O que faz o farmacêutico no NASF?: construção do processo de trabalho e promoção da saúde em um município do sul do Brasil

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-graduação em Farmácia, Florianópolis, 2013Em 2008 foi criado no Brasil o Núcleo de Apoio à Saúde da Família (NASF) com o objetivo de apoiar a inserção da Estratégia de Saúde da Família, ampliando a abrangência e o escopo das ações da atenção básica (AB), bem como sua resolutividade. Para isso, o NASF deve atuar em diversas áreas estratégicas, com políticas que incluem a Atenção Básica, a Promoção da Saúde e a Assistência Farmacêutica. A inserção do farmacêutico nessa equipe e neste novo contexto representa uma oportunidade de mudança do seu processo de trabalho. Assim, investigou-se a construção do processo de trabalho e da promoção da saúde pelo farmacêutico no NASF de um município do sul do Brasil. Dessa forma, foi realizada uma revisão integrativa da literatura sobre a promoção da saúde na área farmacêutica e uma pesquisa de campo, de abordagem qualitativa, para observação do processo de trabalho e as atividades de promoção da saúde dos farmacêuticos. A revisão integrativa demonstrou que o uso do termo promoção da saúde está limitado à reorientação do serviço da farmácia e mudança de hábitos pessoais, traduzindo-se em estratégias para transmissão de informações sobre medicamentos e seus usos, cuidados preventivos e combate a hábitos prejudiciais à saúde. O estudo do processo de trabalho foi analisado em suas vertentes de atendimento de demanda de serviços farmacêuticos e a função de apoiador, com o desenvolvimento do trabalho autônomo e ao mesmo tempo limitador. Já o estudo da promoção da saúde demonstrou que o processo de trabalho revela um conceito de promoção da saúde condizente com a literatura, além do desenvolvimento de atividades tanto para os usuários quanto para equipes de Saúde da Família, sendo constatadas importantes barreiras e (algumas) possibilidades para o desenvolvimento pontual dessas ações. Conclui-se que a falta de planejamento e objetivo claro para o trabalho no NASF, além da deficiência de serviços farmacêuticos na AB torna o desenvolvimento de qualquer tipo de atividade (gerencial ou assistencial) importante e necessário, mesmo não atendendo integralmente a expectativa da proposta do NASF.2013-12-05T22:57:20

Pharmaceutical services and health promotion: how far have we gone and how are we faring? Scientific output in pharmaceutical studies

The objective of this study was to investigate the scientific output on health promotion within the pharmaceutical field and its relation with the development of pharmaceutical services within health systems. A comprehensive review of published scientific articles from the Medline and Lilacs databases was carried out. The review comprised articles published until December 2011, and used combinations of the terms 'health promotion' or 'health education' and 'pharmacy', 'pharmacist' or 'pharmaceutical'. The articles were selected according to inclusion and exclusion criteria. A total of 170 full texts and 87 indexed abstracts were analyzed, evidencing that most described actions of health promotion in community pharmacies and other services. Following the Ottawa Charter, most of the studies dealt with new guidance of the service and the supply of pharmaceutical information and services. It was concluded that there is a lack of theoretical background on health promotion in the pharmaceutical field to sustain the professional education and practice required by the health system and the population.O objetivo do estudo foi investigar a produção científica sobre o desenvolvimento teórico e prático da promoção da saúde na farmácia e sua relação com o desenvolvimento da área e dos serviços farmacêuticos. A revisão integrativa de artigos científicos foi realizada a partir das bases de dados Medline e Lilacs. Ela compreendeu os artigos publicados até dezembro de 2011, através da combinação dos termos 'promoção da saúde ou educação em saúde' e 'farmácia, farmacêutico ou farmacêutica'. Critérios de inclusão e exclusão definiram a seleção dos textos. Ao todo, 170 artigos e 87 resumos foram analisados, sendo a maioria identificada como trabalhos teóricos que relatam atividades descritas como de promoção da saúde em farmácias comunitárias ou outros serviços. Confrontando com o referencial da Carta de Ottawa, a maioria dos estudos revelou ter como campo de investigação principal alguma proposição de reorientação dos serviços de saúde e oferta de informações e práticas farmacêuticas. Conclui-se que há uma carência de embasamento teórico sobre promoção da saúde na área farmacêutica para sustentar a formação e prática profissional, conforme exigido pelo sistema de saúde e pela população

Effect of a task-shared, collaborative care psychosocial intervention to improve depressive symptomatology among older adults in socioeconomically deprived areas of Brazil (PROACTIVE):cluster randomised controlled trial

BACKGROUND: There is an urgent need to reduce the burden of depression among older adults in low-income and middle-income countries (LMICs). We aimed to evaluate the efficacy of a task-shared, collaborative care psychosocial intervention for improving recovery from depression in older adults in Brazil. METHODS: PROACTIVE was a pragmatic, two-arm, parallel-group, cluster-randomised controlled trial conducted in Guarulhos, Brazil. Primary care clinics (clusters) were stratified by educational level and randomly allocated (1:1) to either enhanced usual care alone (control group) or to enhanced usual care plus the psychosocial intervention (intervention group), which involved a 17-week psychosocial programme based on psychoeducation and behavioural activation approaches. Individuals approached for the initial screening assessment were selected randomly from a list of individuals provided by the Health Secretariat of Guarulhos. Face-to-face baseline assessments were conducted among adults aged 60 years or older registered with one of the primary care clinics and identified with clinically significant depressive symptomatology (9-item Patient Health Questionnaire [PHQ-9] score ≥10). Community health workers delivered the programme through home sessions, supported by a dedicated tablet application. Masking of clinic staff and community health workers who delivered the intervention was not feasible; however, research assistants conducting recruitment and follow-up assessments were masked to trial allocation. The primary outcome was recovery from depression (PHQ-9 score <10) at 8-month follow-up. All primary analyses were performed by intention to treat with imputed data. Adaptations to the protocol were made due to the COVID-19 pandemic; recruitment and intervention home sessions were stopped, and follow-up assessments were conducted by telephone. This trial is registered with the ISRCTN registry, ISRCTN57805470. FINDINGS: We identified 24 primary care clinics in Guarulhos that were willing to participate, of which 20 were randomly allocated to either the control group (ten [50%] clusters) or to the intervention group (ten [50%] clusters). The four remaining eligible clusters were kept as reserves. Between May 23, 2019, and Feb 21, 2020, 8146 individuals were assessed for eligibility, of whom 715 (8·8%) participants were recruited: 355 (49·7%) in the control group and 360 (50·3%) in the intervention group. 284 (80·0%) participants in the control group and 253 (70·3%) in the intervention group completed follow-up at 8 months. At 8-month follow-up, 158 (62·5%) participants in the intervention group showed recovery from depression (PHQ-9 score <10) compared with 125 (44·0%) in the control group (adjusted odds ratio 2·16 [95% CI 1·47–3·18]; p<0·0001). These findings were maintained in the complete case analysis. No adverse events related to the intervention were observed. INTERPRETATION: Although the COVID-19 pandemic altered delivery of the intervention, the low-intensity psychosocial intervention delivered mainly by non-mental health professionals was highly efficacious in improving recovery from depression in older adults in Brazil. Our results support a low-resource intervention that could be useful to reduce the treatment gap for depression among older people in other LMICs. FUNDING: São Paulo Research Foundation and Joint Global Health Trials (UK Department for International Development, Medical Research Council, and the Wellcome Trust)

Depressive and subthreshold depressive symptomatology among older adults in a socioeconomically deprived area in Brazil

Depressive and subthreshold depressive symptomatology are common but often neglected in older adults. / Objective: This study aimed to assess rates of depressive and subthreshold depressive symptomatology, and the characteristics associated, among older adults living in a socioeconomically deprived area of Brazil. / Methods: This study is part of the PROACTIVE cluster randomised controlled trial. 3356 adults aged 60+ years and registered in 20 primary health clinics were screened for depressive symptomatology with the Patient Health Questionnaire-9 (PHQ-9). Depressive status was classified according to the total PHQ-9 score and the presence of core depressive symptoms (depressed mood and anhedonia) as follows: no depressive symptomatology (PHQ-9 score 0–4, or 5–9 but with no core depressive symptom); subthreshold depressive symptomatology (PHQ-9 score 5–9 and at least one core depressive symptom); and depressive symptomatology (PHQ-9 score ≥ 10). Sociodemographic information and self-reported chronic conditions were collected. Relative risk ratios and 95% CIs were obtained using a multinomial regression model. / Results: Depressive and subthreshold depressive symptomatology were present in 30% and 14% of the screened sample. Depressive symptomatology was associated with female gender, low socioeconomic conditions and presence of chronic conditions, whereas subthreshold depressive symptomatology was only associated with female gender and having hypertension. / Conclusions: Depressive and subthreshold depressive symptomatology is highly prevalent in this population registered with primary care clinics. Strategies managed by primary care non-mental health specialists can be a first step for improving this alarming and neglected situation among older adults