Pharmaceutical services for endemic situations in the Brazilian Amazon: organization of services and prescribing practices for Plasmodium vivax and Plasmodium falciparum non-complicated malaria in high-risk municipalities

<p>Abstract</p> <p>Background</p> <p>In spite of the fact that pharmaceutical services are an essential component of all malaria programmes, quality of these services has been little explored in the literature. This study presents the first results of the application of an evaluation model of pharmaceutical services in high-risk municipalities of the Amazon region, focusing on indicators regarding organization of services and prescribing according to national guidelines.</p> <p>Methods</p> <p>A theoretical framework of pharmaceutical services for non-complicated malaria was built based on the Rapid Evaluation Method (WHO). The framework included organization of services and prescribing, among other activities. The study was carried out in 15 primary health facilities in six high-risk municipalities of the Brazilian Amazon. Malaria individuals ≥ 15 years old were approached and data was collected using specific instruments. Data was checked by independent reviewers and fed to a data bank through double-entry. Descriptive variables were analyzed.</p> <p>Results</p> <p>A copy of the official treatment guideline was found in 80% of the facilities; 67% presented an environment for receiving and prescribing patients. Re-supply of stocks followed a different timeline; no facilities adhered to forecasting methods for stock management. No shortages or expired anti-malarials were observed, but overstock was a common finding. On 86.7% of facilities, the average of good storage practices was 48%. Time between diagnosis and treatment was zero days. Of 601 patients interviewed, 453 were diagnosed for <it>Plasmodium vivax</it>; of these, 99.3% received indications for the first-line scheme. Different therapeutic schemes were given to <it>Plasmodium falciparum </it>patients. Twenty-eight (4.6%) out of 601 were prescribed regimens not listed in the national guideline. Only 5.7% individuals received a prescription or a written instruction of any kind.</p> <p>Conclusions</p> <p>The results show that while diagnostic procedure is well established and functioning in the Brazilian malaria programme, prescribing is still an activity that is actually not performed. The absence of physicians and poor integration between malaria services and primary health services make for the lack of a prescription or written instruction for malaria patients throughout the Brazilian Amazon. This fact may lead to a great number of problems in rational use and in adherence to medication.</p

Uso de medicamentos por gestantes usuárias do Sistema Único de Saúde Uso de medicamentos por gestantes del Sistema Único de Salud The use of medicines by pregnant women who receive care in the Brazilian Universal Healthcare System

OBJETIVO: Identificar o uso de medicamentos por gestantes usuárias do Sistema Único de Saúde do município de Bandeirantes - Paraná. MÉTODOS: Estudo analítico transversal. População: 245 gestantes e amostra de 205. O instrumento para coleta de dados foi um questionário estruturado. Estudo realizado de julho de 2006 a novembro de 2007. RESULTADOS: 83,4% das gestantes entrevistadas declararam utilizar pelo menos um medicamento, destas 8,2% o fizeram sem prescrição médica e 80,5% receberam alerta sobre perigos de certos medicamentos. Os dados evidenciaram uma relação estatisticamente significante entre o 3º trimestre e o maior uso de medicamentos. Sulfato ferroso (45,0%) e paracetamol (43,4%) foram os mais utilizados, porém medicamentos considerados de risco para o feto também foram empregados. CONCLUSÃO: As gestantes estão sendo expostas a uma variedade de medicamentos, o que exige atenção criteriosa para evitar possíveis danos ao feto.<br>OBJETIVO: Identificar el uso de medicamentos por gestantes del Sistema Único de Salud del municipio de Bandeirantes - Paraná. MÉTODOS: Se trata de un estudio analítico transversal. La población estuvo constituida por 245 gestantes siendo la muestra de 205. El instrumento para la recolección de datos fue un cuestionario estructurado. El estudio fue realizado de julio del 2006 a noviembre del 2007. RESULTADOS: el 83,4% de las gestantes entrevistadas declararon utilizar por lo menos un medicamento, de éstas el 8,2% lo hicieron sin prescripción médica y el 80,5% fueron alertadas sobre los peligros de ciertos medicamentos. Los datos evidenciaron una relación estadísticamente significativa entre el 3º trimestre y el mayor uso de medicamentos. El Sulfato ferroso (45,0%) y el paracetamol (43,4%) fueron los más utilizados, pero también los medicamentos considerados de riesgo para el feto. CONCLUSIÓN: Las gestantes están siendo expuestas a una variedad de medicamentos, lo que exige una atención con criterio para evitar posibles daños al feto.<br>OBJECTIVE: To identify the use of medicines by pregnant women who receive care at the Brazilian universal healthcare system, specifically in the municipal district of Bandeirantes, Paraná. METHODS: A cross-sectional descriptive study was used. A sample of 205 women participated in the study. Data were collected from July 2006 to November 2007 using a structured questionnaire. RESULTS: A great number of participants (83.4%) reported they had used at least one medicine during their pregnancy and 8.2% of them used over-the-counter medicines. The majority of the women (80.5%) received warnings about the use of medicines during pregnancy. There was significant statistical relationship between the last 3 months of pregnancy and the increase in medicines use. Although Ferrous sulfate (45.0%) and Paracetamol (43.4%) offer serious risks to the fetus, these two medicines were among those most used by the participants. CONCLUSION: Pregnant women have been exposed to a variety of medicines. There is a need to improve the quality of care to pregnant women in order to prevent potential risks to the fetus

Mandados judiciais como ferramenta para garantia do acesso a medicamentos no setor público: a experiência do Estado do Rio de Janeiro, Brasil Can court injunctions guarantee access to medicines in the public sector? The experience in the State of Rio de Janeiro, Brazil

O crescente número de mandados judiciais impetrados contra a Secretaria de Estado de Saúde do Rio de Janeiro, Brasil, buscando acesso a medicamentos ensejou a condução do estudo. Um desenho seccional foi utilizado para descrever as ações impetradas de janeiro de 1991 a dezembro de 2002, analisando-as frente à definição de competências dentro do Sistema Único de Saúde (SUS). Utilizou-se amostra estratificada de 389 ações, tendo como base o ano de início. Os resultados sugerem demora no julgamento das ações, sendo a maioria conduzida pela defensoria pública para usuários do SUS. Os medicamentos mais solicitados foram os de ação sobre os sistemas nervoso e cardiovascular, muitos de uso contínuo. Notou-se a oficialização de práticas prescritivas, com a inclusão de medicamentos freqüentemente solicitados nas listas de financiamento público, dificultando adesão ao uso racional de medicamentos. Medicamentos da competência de fornecimento dos municípios são solicitados ao Estado, que, por sua vez, falha no repasse. A aparente falta de esclarecimento dos autores e condutores das ações gera desgaste na relação executivo-judiciário e desvio dos recursos para ações coletivas de assistência farmacêutica.<br>There are increasing numbers of legal suits concerning access to medicines brought against the Rio de Janeiro State Health Department. The situation indicated the need for a study to clarify the underlying issues. A sample of 389 court suits from January 1991 to December 2001 (stratified by year) was used. A cross-sectional design was used to describe and analyze the legal suits in relation to the responsibilities defined under the Unified National Health System (SUS). Results suggest major delays in court decisions. Most suits are filed by the Public Defender's Office for users of the National Health System. The most frequent cases involve medicines for the cardiovascular and nervous systems, many of which involve continuous use. Prescribing practices are institutionalized through the inclusion of the most frequently prescribed drugs in public financing lists, which makes rational drug use difficult to achieve. Municipalities are not fulfilling their responsibility to supply medicines to users, and the State is thus encumbered with these responsibilities. However, the State does not adequately supply medicines to the municipalities. The apparent lack of awareness among both lawyers and clients generates stress between the Executive and Judiciary branches and limits the resources for collective pharmaceutical services