Antidepressivos, ansiolíticos, hipnóticos e sedativos : uma análise dos gastos em Minas Gerais

The allocation of financial resources on medicines procurement is one of the greatest challenges to the effectiveness of the Pharmaceutical Services in the Brazilian National Health System. However, there are few studies evaluating this expenditure trends at state level, especially with antidepressants, anxiolytics, hypnotics and sedatives. The study evaluated public expenditure trends and drivers for these therapeutic classes in Minas Gerais state, Brazil, by using data from SIAD database [Sistema Integrado de Administração de Materiais e Serviços] from 2010 to 2015. Total expenditure, volume and also expenditures with medicines not included in the essential lists were estimated. The top 10 medicines in terms of expenditure and drugs accounting for 90% of the total cost were identified. Decomposition analysis was conducted to assess the drivers of expenditure. Expenditure in the period totaled R$ 81 million and increased 2.5 times from 2010 to 2015. Antidepressants accounted for 89% of expenses and 71% of volume. Price contributed positively to the expenditure variation during the period, especially in antidepressants. The results highlight the need of improvement of public procurement procedures adopted by Minas Gerais state

Padrões de prescrição, dispensação e comercialização de metilfenidato

OBJETIVO Analisar padrões e requisitos legais do consumo de metilfenidato. MÉTODOS Estudo transversal realizado em Belo Horizonte, MG, em 2006. Foram analisados dados de notificações de receitas de metilfenidato e de balanços de vendas de medicamentos – psicoativos e outros – sujeitos a controle especial. Determinou-se a dose diária definida, a dose diária prescrita, o período médio de prescrição e de dispensação, bem como a distribuição regional das vendas desse medicamento no município. Foram estimados, ainda, os gastos com a aquisição do medicamento e analisado o perfil de consumo individual do fármaco por meio da Curva de Lorenz. RESULTADOS Os dados dos balanços mensais de comercialização de psicotrópicos cobriram toda a comercialização notificada do fármaco, enquanto aqueles coletados nas notificações de receita cobriram 50,6% das farmácias que o comercializaram, incluindo aquelas de maior volume de venda. O consumo de metilfenidato foi 0,37 DDD/1.000 habitantes/dia. As vendas concentraram-se em áreas mais desenvolvidas e as formulações farmacêuticas de liberação não controlada foram as mais prescritas. A prescrição e a dispensação com dosagens >; 30 mg/dia e período de tratamento >; 30 dias apresentaram valores em torno de 20,0% em algumas regiões da cidade. CONCLUSÕES O consumo de metilfenidato apresentou-se elevado no município, maior em áreas mais favorecidas economicamente e predominando o consumo de formulações com maior risco de abuso. Tanto a prescrição quanto a dispensação apresentaram características não compatíveis com as recomendações farmacoterapêuticas e determinações legais. O controle de venda do fármaco deve ser monitorado e a farmacoterapia das alterações comportamentais amplamente rediscutida em concordância com os conceitos do uso de medicamentos com qualidade.OBJECTIVE To analyze the patterns and legal requirements of methylphenidate consumption. METHODS We conducted a cross-sectional study of the data from prescription notification forms and balance lists of drugs sales – psychoactive and others – subject to special control in the fifth largest city of Brazil, in 2006. We determined the defined and prescribed daily doses, the average prescription and dispensation periods, and the regional sales distribution in the municipality. In addition, we estimated the costs of drug acquisition and analyzed the individual drug consumption profile using the Lorenz curve. RESULTS The balance lists data covered all notified sales of the drug while data from prescription notification forms covered 50.6% of the pharmacies that sold it, including those with the highest sales volumes. Total methylphenidate consumption was 0.37 DDD/1,000 inhabitants/day. Sales were concentrated in more developed areas, and regular-release tablets were the most commonly prescribed pharmaceutical formulation. In some regions of the city, approximately 20.0% of the prescriptions and dispensation exceeded 30 mg/day and 30 days of treatment. CONCLUSIONS Methylphenidate was widely consumed in the municipality and mainly in the most developed areas. Of note, the consumption of formulations with the higher abuse risk was the most predominant. Both its prescription and dispensation contrasted with current pharmacotherapeutic recommendations and legal requirements. Therefore, the commercialization of methylphenidate should be monitored more closely, and its use in the treatment of behavioral changes of psychological disorders needs to be discussed in detail, in line with the concepts of the quality use of medicines

Diferenças na disponibilidade de medicamentos prescritos na Atenção Primária : evidências do Projeto Prover

Estudo transversal da disponibilidade de medicamentos prescritos na Atenção Primária, com amostra probabilística de 1221 usuários das farmácias públicas de município polo de saúde em Minas Gerais, em 2017. Foram estimados indicadores de disponibilidade dos medicamentos e realizou-se regressão logística hierárquica, segundo o modelo comportamental de uso de serviços de saúde. Apenas 39,3% dos usuários receberam todos os medicamentos nas quantidades prescritas. Os medicamentos mais e menos disponíveis foram, respectivamente, os que atuam no sistema digestivo/metabolismo, e no sangue e órgãos hematopoiéticos. A disponibilidade integral do tratamento se mostrou associada a mais escolaridade (≥ 8 anos OR: 1,7; IC 95%: 1,3-2,4); proximidade até a farmácia (≤15 min OR: 1,7; IC 95%: 1,2- 2,3); ausência de gastos privados com medicamentos (OR: 2,2; IC 95%: 1,7-2,9) e menor número de medicamentos prescritos (≤ 2 OR: 3,2; IC 95%: 2,3-4,4; 3/4 OR: 1,6; IC 95%: 1,2-2,1). Esses resultados mostram diferenças na disponibilidade de medicamentos dentro do SUS, evidenciando a necessidade de reorganização da rede de atendimento dos serviços de dispensação e do planejamento das aquisições de medicamentos, além da proposição de políticas públicas que priorizem a população mais vulnerável

Tendência nos gastos com medicamentos neuropsiquiátricos em Minas Gerais : Há aumento da oferta de antiparkinsonianos?

Introduction: Neuropsychiatric drugs are used for a wide variety of neurological and psychiatric conditions. Aims: To analyze the evolution and determinants of public spending on these medicines in Minas Gerais,2010 to 2017. Methods: Datathe Integrated Materials and Services Administration System (SIAD) database were used to estimate volumes of acquisition and expenses. Decomposition analysis was performed and, for anti-Parkinson drugs, the list of purchased drugs was analyzed and Drug Utilization technique (DU90%) was applied. Results: Annual expenditure decreased by 36%,R$111.7 million in 2010 to R$ 40.9 million in 2017, having as determinant factors the drops in prices and volume, associated with changes in the drug mix, that favored the acquisition of more expensive products, on average. The expenditure increase for anti-parkinsonians stands out, nonetheless, with significant change in the drug mix purchased. Conclusion: This study contributed to a better understanding of public spending on neuropsychiatric drugs. Reduction in volume can increase the risk of shortages. Regarding anti-parkinsonians, there is no evidence to suggest an increase in supply to the population

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

Background: Essential Medicines Policy (EMP) has been adopted in Brazil to improve the provision and use of pharmaceuticals. This mixed methods study aims to bring evidence of the EMP implemented in municipalities in the context of primary care in Minas Gerais (20,997,560 inhabitants), Southeast Brazil. Methods: We analysed the core output of the EMP, i.e., the municipal essential medicines lists (MEML) and the effects of the policy on the procurement and availability of medicines. Data sources included a sample of 1,019 individuals (patients, health managers and health professionals), 995 prescriptions, 2,365 dispensed medicines and policy documents from 26 municipalities. Data were collected between April and October 2019. Document analysis and thematic content analysis were performed, and four availability indexes were estimated. Results: The findings suggest an overall lack of standardised and methodologically sound procedures to elaborate the MEML. Funding and public purchasing processes were found to be the major obstacles to medicine procurement. Only 63% of medicines were available at public community pharmacies and just 46.2% of patients had full access to their pharmaceutical treatment. Conclusion: This study reveals weaknesses in the implementation of EMP and a clear disconnection between medicines selection, procurement, and availability, the three core elements of the supply system. These findings contribute to informing future policy improvement actions to strengthen this system. Other countries aiming to advance towards universal health coverage may learn from the challenges that primary care in Brazil still needs to address

Pharmaceutical services in primary health care : are pharmacists and users on the same page?

This study investigated structural and organizational characteristics of the Pharmaceutical Services based on Primary Health Care (PHCPS) from the viewpoints of users and pharmacists. A mixed method design was applied, combining one-to-one semi-structured interviews with four pharmacists in charge of five public dispensing facilities and 69 users, with a secondary database analysis. Data were collected from February to August 2014 in Divinopolis, a municipality in Minas Gerais State. PHCPS were similar in terms of general activities performed and staff profile and background. While users were concerned about medicines' availability and improvements related to the PHCPS' conveniences and personnel, pharmacists pointed out problems regarding infrastructure to storage. Despite most users had low information on how to use their medicines, no pharmacists declared to participate in medicines dispensing activities. There was a low match between users and pharmacists viewpoints and advantages for concentrate medicines dispensing in a smaller number of facilities were not clear

Performance of a pharmaceutical services regionalization strategy policy in Minas Gerais, Brazil : pre-post analysis from ERAF project

Background: In 2016, the Brazilian state of Minas Gerais (∼20 million people), implemented the ERAF policy ("Regionalization Strategy of Pharmaceutical Services") in an effort to improve medicine procurement and distribution within primary care. We evaluated the impact of the policy on three main goals: price reductions, volume increases, and expansion of therapeutic options. Methods: We analyzed the procurement data from the Integrated System of Management of Pharmaceutical Services database in 2012 and 2018. We estimated the volume, drug mix, and expenditure indicators for all major therapeutic classes, and, in detail, for cardiovascular and nervous system drugs. We evaluated the expenditure drivers using decomposition analyses. Results: Overall, the expenditure increased by 14.5%, drug mix almost doubled, while the volume decreased by a third. Cardiovascular and neurological system drugs followed similar patterns. Decomposition analyses showed that prices and drug mix had positive effects while the volume had negative effects, resulting in an overall increase in expenditure. Conclusion: Our findings suggest that the ERAF policy cannot be considered effective as it has not fulfilled its intended purposes so far. Strategies to address the identified problems and to build a platform for a more sustainable long-lasting policy should be put in place by the government

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

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)