Abstract
ABSTRACTOBJECTIVE To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS).METHODS This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions.RESULTS We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators.CONCLUSIONS Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.
Highlights
Implementing pharmaceutical services (PS) is pointed out as one of the challenges for the consolidation of the Brazilian Unified Health System (SUS)[8]
We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators
In-person interviews were held with patients, doctors, and those responsible for delivering medicines in primary health care services of SUS, in addition to observation of the pharmaceutical services facilities and telephone interviews with the professionals responsible for pharmaceutical services in the cities
Summary
Implementing pharmaceutical services (PS) is pointed out as one of the challenges for the consolidation of the Brazilian Unified Health System (SUS)[8]. Brazilian cities have several weaknesses regarding the decentralization of activities and PS management capacity, especially in primary health care[8,12]. The Brazilian Ministry of Health has been providing new guidelines for pharmaceutical services to avoid restricting logistics actions, and improve the management and quality of these services[21]. The constant problems in managing PS experienced by Brazilian cities show the difficulties still faced by SUS – regarding the quality of the pharmaceutical services provided – to ensure access and the effectiveness of health actions[18]
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