidas como um elemento importante na tomada de decisao dos gestores e, muitas vezes, na melhoria do acesso aos medicamentos no âmbito do SUS. No contexto democratico brasileiro, a judicializacao pode expressar reivindicacoes e modos de atuacao legitimos de cidadaos e de instituicoes. O principal desafio e formular estrategias politicas e sociais orquestradas com outros mecanismos e instrumentos de garantia democratica, que aperfeicoem os sistemas de saude e de justica com vistas a efetividade do direito a saude.

Avaliação dos serviços hospitalares de emergência do estado do Rio de Janeiro

This study aimed at the evaluation of urgency/emergency hospital units and recorded the relations of emergency units with users, other hospital services and the healthcare network and approached the size of the teams, the relations among the professionals, their qualification and income. It further describes the infrastructure of these services including basic organizational aspects. The aspect care was one component in this broader object. It is a descriptive study applying a questionnaire to the heads of the emergency services of a sample of 30 hospitals.The statements suggest the overcrowding of emergency services (in 80% of hospitals) deteriorating the work and care conditions to be due to the inefficiency of primary care and the healthcare network. The deficit of human resources was found larger than the lack of technology. The precarious employment relations were considered a factor hampering the qualification and retention of professionals. The most favorably evaluated items were: relationship with service heads, trust and expectations with regard to the service. The worst items were: wages, team size and labor medicine. The nvestment in human resources is indispensable. There is a need for public policies that articulate more efficient interventions given that those in force are defining the configuration of territories with their hierarchized and solidary networks.

Censo dos pacientes internados em uma instituição asilar no Estado do Rio de Janeiro: dados preliminares

O Estado do Rio de Janeiro concentra uma das maiores redes de hospitais psiquiatricos do pais, sendo um deles a Casa de Saude Dr. Eiras/Paracambi (CSDE-P). A atual Assessoria de Saude Mental da Secretaria de Estado de Saude do Estado do Rio de Janeiro, realizou em fins de 2000, o Censo Clinico e Psicossocial dos Pacientes Internados na CSDE-P. Encontrou uma populacao de 1494 individuos, com predominio de homens (53,4%), solteiros (81,6%), faixa etaria produtiva (66,4%) e baixa escolaridade (11,5% com primeiro grau completo ou mais). A maioria tinha um tempo de internacao superior/igual a 2 anos (77,6%), recebiam visitas de familiares (60,5%) mas nao saiam de licenca (73,8%). Os diagnosticos predominantes foram as esquizofrenias (53,6%) e o retardo mental (26,4%). A principal abordagem terapeutica foi a psiquiatrica (84,1%). Realizavam atividades sistematicas durante o dia 13,3% dos pacientes, embora cerca de 36% apresentassem bons indicativos de condicoes de autonomia. A CSDE-P e um macro hospital, onde a maioria dos pacientes encontra-se desterritorializada e com lacos sociais precarios, exigindo a construcao de estrategias de cuidados que levem em conta essa particularidade.Rio de Janeiro State has one of the largest networks of psychiatric hospitals in Brazil, one of them the Dr. Eiras Paracambi Hospital (CSDE-P). In late 2000, the current Mental Health Advisory Division of the Rio de Janeiro State Health Department conducted a clinical and psychosocial census of patients hospitalized in the CSDE-P. The hospital population consisted of 1,494 individuals, the majority men (53.4%), single (81.6%), working-age (66.4%), and with limited schooling (only 11.5% with a complete primary education or more). Most had been in hospital for at least two years (77.6%), received visits from relatives (60.5%), but did not have hospital leave (73.8%). The predominant diagnoses were schizophrenia (53.6%) and mental retardation (26.4%). The main therapeutic approach was psychiatric (84.1%). Only 13.3% took part in systematic activities during the day, although 36% were in a condition to do so. CSDE-P is a mega-hospital where most patients have precarious social links, demanding treatment strategies which take this characteristic into account.

Consumo de psicofármacos em uma região administrativa do Rio de Janeiro: a Ilha do Governador

Em 1988, um inquerito epidemiologico foi realizado para se estimar a prevalencia de alcoolismo cronico e uso de alcool na populacao da XX Regiao Administrativa da cidade do Rio de Janeiro. O instrumento incluiu perguntas sobre o consumo de psicofarmacos, cafe e cigarros. Este trabalho analisa os dados referentes ao consumo de psicofarmacos nos 30 dias anteriores a pesquisa. A amostra representativa da populacao acima de 13 anos foi composta por 1.459 pessoas, Os resultados mostram uma prevalencia de consumo global de 5,2% (3,1% para homens e 6,7% para mulheres). As mulheres, as pessoas mais velhas (especialmente pessoas entre 60 e 69 anos), os separados e viuvos, e as pessoas de renda mais baixa apresentaram prevalencias mais elevadas. Avaliou-se a associacao de cada variavel demografica atraves do calculo deodds ratio ajustado por regressao logistica. Os tranquilizantes derivados dos benzodiazepinicos predominaram entre os tipos de psicofarmacos referidos (85,23%), seguidos pelos antiepilepticos (5,68%) e pelos hipnoticos e sedativos (4,54%). Os clinicos nao-especializados em neurologia ou psiquiatria lideraram as prescricoes (65,8%). Oitenta por cento dos medicamentos foram obtidos na rede privada, enquanto 13,16% foram adquiridos na farmacia publica, quase todos mediante a apresentacao do receituario controlado. Os resultados sao discutidos e novas linhas de pesquisa sao apontadas.

Uso indicado e uso referido de medicamentos durante a gravidez

Few studies describe drug utilization in pregnancy focusing on prescribing practices. This study is part of a larger survey on perinatal care in the City of Rio de Janeiro, Brazil. The type of hospital (public, contracted out by the Unified National Health System, or private) determined the stratification of 10,072 hospitalized post-partum women, who were asked about medication used during pregnancy. Hospital records supplied information on drugs prescribed during labor. Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) system. Another system was used for specific cases of referred use. A mean of 2.08 drugs was prescribed during labor, and a mean of 2.3 was reported during pregnancy. Anesthetics, antibiotics, oxytocin, and analgesics were the most frequently prescribed during labor, with significant differences between strata. Ferrous sulfate, vitamins, scopolamine, and acetaminophen were the main drugs reported during pregnancy. Women who had attempted abortion referred use of various kinds of tea (49.7%) and misoprostol (9.2%). The drug utilization pattern was consistent with the literature. This study offers knowledge on prescribing patterns during labor and self-reported use during pregnancy in both the public and private sectors.

Algoritmo para a composição de dados por internação a partir do sistema de informações hospitalares do sistema único de saúde (SIH/SUS) - Composição de dados por internação a partir do SIH/SUS

The authorization form for hospital admittance (AIH), an observation unit under the Hospital Information System of the Unified Health System (SIH/SUS), may represent a short-term hospital admittance or a longer hospital stay. This study presents an algorithm for composing admittance data based on the AIH forms, allowing for a proper assessment of hospital mortality, costs under the Unified Health System (SUS), and longer hospital stays, typical of chronic, terminal, and psychiatric patients.

Essencialidade e assistência farmacêutica: considerações sobre o acesso a medicamentos mediante ações judiciais no Brasil

The guarantee of pharmaceutical care as a legal right established by the Brazilian federal constitution of 1988 led to an increase in lawsuits to put that right into practice. This phenomenon has been dubbed the judicialization of pharmaceutical care. Studies on this topic have revealed, on the one hand, deficiencies in the access of Unified Health Care (SUS) users to drugs included in Ministry of Health pharmaceutical care lists, and, on the other hand, limitations of the legal system to deal with the situation. The present article addresses these issues in the context of the conceptual framework that supports the Brazilian drug policy and pharmaceutical care policy, especially the notions of essential drugs and allocation of scarce resources.

Racionalidade terapêutica: elementos médico-sanitários nas demandas judiciais de medicamentos

OBJECTIVE To characterize the main medical, scientific and health-related procedural elements upon which decisions are made in individual lawsuits demanding medicines that are considered essential to the Court of Justice. METHODS Retrospective descriptive study based on 27 cases ruled on by the Court of Appeals in Rio de Janeiro, Southeastern Brazil, in 2006. The original proceedings were solicited from the Central Archive of the Court of Justice of the State of Rio de Janeiro and were photographed and analyzed in full. RESULTS Prescriptions and medical certificates were present in 100% of the lawsuits. All prescriptions lacked conformity to legislation. No expert medical reports were added, and only 7.4% of the lawsuits presented complementary examinations. In spite of the scarcity of medical information present in the records, all of the demands were granted. CONCLUSIONS The admission of judicial demands devoid of clinical and diagnostic substantiation results in managerial and health-related constraints on the health system. Besides creating havoc in standard pharmaceutical services, badly justified medicine demands may compromise rational drug use.OBJETIVO: Caracterizar os principais elementos processuais, medico-cientificos e sanitarios que respaldam as decisoes das demandas judiciais individuais por medicamentos consideradas essenciais. METODOS: Estudo descritivo retrospectivo com base em 27 acoes julgadas em 2a instância no Estado do Rio de Janeiro em 2006. Os processos originais foram solicitados ao Arquivo Central do Tribunal de Justica do Estado do Rio de Janeiro, fotografados e analisados na integra. RESULTADOS: Todas as acoes incluiram prescricao e atestado medicos. As prescricoes estavam em desacordo com a legislacao. Nao houve pericia medica em nenhuma das acoes e em 7,4% constavam exames complementares. Apesar da escassa informacao medica contida nos autos, todos os pedidos foram deferidos. CONCLUSOES: O acolhimento de demandas judiciais carentes de subsidios clinicos e diagnosticos traz embaracos de ordem gerencial e sanitaria ao sistema de saude, pois comprometem a assistencia farmaceutica regular e fomentam o uso irracional de medicamentos.

Pharmaceutical services evaluation in Brazil: broadening the results of a WHO methodology.

The objective of this paper is to explore and analyze the results of the Diagnosis of the Pharmaceutical Situation in Brazil (DiagAF-Br) from a regional perspective. The study made use of an exploratory approach of multiple cases based on the DiagAF-Br data collected in five Brazilian states. A descriptive analysis of selected indicators was performed in each of the Brazilian states in three pharmaceutical dimensions: access, quality, and rational use of medicines. The mainly results concerning the percentage of completed prescriptions varied from 1.1% in the State of Goiás to 98.6% in Espírito Santo; the percentage of patients who know how to take their medicines varied from 60.4% in Sergipe to 93.3% in Rio Grande do Sul. Educational level showed to be an important predictor of knowledge on how to use medicines, especially relevant when prescription is completed. The average number of prescribed medicines, approximately 2.1, did not show any difference between the visited sites. Different levels of management capacity and services organization were identified, suggesting the need for more adequate strategies to improve access, quality and mainly rational use of medicines in Brazil.