National Health Survey 2019: medication obtainment through the Brazilian Popular Pharmacy Program by adults being treated for hypertension and diabetes. / Pesquisa Nacional de Saúde 2019: obtenção de medicamentos por adultos em tratamento para hipertensão e diabetes no Programa Farmácia Popular do Brasil.

OBJECTIVE: To describe the proportion of adults with hypertension and diabetes who obtained medication through the Brazilian Popular Pharmacy Program (Programa Farmácia Popular). METHOD: Population-based descriptive study, using data from the 2019 Brazilian National Health Survey. The proportion of individuals who obtained at least one type of medication for hypertension and diabetes in the Program was analysed according to socioeconomic and demographic characteristics, by regions and federative units. RESULTS: The proportion of individuals who obtained medication for hypertension was 45.1% (95%CI 43.7;46.5), and, for diabetes, 51.5% (95%CI 49.5;53.6). Respectively for both conditions, medication obtainment was higher in the South region (54.3%; 95%CI 51.3;57.2 and 59.1%; 95%CI 54.6;63.7) and lower in the higher strata level of education (30.9%; 95%CI 27.7;34.2 and 40.7%; 95%CI 35.1;46.3) and income (24.0%; 95%CI 19.7;28.2 and 28.9%; 95%CI 22.1;35.7). CONCLUSION: Regional and socioeconomic inequalities were identified in obtaining medication for hypertension and diabetes through the Program.

Pesquisa Nacional de Saúde 2019: obtenção de medicamentos por adultos em tratamento para hipertensão e diabetes no Programa Farmácia Popular do Brasil / Encuesta Nacional de Salud 2019: obtención de medicamentos por adultos en tratamiento para hipertensión y diabetes en el Programa de Farmacia Popular de Brasil / National Health Survey 2019: medication obtainment through the Brazilian Popular Pharmacy Program by adults being treated for hypertension and diabetes

Objetivo: Descrever a proporção de adultos com hipertensão e diabetes que obtiveram medicamentos no Programa Farmácia Popular do Brasil. Método: Estudo descritivo de base populacional, com dados da Pesquisa Nacional de Saúde 2019. Analisou-se a proporção de indivíduos que obtiveram ao menos um medicamento para hipertensão e diabetes no Programa, segundo características socioeconômicas e demográficas, por regiões e Unidades da Federação. Resultados: A proporção de indivíduos que obtiveram medicamentos para hipertensão foi de 45,1% (IC95% 43,7;46,5), e para diabetes, 51,5% (IC95% 49,5;53,6). Para ambas as condições, hipertensão e diabetes, respectivamente, a aquisição foi maior na região Sul (54,3%; IC95% 51,3;57,2 e 59,1%; IC95% 54,6;63,7) e menor nos estratos de maior nível de instrução (30,9%; IC95% 27,7;34,2 e 40,7%; IC95% 35,1;46,3) e renda (24,0%; IC95% 19,7;28,2 e 28,9%; IC95% 22,1;35,7). Conclusão: Desigualdades regionais e socioeconômicas foram identificadas na obtenção de medicamentos para hipertensão e diabetes pelo programa.

Objetivo: Describir la proporción de adultos con hipertensión y diabetes que obtuvieron medicación del Programa Farmacia Popular de Brasil. Método: Estudio descriptivo de base poblacional, con datos de la Encuesta Nacional de Salud 2019. Se analizó la proporción de obtener medicamento para la hipertensión y la diabetes en el Programa según características socioeconómicas y demográficas, por regiones y unidades federativas. Resultados: La proporción de obtención fue del 45,1% (IC95% 43,7;46,5), para la hipertensión y del 51,5% (IC95% 49,5;53,6) para la diabetes. Respectivamente para ambas condiciones, la obtención fue mayor en el Sur (54,3%; IC95% 51,3;57,2 y 59,1%; IC95% 54,6;63,7) y menor en estrato superior de educación (30,9%; IC95% 27,7;34,2 y 40,7%; IC95% 35,1;46,3) e ingresos (24,0%; IC95% 19,7;28,2 y 28,9%; IC95% 22,1;35,7). Conclusión: Se identificaron desigualdades regionales y socioeconómicas en la obtención de medicamentos para la hipertensión y la diabetes por parte del programa.

Objective: To describe the proportion of adults with hypertension and diabetes who obtained medication through the Brazilian Popular Pharmacy Program (Programa Farmácia Popular). Method: Population-based descriptive study, using data from the 2019 Brazilian National Health Survey. The proportion of individuals who obtained at least one type of medication for hypertension and diabetes in the Program was analysed according to socioeconomic and demographic characteristics, by regions and federative units. Results: The proportion of individuals who obtained medication for hypertension was 45.1% (95%CI 43.7;46.5), and, for diabetes, 51.5% (95%CI 49.5;53.6). Respectively for both conditions, medication obtainment was higher in the South region (54.3%; 95%CI 51.3;57.2 and 59.1%; 95%CI 54.6;63.7) and lower in the higher strata level of education (30.9%; 95%CI 27.7;34.2 and 40.7%; 95%CI 35.1;46.3) and income (24.0%; 95%CI 19.7;28.2 and 28.9%; 95%CI 22.1;35.7). Conclusion: Regional and socioeconomic inequalities were identified in obtaining medication for hypertension and diabetes through the Program.

Free acquisition of psychotropic drugs by the Brazilian adult population and presence on the National List of Essential Medicines

Abstract The aims of the present study were to estimate the free-of-charge acquisition of psychotropic drugs among Brazilian adults; analyze the distribution of psychotropics according to their presence on the Relação Nacional de Medicamentos Essenciais (RENAME [National List of Essential Medicines]) and acquisition according to the source of funding (free of charge or direct payment); and estimate the proportion of free-of-charge psychotropic drugs according to therapeutic class and presence on the RENAME. This study involved the analysis of data from the 2014 National Survey on the Accessibility, Use and Promotion of the Rational Use of Medicines considering psychotropic drugs used by the adult population (≥20 years; n = 32,348). The prevalence of the acquisition of free-of-charge psychotropic drugs was 53.3% and 64.6% of these drugs were on the RENAME. Among the psychotropic drugs acquired by direct payment, 70.8% were not on the national list. Regarding free-of-charge acquisition according to the therapeutic class and presence on the RENAME, differences were found for antidepressants, anxiolytics and antipsychotics (p <0.05). In conclusion, the most used psychotropic medicines were listed in the RENAME, but free-of-charge acquisition was not provided for all of them

Use of medicines in São Paulo, Brazil, and State Health Care Coverage, 2003 and 2015.

OBJECTIVES: To analyze the use and acquisition of medicines in São Paulo, Brazil, in 2003 and 2015, according to sociodemographic factors, socioeconomic status, and health conditions of the population. METHODS: Data were obtained from population health surveys "ISA-Capital". Descriptive analysis, bivariate analysis, and logistic regression models were used to evaluate the use of medicines and coverage by the Brazilian Unified Health System (SUS) according to socioeconomic status and health conditions in two periods: 2003 and 2015. RESULTS: From 2003 to 2015, the surveys showed an increase in the income and education level of the study population. There was no increase in the prevalence of chronic diseases and use of medicines from 2003 to 2015. The provision of medicines by SUS was higher in 2015 than in 2003, and the coverage by SUS was higher in the population with lower education level and income in both 2003 and 2015. CONCLUSIONS: The use of medicines, mainly for chronic disease control, did not change over the years, and there was an increase in SUS coverage for medicines during 2003-2015 in all population groups, with a greater impact on the lower socioeconomic status population. The programs of the provision of medicines implanted since 2003 had influenced the greater SUS coverage for medicines and in the reduction of inequalities in access to medicines.

Tendency of use and sources for obtaining oral antidiabetic drugs for treatment of diabetes in Brazil from 2012 to 2018: analysis of the Vigitel survey. / Tendência do uso e fontes de obtenção de antidiabéticos orais para tratamento de diabetes no Brasil de 2012 a 2018: análise do inquérito Vigitel.

OBJECTIVE: To estimate the prevalence of use of oral medications for the treatment of diabetes, as well as the distribution of sources for obtaining according to sociodemographic variables, in the Brazilian states' capitals and in the Federal District, and their evolution from 2012 to 2018. METHODS: Cross-sectional and population-based study with individuals aged ≥ 20 years who reported a medical diagnosis of diabetes, interviewed through Vigitel from 2012 to 2018. We estimated the prevalence of use and the distribution of sources for obtaining according to sociodemographic variables (95%CI). We checked differences among proportions using the Pearson's χ2 test (Rao-Scott), with a significance level of 5%. RESULTS: There was an increase in the prevalence of use of oral medications for the treatment of diabetes from 77.4 to 85.2% between 2012 and 2018, and a decrease in obtaining in the Health Unit Pharmacies of the Unified Health System (SUS), while there was an increase in obtaining in Popular Pharmacies. CONCLUSIONS: In Brazil, SUS remained the main source for obtaining oral antidiabetic drugs, financing more than 70% of them in the country, considering the Health Unit Pharmacies and Popular Pharmacies, thereby showing the importance of public Pharmaceutical Policies in guaranteeing the access to medications by the Brazilian population, as well as in reducing inequities in the country. Nevertheless, the migration of obtaining by users from SUS Health Units to Popular Pharmacies suggests the weakening the responsibility of Primary Health Care in the provision oral antidiabetic drugs, thereby undermining the bond and the longitudinal care.

OBJETIVO: Estimar as prevalências de uso de medicamento oral para tratamento de diabetes, bem como a distribuição das fontes de obtenção segundo variáveis sociodemográficas, nas capitais dos estados brasileiros e no Distrito Federal e sua evolução no período de 2012 a 2018. MÉTODOS: Estudo transversal de base populacional com indivíduos de 20 anos ou mais que referiram diagnóstico médico de diabetes, entrevistados pelo Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) de 2012 a 2018. Estimaram-se a prevalência de uso e a distribuição das fontes de obtenção segundo variáveis sociodemográficas (IC95%). Verificaram-se as diferenças entre as proporções pelo teste χ2 de Pearson (Rao-Scott), com nível de significância de 5%. RESULTADOS: Houve aumento na prevalência de uso de medicamento oral para tratamento de diabetes de 77,4 para 85,2%, entre 2012 e 2018, e diminuição da obtenção nas farmácias de unidade de saúde do Sistema Único de Saúde (SUS) com aumento da obtenção nas farmácias populares. CONCLUSÕES: O SUS manteve-se como a principal fonte de obtenção de antidiabéticos orais no Brasil, financiando mais de 70% dos medicamentos orais para tratamento de diabetes no país, considerando as farmácias de unidades de saúde e as farmácias populares, mostrando, assim, a importância das políticas farmacêuticas públicas na garantia do acesso a medicamentos pela população brasileira e na diminuição das iniquidades no país. Contudo a migração da obtenção pelos usuários nas unidades de saúde do SUS para as farmácias populares sugere enfraquecimento da responsabilidade da atenção primária à saúde na oferta de medicamentos antidiabéticos orais, fragilizando o vínculo e o cuidado longitudinal.

Use of medicines in São Paulo, Brazil, and State Health Care Coverage, 2003 and 2015

OBJECTIVES: To analyze the use and acquisition of medicines in São Paulo, Brazil, in 2003 and 2015, according to sociodemographic factors, socioeconomic status, and health conditions of the population. METHODS: Data were obtained from population health surveys "ISA-Capital". Descriptive analysis, bivariate analysis, and logistic regression models were used to evaluate the use of medicines and coverage by the Brazilian Unified Health System (SUS) according to socioeconomic status and health conditions in two periods: 2003 and 2015. RESULTS: From 2003 to 2015, the surveys showed an increase in the income and education level of the study population. There was no increase in the prevalence of chronic diseases and use of medicines from 2003 to 2015. The provision of medicines by SUS was higher in 2015 than in 2003, and the coverage by SUS was higher in the population with lower education level and income in both 2003 and 2015. CONCLUSIONS: The use of medicines, mainly for chronic disease control, did not change over the years, and there was an increase in SUS coverage for medicines during 2003-2015 in all population groups, with a greater impact on the lower socioeconomic status population. The programs of the provision of medicines implanted since 2003 had influenced the greater SUS coverage for medicines and in the reduction of inequalities in access to medicines.

Tendência do uso e fontes de obtenção de antidiabéticos orais para tratamento de diabetes no Brasil de 2012 a 2018: análise do inquérito Vigitel / Tendency of use and sources for obtaining oral antidiabetic drugs for treatment of diabetes in Brazil from 2012 to 2018: analysis of the Vigitel survey

RESUMO: Objetivo: Estimar as prevalências de uso de medicamento oral para tratamento de diabetes, bem como a distribuição das fontes de obtenção segundo variáveis sociodemográficas, nas capitais dos estados brasileiros e no Distrito Federal e sua evolução no período de 2012 a 2018. Métodos: Estudo transversal de base populacional com indivíduos de 20 anos ou mais que referiram diagnóstico médico de diabetes, entrevistados pelo Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) de 2012 a 2018. Estimaram-se a prevalência de uso e a distribuição das fontes de obtenção segundo variáveis sociodemográficas (IC95%). Verificaram-se as diferenças entre as proporções pelo teste χ2 de Pearson (Rao-Scott), com nível de significância de 5%. Resultados: Houve aumento na prevalência de uso de medicamento oral para tratamento de diabetes de 77,4 para 85,2%, entre 2012 e 2018, e diminuição da obtenção nas farmácias de unidade de saúde do Sistema Único de Saúde (SUS) com aumento da obtenção nas farmácias populares. Conclusões: O SUS manteve-se como a principal fonte de obtenção de antidiabéticos orais no Brasil, financiando mais de 70% dos medicamentos orais para tratamento de diabetes no país, considerando as farmácias de unidades de saúde e as farmácias populares, mostrando, assim, a importância das políticas farmacêuticas públicas na garantia do acesso a medicamentos pela população brasileira e na diminuição das iniquidades no país. Contudo a migração da obtenção pelos usuários nas unidades de saúde do SUS para as farmácias populares sugere enfraquecimento da responsabilidade da atenção primária à saúde na oferta de medicamentos antidiabéticos orais, fragilizando o vínculo e o cuidado longitudinal.

ABSTRACT: Objective: To estimate the prevalence of use of oral medications for the treatment of diabetes, as well as the distribution of sources for obtaining according to sociodemographic variables, in the Brazilian states' capitals and in the Federal District, and their evolution from 2012 to 2018. Methods: Cross-sectional and population-based study with individuals aged ≥ 20 years who reported a medical diagnosis of diabetes, interviewed through Vigitel from 2012 to 2018. We estimated the prevalence of use and the distribution of sources for obtaining according to sociodemographic variables (95%CI). We checked differences among proportions using the Pearson's χ2 test (Rao-Scott), with a significance level of 5%. Results: There was an increase in the prevalence of use of oral medications for the treatment of diabetes from 77.4 to 85.2% between 2012 and 2018, and a decrease in obtaining in the Health Unit Pharmacies of the Unified Health System (SUS), while there was an increase in obtaining in Popular Pharmacies. Conclusions: In Brazil, SUS remained the main source for obtaining oral antidiabetic drugs, financing more than 70% of them in the country, considering the Health Unit Pharmacies and Popular Pharmacies, thereby showing the importance of public Pharmaceutical Policies in guaranteeing the access to medications by the Brazilian population, as well as in reducing inequities in the country. Nevertheless, the migration of obtaining by users from SUS Health Units to Popular Pharmacies suggests the weakening the responsibility of Primary Health Care in the provision oral antidiabetic drugs, thereby undermining the bond and the longitudinal care.

Use and sources of psychotropic drugs by Brazilian adults and seniors. / Uso e fontes de obtenção de psicotrópicos em adultos e idosos brasileiros.

The aim of the present study was to estimate the prevalence of psychotropic drug utilization among adults and seniors and determine associated factors, therapeutic classes and sources of acquisition. Data from the Brazilian National Survey on Access, Use and Promotion of the Rational Use of Medicines (2013-2014) were analyzed. The prevalence of use of at least one psychotropic drug in the overall sample (adults and seniors) was 8.7%. In the adjusted analyses, positive associations were found between the use of psychotropic drugs and the female sex, poorer self-rated health and chronic diseases (p < 0.05). The most frequently used therapeutic classes were antidepressants (55.3%) by the adults and anxiolytics (59.3%) by the seniors. Approximately 23.0% of psychotropic drugs were obtained exclusively from pharmacies of the public healthcare system and 77.0% were acquired from other sources. The findings reveal a low proportion of attaining psychotropic drugs through the Brazilian public healthcare system as well as the need for public policies that encourage the rational use of prescriptions and treatments to promote a better quality of life and ensure the population's right to health.

O objetivo do presente estudo foi verificar a prevalência do uso de psicotrópicos nos adultos e idosos e os fatores associados, classes terapêuticas de medicamentos e fontes de obtenção. Foram analisados dados da Pesquisa Nacional sobre o Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM/2013-2014). A prevalência do uso de ao menos um psicotrópico para o conjunto de adultos brasileiros foi de 8,7%. Nas análises ajustadas para adultos e idosos, observaram-se associações positivas entre uso de psicotrópicos e sexo feminino, pior autoavaliação de saúde e presença de doenças crônicas (p < 0,05). As classes terapêuticas mais utilizadas foram os antidepressivos (55,3%) por adultos e os ansiolíticos (59,3%) por idosos. Cerca de 23,0% dos psicotrópicos foram obtidos exclusivamente nas farmácias do SUS e os outros 77,0% por outras fontes. Os resultados mostraram baixa proporção de obtenção dos psicotrópicos no SUS e a necessidade de políticas que incentivem a prescrição e tratamentos com mais racionalidade, promovendo melhor qualidade de vida e garantia do direito à saúde a população.

Uso e fontes de obtenção de psicotrópicos em adultos e idosos brasileiros / Use and sources of psychotropic drugs by Brazilian adults and seniors

Resumo O objetivo do presente estudo foi verificar a prevalência do uso de psicotrópicos nos adultos e idosos e os fatores associados, classes terapêuticas de medicamentos e fontes de obtenção. Foram analisados dados da Pesquisa Nacional sobre o Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM/2013-2014). A prevalência do uso de ao menos um psicotrópico para o conjunto de adultos brasileiros foi de 8,7%. Nas análises ajustadas para adultos e idosos, observaram-se associações positivas entre uso de psicotrópicos e sexo feminino, pior autoavaliação de saúde e presença de doenças crônicas (p < 0,05). As classes terapêuticas mais utilizadas foram os antidepressivos (55,3%) por adultos e os ansiolíticos (59,3%) por idosos. Cerca de 23,0% dos psicotrópicos foram obtidos exclusivamente nas farmácias do SUS e os outros 77,0% por outras fontes. Os resultados mostraram baixa proporção de obtenção dos psicotrópicos no SUS e a necessidade de políticas que incentivem a prescrição e tratamentos com mais racionalidade, promovendo melhor qualidade de vida e garantia do direito à saúde a população.

Abstract The aim of the present study was to estimate the prevalence of psychotropic drug utilization among adults and seniors and determine associated factors, therapeutic classes and sources of acquisition. Data from the Brazilian National Survey on Access, Use and Promotion of the Rational Use of Medicines (2013-2014) were analyzed. The prevalence of use of at least one psychotropic drug in the overall sample (adults and seniors) was 8.7%. In the adjusted analyses, positive associations were found between the use of psychotropic drugs and the female sex, poorer self-rated health and chronic diseases (p < 0.05). The most frequently used therapeutic classes were antidepressants (55.3%) by the adults and anxiolytics (59.3%) by the seniors. Approximately 23.0% of psychotropic drugs were obtained exclusively from pharmacies of the public healthcare system and 77.0% were acquired from other sources. The findings reveal a low proportion of attaining psychotropic drugs through the Brazilian public healthcare system as well as the need for public policies that encourage the rational use of prescriptions and treatments to promote a better quality of life and ensure the population's right to health.

Use of drugs for gastrointestinal disorders: evidence from National Survey on Access, Use and Promotion of Rational Use of Medicines.

Objective To estimate the prevalence of use of drugs to treat gastrointestinal disorders, according to demographic, socioeconomic, and health characteristics of the Brazilian population. Methods This is a population-based survey that interviewed individuals residing in cities of the five regions in Brazil. The study sample was composed of 32,348 individuals aged 20 or more years. The profile of use of drugs for gastrointestinal disorders was evaluated considering the variables sex, age, healthcare plan, region, and number of chronic diseases. We also analyzed the frequency of individuals who declared using other drugs, besides those already employed for treatment of gastrointestinal disorders. Additionally, the estimated frequencies of the drug classes used were determined. Results The prevalence of use of drugs for gastrointestinal disorders in Brazil was 6.9% (95% confidence interval - 6.4-7.6), higher in females, among persons aged over 60 years, in those who had a private healthcare insurance, and presented with two or more chronic diseases. It was noted that 42.9% of the aged who used drugs for gastrointestinal disorders were also on polypharmacy. As to the classes of drugs, 82% corresponded to drugs for the food tract and metabolism, particularly proton pumps inhibitors. Conclusion The use of drugs for treatment of gastrointestinal disorders was significant among women and elderly. In this age group, consumption may be linked to gastric protection due to polypharmacy. This study is an unprecedented opportunity to observe the self-reported consumption profile of these drugs in Brazil and, therefore, could subsidize strategies to promote their rational use.

User evaluation of public pharmacy services in Brazil. / Avaliação dos usuários sobre as farmácias públicas no Brasil.

Objective of this article is to evaluate aspects related to the services provided in SUS pharmacies in Brazil, according to users' perception. Data from the National Survey of Access, Use and Promotion of Rational Use of Medicines carried out between 2013 and 2014 were used. Individuals who obtained drugs from public pharmacies were analyzed. To calculate prevalence estimates, the total number of users of drugs with 95%CI was used as denominator. From the age group of 20 to 24 years up to 60 to 64 years, there were significant differences between men and women in terms of use of public pharmacies. More than 30% of people from all socioeconomic classes who did not obtain drugs from SUS pharmacies never thought about this possibility. Not having to wait much time to obtain the medication and a positive evaluation of the opening hours had a strong association with the positive evaluation of users of SUS pharmacies. Opening hours and waiting time are potential barriers in SUS pharmacies. The evaluation of users of SUS was positive, but it pointed to regional differences, and the identification of the magnitude of such differences can contribute to the planning of more effective and equitable policies.

O objetivo deste artigo é avaliar aspectos relacionados aos serviços prestados nas farmácias do SUS do Brasil, segundo a percepção dos usuários. Utilizou-se dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos, realizada entre 2013 e 2014. Analisou-se indivíduos que obtiveram algum medicamento nas farmácias públicas. Para o cálculo das estimativas de prevalências, foi usado como denominador o total de usuários de medicamentos com IC95%. A partir da faixa etária de 20 a 24 anos até 60 a 64 anos observa-se diferenças significativas entre homens e mulheres, em relação ao uso de farmácias públicas. Mais de 30% das pessoas de todas as classes socioeconômica que não obtiveram medicamentos nas farmácias do SUS, nunca pensaram nessa possibilidade. Não costumam esperar para obtenção dos medicamentos e avaliação positiva do horário de funcionamento tiveram uma associação mais forte em relação a avaliação positiva dos usuários das farmácias do SUS. O horário de funcionamento e o tempo de espera são potenciais barreiras nas farmácias do SUS. A avaliação dos usuários que utilizam o SUS é positiva, mas aponta diferenças regionais e a identificação da magnitude dessas pode contribuir na formulação de políticas mais eficazes e equânimes.

Prevalence of use and sources of antihypertensive medicine in Brazil: an analysis of the VIGITEL telephone survey. / Prevalência de uso e fontes de obtenção de medicamentos anti-hipertensivos no Brasil: análise do inquérito telefônico VIGITEL.

OBJECTIVE: The prevalence of hypertension in Brazil and worldwide has been increasing in recent decades, and drug therapy is one of the strategies used to control this condition. The objective of this study was to estimate the prevalence of use and identify the sources for obtaining antihypertensive drugs in Brazil, according to sociodemographic variables, comparing three periods: 2011, 2014 and 2017. METHODS: Data from individuals aged ≥20 years who reported a medical diagnosis of hypertension, interviewed by Vigitel in 2011, 2014 and 2017 were used. Frequency and prevalence of drug use in addition to the sources for obtaining medication were estimated by sociodemographic variables, with 95% confidence intervals. The differences between proportions were verified by Pearson's chi-square test (Rao-Scott), with a significance level of 5%. RESULTS: The prevalence of antihypertensive drug use remained stable (80%). Regarding the sources for obtaining these medicines, there was variation in the period, indicating a decrease in usage through the Brazilian Unified Health System (SUS) (44.2% in 2011; 30.5% in 2017). This decrease was accompanied with increase in PFPB (16.1% in 2011; 29.9% in 2017). The prevalence of other sources for obtaining medicine (private pharmacies/drugstores) showed stability in the period. CONCLUSIONS: The prevalence of medication use remained high and there was a change in the pattern of use according to sources, demonstrating migration between SUS pharmacies to the PFPB, and suggesting a reduction in the availability of medicines from public pharmacies universally, and for free.

Prevalência de uso e fontes de obtenção de medicamentos anti-hipertensivos no Brasil: análise do inquérito telefônico VIGITEL / Prevalence of use and sources of antihypertensive medicine in Brazil: an analysis of the VIGITEL telephone survey

RESUMO: Objetivo: A prevalência de hipertensão arterial no Brasil e no mundo vem aumentando nas últimas décadas, sendo o uso de medicamentos uma das estratégias utilizadas no controle da doença. O objetivo deste estudo foi estimar a prevalência de uso e identificar as fontes de obtenção de anti-hipertensivos no Brasil, segundo variáveis sociodemográficas, comparando três períodos: 2011, 2014 e 2017. Métodos: Foram utilizados dados de indivíduos com idade ≥20 anos que referiram diagnóstico médico de hipertensão arterial, entrevistados pelo Vigitel nos anos de 2011, 2014 e 2017. Foi estimada a distribuição de frequências e as prevalências de uso de medicamentos, segundo variáveis sociodemográficas, de acordo com as fontes de obtenção, com intervalos de confiança de 95%. As diferenças entre as proporções foram verificadas pelo teste χ2 de Pearson (Rao-Scott), com nível de significância de 5%. Resultados: A prevalência de uso manteve-se estável (80%). Quanto às fontes de obtenção observou-se variação no período, indicando diminuição na obtenção por meio das Unidades de Saúde do SUS (44,2% em 2011; 30,5% em 2017). Esse decréscimo esteve acompanhado do aumento na obtenção pela Farmácia Popular (16,1% em 2011; 29,9% em 2017). A prevalência de obtenção por meio de farmácias privadas/drogarias mostrou estabilidade no período. Conclusões: A prevalência de uso de medicamentos se manteve alta e houve modificação no padrão de utilização segundo fontes de obtenção, evidenciando migração entre Unidades de Saúde do SUS para a Farmácia Popular, sugerindo redução da disponibilidade dos medicamentos pelas farmácias públicas de forma universal e gratuita.

ABSTRACT: Objective: The prevalence of hypertension in Brazil and worldwide has been increasing in recent decades, and drug therapy is one of the strategies used to control this condition. The objective of this study was to estimate the prevalence of use and identify the sources for obtaining antihypertensive drugs in Brazil, according to sociodemographic variables, comparing three periods: 2011, 2014 and 2017. Methods: Data from individuals aged ≥20 years who reported a medical diagnosis of hypertension, interviewed by Vigitel in 2011, 2014 and 2017 were used. Frequency and prevalence of drug use in addition to the sources for obtaining medication were estimated by sociodemographic variables, with 95% confidence intervals. The differences between proportions were verified by Pearson's chi-square test (Rao-Scott), with a significance level of 5%. Results: The prevalence of antihypertensive drug use remained stable (80%). Regarding the sources for obtaining these medicines, there was variation in the period, indicating a decrease in usage through the Brazilian Unified Health System (SUS) (44.2% in 2011; 30.5% in 2017). This decrease was accompanied with increase in PFPB (16.1% in 2011; 29.9% in 2017). The prevalence of other sources for obtaining medicine (private pharmacies/drugstores) showed stability in the period. Conclusions: The prevalence of medication use remained high and there was a change in the pattern of use according to sources, demonstrating migration between SUS pharmacies to the PFPB, and suggesting a reduction in the availability of medicines from public pharmacies universally, and for free.

Análise da assistência farmacêutica no planejamento: participação dos profissionais e a qualificação da gestão / Analysis of pharmaceutical assistance in planning: participation of professionals and qualification of management

Resumo Introdução O desenvolvimento da assistência farmacêutica, assim como de todas as áreas de atuação do SUS, é de responsabilidade das três instâncias gestoras (municipal, estadual e federal) e, nesse contexto, é fundamental a participação dos atores responsáveis pela sua gestão no planejamento da previsão de recursos orçamentários próprios para alocação nessa área, conforme sua capacidade e prioridade, levando-se em conta a escassez de recursos e as necessidades verificadas. Objetivo Descrever a participação dos profissionais responsáveis pela assistência farmacêutica no processo de planejamento em saúde em municípios brasileiros. Método Para este estudo foram utilizados dados da pesquisa "A assistência farmacêutica nas Redes de Atenção à Saúde: um recorte nas regiões do Projeto QualiSUS-Rede", cuja coleta ocorreu de dezembro de 2013 a julho de 2015 em 485 municípios e Distrito Federal, onde foram entrevistados os responsáveis pela assistência farmacêutica nos municípios. Tal estudo teve delineamento transversal, e as variáveis analisadas para o recorte aqui tratado foram as relativas ao perfil dos profissionais responsáveis pela assistência farmacêutica e a participação destes na elaboração e conhecimento dos conteúdos relacionados à assistência farmacêutica nos instrumentos de planejamento orçamentário (PPA, LOA e LDO) e da saúde (PS, PAS, RAG). Verificou-se também a inserção dos instrumentos de planejamento relativos ao período de estudo no Sistema SARGSUS. Resultados Observou-se uma baixa participação dos responsáveis (n=417) na elaboração dos instrumentos de planejamento orçamentário e da saúde, com maior participação na elaboração do PPA (24,0%) e do PS (52,0%). Em relação à PAS e ao RAG, observou-se maior conhecimento da presença de ações relacionadas à assistência farmacêutica por aqueles que participaram da sua elaboração (67,0% e 68,8% respectivamente). Conclusão Os resultados apontam baixa participação dos atores responsáveis pela assistência farmacêutica municipal na elaboração das ferramentas de planejamento dos municípios e pouco conhecimento das ações previstas, e sugerem que os instrumentos de planejamento produzidos podem não condizer com a realidade dos serviços e com a alocação racional dos recursos aplicáveis à assistência farmacêutica.

Abstract Background The development of Pharmaceutical Assistance, as well as all areas of action of the SUS, is the responsibility of the three managing instances (municipal, state and federal). In this context, the participation of the actors responsible for its management in the forecast planning budget resources for allocation in this area is fundamental, according to their capacity and priority, taking into account the scarcity of resources and the needs verified. Objective To describe the participation of the ones involved in the pharmaceutical assistance, regarding instruments development for budgeting and health planning for their municipalities. Method This paper has analyzed information produced by the project "A assistência farmacêutica nas Redes de Atenção à Saúde: um recorte nas regiões do Projeto QualiSUS-Rede", where data gathering, conducted from December 2013 to July 2015, in 485 municipalities and the Federal District, was handled through the interview of those in charge of the Pharmaceutical Assistance in the municipalities. The study was cross-sectional and analyzed variables related to the profile of the professionals responsible for Pharmaceutical Assistance regarding professional training, workload and work relationship, as well as the participation of these professionals in the elaboration of the budget planning (PPA, LOA, LDO) and health instruments (PS, PAS, RAG). Complimentarily, we verified the insertion of the planning instruments related to the study period in the SARGSUS System. Results Pharmaceutical assistance (n=417) was low as in the elaboration of the budget planning and health instruments, with a greater participation in the elaboration of PPP (24.0%) and PS (52.0%). Regarding PAS and RAG, there was a greater knowledge of the presence of actions related to pharmaceutical assistance by those who participated in its elaboration (67.0% and 68.8%, respectively). Conclusion The data depict unsatisfactory engagement of the actors responsible for Pharmaceutical Assistance in elaboration and awareness of the actions foreseen at the municipalities' planning tools and suggests the produced planning instruments may not be linked with the real situation of the health services as well as with the rational use of financing for the Pharmaceutical Assistance.

[Sources of medicines for chronic patients using the Brazilian Unified National Health System]. / Fontes de obtenção de medicamentos por pacientes diagnosticados com doenças crônicas, usuários do Sistema Único de Saúde.

The article aimed to identify the sources of medicines for users of the Brazilian Unified National Health System (SUS) that reported chronic non-communicable diseases, characterizing the group according to demographic, socioeconomic, and health variables in the different regions of Brazil. Data were analyzed from the National Survey on Access, Use, and Promotion of Rational Use of Medicines in Brazil (PNAUM), a cross-sectional population-based study. The dependent variable was "source of medicines", and the associations were analyzed with demographic, socioeconomic, and health status variables. Users that obtained care and medicines solely in the SUS were designated here as SUS-exclusive. Some 39% of persons obtained their medicines from SUS pharmacies and 28.5% from other sources. The study found 42.9%, 41.8%, 40.2%, and 31% of exclusive SUS users in the Southeast, South, North, and Northeast regions of Brazil, respectively. SUS users have the SUS as their primary source of medicines, but there is also a relevant share from other sources, suggesting problems with access in the SUS. In the South and Southeast regions, the population relies less on private pharmacies than in the Northeast and North.

Este artigo teve como objetivo identificar as fontes de obtenção de medicamentos utilizadas por usuários do Sistema Único de Saúde (SUS) com relato de doenças crônicas, caracterizando tal população quanto a variáveis demográficas, socioeconômicas e de saúde nas diferentes regiões do Brasil. Foram analisados dados da Pesquisa Nacional sobre o Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), um estudo transversal de base populacional. A variável dependente foi a "fonte de obtenção de medicamentos" e foram analisadas associações com variáveis demográficas, socioeconômicas e com o estado de saúde. Os usuários que obtiveram cuidado e medicamentos unicamente no SUS foram aqui designados como SUS-exclusivos. Cerca de 39% das pessoas obtiveram seus medicamentos exclusivamente em farmácias do SUS e 28,5% recorreram a outras fontes. Foram encontrados 42,9%, 41,8%, 40,2%, 31%, usuários SUS-exclusivos, respectivamente, no Sudeste, Sul, Norte, e Nordeste. Os usuários do SUS têm como fonte primária de medicamentos o próprio SUS, entretanto há uma participação relevante de outras fontes de obtenção, indicando problemas no acesso dentro do SUS. No Sul e Sudeste, a população busca menos a farmácia privada do que no Nordeste e Norte do país.

El objetivo de este artículo fue identificar las fuentes de obtención de medicamentos, utilizados por usuarios del Sistema Único de Salud brasileño (SUS), con antecedentes de enfermedades crónicas, caracterizando tanto a la población, como las variables demográficas, socioeconómicas y de salud, en las diferentes regiones del país. Se analizaron los datos de la Encuesta Nacional sobre el Acceso, Utilización y Promoción del Uso Racional de Medicamentos en Brasil (PNAUM), un estudio transversal de base poblacional. La variable dependiente fue la 'fuente de obtención de medicamentos' y se analizaron asociaciones con variables demográficas, socioeconómicas y con el estado de salud. Los usuarios que recibieron cuidados y medicamentos únicamente en el SUS fueron designados aquí como SUS exclusivos. Cerca de un 39% de las personas obtuvieron sus medicamentos exclusivamente en farmacias del SUS y un 28,5% recurrieron a otras fuentes. Se encontraron un 42,9%, 41,8%, 40,2%, 31%, usuarios SUS exclusivos, respectivamente, en el Sudeste, Sur, Norte, y Nordeste. Los usuarios del SUS tienen como fuente primaria de medicamentos el propio SUS, no obstante, existe una participación relevante de otras fuentes de obtención, indicando problemas en el acceso dentro del SUS. En el Sur y Sudeste, la población busca menos la farmacia privada que en el Nordeste y Norte del país.

Rede de Atenção à Saúde Mental: estudo comparado Brasil e Catalunha / Mental Health Care Network: comparative study between Brazil and Catalonia

Resumo O estudo pretende analisar e comparar as redes de atenção à saúde mental do Brasil e da Catalunha através dos componentes macroestruturais da política. Trata-se de uma revisão dos documentos orientadores da política de saúde mental do Brasil e da Comunidade Autônoma da Catalunha na Espanha. Ambos os territórios possuem leis que sustentam o modelo de saúde mental de base comunitária. Na Catalunha, a política é construída de modo mais técnico e verticalizado, influenciada pelas OMS, enquanto no Brasil a construção é ascendente, com ampla participação social na definição das ações. O financiamento na Catalunha é maior tanto na saúde global quanto, especificamente, na saúde mental; no Sistema Único de Saúde (SUS), a saúde mental é área subfinanciada dentro de um sistema subfinanciado. Em ambos, o foco do financiamento vem se alterando, com maior investimento em serviços comunitários, mas a Catalunha ainda despende maior parte do financiamento para os hospitais. O modelo de gestão no Brasil ainda é, fundamentalmente, de gestão direta e na Catalunha, indireto. Ambos possuem uma rede ampla e diversificada de serviços, mas com necessidade de lidar com o contingente de moradores de hospitais psiquiátricos e avançar em mecanismos avaliativos que respondam à complexidade da política.

Abstract The study aims to analyze and compare the networks of mental health care in Brazil and Catalonia through the macrostructural components of the policy. This is a review of the guiding documents of mental health policy in Brazil and the Autonomous Community of Catalonia in Spain. Both territories have laws that support the community-based model of mental health. In Catalonia, the policy is built in a more technical and vertical way, influenced by the WHO, while in Brazil the construction is ascending with broad social participation in the definition of actions. Financing in Catalonia is greater both in global health and, specifically, in mental health; in the SUS, mental health is an underfunded area within an underfunded system. In both, the focus of financing is changing, with more investment in community services, but Catalonia still spends most of the funding for hospitals. The management model in Brazil is still, fundamentally, direct management and in Catalonia, indirect. Both have a wide and diversified network of services, but need to deal with the contingent of residents of Psychiatric Hospitals and advance in evaluation mechanisms that respond to the complexity of the policy.

Fontes de obtenção de medicamentos por pacientes diagnosticados com doenças crônicas, usuários do Sistema Único de Saúde / Sources of medicines for chronic patients using the Brazilian Unified National Health System / Fuentes de obtención de medicamentos por parte de pacientes diagnosticados con enfermedades crónicas, usuarios del Sistema Único de Salud brasileño

Resumo: Este artigo teve como objetivo identificar as fontes de obtenção de medicamentos utilizadas por usuários do Sistema Único de Saúde (SUS) com relato de doenças crônicas, caracterizando tal população quanto a variáveis demográficas, socioeconômicas e de saúde nas diferentes regiões do Brasil. Foram analisados dados da Pesquisa Nacional sobre o Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), um estudo transversal de base populacional. A variável dependente foi a "fonte de obtenção de medicamentos" e foram analisadas associações com variáveis demográficas, socioeconômicas e com o estado de saúde. Os usuários que obtiveram cuidado e medicamentos unicamente no SUS foram aqui designados como SUS-exclusivos. Cerca de 39% das pessoas obtiveram seus medicamentos exclusivamente em farmácias do SUS e 28,5% recorreram a outras fontes. Foram encontrados 42,9%, 41,8%, 40,2%, 31%, usuários SUS-exclusivos, respectivamente, no Sudeste, Sul, Norte, e Nordeste. Os usuários do SUS têm como fonte primária de medicamentos o próprio SUS, entretanto há uma participação relevante de outras fontes de obtenção, indicando problemas no acesso dentro do SUS. No Sul e Sudeste, a população busca menos a farmácia privada do que no Nordeste e Norte do país.

Abstract: The article aimed to identify the sources of medicines for users of the Brazilian Unified National Health System (SUS) that reported chronic non-communicable diseases, characterizing the group according to demographic, socioeconomic, and health variables in the different regions of Brazil. Data were analyzed from the National Survey on Access, Use, and Promotion of Rational Use of Medicines in Brazil (PNAUM), a cross-sectional population-based study. The dependent variable was "source of medicines", and the associations were analyzed with demographic, socioeconomic, and health status variables. Users that obtained care and medicines solely in the SUS were designated here as SUS-exclusive. Some 39% of persons obtained their medicines from SUS pharmacies and 28.5% from other sources. The study found 42.9%, 41.8%, 40.2%, and 31% of exclusive SUS users in the Southeast, South, North, and Northeast regions of Brazil, respectively. SUS users have the SUS as their primary source of medicines, but there is also a relevant share from other sources, suggesting problems with access in the SUS. In the South and Southeast regions, the population relies less on private pharmacies than in the Northeast and North.

Resumen: El objetivo de este artículo fue identificar las fuentes de obtención de medicamentos, utilizados por usuarios del Sistema Único de Salud brasileño (SUS), con antecedentes de enfermedades crónicas, caracterizando tanto a la población, como las variables demográficas, socioeconómicas y de salud, en las diferentes regiones del país. Se analizaron los datos de la Encuesta Nacional sobre el Acceso, Utilización y Promoción del Uso Racional de Medicamentos en Brasil (PNAUM), un estudio transversal de base poblacional. La variable dependiente fue la 'fuente de obtención de medicamentos' y se analizaron asociaciones con variables demográficas, socioeconómicas y con el estado de salud. Los usuarios que recibieron cuidados y medicamentos únicamente en el SUS fueron designados aquí como SUS exclusivos. Cerca de un 39% de las personas obtuvieron sus medicamentos exclusivamente en farmacias del SUS y un 28,5% recurrieron a otras fuentes. Se encontraron un 42,9%, 41,8%, 40,2%, 31%, usuarios SUS exclusivos, respectivamente, en el Sudeste, Sur, Norte, y Nordeste. Los usuarios del SUS tienen como fuente primaria de medicamentos el propio SUS, no obstante, existe una participación relevante de otras fuentes de obtención, indicando problemas en el acceso dentro del SUS. En el Sur y Sudeste, la población busca menos la farmacia privada que en el Nordeste y Norte del país.

National Survey on Access, Use and Promotion of Rational Use of Medicines: methods.

The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos -Serviços (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services) aimed to characterize the organization of pharmaceutical services in the Primary Health Care of the Brazilian Unified Health System (SUS). PNAUM - Services is a cross-sectional and evaluative study, with planned sample of 600 cities, held between 2014 and 2015, composed of a remote phase, with telephone interviews with health managers. Of these 600 cities, 300 were selected for a survey on health services. We selected the 27 capitals, the 0.5% largest cities of each region, and the remaining cities were drawn. The estimate of the representative national sample size considered three levels: cities, medicine dispensing services, and patients. The interviews were carried out with a structured questionnaire specific for: municipal secretaries of health, professionals responsible for pharmaceutical services in the city, professionals responsible for the dispensing of medicines, physicians, and patients. The secondary data were obtained in official databases, in the latest update date. PNAUM - Services was the first nationwide research aimed at the assessment and acquisition of national and regional indicators on access to medicines, as well as use and rational use, from the perspective of various social subjects.

Financing of Pharmaceutical Services in the municipal management of the Brazilian Unified Health System.

OBJECTIVE: To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System. METHODS: The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil - Serviços (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone. RESULTS: Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF - Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities. CONCLUSIONS: We found serious deficiencies in the public financing of medicines, as well as little concern about the formality in the use of public resources, expenses that meet individual demands to the detriment of the community, insufficient resources allocated to the Basic Component of Pharmaceutical Services, and exhaustion of the financing model.