Abstract
ABSTRACTOBJECTIVETo characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS).METHODSThis is a cross-sectional and evaluative study, part of 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). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename – National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed.RESULTSOne thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis.CONCLUSIONSThe low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer medicines in SUS confirm the general availability verified in this study. Among patients, about 60% said they obtain medicines in SUS units, data consistent with the lack of medicines reported by medicine dispensers and in line with physicians’ evaluations.
Highlights
Primary health care is characterized by individual and collective actions, comprising health promotion and protection, injury prevention, diagnosis, treatment, rehabilitation, and health maintenance
Important changes in the epidemiological profile that occurred in the last century led to a significant increase in life expectancy and increase in life expectancy and predominance of predominance of chronic non-communicable diseases (CNCD)[3,12]
Health care in Brazil is characterized by an accelerated demographic transition and expressed by triple burden of disease: an agenda of infectious diseases not yet overcome, diseases associated with external causes, and the chronic conditions’ hegemony. The answer to this situation has been structured by the health care network, with access to actions and services coordinated by primary health care[8,12]
Summary
Primary health care is characterized by individual and collective actions, comprising health promotion and protection, injury prevention, diagnosis, treatment, rehabilitation, and health maintenance. Medicines are one of the most important technologies used by modern society and a fundamental health care therapeutic resource[21,23]. Health care in Brazil is characterized by an accelerated demographic transition and expressed by triple burden of disease: an agenda of infectious diseases not yet overcome, diseases associated with external causes, and the chronic conditions’ hegemony. The answer to this situation has been structured by the health care network, with access to actions and services coordinated by primary health care[8,12]
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