Comments On “the Organization Of Pharmaceutical Services By ‘health Region’ In Brazil’s Unified Health System”

This study aimed to describe and characterize the pharmaceutical services provided in Brazil’s Unified Health System (SUS) from the point of view of the healthcare networks that are organized by region in the QualiSUS-Rede Project. This was a cross-sectional study, with data collected from December 2013 to July 2015, in public health establishments that carried out delivery or warehousing of medications (n = 4,938), in 465 municipalites, and the Federal District, in 43‘Health Regions’. The results show the existence of at least one management service supporting the health network, and warehousing of medications in all the regions (> 90%). It also showed the availability of at least one healthcare service, in healthcare locations, by pharmaceutical professionals is irregular between the Regions, being highest in the Southeastern Region (74.3%), and lowest in the Northeastern Region (43.3%). The results underpine the need for effective structuring of pharmaceutical assistance in the SUS networks, overcoming the current restrictive vision of its activities, which gives value almost exclusively to the logistical component of support to the network, to the detriment of the clinical component. It is also important to expand, and improve the quality of, the population’s access to medical drugs, and improve the quality of the healthcare offered to users of the system. © 2017, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.2241181119

Fibrosis assessment using FibroMeter combined to first generation tests in hepatitis C

AIM: To evaluate the performance of FibroMeter combined to the first generation tests aspartate aminotransferase-to-platelet ratio index (APRI) or Forns index to assess significant fibrosis in chronic hepatitis C (CHC). METHODS: First generation tests APRI or Forns were initially applied in a derivation population from Rio de Janeiro in Brazil considering cut-offs previously reported in the literature to evaluate significant fibrosis. FibroMeter was sequentially applied to unclassified cases from APRI or Forns. Accuracy of non-invasive combination of tests, APRI plus FibroMeter and Forns plus FibroMeter was evaluated in the Brazilian derivation population. APRI plus FibroMeter combination was validated in a population of CHC patients from Angers in France. All patients were submitted to liver biopsy staged according to METAVIR score by experienced hepatopathologists. Significant fibrosis was considered as METAVIR F ≥ 2. The fibrosis stage classification was used as the reference for accuracy evaluation of non-invasive combination of tests. Blood samples for the calculation of serum tests were collected on the same day of biopsy procedure or within a maximum 3 mo interval and stored at -70 °C. RESULTS: Seven hundred and sixty CHC patients were included (222 in the derivation population and 538 in the validation group). In the derivation population, the FibroMeter AUROC was similar to APRI AUROC (0.855 0.815, = 0.06) but higher than Forns AUROC (0.769, < 0.001). The best FibroMeter cut-off to discriminate significant fibrosis was 0.61 (80% diagnostic accuracy; 75% in the validation population, = 0.134). The sequential combination of APRI or Forns with FibroMeter in derivation population presented similar performance compared to FibroMeter used alone (79% 78% 80%, respectively, = 0.791). Unclassified cases of significant fibrosis after applying APRI and Forns corresponded to 49% and 54%, respectively, of the total sample. However, the combination of APRI or Forns with FibroMeter allowed 73% and 77%, respectively, of these unclassified cases to be correctly evaluated. Moreover, this combination resulted in a reduction of FibroMeter requirement in approximately 50% of the entire sample. The stepwise combination of APRI and FibroMeter applied to the validation population correctly identified 74% of patients with severe fibrosis (F ≥ 3). CONCLUSION: The stepwise combination of APRI or Forns with FibroMeter may represent an accurate lower cost alternative when evaluating significant fibrosis, with no need for liver biopsy