It is necessary to increase efforts to ensure access to these drugs in the primary health care network.

OBJETIVO: Analisar os custos para a assistência à saúde de portadores de diabetes melito e hipertensão arterial e estimar o custo de procedimentos ambulatoriais de média complexidade comparando-os com os valores da tabela de reembolso do Sistema Único de Saúde (SUS). MATERIAIS E MÉTODOS: Foram analisados os custos diretos sanitários, em unidade pública de referência em Recife/PE no ano de 2007. Para o levantamento e alocação dos custos, utilizaram-se as técnicas de custeio por absorção e de rateio. RESULTADOS: Os custos diretos e o valor reembolsado pelo SUS totalizaram R$ 4.855.291,82 e R$ 2.118.893,56, respectivamente. Os grupos de despesas que apresentaram maiores custos foram: medicamentos R$ 1.762.424,42 (36,3%), serviços de terceiros R$ 996.637,82 (20,5%) e pessoal R$ 978.096,10 (20,1%). Todos os procedimentos apresentaram maior custo estimado que os valores pagos pela tabela SUS. CONCLUSÕES: Os medicamentos representaram os maiores custos para assistência e identificou-se diferença considerável entre os custos estimados e os valores reembolsados pelo SUS.

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IntroductionParkinson disease is a frequent neurodegenerative disorder. Presence of psychopathology is well described in this illness, nevertheless the etiology is still unknown.Methods and aimsThe authors present a clinical case of a patient with idiopathic Parkinson disease with depressive symptoms after the decline of his functioning. We aim to emphasize the importance of a multidisciplinary approach and the central role of general physicians in screening these situations.ResultsThe patient is a male with 64 years old, reformed with a personal history of hypertension. With 62 years old he started with mild motor complaints that got worse over time, culminating after a year and half on him being almost dependant for most of his daily activities. He also started to express feelings of sadness, despair, and recurrent thoughts of death. He refused to seek out medical help, but was convinced by his wife to consult his general physician that observed the patient and referenced him to Neurology and Psychiatry consultations. He also started sertraline 50 mg/day. He was diagnosed with Parkinson disease and started medication with ropinirole, levodopa and carbidopa with a good response. In Psychiatry consultation the dose of sertraline was increased to 100 mg/day with improvement, and it was provided information on the disease to the patient and family and also supportive psychotherapy.ConclusionsGeneral physicians have a privileged position on screening patients with psychopathology when other physical conditions or illnesses are present. The fast and correct referencing of these patients can improve the prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

To study the cost related to the management of type 2 diabetes mellitus (T2DM) in public health care by standard approach as a means to assist in the evaluation of health services in Brazil. METHODS: A small municipality was considered for this study, with less than 50,000 habitants, it is representative of 81% of the state's municipalities and 89% of Brazil's. The data sources used were obtained from the Municipal Health Office and public data systems online. Direct medical costs were selected according to standard care recommended by the Ministry of Health and Brazilian Associations of Cardiology and Diabetes, and lately divided into three categories of analysis: Health professional salary, Procedures and tests costs, and Medication costs, both for Primary Health Care (PHC) and Medium/High Complexity Care (MHCC). RESULTS: In 2011, the total expense in a year for a user with T2DM was U$ 491.04, regarding the individual without complication, attended in PHC. After developing chronic complications (either microvascular or macrovascular), the patient continues to receive PHC, but also needs the attention of specialists, therefore costs for specific treatments in MHCC services were added to the PHC costs. The sum ranged from U$ 732.86 for nephropathy to U$ 3182.59 for Acute Myocardial Infarction. In evaluation of each category of analysis, the investment made by the National Health System in the management of T2DM showed uneven distribution, where a subcategory of Health professionals salary, the PHC's doctors salary, represented an important share of spending in exchange of others categories. CONCLUSIONS: The standard cost method is presented as an alternative that offers greater convenience and flexibility in the determination of costs to assist health managers in decision-making, considering the shortcomings of Brazilian's information system.