Pharmaceutical services in the primary health care of the Brazilian Unified Health System:: advances and challenges

This study is a synthesis of the main results of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), Evaluation Component of the Basic Pharmaceutical Services. Based on the critical narrative of the elements of Brazil’s pharmaceutical policies, we discuss aspects related to the structure of the pharmaceutical services, the medicines’ sanitary state, human resources, access to medicines, rational use and management. Despite the advances that reflect the commitment of the group of actors involved, the results of the Survey indicate challenges, such as equitable access to medicines, the structuring of pharmaceutical services, the improvement of logistics and administration, and the implementation of actions directed to pharmaceutical care in the health unitsTrata-se de uma síntese dos principais resultados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos, componente de Avaliação dos Serviços de Assistência Farmacêutica Básica. Com base em narrativa crítica dos elementos das políticas farmacêuticas no Brasil, discutem-se aspectos relacionados à estrutura dos serviços farmacêuticos, situação sanitária dos medicamentos, recursos humanos, acesso a medicamentos, uso racional e gestão. Apesar dos avanços que refletem o empenho do conjunto de atores implicados, os resultados da Pesquisa apontam desafios, como o acesso equitativo dos medicamentos, a estruturação dos serviços farmacêuticos, o aprimoramento da logística e da gestão e a implantação de ações voltadas ao cuidado farmacêutico nas unidades de saúd

Ações judiciais e demandas administrativas na garantia do direito de acesso a medicamentos em Florianópolis-SC

This study aims at analyzing the requests for drugs by individual users, from 2003 to 2006, in the city of Florianópolis. It was analyzed 2,426 authorizations for the supply of 5,645 drugs and 5,283 correlated products in the Secretary for Health, the Secretary for Social Development and in the Volunteering Association of Florianópolis, considering the types of drugs requested, costs and characteristics of those who requested them. Secretary of Health received the highest number of requests throughout the years and the authorizations for purchase did not present all the data of the requests. The main type of demand met by the Secretary of Health was originated from judicial decisions, while the main type met by the Secretary for Social Development was internal demands. The most frequently requested class of drugs, whether by legal writ or not, was the one which affects the Nervous System, with Carbamazepine being the primary medication, while a Pimecrolimus cream was the most frequently requested medication representing the highest cost. The majority of the drugs were prescribed by their commercial name and 32% of them were standardized by the Brazilian National Health System. It is concluded that the supply of drugs by direct purchase is not adequately dealt by the municipal pharmaceutical assistance, disrespecting the National Drug Policy.O estudo objetivou analisar as solicitações de medicamentos por usuários individuais, de 2003 a 2006, no município de Florianópolis. Foram analisadas 2.426 autorizações para fornecimento de 5.645 medicamentos e 5.283 produtos correlatos na Secretaria de Saúde e na Secretaria da Criança, Adolescente, Idoso, Família e Desenvolvimento Social (SMDS) e na Associação Florianopolitana de Voluntários, considerando os tipos de medicamentos solicitados, valores empregados e características dos solicitantes. A Secretaria de Saúde recebeu, em comparação à SMDS e à Associação Florianopolitana de Voluntários, o maior número de solicitações em todos os anos e as autorizações de compra não apresentavam todos os dados sobre as solicitações, sendo que, o principal tipo de demanda atendido foi via decisão judicial. Na SMDS, a principal demanda era interna. A classe de medicamentos mais solicitada, via mandado judicial ou não, foi a dos que atuam no Sistema Nervoso, sendo Carbamazepina o principal medicamento, enquanto o medicamento Pimecrolimo, por via dermatológica, foi o mais solicitado e o que representou maior custo. Os medicamentos estavam prescritos, em sua maioria, pelo nome comercial e 32% constavam de programas de fornecimento de medicamentos padronizados pelo SUS. Conclui-se que o fornecimento de medicamentos por compra direta não está adequadamente inserido na gestão da assistência farmacêutica municipal, desrespeitando a Política Nacional de Medicamentos

Ações judiciais e demandas administrativas na garantia do direito de acesso a medicamentos em Florianópolis-SC

This study aims at analyzing the requests for drugs by individual users, from 2003 to 2006, in the city of Florianópolis. It was analyzed 2,426 authorizations for the supply of 5,645 drugs and 5,283 correlated products in the Secretary for Health, the Secretary for Social Development and in the Volunteering Association of Florianópolis, considering the types of drugs requested, costs and characteristics of those who requested them. Secretary of Health received the highest number of requests throughout the years and the authorizations for purchase did not present all the data of the requests. The main type of demand met by the Secretary of Health was originated from judicial decisions, while the main type met by the Secretary for Social Development was internal demands. The most frequently requested class of drugs, whether by legal writ or not, was the one which affects the Nervous System, with Carbamazepine being the primary medication, while a Pimecrolimus cream was the most frequently requested medication representing the highest cost. The majority of the drugs were prescribed by their commercial name and 32% of them were standardized by the Brazilian National Health System. It is concluded that the supply of drugs by direct purchase is not adequately dealt by the municipal pharmaceutical assistance, disrespecting the National Drug Policy.O estudo objetivou analisar as solicitações de medicamentos por usuários individuais, de 2003 a 2006, no município de Florianópolis. Foram analisadas 2.426 autorizações para fornecimento de 5.645 medicamentos e 5.283 produtos correlatos na Secretaria de Saúde e na Secretaria da Criança, Adolescente, Idoso, Família e Desenvolvimento Social (SMDS) e na Associação Florianopolitana de Voluntários, considerando os tipos de medicamentos solicitados, valores empregados e características dos solicitantes. A Secretaria de Saúde recebeu, em comparação à SMDS e à Associação Florianopolitana de Voluntários, o maior número de solicitações em todos os anos e as autorizações de compra não apresentavam todos os dados sobre as solicitações, sendo que, o principal tipo de demanda atendido foi via decisão judicial. Na SMDS, a principal demanda era interna. A classe de medicamentos mais solicitada, via mandado judicial ou não, foi a dos que atuam no Sistema Nervoso, sendo Carbamazepina o principal medicamento, enquanto o medicamento Pimecrolimo, por via dermatológica, foi o mais solicitado e o que representou maior custo. Os medicamentos estavam prescritos, em sua maioria, pelo nome comercial e 32% constavam de programas de fornecimento de medicamentos padronizados pelo SUS. Conclui-se que o fornecimento de medicamentos por compra direta não está adequadamente inserido na gestão da assistência farmacêutica municipal, desrespeitando a Política Nacional de Medicamentos

Satisfação de usuários com serviços da assistência farmacêutica na atenção primária no Brasil

Objetivo: avaliar a satisfação dos usuários com os serviços de assistência farmacêutica na atenção primária. Métodos: estudo transversal, exploratório, de natureza avaliativa, com amostra representativa das cinco regiões geopolíticas do Brasil, oriundas da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015. O desfecho foi a satisfação do usuário obtida pelo método de teoria da resposta ao item. Foram testadas associações por meio do teste qui-quadrado de Pearson com variáveis sociodemográficas e de saúde e realizadas análises de regressão logística múltipla. O teste de Hosmer-Lemeshow foi utilizado para verificar a adequação do modelo final. Os resultados da regressão logística foram apresentados por meio de razão de chances. Resultados: o percentual geral de usuários satisfeitos com esses serviços foi de 58,4% (IC95% 54,4–62,3). A dimensão oportunidade/conveniência apresentou menor percentual de satisfação (49,5%; IC95% 46,4–52,6) e o maior percentual foi na dimensão aspectos interpessoais (90,5%; IC95%88,9–91,8), significativamente maior que as demais dimensões. No modelo logístico múltiplo final em relação à satisfação geral, permaneceram associadas as variáveis sexo, faixa etária, limitação por doenças e autopercepção da saúde. Conclusões: a maior parte dos usuários entrevistados mostrou-se satisfeita com os serviços da assistência farmacêutica dos municípios brasileiros e a satisfação com o atendimento apresentou-se como fator relevante na satisfação geral do usuário.Objective: to evaluate patient satisfaction with pharmaceutical services in Brazilian primary health care. Methods: this is a cross-sectional, exploratory, and evaluative study on a representative sample from the five Brazilian geopolitical regions resulting from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The outcome was the patient’s satisfaction, obtained using the item response theory. Associations were tested using Pearson’s Chi-square test with sociodemographic and health variables, and multiple logistic regression analyses were carried out. The Hosmer-Lemeshow test was used to verify the adequacy of the final model. Logistic regression results were presented as odds ratio. Results: the overall percentage of patients satisfied with these services was 58.4% (95%CI 54.4-62.3). The “opportunity/convenience” aspect had the lowest satisfaction percentage (49.5%; 95%CI 46.4-52.6) and “interpersonal aspects,” the highest percentage (90.5%; 95%CI 88.9-91.8), significantly higher than other aspects. Sex, age group, limitations due to disease, and self-perception of health remained associated in the final multiple logistic model regarding general satisfaction. Conclusions: most of the interviewed users were satisfied with pharmaceutical services in Brazilian cities, and the satisfaction with the customer’s service was determinant in the patient’s overall satisfaction

Estimating the global conservation status of more than 15,000 Amazonian tree species

Estimates of extinction risk for Amazonian plant and animal species are rare and not often incorporated into land-use policy and conservation planning. We overlay spatial distribution models with historical and projected deforestation to show that at least 36% and up to 57% of all Amazonian tree species are likely to qualify as globally threatened under International Union for Conservation of Nature (IUCN) Red List criteria. If confirmed, these results would increase the number of threatened plant species on Earth by 22%. We show that the trends observed in Amazonia apply to trees throughout the tropics, and we predict thatmost of the world’s >40,000 tropical tree species now qualify as globally threatened. A gap analysis suggests that existing Amazonian protected areas and indigenous territories will protect viable populations of most threatened species if these areas suffer no further degradation, highlighting the key roles that protected areas, indigenous peoples, and improved governance can play in preventing large-scale extinctions in the tropics in this century

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

Aim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types