Vera Lucia Luiza

Aquisição de medicamentos no setor público: o binômio qualidade - custo

The authors discuss procurement and provision of pharmaceutical products from the perspective of supply management in the public health sector, focusing on two main aspects: quality and cost. The article analyzes issues to be considered by buyers when evaluating drug quality, especially formulation stability, bioequivalence, and the role of generics. Also discussed are factors involving costs and cost management in relation to technological innovations and consumer demands. New alternatives and suggestions are examined and presented for procurement of high-quality, cost-effective drug products.

Avaliação da assistência farmacêutica às pessoas vivendo com HIV/AIDS no Município do Rio de Janeiro

This study evaluates access by people living with HIV/AIDS to pharmaceutical care provided by public health care facilities in the city of Rio de Janeiro, Brazil, focusing on availability, accessibility, and accommodation. The evaluation was conducted using the implementation analysis approach, assessing the process of producing intervention outcomes, considering its relationship to the organizational context. A case study was performed in 11 public health facilities selected according to: different health program areas; diverse levels of complexity; and more than 100 HIV/AIDS patients registered. The degree of implementation (89%) was considered acceptable. Problems with human resources skills and lack of a quality program were identified. Some limitations of the indicators are discussed. Finally, the study highlights the importance of this kind of evaluation as a methodology for continuous monitoring of quality in pharmaceutical care.

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.

Disponibilidade no setor público e preços no setor privado: um perfil de medicamentos genéricos em diferentes regiões do Brasil

A study to identify availability and prices of medicines, according to type of provider, was conducted in the five regions of Brazil. A list of medicines to treat prevalent diseases was investigated, using the medicines price methodology developed by the World Health Organization and Health Action International, adapted for Brazil. In the public sector, bioequivalent (vis-a-vis reference brand) generics are less available than multisource products. For most medicines (71.4%), the availability of bioequivalent generics was less than 10%. In the private sector, the average number of different bioequivalent generic versions in the outlets was far smaller than the number of versions on the market. There was a positive correlation between the number of generics on the market, or those found at outlets, and the price variation in bioequivalent generic products, in relation to the maximum consumer price. It is estimated that price competition is occurring among bioequivalent generic drugs and between them and multisource products for the same substance, but not with reference brands.

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.

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.

Access to medicines in Latin America and the Caribbean (LAC): a scoping study

Objective To assess scientific publication and map research gaps on access to medicines (ATM) in Latin American and the Caribbean low-income and middle-income countries (LMIC). Design Scoping review. Two independent reviewers assessed studies for inclusion and extracted data from each study. Information sources Search strategies were developed and the following databases were searched: MEDLINE, ISI, SCOPUS and Lilacs, from 2000 to 2010. Eligibility criteria Research articles and reviews published in English, Spanish and Portuguese were included. Studies including only high-income countries were excluded, as well as those carried out in very limited settings and discussion papers. Results The 77 articles retained were categorised through consensus among the research team according to the level of the health system addressed, ATM domain and research issues covered. Publications on ATM have increased over time during the study period (r 0.93, p=0.00; R2 0.85). The top five countries covered were Brazil (68.8%), Mexico (15.6%), Colombia (11.7%), Argentina (10.4%) and Peru (10.4%). ‘Health services delivery’ and ‘patients, household and communities’ were the health system levels most frequently covered. The ATM domains ‘leadership and governance’, ‘sustainable financing, affordability and price of medicines’, ‘medicines selection and use’ and ‘availability of medicines’ were the top four explored. There are research gaps in important areas such as ‘human resources for health’, ‘global policies and human rights’, ‘production of medicines’ and ‘traditional medicine’. Conclusions The upward trend on scientific publication reflects a growing research capacity in the region, which is concentrated on research teams in selected countries. The gaps on research capacity could be overcome through research collaboration among countries. It is important to strengthen these collaborations, assuring that interests and needs from the LMIC are addressed and local capacity building is promoted.

Logic models from an evaluability assessment of pharmaceutical services for people living with HIV/AIDS

Brazil was the first developing country to provide people living with HIV/AIDS (PLWA) with comprehensive, universal, free access to antiretroviral medicines (ARV). Pharmaceutical services are considered a strategic action that has the goal of providing access to rational use of quality medicines while also promoting user satisfaction. User satisfaction is a complex concept, and evaluation models for pharmaceutical services for PLWA were not found in the literature. Therefore, an evaluation approach to help assess this issue had to be developed. This article seeks to describe a theoretical evaluation model of user satisfaction with the dispensing of ARV, developed as part of an Evaluability Assessment (EA). It presents a brief review of the EA and user satisfaction and describes the development of models created during the EA. The lessons learned in the process are presented as a conclusion.O Brasil foi o primeiro pais em desenvolvimento a fornecer medicamentos antiretrovirais (ARV) de forma integral, universal e gratuita as pessoas vivendo com HIV/Aids (PVHA). A Assistencia Farmaceutica e considerada uma acao estrategica e busca prover acesso a medicamentos de qualidade, com uso racional, promovendo a satisfacao dos usuarios. Satisfacao do usua-rio e um conceito complexo e modelos para avaliarem servicos farmaceuticos para PVHA nao sao encontrados na literatura. Este artigo objetiva descrever o desenvolvimento de tres modelos criados em um Estudo de Avaliabilidade (EA). E apresentada uma breve revisao dos conceitos de EA e de Satisfacao do Usuario. As licoes apreendidas no processo sao apresentadas como conclusao.

Farmácia Popular Program: changes in geographic accessibility of medicines during ten years of a medicine subsidy policy in Brazil

ObjectivesThe Brazilian constitution guarantees the right to health, including access to medicines. In May 2004, Brazil’s government announced the “Farmácia Popular” Program (FPP) as a new mechanism to improve the Brazilian population’s access to medicines. Under FPP, a selected list of medicines is subsidized by the government and provided in public and private pharmacies.The aim of this study is to describe the historical stages of the FPP and to identify associated changes in the geographical accessibility of medicines through the FPP over time.MethodsIt was performed documentary review and an ecological study assessing program coverage in terms of number of facilities and a FPP Pharmacy Facilities Density (PFD) index at national and regional levels from 2004 to 2013, using the FPP database. We used geographic information system mapping to depict a pharmaceutical facilities density (PFD) index at the municipality level on thematic maps.ResultsA growth of the PFD index coincident with the phases of the FPP was noticed. In the public sector, the program started in 2004; by 2006, there was a sharp increase in the numbers of participating pharmacies, stabilizing in 2009. In the private sector, the program started in 2006; by 2009 the PFD ratio had increased substantially and it continued to grow through 2011. There was an increase in FPP coverage in most regions between 2006, when the private pharmacy component started, and 2013, but participating pharmacies remain unequally distributed across geographical regions. Specifically, the wealthy areas in the South and Southeast have higher coverage, with lower coverage mostly in the North and Northeast, relatively poorer areas with greater need for access to medicines, health care, and other basic services such as potable water and sanitization.ConclusionsThere has been a substantial increase in the number of pharmacies participating in the FPP over time. This has led to greater program coverage and has potentially improved access to FPP medicines in the country. Nevertheless, disparities in pharmacy coverage remain among the regions.

Access to medicines for acute illness in middle income countries in Central America

OBJECTIVE To analyze the main predictors of access to medicines for persons who experienced acute health conditions. METHODS This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1) seeking care for acute illness in the formal health care system and (2) obtaining all medicines sought for the acute condition. RESULTS The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0). For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors. CONCLUSIONS A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines.OBJECTIVE: To analyze the main predictors of access to medicines for persons who experienced acute health conditions METHODS: This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1) seeking care for acute illness in the formal health care system and (2) obtaining all medicines sought for the acute condition. RESULTS: The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0). For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors. CONCLUSIONS: A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines.