Management Of Pharmaceutical Services Research Articles

What we know about antibiotics prescribed by dentists in a Brazilian southeastern state.

The objective of this study was to analyze possible associations between antibiotic dental prescriptions in the public health service, health service characteristics, and social characteristics of the municipalities. Using the register of dispensing in the public health service of a state in the Southeast region of Brazil, in 2017 we analyzed patterns of antibiotic prescriptions by dentists. Data were obtained from the Integrated Pharmaceutical Services Management System (SIGAF, in Portuguese). The outcome variable was the number of Daily Defined Doses (DDD) per 1,000 residents/year in each municipality. CART (Classification and Regression Tree) technique was used to determine the influence of the following variables: populational social characteristics (Human Development Index, Gini Index, the proportion of rural population and proportion of families benefiting from the Bolsa Família Program) and oral health services characteristics (access to individual dental care, number of dentists and oral health teams per 1,000 residents, and percentage of preventive and restorative individual dental procedures. Data analysis was performed using IBM SPSS Statistics 21.0. Antibiotics were the medications most prescribed by dentists in the public health service, with penicillin being the most frequently prescribed class. The average DDD/1,000 residents/year for the 421 municipalities surveyed was 96.54 (range 0.008 and 619.660). Select factors were associated with antibiotic prescriptions including access to individual dental care (Adjusted p-value ≤0.001), a number of oral health teams/1,000 inhabitants (Adjusted p-value=0.001), and Gini Index (Adjusted p-value = 0.046). Access to oral health services and inequality were associated with the use of antibiotics.

Drugs supply and pharmaceutical care management practices at a designated hospital during the COVID-19 epidemic.

The coronavirus disease-19 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus that was first detected at the end of December 2019. The epidemic has affected various regions of China in different degrees. As the situations evolve, the COVID-19 had been confirmed in many countries, and made a assessment that it can be characterized as a pandemic by the World Health Organization on March 11, 2020. Drugs are the main treatment of COVID-19 patients. Pharmaceutical service offers drug safety ensurance for COVID-19 patients.According to COVID-19 prevention and control policy and requirements, combined with series of diagnosis and treatment plans, pharmacists in the first provincial-level COVID-19 diagnosis and treatment unit in Jilin Province in Northeast China have established the management practices of drug supply and pharmaceutical care from four aspects: personnel, drugs supply management, off-label drug use management and pharmaceutical care. During the outbreak, the pharmaceutical department of THJU completed its assigned workload to ensure drug supply. So far, no nosocomial infections and medication errors have occurred, which has stabilized the mood of the staff and boosted the pharmacists' confidence in fighting the epidemic. For the treatment of COVID-19, pharmacists conducted adverse reaction monitoring and participated in the multidisciplinary consultation of COVID-19. Up to now, the COVID-19 patients admitted to THJU have not shown any new serious adverse reactions and been cured finally. The hospital pharmacy department timely adjusted the work mode, and the formed management practices is a powerful guarantee for the prevention and control of the COVID-19 epidemic. This paper summarized the details and practices of drug supply and pharmaceutical services management to provide experience for the people who involving in COVID-19 prevention and contain in other abroad epidemic areas.

Origin-destination flows in chemotherapy for breast cancer in Brazil: implications for pharmaceutical services.

This study maps and analyzes patient flows for breast cancer chemotherapy in order to identify the potential implications for organization of pharmaceutical services in the cancer care network. An ecological study design sought to correlate the place of residence with place of care for breast cancer patients. All chemotherapy procedures financed by Brazil's Unified Health System (SUS) and performed from January to December 2013 were included. Flows were mapped using TerraView® software. A total of 1 347 803 outpatient chemotherapy procedures were delivered by 243 cancer care units located in 156 municipalities. Seventeen cities concentrated approximately 50.0 % of the procedures. A total of 8 538 origin-destination flows were generated and 49.2% of procedures were performed in services located outside the municipality in which the patient resided. Context challenges, related to inequality of access to chemotherapy and hindrances in planning and management of pharmaceutical services, were discussed.

Strategic situational planning and management of pharmaceutical services and supply: The experience of a municipality in the State of São Paulo with regard to optimizing spending on medicinal lawsuits

One of the actions taken was to offer training on pharmaceuticals via the distance education model (EAD) with the course titled Pharmaceutical Services and Supply Management Course (PSSMC). PSSMC, which was based on the idea of expanded management, is guided by Strategic Situational Planning (PES) concepts, and structured around an Operational Plan (OP) that serves as a practical didactic tool. The aim of this study is to report and analyze a case study based on the implementation of the Operational Plan in a municipality in the State of Sao Paulo, while focusing on the judicialization of access to medicines and health products. Since judicialization is an important topic, the problem chosen for resolution with the PES was attendance at the issuance of court orders by the municipality for items of medium and high complexity. The PES allows researchers to analyze reality through different points of view, of which participation is a key aspect. With the OP, it was possible to disseminate a proposal for expanded planning, to advance resolution of the problem, achieve positive results, and reduce expenses associated with the municipality’s legal actions.

Outbreak of Guillain-Barré syndrome possibly related to prior Zika virus infection, Metropolitan Region of Recife, Pernambuco, Brazil, 2015.

to investigate the occurrence of GBS in the Metropolitan Region of Recife, PE, Brazil, 2015. this was a descriptive study using data from the Hospital Information System, National Pharmaceutical Services Management System and interviews; GBS cases were classified according to Brighton criteria and prior infection according to laboratory and clinical criteria. in 2015, the number of GBS hospitalizations had a threefold increase in comparison to 2014. We investigated 44 confirmed or probable GBS cases, of which 18 had symptoms of Zika infection up to 35 days before the occurrence of GBS, mainly rash; one case was laboratory-confirmed for Zika virus infection and one death was registered. the findings reinforce a possible relationship between GBS and Zika infection, given the absence of increased GBS occurrence in previous dengue epidemic years, absence of chikungunya transmission records, presence of clinical manifestations compatible with infection and a laboratory confirmation.

Management of pharmaceutical services in the Brazilian primary health care.

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.

Workforce in the pharmaceutical services of the primary health care of SUS, Brazil.

ABSTRACTOBJECTIVE To characterize the workforce in the pharmaceutical services in the primary care of the Brazilian Unified Health System (SUS). METHODS This is a cross-sectional and quantitative study, with data from 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). For the analysis, we considered the data stratification into geographical regions. We analyzed the data on workers in the municipal pharmaceutical services management and in the medicine dispensing units, according to the country’s regions. For the statistical association analysis, we carried out a Pearson correlation test for the categorical variables.RESULTS We analyzed 1,175 pharmacies/dispensing units, 507 phone interviews (495 pharmaceutical services coordinators), and 1,139 professionals responsible for medicine delivery. The workforce in pharmaceutical services was mostly constituted by women, aged from 18 to 39 years, with higher education (90.7% in coordination and 45.5% in dispensing units), having permanent employment bonds (public tender), being for more than one year in the position or duty, and with weekly work hours above 30h, working both in municipal management and in medicine dispensing units. We observed regional differences in the workforce composition in dispensing units, with higher percentage of pharmacists in the Southeast and Midwest regions.CONCLUSIONS The professionalization of municipal management posts in primary health care is an achievement in the organization of the workforce in pharmaceutical services. However, significant deficiencies exist in the workforce composition in medicine dispensing units, which may compromise the medicine use quality and its results in population health.

Access to medicines: relations with the institutionalization of pharmaceutical services.

ABSTRACTOBJETIVE To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care.METHODS This study is 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), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis.RESULTS Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: “management tools,” “participation and social control,” “financing,” and “personnel structure,” with significant associations in the bivariate analysis. The “pharmaceutical care” dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5).CONCLUSIONS Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies.

Drugs use in pregnancy in the Valencia Region and the risk of congenital anomalies

Abstract Background Despite the potential risks of drug use during pregnancy, consumption has increased in recent decades. Objective To identify the risk of congenital anomalies (CA) associated with the use of drugs in primary care in pregnant women resident in the Valencia Region. Methods A case-control study, considering a case as a less than one year old live birth in 2009–2010, diagnosed with a CA and resident in the Valencia Region, obtained from the CA population-based registry. Controls were selected from the Metabolic Disease Registry, and the drugs prescribed and dispensed from the Integral Management of Pharmaceutical Services. Crude odds ratio (OR) was calculated with its 95% confidence intervals and adjusted OR was calculated using logistic regression. Results A total of 1.913 cases and 3.826 controls were identified. The most frequently used drug groups were those acting on the musculoskeletal, nervous and respiratory systems, on the blood and blood forming organs, and anti-infection drugs. The most common drugs used were ibuprofen, dexketoprofen, paracetamol, amoxicillin, ferrous sulphate, and a combination of folic acid. A significantly increased risk of CA was identified for drugs acting on the musculoskeletal system (adjusted OR 1.14 [95% confidence interval 1.02–1.28]). A significantly decreased risk was observed for drugs acting on the blood and blood forming organs (adjusted OR 0.87 [95% confidence interval 0.78–0.98]). Conclusions Associations between drugs and CA in pregnant women resident in the Valencia Region have been identified for drugs that act as risk factors of CA, and for drugs that act as protective factors of CA.

Consumo de medicamentos en el embarazo y riesgo de anomalías congénitas en la Comunitat Valenciana

BackgroundDespite the potential risks of drug use during pregnancy, consumption has increased in recent decades. ObjectiveTo identify the risk of congenital anomalies (CA) associated with the use of drugs in primary care in pregnant women residents in the Valencia Region. MethodsA case-control study, considering a case as a less than one year old live birth in 2009-2010, diagnosed with a CA and resident in the Valencia Region, obtained from the CA population-based registry. Controls were selected from the Metabolic Disease Registry, and the drugs prescribed and dispensed from the Integral Management of Pharmaceutical Services. Crude odds ratio (OR) was calculated with its 95% confidence intervals and adjusted OR was calculated using logistic regression. ResultsA total of 1,913 cases and 3,826 controls were identified. The most frequently used drug groups were those acting on the musculoskeletal, nervous and respiratory systems, on the blood and blood forming organs, and anti-infection drugs. The most common drugs used were ibuprofen, dexketoprofen, paracetamol, amoxicillin, ferrous sulphate, and a combination of folic acid. A significantly increased risk of CA was identified for drugs acting on the musculoskeletal system (adjusted OR 1.14 [95% confidence interval 1.02-1.28]). A significantly decreased risk was observed for drugs acting on the blood and blood forming organs (adjusted OR 0.87 [95% confidence interval 0.78-0.98]). ConclusionsAssociations between drugs and CA in pregnant women resident in the Valencia Region have been identified for drugs that act as risk factors of CA, and for drugs that act as protective factors of CA.

Ethical challenges in designing and conducting medicine quality surveys

ObjectivesIn this paper we discuss the main ethical challenges related to the conduct of medicine quality surveys and make suggestions on how to address them.MethodMost evidence‐based information regarding medicine quality derives from surveys. However, existing research ethical guidelines do not provide specific guidance for medicine quality surveys. Hence, those conducting surveys are often left wondering how to judge what counts as best practice. A list of the main ethical challenges in the design and conduct of surveys is presented.Results and conclusionsIt is vital that the design and conduct of medicine quality surveys uphold moral and ethical obligations and analyse the ethical implications and consequences of such work. These aspects include the impact on the local availability of and access to medicines; the confidentiality and privacy of the surveyors and the surveyed; questions as to whether outlet staff personnel should be told they are part of a survey; the need of ethical and regulatory approvals; and how the findings should be disseminated. Medicine quality surveys should ideally be conducted in partnership with the relevant national Medicine Regulatory Authorities. An international, but contextually sensitive, model of good ethical practice for such surveys is needed.

Gestão da Assistência Farmacêutica: Análise da situação de alguns municípios.

Os objetivos deste trabalho são descrever e analisar a gestão da assistência farmacêutica em alguns municípios, produzindo mais evidências sobre problemas que podem comprometer o acesso a medicamentos no Sistema Único de Saúde – SUS. Realizou-se pesquisa exploratória, transversal, elaborando-se questionário com questões fechadas sobre a gestão da assistência farmacêutica. O tamanho da amostra foi definido em 431 municípios, selecionados por amostragem aleatória estratificada. Dos 431 municípios, apenas 36 responderam o questionário (8,4%). Destes, 44,4% (n = 16) informaram ter a assistência farmacêutica formalizada, das quais 93,4% (n = 15) contam com pelo menos um farmacêutico. Dos 36 municípios, 97% (n = 35) informaram ter lista de medicamentos para dispensação à população. O controle de estoque foi considerado adequado em 26 deles (72,2%). Estão cumprindo determinação judicial para o fornecimento de medicamentos 14 (38,9%) municípios e em 13 deles (36%) todas as Unidades Básicas de Saúde – UBS contam com farmacêutico. Os resultados reforçam a necessidade do SUS de avançar no fortalecimento da gestão da assistência farmacêutica a fim de garantir o acesso a medicamentos e a efetividade das ações de saúde.

Essential medicines and the selection process in management practices of pharmaceutical services in Brazilian states and municipalities

The selection of medicines is a skilled process that produces an essential medicines list (EML) and substantiates rational management of pharmaceutical services. This paper presents the selection of essential medicines in Brazilian states and municipalities. It discusses the perception of pharmaceutical services managers regarding the concept of essential medicines and strategies adopted for their implementation, in addition to investigating how the National Essential Medicines List was adopted and is supporting local pharmaceutical services actions. A nationwide study was carried out adopting a qualitative methodological approach in health. State and municipal managers from the five Brazilian regions were interviewed. The findings point to weaknesses in local selection procedures and in the use of the National Essential Medicines List (Rename). Barriers such as lack of formalization of pharmaceutical services at regional levels, difficulties in drafting and maintaining a pharmacy and therapeutics committee and the acritical incorporation of drugs on the EML were identified. States and municipalities have distortions that exclude the EML form the concept of essential medicines.

Dispensação de medicamentos do componente especializado em polos no Estado do Rio de Janeiro

The Specialized Pharmaceutical Services Component (CEAF) ensures the dispensing of high-cost medicines for the treatment of specific diseases. The fact that these medicines are mandatory though access is only through legal injunctions, suggests flaws in the management of pharmaceutical services. This paper analyzed adherence to Clinical Protocols and Therapeutic Guidelines (PCDT) in the dispensing of these CEAF medicines. Qualitative research was also conducted in facilities with different characteristics in the State of Rio de Janeiro. It was noted that the lack of adequate structure in the units studied, including trained personnel, compromises the dispensing CEAF medicines in all facilities. The CEAF dispensing procedure, heavily dependent on interaction between prescribers and dispensers, is not carried out as would be expected. It is possible that inadequate performance is also linked to flaws in the planning and organization of services. The results indicate barriers in adherence to PCDT by health professionals, prejudicing health system users and possibly leading them to access medicines by legal means. It is believed that characteristics of the investigated facilities are similar to others in Brazil, and the barriers identified may be the same, compromising healthcare.

La prescripción farmacéutica en atención primaria. Informe SESPAS 2012

In 2010, the Spanish National Health Service (NHS) paid for 958 million prescriptions. Given the massive population exposure to medication, the risks associated with drug consumption are highly significant from the perspective of public health. Areas requiring improvement in primary care prescription include overtreatment of patients in low risk situations, undertreatment of those in whom medication is indicated, poor patient information, polymedication, self-medication and the appreciable percentage of preventable adverse effects. Surprisingly, most of the pharmaceutical strategies in the NHS have not aimed to address these problems but have instead concentrated on reducing pharmaceutical expenditure, which is not a problem of pharmaceutical expenditure per se but is rather a consequence of “the problems” of prescription (and of the regulation and management of pharmaceutical services). Some key elements to improve this situation include more integrated healthcare, the development of electronic medical records systems, overall strategies to improve safety, and reducing the role of the pharmaceutical industry. Macro strategies include creating an agency able to objectively assess the additional value provided by a new drug and its additional cost, price fixing in line with cost-effectiveness, and exclusion of drugs with little or no added value from coverage, etc. Managing prescription involves the development of longitudinal patient care programs that incorporate clinical actions from different professionals, including whom to treat, how much to treat and how to treat.

Assistência farmacêutica integrada ao processo de cuidado em saúde: gestão clínica do medicamento

ABSTRACT This is a narrative review on pharmaceutical services integrated into the primary healthcare process. A literature review was performed to collect national and international evidence and has been combined with the empirical knowledge gained by the authors during the teaching-learning process and research on this area of study to structure a logical, conceptual model that integrates clinical management of medicines with the technical management of pharmaceutical services. It is inferred that an efficient technical management of pharmaceutical services and an efficient clinical management of medicines help promote rational drug use and improve primary healthcare as well as Brazil's Unified Health System (Sistema Unico de Saude - SUS) as a whole.

A judicialização da saúde e os novos desafios da gestão da assistência farmacêutica

Health litigation spurs many challenges in the management of pharmaceutical services. Performance of health managers and decisionmakers must be adjusted to new administrative and legal boundaries. Their actions must also be efficient in responding to ongoing lawsuits, as well as in avoiding additional litigation and in upholding principles and directives of the Brazilian Health System (SUS). This paper proposes to better understand one of the aspects of health litigation, namely the growing use of lawsuits demanding medicines, and the relationship between this phenomenon and pharmaceutical services management in SUS. Through review and analysis of available published research on the subject, from various Brazilian states, the main elements of "medicines litigation" are presented and examined in light of their interference on the activities of the pharmaceutical services cycle. The analysis points to possible mechanisms to be adopted by decision-makers in management and in the Judicial System, since the right to health can only be effectively established when management and Justice are predominantly aware and committed to the safety and the protection of patients and users.