MedMinas project: design and use of mixed methods in the evaluation of pharmaceutical services in primary health care in Minas Gerais, Brazil

Abstract

Background The main purposes of primary care-based pharmaceutical services (PHCPS) in Brazil are to provide free access to medicines and pharmaceutical care to patients. Several obstacles hinder achieving their goals; thus, MedMinas Project aimed to evaluate the PHCPS, the supply system, and the use of medicines. This paper reflects on our experience designing, planning, and conducting the project, describing the issues yielded in the field and lessons learned. Methods This work consists of a mixed-methods study conducted in Minas Gerais, Southeastern Brazil. We adopted the principles of Rapid Evaluation Methods, employing a multistage stratified sampling for the quantitative and a purposeful sampling for the qualitative components, respectively, and a documentary research. Data sources included individuals (patients and professionals), prescriptions, dispensed medicines, and policy documents collected between April and October 2019. The quantitative data described in this paper were analysed by descriptive statistics and the qualitative by Thematic Content Analysis. Results A total of 26 municipalities varying from 37,784 to 409,341 inhabitants were included. The field team spent, on average, 16 days in each location. We interviewed 1019 respondents, of which 127 were professionals and 892 patients. The participation rate varied from 92 to 100%, depending on the respondent subgroup. Most interviews lasted between 45 min and one hour. Fieldwork challenges included participants’ enrolment, field team, interview processes, and project budget. The participants provided positive feedback and five main themes emerged from the interview experience (self-awareness, sense of gratitude, research value, access to findings, and benefits of the research). Additionally, we collected copies of 1072 documents and 2070 pieces of data from prescriptions filled and medicines dispensed at the PCP. Conclusion We demonstrated the viability of conducting the MedMinas Project in an extensive geographic area within effective time frames that provided meaningful, high-quality data from multiple actors. The methods and lessons learned are valuable for researchers across various disciplines in similar urban settings in Brazil and other countries of low- and middle-income (LMIC).

An analysis of the essential medicines policy in primary care: Findings from MedMinas project

“…We managed such interferences by using pre-tested and piloted instruments and by employing trained interviewers that followed standardized procedures during fieldwork. Patients were interviewed after dispensing, with the presentation of medical prescriptions and medicines, minimizing the risk of memory bias ( Luz et al, 2022 ). We adopted the principles of Rapid Evaluation Methods, so our patient sample cannot be considered representative of the Brazilian primary care population.…”

“…Policy documents were collected at the MHS. More details about MedMinas methods can be found in another publication ( Luz et al, 2022 ).…”

Prevalence and Factors Associated With Out-of-Pocket Pharmaceutical Expenditure Among Primary Healthcare Patients: Evidence From the Prover Project

“…This study is part of the Prover Project, an exit-survey in the public community pharmacies conducted between August and November of 2017 in a large municipality (population greater than 200,000 inhabitants) in the state of Minas Gerais, Brazil 23 . The municipal Human Development Index (HDI) is 0.764 8 , slightly better than Brazil as a whole (0.755) 8 .…”