Availability and Accessibility to Medicines in Primary Health Care in a Brazilian Region

Abstract

Objective: The aim with the present study was to evaluate availability and accessibility to medicines in Primary Health Care in Northeast Health District, Belo Horizonte, Brazil. Method: It was an epidemiological, descriptive and cross-sectional study, conducted in the central warehouse and in twenty Primary Health Care units. The data was collected through direct observation, in information systems and in a survey with patients. Indicators proposed by World Health Organization were used to analyze the availability and accessibility. Results: The average availability of essential medicines from a key list in stock observed in visits in Primary Health Care units was 98,3 ± 3,7% and in the past 12 months was 42,5 ± 13,6%. One thousand and three hundred eighty-three medicines were prescribed to patients and 1066 (77,1%) of them were actually dispensed. An association of the presence of medicine in Essential Medicine List with dispensing of medicine was observed (p=0,00). It was observed that 93,2% of patients spent until 30 min in the way from their residence to Primary Health Care unit. Conclusion:The conditions of availability of medicines in stock in visits and the accessibility to services in PHC were satisfactory; however, limitations were observed in yearly availability of medicines and in the attendance of patient`s needs for prescribed medicines. Actions are recommended to improve availability of medicines such as the adoption of the Essential Medicine List.

Use of World Health Organization Indicators to Assess Pharmaceutical Assistance in Primary Health Care: An Integrative Review

“…About the indicator percentage of availability of key drugs, six publications that used this indicator were also found in the review. 6,9,14,18,26,33 For this indicator, publications also show an unsatisfactory result in relation to that recommended by the World Health Organization (100%). None of the articles were in agreement with the World Health Organization, but one of the studies carried out in Brazil showed an availability of medicines of 98.3%, a result very close to the recommended value.…”

“…However, one of its weaknesses would be the failure to measure all the important aspects of medication use; this requires more intensive methodologies and more comprehensive and varied data sources. Only one of the selected studies 9 it addresses other indicators that measure the availability of medicines and geographical access in primary health care units, in addition to the indicators of rational use of medicines. In this study, the availability of essential drugs varied from 100% to 60% between the time of the visit for restrictive and educational measures regarding the use of antibiotics.…”

“…17 The authors suggested the inclusion of the pharmacist in the health team so that this professional with his knowledge can contribute to better management, both logistically and clinically. 9 The group of prescription indicators consists of: average number of drugs prescribed per consultation; percentage of drugs prescribed by the generic name; percentage of antibiotics prescribed; percentage of prescribed injectables; percentage of prescription drugs present in the Local Drug List. The average number of drugs prescribed per consultation was observed that all studies, which used this indicator, were above the value recommended by the World Health Organization (<2), however, three studies showed values close to this reference value.…”

“…The value closest to that recommended by the World Health Organization was found in the publication from Kuwait that detected an average of 97.9% of medicines dispensed. 6,[8][9][18][19]26,[32][33] The main reason involved in the low percentage of drugs dispensed may be the inadequate availability of drugs in stock. 6 Of the selected publications, five publications used the indicator percentage of properly labeled drugs and in only one of them (originally from Pakistan) a positive result was observed in relation to the value established by the World Health Organization, which must be 100% adequate in relation to this indicator.…”

“…In addition, the use of these indicators is mostly performed by developing countries. [4][5][6][7][8][9][10][11][12][13][14][15] In this context, this study presents an integrative review that covers information on the use of indicators for the monitoring and evaluation of Pharmaceutical Assistance in Primary Health Care in several countries, generating a critical analysis regarding the results found against the standards established by the World Health Organization. The objective of this integrative review, based on the PRISMA recommendation to synthesize evidence, was to analyze articles published in the last ten years and substantiate the evidence related to Pharmaceutical Care, using the World Health Organization's indicators in the context of Primary Health Care.…”