Abstract
Pharmaceutical assistance is essential in health care and a right of citizens according to Brazilian law and drug policies. The study purpose was to evaluate aspects of pharmaceutical assistance in public primary health care. A cross-sectional study using WHO drug indicators was carried out in Brasilia in 2001. From a random sample of 15 out of 62 centers thirty exiting patients per center were interviewed. Only 18.7% of the patients fully understood the prescription, 56.3% could read it, 61.2% of the prescribed drugs were actually dispensed, and mean duration of pharmaceutical dispensing was 53.2 seconds. Each visit lasted on average 9.4 minutes. Of prescribed and non-dispensed drugs, 85.3% and 60.6% were on the local essential drug list (EDL) respectively. On average 83.2% of 40 essential drugs were in stock, and only two centers had a pharmacist in charge of the pharmacy. The mean number of drugs per prescription was 2.3, 85.3% of prescribed drugs were on the EDL, 73.2% were prescribed using the generic denomination, 26.4% included antibiotics and 7.5% were injectables. The most prescribed groups were: cardiovascular drugs (26.8%), anti-infective drugs (13.1%), analgesics (8.9%), anti-asthmatic drugs (5.8%), anti-diabetic drugs (5.3%), psychoactive drugs (3.7%), and combination drugs (2.7%). Essential drugs were only moderately available almost 30 years after the first Brazilian EDL was formulated. While physician use of essential drugs and generic names was fairly high, efficiency was impaired by the poor quality of pharmaceutical care, resulting in very low patient understanding and insufficient guarantee of supply, particularly for chronic diseases.
Highlights
Brazil is a middle income country showing significant economic growth while it has one of the most markedly uneven income distributions in the world
Methods suggested by the World Health Organization (WHO) for rapid and simple analysis of drugs in primary care services were used in addition to few new indicators
Significant progress has clearly been achieved in assuring a fair drug stock for most primary care centers, physician’s compliance with the Essential Drug List, and use of the generic denomination while prescribing
Summary
Brazil is a middle income country showing significant economic growth while it has one of the most markedly uneven income distributions in the world. This pattern of economic growth has led to grossly unequal access to medical and pharmaceutical care.[7] A profound health reform, established by the 1988 review of the Brazilian Constitution, created a universal publicly-financed health system. According to the national household survey on access to and utilization of health services family income is strongly correlated with access to health services, either public or private.[7] Insufficient access to essential drugs due to inadequacies in acquisition and distribution and poor physician prescribing have been described as factors aggravating the unequal access to good quality pharmaceutical assistance.[4,9]
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