Implementation of pharmaceutical services in Brazilian primary health care: a cross-sectional study

Abstract

Background In the Brazilian public health system, primary health care (PHC) is provided by the municipalities and is considered the entry level of the Unified Health System (SUS). Governmental pharmaceutical services (PharmSes) are part of the SUS, including PHC, and are the most significant way in which patients access medicine and services. Considering the diversity of the country, the municipalities have the autonomy to decide how PharmSes are implemented. Even though policies and procedures should be implemented as expected by policy makers and experts, municipality characteristics may interfere with implementation fidelity. Therefore, this study evaluated the degree to which the PharmSes in PHC were delivered as intended in Brazilian municipalities. Methods We analysed data from a secondary database originating from a cross-sectional nationwide study carried out by the Ministry of Health and the World Bank from 2013 to 2015. Data on 465 municipalities and the Federal District were collected from 4939 governmental PharmSes. A rating system comprising 43 indicators was developed and applied to the dataset to obtain the implementation degree (ID) of each PharmSe. Additionally, the IDs of the two PharmSes dimensions and the nine components were measured. Results Overall, the ID of the PharmSes in Brazilian PHC was evaluated as critical. The ID was critical in 81% of the municipalities (n = 369), incipient in 14% (n = 65) and unsatisfactory in 4.8% (n = 22). Regarding the PharmSes dimensions, the ‘medicine management’ (MM) ID was considered critical (Mean = 46%), while the ‘care management’ (CM) ID was incipient (Mean = 22%). In terms of the PharmSes components, the highest ID was achieved by ‘forecasting’ (58%). In contrast, ‘continuing education and counselling’ showed the lowest figure (ID = 11%) in the whole sample, followed by ‘information and communication’ and ‘teamwork’. Conclusions The degree to which PharmSes were implemented was critical (ID< 50%). This analysis demonstrated that PharmSes were implemented with low fidelity, which may be related to the low availability of medicine in PHC. Although the care management component requires more attention, considering their incipient ID, all components must be reviewed. Municipalities must increase their investment in PharmSes implementation in order to maximize the benefits of these services and guarantee the essential right of access to medicine.

Pharmaceutical Services Management Capacity and the Municipal Socioeconomic Scenario: Persistent Inequalities

“…Due to the country size and the complexity to obtain a national sample, most studies regarding pharmaceutical services in the public health system are of a local nature. Data were collected between 2014 and 2015 [36,37] and represent a milestone for understanding the national panorama of access and use of medicines in the Brazilian population [29].The variables that made up the indicator (PSMind) were selected as described by Faraco et al [33]; 2. Association of PSMind with the density of pharmacists per 10,000 inhabitants, as described by Faraco et al [33] and with each municipality's socioeconomic indexes, which were collected on public databases (2014 and 2015).…”

“…Calculation of the PS Management Capacity Indicator (PSMind) in Brazilian municipalities' PHC [34], in a sample of 507 municipalities selected by the National Survey on Access, Use and Promotion of Rational Use of Medicines in Brazil (PNAUM). PNAUM was a cross-sectional exploratory study, consisting of the primary data survey on a representative sample of PHC services in 600 municipalities in Brazilian regions [13,29,35]. Due to the country size and the complexity to obtain a national sample, most studies regarding pharmaceutical services in the public health system are of a local nature.…”

Evaluation Of COVID Drugs Management in Pharmaceutical Installations Of Royal Prima Hospital Medan During the COVID-19 Pandemic

“…According to (Pereira, Luiza, Campos, & Chaves, 2021) gathering standard procedure in service pharmacy as for purpose service pharmacy is as follows: 1) Guarantee quality, benefits, safety as well as efficacy ready pharmaceuticals and tools health; 2) Guarantee certainty law for power health;3) Protect patients, community and staff from use drugs that don't rational in skeleton safety patients (patient safety) and 4) Reduce number error use medicine.…”

Saúde um direito de tod(e)s? Impasses encontrados pela população LGBTQIA+ no âmbito da Atenção Primária à Saúde

“…No Brasil, por exemplo, a APS é outorgada pelos municípios, sendo vinculada ao governo estadual e federal, e é caracterizada como a porta de entrada para o SUS. Assim, as equipes da APS são encarregadas de fornecer serviços relacionados à saúde, bem como coordenar o atendimento aos pacientes em diferentes ambientes e níveis de complexidade (Bianchi;Pereira et al, 2021).…”