Conciliação medicamentosa na admissão de pacientes transplantados renais em um hospital universitário / Medication reconciliation in the admission of kidney transplant patients to a university hospital

Introdução:O presente estudo considerou conciliações medicamentosas realizadas na admissão hospitalar de pacientes transplantados renais e intervenções farmacêuticas decorrentes desse processo.Métodos:Trata-se de um estudo transversal realizado no período de julho de 2018 a julho de 2019 no Hospital de Clínicas de Porto Alegre. Foram coletadas as características dos pacientes, as conciliações medicamentosas realizadas pelo farmacêutico clínico, as discrepâncias identificadas pelo mesmo (intencionais e não intencionais) e o resultado das intervenções. Os medicamentos foram classificados de acordo com a Anatomic Therapeutic Chemical (ATC).Resultados:Dos 719 pacientes acompanhados pelo farmacêutico clínico, 175 tiveram a conciliação medicamentosa de admissão realizada, desses, 56 apresentaram discrepâncias não intencionais. Encontramos a média de 2,2 medicamentos omissos por prescrição com desvio padrão de 1,3 medicamentos. No total, foram realizadas 122 intervenções farmacêuticas, sendo que em 61,5% houve adesão por parte da equipe médica. A classe terapêutica com maior ocorrência (43,4%) de discrepâncias não intencionais foi a que atuava sobre o aparelho cardiovascular. As variáveis observadas foram sexo, número de medicamentos nas intervenções (ambas com associação significativa com a adesão médica), idade, tempo de internação, número de medicamentos na internação e número de medicamentos de uso prévio (estas últimas sem associação significativa com a adesão médica). Conclusões:A conciliação medicamentosa previne possíveis erros de medicação, uma vez que a identificação das discrepâncias não intencionais na prescrição médica gera sinalizações que são levadas pelo farmacêutico clínico à equipe assistente, a fim garantir o uso seguro e correto dos medicamentos durante a internação hospitalar.

Introduction:This study considered medication reconciliations performed on hospital admission of kidney transplant patients and pharmaceutical interventions resulting from this process.Methods:This is a cross-sectional study carried out from July 2018 to July 2019 at Hospital de Clínicas de Porto Alegre. The characteristics of the patients, the medication reconciliations performed by the clinical pharmacist, the discrepancies identified by the same (intentional and unintentional) and the result of the interventions were collected. The drugs were classified according to the Anatomic Therapeutic Chemical (ATC). Results:Of the 719 patients monitored by the clinical pharmacist, 175 had medication reconciliation on admission performed, of which 56 had unintentional discrepancies. We found an average of 2.2 missing medications per prescription with a standard deviation of 1.3 medications. In total, 122 pharmaceutical interventions were performed, and in 61.5% there was adherence by the medical team. The therapeutic class with the highest occurrence (43.4%) of unintentional discrepancies was that which acted on the cardiovascular system. The variables observed were gender, number of medications in interventions (both with a significant association with medical adherence), age, length of stay, number of medications in hospitalization and number of medications previously used (the latter without a significant association with medical adherence).Conclusions:Medication reconciliation prevents possible medication errors, since the identification of unintentional discrepancies in the medical prescription generates signals that are taken by the clinical pharmacist to the assistant team, in order to guarantee the safe and correct use of medications during hospitalization.

Análise de intervenções farmacêuticas utilizando um instrumento de acompanhamento farmacêutico em uma Unidade de Terapia Intensiva Pediátrica / Analysis of pharmaceutical interventions using a pharmaceutical monitoring instrument in a Pediatric Intensive Care Unit

Introdução: A pediatria apresenta um cenário bastante específico devido ao uso de medicamentos off-label e carência de estudos científicos direcionados à utilização de medicamentos por essa população. Assim, o farmacêutico clínico pode contribuir na identificação e prevenção de problemas relacionados a medicamentos.Métodos: Estudo de coorte retrospectivo realizado em uma unidade de terapia intensiva pediátrica de um hospital universitário do Rio Grande do Sul. Foram analisadas as intervenções farmacêuticas realizadas entre março de 2016 a julho de 2018 por farmacêuticos clínicos. Tais intervenções foram reclassificadas conforme os critérios de um instrumento de acompanhamento farmacêutico (bundle) utilizado na rotina. Foi realizada análise estatística descritiva das variáveis estudadas.Resultados: Das 582 intervenções farmacêuticas analisadas, as categorias mais prevalentes foram dose (n = 97; 16,7%), necessidade (n = 92; 15,8%) e forma farmacêutica (n = 56; 9,6%). Após reclassificação das intervenções farmacêuticas utilizando o bundle, os critérios mais prevalentes foram: critério 1 (revisão da farmacoterapia; n = 285; 49%), critério 4 (analgesia; n = 78; 13,4%) e critério 10 (antimicrobianos; n = 65; 11,2%). As classes de medicamentos mais frequentes foram os do sistema nervoso (n = 213; 36,6%) e os anti-infecciosos gerais para uso sistêmico (n = 115; 19,8%). A taxa de adesão das intervenções farmacêuticas pela equipe médica foi de 85,1%.Conclusão: A classificação das intervenções farmacêuticas utilizando o bundle pode contribuir no aperfeiçoamento do instrumento tornando-o mais viável para uso na unidade de terapia intensiva pediátrica e direcionar o trabalho do farmacêutico clínico nas situações que geram mais problemas relacionados a medicamentos.

Introduction: Pharmaceutical interventions in the pediatric setting are highly peculiar due to the use of off-label drugs associated with the lack of scientific studies on the use of drug therapies in this population. Thus, clinical pharmacists may help identify and prevent drug-related problems.Methods: We conducted a retrospective cohort study in the pediatric intensive care unit of a teaching hospital in Rio Grande do Sul, Brazil. Pharmaceutical interventions conducted between March 2016 and July 2018 were analyzed by clinical pharmacists. These interventions were reclassified according to the criteria of a routine pharmaceutical monitoring instrument (care bundle). We conducted a descriptive statistical analysis of study variables.Results: Of 582 pharmaceutical interventions analyzed, the most prevalent categories were dose adjustment (n = 97; 16.7%), need for drug therapy (n = 92; 15.8%), and dosage forms (n = 56; 9.6%). After reclassification of pharmaceutical interventions, the most prevalent criteria were criterion 1 (review of drug therapy; n = 285; 49%), criterion 4 (analgesia; n = 78; 13.4%), and criterion 10 (antimicrobials; n = 65; 11.2%). The most common drug classes were nervous system agents (n = 213; 36.6%) and anti-infectives for systemic use (n = 115; 19.8%). The rate of adherence to pharmaceutical interventions by the medical team was 85.1%.Conclusions: The classification of pharmaceutical interventions according to the pharmaceutical care bundle may help improve the instrument, allowing its use in the pediatric intensive care unit and guiding clinical pharmacists in situations causing drug-related problems.

Descrição do seguimento farmacoterapêutico de pacientes com hanseníase em município hiperendêmico do estado de Mato Grosso / Pharmacotherapy follow-up of patients with leprosy in a hyperendemic city in the state of Mato Grosso

Introdução: A hanseníase é uma doença crônica, infectocontagiosa e considerada um problema de saúde pública no Brasil. O objetivo deste estudo foi descrever o seguimento farmacoterapêutico de pacientes com diagnóstico de hanseníase. Métodos: Estudo descritivo, com pacientes com hanseníase multibacilar do município de Rondonópolis, Mato Grosso. O seguimento farmacoterapêutico foi realizado a partir de uma versão adaptada do Método Dáder. Para análise de dados aplicou-se a estatística descritiva e o teste Qui-quadrado de Pearson.Resultados: Uma frequência de 95,6% dos participantes apresentou problemas relacionados aos medicamentos, 59,1% apresentaram 3 ou mais problemas, os mais frequentes foram administração errada do medicamento e interação medicamento/nutriente. A inefetividade não quantitativa foi o resultado negativo associado ao medicamento mais evidenciado. Os indivíduos acompanhados em um serviço especializado apresentaram menor número de problemas relacionados aos medicamentos quando comparados àqueles da Estratégia Saúde da Família (p = 0,027).Conclusão: A maioria dos pacientes acompanhados apresentou problemas relacionados ao uso de medicamentos. O método Dáder possibilitou realizar o seguimento farmacoterapêutico de indivíduos com hanseníase.

Introduction: Leprosy is a chronic, infectious, and contagious disease considered a public health problem in Brazil. The objective of this study was to describe the pharmacotherapy follow-up of patients diagnosed with leprosy. Methods: We conducted a descriptive study of patients with multibacillary leprosy in the city of Rondonópolis, state of Mato Grosso, Brazil. Pharmacotherapy follow-up was conducted based on an adapted version of the Dáder method. Data were analyzed using descriptive statistics and Pearson's chi-square test. Results: Drug-related problems (DRP) were reported in 95.6% of patients, among whom 59.1% had 3 or more problems DRPs. The most common DRPs were incorrect drug administration and drug-nutrient interaction. Nonquantitative ineffectiveness was the most common drug-related negative outcome. Patients monitored in a leprosy treatment center had fewer DRPs than those monitored by a Family Health Strategy team (p = 0.027). Conclusion: Most patients had DRPs. The Dáder method allowed pharmacotherapy follow-up of patients with leprosy.

Fontes de acesso e utilização de medicamentos na zona rural de Pelotas, Rio Grande do Sul, em 2016: estudo transversal de base populacional / Fuentes de acceso y uso de medicamentos en la zona rural de Pelotas, Rio Grande do Sul, Brasil, en 2016: estudio transversal de base poblacional / Sources of access to medication and its use in the rural area of Pelotas, Rio Grande do Sul, Brazil, in 2016: a cross-sectional population-based study

Objetivo: Analisar a prevalência do uso de medicamentos, fontes de acesso e fatores associados, em residentes da zona rural de Pelotas, RS, Brasil. Métodos: Estudo transversal com adultos ≥18 anos, realizado em 2016. Questionou-se o uso e fontes de acesso aos medicamentos no mês anterior à entrevista. Empregou-se regressão de Poisson. Resultados: Dos 1.519 entrevistados, 54,7% (IC95% 48,7;60,5) utilizaram algum medicamento e 3,3% (IC95% 2,4;4,5) deixaram de utilizar medicamento necessário. Exibiram maiores prevalências de utilização: mulheres (RP=1,23 - IC95% 1,12;1,34), idosos (RP=2,36 - IC95% 2,05;2,73), pessoas com pior autopercepção de saúde (RP=1,29 - IC95% 1,14;1,46), com maior número de doenças (RP=2,37 - IC95% 2,03;2,77). Obtiveram medicamentos exclusivamente pelo Sistema Único de Saúde (SUS) 14,0% (IC95% 11,2;17,4), com prevalências maiores entre pessoas de cor da pele autodeclarada não branca e classificação econômica inferior. Conclusão: Pequena parcela deixou de usar medicamentos de que necessitava. A obtenção gratuita de medicamentos foi maior nos grupos de menor poder aquisitivo.

Objetivo: Analizar la prevalencia del uso de medicamentos, las fuentes de acceso y los factores asociados en habitantes rurales de Pelotas, RS, Brasil. Métodos: Estudio transversal con adultos ≥18 años, en 2016. Se preguntó sobre el uso y fuentes de acceso a los medicamentos en el mes anterior a la entrevista. Se utilizó la regresión de Poisson. Resultados: De los 1.519 entrevistados, 54,7% (IC95% 48,7; 60,5) usó algún medicamento y 3,3% (IC95% 2,4; 4,5) dejó de usar un medicamento necesario. Las prevalencias de uso fueron mayores en mujeres (RP=1,23 - IC95% 1,12;1,34), adultos mayores (RP=2,36 - IC95% 2,05;2,73), personas con peor autopercepción de salud (RP=1,29 - IC95% 1,14;1,46) y con más enfermedades (RP=2,37 - IC95% 2,03;2,77). En total, 14,0% (IC95% 11,2;17,4) obtuvo medicamentos exclusivamente por el Sistema Único de Salud (SUS) y la prevalencia fue mayor en los de color de piel no blanca (autodeclarada) y clase económica más baja. Conclusión: Pequeña parcela indicó que dejó de usar medicamentos necesarios. La obtención gratuita fue mayor en grupos de menor poder adquisitivo.

Objective: To analyze the prevalence of medication use, sources of access, and associated factors among rural residents in Pelotas, RS, Brazil. Methods: This was a cross-sectional study conducted in 2016 with adults ≥18 years old. Participants reported on medication use and sources of access to medication in the month prior to the interview. Poisson regression was used. Results: Among the 1,519 respondents, 54.7% (95%CI 48.7;60.5) used some form of medication and 3.3% (95%CI 2.4;4.5) stopped taking necessary medication. Higher prevalence of use occurred in: women (PR=1.23 - 95%CI 1.12;1.34), the elderly (PR=2.36 - 95%CI 2.05;2.73), people with poorer self-perceived health (PR=1.29 - 95%CI 1.14;1.46) and people with a higher number of diseases (PR=2.37 - 95%CI 2.03;2.77). A total of 14.0% (95%CI 11.2;17.4) obtained medication exclusively from the Brazilian National Health System, prevalence of which was higher among those who self-reported themselves to be non-white and from lower economic classification. Conclusion: A low number stopped taking medication they needed to take. Use of free-of-charge medication was greater in groups with lower income.

Acompanhamento clínico farmacêutico no cuidado ao paciente adulto-cirúrgico em um hospital universitário de Porto Alegre / Clinical pharmacist follow-up in adult surgical patient care in a university hospital of Porto Alegre

Introdução: O farmacêutico clínico já está bem estabelecido em algumas instituições e muitos serviços de saúde contam com este profissional em suas equipes, entretanto, poucos conseguem sistematizar o seu trabalho e mapear os dados das atividades desenvolvidas, demonstrando a relevância do profissional na equipe de saúde. O objetivo deste trabalho foi avaliar o acompanhamento clínico-farmacêutico em uma unidade de internação adulto-cirúrgica em um hospital universitário de Porto Alegre. Métodos: Estudo descritivo retrospectivo que quantificou as principais atividades do farmacêutico clínico em uma unidade de internação adulto-cirúrgica no período de janeiro a maio de 2019. Este projeto foi aprovado no Comitê de Ética em Pesquisa da referida instituição. Resultados: 859 pacientes foram admitidos na unidade cirúrgica avaliada, dos quais 490 foram revisados pelo farmacêutico na admissão hospitalar, correspondendo à taxa média de 57,27%. A taxa média de conciliação medicamentosa realizada foi de 14,83%, totalizando 73 pacientes conciliados por entrevista. 361 intervenções farmacêuticas foram realizadas no período estudado, sendo 54 relacionadas a conciliação medicamentosa, com o número total de adesões de 232. As principais especialidades cirúrgicas que internam pacientes na unidade em questão foram a Ortopedia, Cirurgia do Aparelho Digestivo, Urologia e Cirurgia Vascular. Conclusões: Foi possível avaliar o acompanhamento clínico farmacêutico em uma unidade de internação adulto-cirúrgica em um hospital universitário de Porto Alegre, através da quantificação das taxas de pacientes revisados e de conciliação medicamentosa, do número de intervenções farmacêuticas e suas adesões, além de caracterizar as principais especialidades médicas cirúrgicas envolvidas. (AU)

Introduction: Clinical pharmacists are already well established in some institutions, and many health services have these professionals in their teams. However, few are able to systematize their work and map data from the developed activities, demonstrating the relevance of these professionals in the health team. This study aimed to evaluate the clinical pharmacist follow-up in an adult surgical inpatient unit in a university hospital in Porto Alegre. Methods: This is a retrospective, descriptive study that quantified the main activities of the clinical pharmacist in an adult surgical inpatient unit from January to May 2019. This project was approved by the Research Ethics Committee of the institution. Results: Of 859 patients admitted to the s rgical unit, 490 were reviewed by the pharmacist on hospital admission, corresponding to an average rate of 57.27%. The average medication reconciliation rate was 14.83%, totaling 73 patients reconciled per interview. Of 361 pharmaceutical interventions performed during the study period, 54 were related to medication reconciliation, and the total number of adhesions was 232. The main surgical specialties associated with admission to the study unit were Orthopedics, Digestive System Surgery, Urology, and Vascular Surgery. Conclusions: It was possible to evaluate the clinical pharmacist follow-up in an adult surgical inpatient unit in a university hospital in Porto Alegre by quantifying the rates of reviewed patients and medication reconciliations as well as the number of pharmaceutical interventions and their adherences, in addition to characterizing the main medical-surgical specialties involved. (AU)

Perceptions of pharmaceutical services among elderly people on polymedication.

OBJECTIVES: Describe the importance of guidelines provided during pharmaceutical consultation about compliance with medication therapy based on interviews with polymedicated elderly patients. METHODS: A qualitative methodological study carried out during consultations with 40 elderly patients of both genders at the Health Care Center for Elderly Patients and Caregivers. The study used the technique of content analysis, applying a questionnaire with two open questions. RESULTS: Two categories and eight subcategories emerged after the transcription of interviews and exhaustive reading of the data. The category "Pharmaceutical consultation as an education instrument for the self-care of polymedicated elderly patients" presented the highest frequency. The subcategory with the highest frequency was "Concern of elderly patients about self-care". FINAL CONSIDERATIONS: In the case of polymedicated elderly patients, pharmaceutical consultation is an important education instrument which, through the provision of pharmaceutical guidelines, allows the minimization of concerns about pharmacotherapy, contributing to compliance and self-care.

A survey of global biosimilar implementation practice conducted by the International Society of Oncology Pharmacy Practitioners.

Background: The International Society of Oncology Pharmacy Practitioners (ISOPP) Biosimilars Task Force was charged to develop educational activities and resources to assist members when implementing biosimilar medicines into their local practice. To facilitate the process, the task force conducted a survey in order to understand biosimilar implementation practice by ISOPP members across the world and the challenges that oncology pharmacists face when adopting biosimilars into their clinical practice. Methods: A cross-sectional survey was conducted between 20 April 2019 and 27 May 2019. Members of ISOPP and a number of national oncology pharmacy groups were invited to complete the survey. The survey contained 29 items and consisted of three sections: respondents' demographics, respondents' institutional practice relating to biosimilar implementation and post implementation practice at the respondents' institutions. Descriptive statistics were utilized to analyze the survey results. Results: A total of 265 ISOPP members were surveyed, with 50 members providing a response (response rate = 19%). In addition, 40 nonmembers participated in the survey, bringing the total to 90 respondents. The most common factors that influence the decision to implement use of a biosimilar as reported by respondents are medication costs/pricing (92%), available clinical data (73%), and product availability (63%). Respondents also commented on the barriers to biosimilar implementation at their institutions, which included a reluctance of prescribers to use biosimilars (due to the lack of familiarity or perceived inferiority), a reluctance to switch established patients from an originator to a biosimilar and the preferences of insurance companies or funding bodies. Conclusion: The results of this survey reinforce the need for greater education and training for health care professionals in the use of biosimilars, the importance of sharing good practice, and a need for standardization.

Pharmaceutical care-based interventions in type 2 diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials / Intervenções farmacêuticas no diabetes mellitus tipo 2: uma revisão sistemática e metanálise de ensaios clínicos randomizados

ABSTRACT Objective To investigate the impact of pharmaceutical care-based interventions on type 2 diabetes mellitus . Methods PubMed®, Cochrane and Web of Science data bases were searched for randomized controlled clinical trials. Studies evaluating pharmaceutical care-based interventions in type 2 diabetes mellitus published between 2012 and 2017 were included. Glycated hemoglobin was defined as the primary endpoint; blood pressure, triglycerides and cholesterol as secondary endpoints. The random effects model was used in meta-analysis. Results Fifteen trials involving 2,325 participants were included. Meta-analysis revealed considerable heterogeneity (I2>97%; p<0.001), reduction in glycated hemoglobin (-1.07%; 95%CI: -1.32; -0.83; p<0.001), glucose (-29.91mg/dL; 95%CI: -43.2; -16.6; p<0.001), triglyceride (19.8mg/dL; 95%CI: -36.6; -3.04; p=0.021), systolic blood pressure (-4.65mmHg; 95%CI: -8.9; -0.4; p=0.032) levels, and increased HDL levels (4.43mg/dL; 95%CI: 0.16; 8.70; p=0.042). Conclusion Pharmaceutical care-based clincal and education interventions have significant impact on type 2 diabetes mellitus . The tools Summary of Diabetes Self-Care Activities and the Morisky Medication Adherence Scale may be useful to monitor patients.

RESUMO Objetivo Identificar o impacto das intervenções providenciadas pelo cuidado farmacêutico no diabetes mellitus tipo 2. Métodos Buscas por ensaios clínicos randomizados controlados foram realizadas nas bases PubMed®, Cochrane e Web of Science . Foram incluídos estudos publicados entre 2012 e 2017, que avaliaram o impacto do cuidado farmacêutico no diabetes mellitus tipo 2. A hemoglobina glicada foi o desfecho primário, e os secundários foram pressão arterial, triglicérides e colesterol. O modelo de efeitos aleatórios foi utilizado na metanálise. Resultados Foram incluídos 15 estudos envolvendo 2.325 participantes. A metanálise demonstrou heterogeneidade elevada (I2>97%; p<0,001), redução nos níveis de hemoglobina glicada (-1,07%; IC95%: -1,32; -0,83; p<0,001), glicose (-29,91mg/dL; IC95%: -43,2; -16,6; p<0,001), triglicérides (19,8mg/dL; IC95%: -36,6; -3,04; p=0,021), pressão arterial sistólica (-4,65mmHg; IC95%: -8,9; -0,4; p=0,032) e aumento do colesterol HDL (4,43mg/dL; IC95%: 0,16; 8,70; p=0,042). Conclusão As intervenções clínicas e educacionais providenciadas pelo cuidado farmacêutico têm impacto significativo no diabetes mellitus tipo 2. Ferramentas como o Summary of Diabetes Self-Care Activities e a Morisky Medication Adherence Scale podem ser úteis no acompanhamento dos pacientes.

Profile of activities developed by community pharmacists: do they corroborate the precepts of the pharmaceutical profession?

Studies that addressed the profile of pharmaceutical activities and behaviors in community pharmacies in the last decades pointed to a gap between community pharmacy practice and the precepts of the profession. Facing the need to analyze whether the new legislation has impacted this scenario, the objective of this study was to describe the general profile and academic profile of community pharmacists, and the profile of the activities they develop, as well as to know their place of work. This is a descriptive study, to which all pharmacists in charge of community pharmacies in the metropolitan area of ​​Belo Horizonte-MG (n = 1624) were invited. Data collection was performed through a questionnaire validated online, from October to December 2017, via Google Docs®. Responses were obtained from 109 pharmacists, most of them female, aged 31-40 years, being general graduates, and in private institutions. Pharmacotherapeutic follow-up, an activity linked to clinical management, is performed by only 37.60% of pharmacists, evidencing that there is still a lag in relation to the provision of clinical services by community pharmacists. Thus, we emphasize the importance of implementing the precepts established by Brazilian curricular guidelines for undergraduate pharmacy courses which focus on the development of clinical skills, since the insertion of the pharmacist into the health team and the provision of clinical services to the community can add new value to the use of medications, and contribute effectively to their rational use in Brazil.

RDQA - Relatório Detalhado do Quadrimestre Anterior da Secretaria de Saúde do Estado do Tocantins [1º Quadrimestre de 2020] / RDQA - Detailed Report for the Previous Quadrimester of the Tocantins State Health Department [1st Quadrimester of 2020]

O Relatório Detalhado do Quadrimestre Anterior (RDQA) apresentam os resultados alcançados com a execução da PAS a cada quadrimestre e orientam eventuais redirecionamentos. Eles têm a função de comprovar a aplicação de todos os recursos do Fundo de Saúde. É instrumento indissociável do Plano e de suas respectivas Programações, sendo a principal ferramenta para subsidiar o processo de monitoramento e avaliação da gestão. Tem seu modelo padronizado pela Resolução nº 459 do Conselho Nacional de Saúde - CNS, de 10 de outubro de 2012, publicada no DOU de 21/12/2012, conforme dispõe o Parágrafo 4º do Artigo 36 da Lei Complementar nº 141/2012. A Programação Anual de Saúde (PAS) é a referência de execução das ações e serviços públicos em saúde, cujo processo de sua gestão é demonstrado no Relatório de Gestão: a cada quadrimestre no RDQA e ao final do exercício no Relatório Anual de Gestão (RAG).

The Detailed Report for the Previous Quadrimester (RDQA) presents the results achieved with the execution of the PAS every four months and guides any redirections. They have the function of proving the application of all the resources of the Health Fund. It is an inseparable instrument of the Plan and its respective Programs, being the main tool to support the process of monitoring and evaluation of management. Its model is standardized by Resolution No. 459 of the National Health Council - CNS, of October 10, 2012, published in the DOU of 12/21/2012, as provided in Paragraph 4 of Article 36 of Complementary Law No. 141/2012. The Annual Health Program (PAS) is the benchmark for executing public health actions and services, whose management process is demonstrated in the Management Report: every four months in the RDQA and at the end of the year in the Annual Management Report (RAG) ).

El Informe Detallado del Cuatrimestre Anterior (RDQA) presenta los resultados obtenidos con la ejecución del PAS cada cuatro meses y orienta las redirecciones. Tienen la función de acreditar la aplicación de todos los recursos del Fondo de Salud, instrumento inseparable del Plan y sus respectivos Programas, siendo la principal herramienta de apoyo al proceso de seguimiento y evaluación de la gestión. Su modelo se encuentra estandarizado por la Resolución No. 459 del Consejo Nacional de Salud - CNS, de 10 de octubre de 2012, publicada en el DOU de 21/12/2012, según lo dispuesto en el numeral 4 del artículo 36 de la Ley Complementaria No. 141/2012. El Programa Anual de Salud (PAS) es el referente para la ejecución de acciones y servicios de salud pública, cuyo proceso de gestión se demuestra en el Informe de Gestión: cuatrimestral en el RDQA y al final del año en el Informe Anual de Gestión (RAG) ).

Le rapport détaillé du quadrimestre précédent (RDQA) présente les résultats obtenus avec l'exécution du PAS tous les quatre mois et guide les éventuelles réorientations. Ils ont pour fonction de prouver l'application de toutes les ressources du Fonds de la Santé, instrument indissociable du Plan et de ses Programmes respectifs, étant le principal outil d'appui au processus de suivi et d'évaluation de la gestion. Son modèle est normalisé par la résolution n ° 459 du Conseil national de la santé - CNS du 10 octobre 2012, publiée au DOU du 21/12/2012, comme prévu au paragraphe 4 de l'article 36 de la loi complémentaire n ° 141/2012. Le Programme Annuel de Santé (PAS) est la référence pour la mise en œuvre d'actions et de services de santé publique, dont le processus de gestion est démontré dans le rapport de gestion: tous les quatre mois dans le RDQA et en fin d'année dans le rapport annuel de gestion (RAG) ).

Perceptions of pharmaceutical services among elderly people on polymedication / Impressão de idosos polimedicados sobre o serviço farmacêutico / Impresión de los ancianos polimedicados respecto del servicio farmacéutico

ABSTRACT Objectives: Describe the importance of guidelines provided during pharmaceutical consultation about compliance with medication therapy based on interviews with polymedicated elderly patients. Methods: A qualitative methodological study carried out during consultations with 40 elderly patients of both genders at the Health Care Center for Elderly Patients and Caregivers. The study used the technique of content analysis, applying a questionnaire with two open questions. Results: Two categories and eight subcategories emerged after the transcription of interviews and exhaustive reading of the data. The category "Pharmaceutical consultation as an education instrument for the self-care of polymedicated elderly patients" presented the highest frequency. The subcategory with the highest frequency was "Concern of elderly patients about self-care". Final Considerations: In the case of polymedicated elderly patients, pharmaceutical consultation is an important education instrument which, through the provision of pharmaceutical guidelines, allows the minimization of concerns about pharmacotherapy, contributing to compliance and self-care.

RESUMO Objetivos: Descrever a importância das orientações fornecidas durante a consulta farmacêutica sobre a adesão ao tratamento farmacológico com base nos depoimentos de idosos polimedicados. Métodos: Estudo metodológico, qualitativo, realizado durante consultas com 40 pacientes idosos de ambos os sexos no Centro de Atenção à Saúde para Idosos e Cuidadores. A técnica da análise de conteúdo foi utilizada, e um questionário com duas perguntas aber tas foi aplicado. Resultados: Duas categorias e oito subcategorias emergiram da transcrição das entrevistas e leitura exaustiva dos dados. A categoria "Consulta farmacêutica como um instrumento educativo para o autocuidado de idosos polimedicados" apresentou a maior frequência. A subcategoria mais frequente foi "Preocupação dos idosos com o autocuidado" Considerações finais: No caso de pacientes idosos polimedicados, a consulta farmacêutica constitui um instrumento educativo importante que, através do fornecimento de orientações farmacêuticas, permite minimizar as preocupações com relação a farmacoterapia, contribuindo com a adesão e autocuidado.

RESUMEN Objetivos: Describir la importancia de las indicaciones brindadas durante la consulta farmacéutica sobre la adhesión al tratamiento farmacológico según discursos de ancianos polimedicados. Métodos: estudio metodológico, cualitativo, realizado durante consultas con 40 pacientes ancianos de ambos sexos en el Centro de Atención de Salud de Ancianos y Cuidadores. Se utilizó análisis de contenido, con un cuestionario de dos preguntas abiertas. Resultados: Surgieron dos categorías y ocho subcategorías tras la transcripción de discursos y la lectura exhaustiva de datos. La categoría "Consulta farmacéutica como instrumento educativo para el autocuidado de ancianos polimedicados" expresó la mayor frecuencia. La subcategoría más frecuente fue "Preocupación de los ancianos por el autocuidado". Consideraciones finales: En el caso de pacientes mayores polimedicados, la consulta farmacéutica constituye un importante instrumento educativo que, a través de la provisión de indicaciones farmacéuticas, permite minimizar las preocupaciones respecto de la farmacoterapia, contribuyendo así al cumplimiento y al autocuidado.

A Judicialização de medicamentos no estado da Bahia: os números no período de 2014 a 2017 / The judicialization of medications in the state of Bahia, Brazil: the numbers from 2014 to 2017 / La judicialización de los medicamentos en el estado de Bahía, Brasil: las cifras en el período de 2014 a 2017

Objetivo: o trabalho é dedicado ao tema da judicialização no estado da Bahia, visando analisar sua dimensão e trajetória entre 2014 e 2017, com destaque para os números relacionados à assistência farmacêutica. Metodologia: estudo de caso em que se utilizou a base de dados do Núcleo de Atendimento à Judicialização da Saúde (NAJS) do estado da Bahia. Resultados: curva crescente da judicialização no âmbito da assistência farmacêutica; predomínio de ações individuais; incremento de gastos com a judicialização no componente especializado. Conclusão: a judicialização no estado da Bahia segue a tendência nacional de aumento, sem que se vislumbre uma adequada discussão entre o Poder Público, o Judiciário e a sociedade.

Objective: the work is devoted to the subject of judicialization in the state of Bahia, aiming to analyze its size and trajectory between 2014 and 2017, with emphasis on the numbers related to pharmaceutical care. Methodology: a case study in which the database of the nucleus of care for the judicialization of the state of Bahia was used. Results: increasing curve of judicialization in the scope of pharmaceutical care; predominance of individual actions; reduction of costs with judicialization in the specialized component. Conclusion: the judicialization in the state of Bahia follows the national trend of increase, without a glimpse of an adequate discussion between the public power, the Judiciary and the society. Keyword: Health's judicialization. Public policy. Pharmaceutical assistance

Objetivo: el trabajo se dedica al tema de la judicialización en el estado de Bahía, con el objetivo de analizar su tamaño y trayectoria entre 2014 y 2017, con énfasis en las cifras relacionadas con la atención farmacéutica. Metodología: un estudio de caso en el que se utilizó la base de datos del núcleo de atención para la judicialización del estado de Bahía. Resultados: aumento de la curva de judicialization en el ámbito de la atención farmacéutica; predominio de acciones individuales; reducción de costes con judicialización en el componente especializado. Conclusión: la judicialización en el estado de Bahía sigue la tendencia nacional de aumento, sin vislumbrar una discusión adecuada entre el poder público, el poder judicial y la sociedad

Judicialização do acesso a medicamentos no município de Ivinhema, Mato Grosso do Sul / Judicialization of access to medicines in the municipality of Ivinhema, Mato Grosso do Sul, Brazil / Judicialización del acceso a medicamentos en la ciudad de Ivinhema, Mato Grosso do Sul, Brasil

Objetivo: conhecer o perfil das requisições de medicamentos na esfera administrativa, recebidas pela Secretaria de Saúde do Município de Ivinhema, Mato Grosso do Sul, no ano de 2017. Métodos: estudo descritivo, retrospectivo, com foco em base documental. Definiuse como universo da pesquisa os ofícios recebidos pelo departamento jurídico da Secretaria de Saúde no Município de Ivinhema/MS, no período de primeiro de janeiro a 31 de dezembro de 2017. As variáveis concatenadas foram: quantificação das requisições de medicamentos no período supracitado; classificação da autoria dos ofícios recebidos; características dos medicamentos requeridos: pertinência à rede de assistência farmacêutica do SUS e classificação pela Anatomical Therapeutic Chemical Classification (ATC), de acordo com a recomendação da Organização Mundial de Saúde. Resultados: foram recebidos 59 ofícios, requisitando um total de 169 medicamentos. Desse total, 118 (69,8%) não faziam parte da rede de assistência farmacêutica do SUS. Dos 51 (30,2%) medicamentos listados na rede pública de saúde, 38 (74,5%) estavam elencados na Relação Estadual de Medicamentos Essenciais (Resme) e 13 (25,5%), na lista do componente especializado. Os fármacos solicitados com maior frequência foram: ácido acetilsalicílico (3,5%), metoprolol e cilostazol (2,4%). A maioria das requisições recebidas veio da Defensoria Pública (93,2%). Além disso, segundo a classificação terapêutica dos medicamentos solicitados, verificou-se que os grupos anatômicos mais frequentes foram: sistema nervoso central (31,9%), sistema cardiovascular (26,0%) e sangue e órgãos hematopoiéticos (10,6%). Conclusão: a maioria dos ofícios era de autoria da Defensoria Pública e requisitavam medicamentos que não faziam parte da rede de assistência farmacêutica do SUS

Objective: to know the profile of medicines requests in the administrative level, received by the Secretary of Health of Ivinhema, Mato Grosso do Sul, Brazil, in 2017. Methodology: descriptive, retrospective study, focusing on documentary basis. The universe of research was defined as the documents received by the law department of Secretary of Health of Ivinhema, Mato Grosso do Sul, from January 1 to December 31, 2017. The variables studied were: quantification of medicines requests; authorship classification of the received documents; characteristics of the required medicines: relevance to the SUS pharmaceutical assistance network and classification by the Anatomical Therapeutic Chemical Classification (ATC), according to the recommendation of the World Health Organization. Results: 59 documents were received, requesting a total of 169 medicines. Of this total, 118 (69.8%) were not part of SUS's pharmaceutical assistance network. Of the 51 (30.2%) medicines listed in the public health network, 38 (74.5%) were listed in the State List of Essential Medicines (Resme), and 13 (25.5%) in the specialized component list. The most frequently requested medicines were acetylsalicylic acid (3.5%), metoprolol and cilostazol (2.4%).Most of the documents received came from the Public Defender's Office (93.2%). In addition, according to the therapeutic classification of the medicine requested, it was found that the most frequent anatomical groups were: central nervous system (31.9%), cardiovascular system (26.0%) and blood and hematopoietic organs (10.6%). Conclusion: Most of the documents were from the Public Defender's and requested medicines that were not part of SUS's pharmaceutical assistance network.

Objetivo: conocer el perfil de las requisiciones de medicamentos en la esfera administrativa, recibidas por la Secretaría de Salud del Municipio de Ivinhema, Mato Grosso do Sul, en el año 2017. Metodología: estudio descriptivo, retrospectivo con foco en base documental. Se definió como universo de la investigación los oficios recibidos por el departamento jurídico de la Secretaría de Salud en el Municipio de Ivinhema/MS, en el período del primero de enero al 31 de diciembre de 2017. Las variables concatenadas fueron: cuantificación de las solicitudes de drogas en el período mencionado; clasificación de autoría de los oficios recibidas; características de los medicamentos requeridos: relevancia para la red de atención farmacéutica del SUS y clasificación según la Clasificación Química Terapéutica Anatómica (ATC), según la recomendación de la Organización Mundial de la Salud. Resultados: recibieron 59 oficios, solicitando un total de 169 medicamentos. De este total, 118 (69,8%) no formaban parte de La red de Asistencia Farmacéutica del SUS. De los 51 (30,2%) medicamentos listados en la red pública de salud, 38 (74,5%) estaban enumerados en la Lista Estatal de Medicamentos Esenciales (Resme) y 13 (25,5%) en la lista del componente especializado. Los fármacos solicitados com mayor frecuencia fueron: ácido acetilsalicílico (3,5%), metoprolol y cilostazol (2,4%). La mayoría de las acciones recibidas vinieron de La Defensoría Pública (93,2%). Además, según La clasificación terapéutica de los medicamentos solicitados, se verificó que los grupos anatómicos más frecuentes fueron: sistema nervioso central (31,9%), sistema cardiovascular (26,0%) y sangre y órganos hematopoyéticos (10,6%). Conclusion: La mayoría de los documentos provenían de la Oficina del Defensor Público y solicitaban medicamentos que no formaban parte de la red de asistencia farmacéutica del SUS.

Evolution of the TRICARE Pharmacy Benefit: A Decade of Change.

TRICARE is the military's health plan that provides coverage to 9.4 million active duty and retired uniformed services personnel and their family members. The TRICARE pharmacy benefit has undergone many changes in the last decade. These changes include assigning newly approved drugs to nonformulary status after regulatory approval, the addition of weight loss medications to the benefit, channel management point-of-service requirements for some medications, and copay increases. Several initiatives have resulted in significant cost avoidance to the Department of Defense (DoD). The purpose of this article is to discuss the changes to the TRICARE pharmacy benefit, describe the continual challenges, and estimate cost savings associated with implementation of these changes. DoD implemented its 3-tier Uniform Formulary in 2005. Since then, many changes have been enacted, including more extensive use of prior authorization, step therapy, and quantity limits; coverage of over-the-counter medications; the retail refund program; coverage of vaccines and smoking cessation agents; mandatory mail/military treatment facility requirements; rapid review and initial nonformulary status for newly approved innovator drugs; revisions to the compounded drug benefit; initial deployment of a new medical record system; coverage of weight loss medications; and the ability to exclude medications from the Uniform Formulary. Although the TRICARE pharmacy benefit has evolved significantly, the focus remains on the beneficiaries, with an overall goal of providing integrated, affordable, and high quality health services for the Military Health System. Challenges for the future include maximizing clinical effectiveness in the face of rising pharmaceutical costs and cost avoidance, while supporting the needs of TRICARE beneficiaries. DISCLOSURES: No outside funding supported this study. The authors declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. The information discussed here represents the views of the authors and does not necessarily reflect the views of the Defense Health Agency (DHA), the Department of Defense (DoD), or the Departments of the Army, Navy, and Air Force. The authors have nothing to disclose that presents a potential conflict of interest.

Implementation of an innovative surgical pharmacy service to improve patient outcomes-Twelve-month outcomes of the Enhanced Surgical Medicines Optimization Service.

WHAT IS KNOWN AND OBJECTIVE: Pharmacists play vital roles in medicines optimization in different care settings. Studies have shown that optimizing patient's pre-existing co-morbidities prior to the surgery leads to better post-operative outcomes. The Enhanced Surgical medicines optimization service (ESMOS) is an innovative surgical pharmacy service introduced at a large teaching hospital in the UK in September 2017 which aimed to reduce the length of stay and post-operative complications in general surgical patients. This purpose of this study is to evaluate the implementation and outcomes of this service at 12 months after it was rolled out. METHODS: This cohort study was undertaken between September 2017 and September 2018. Adult patients undergoing elective major general surgical procedures were included and stratified into four sub-specialties, including hepato-pancreato-biliary (HPB), upper gastrointestinal (GI), lower GI and vascular surgery. Patients undergoing emergency and day case procedures or with missing outcome data were excluded from this study. Patients' demographics, baseline co-morbidities, high-risk medications, American Society of Anaesthesiologists (ASA) physical status classification, surgical procedure, post-operative complications, length of stay and nature of pharmacist interventions were collected and reported by descriptive statistics. Length of stay was compared with the corresponding expected length of stay by the national standard. RESULTS AND DISCUSSION: A total of 246 patients were included in the four general sub-specialties: HPB (n = 82), upper GI (n = 17), lower GI (n = 87) and vascular (n = 60). There was a significant reduction in the median length of stay in three surgical specialties, compared with the national standard: lower GI (median reduction: -2; IQR: -4, 1.8; P = .038), HPB (median reduction: -4.5; IQR: -7, -1; P = .001) and vascular (median reduction: -2; IQR: -4, 0; P = .043). WHAT IS NEW AND CONCLUSION: The ESMOS model is a novel care pathway that allows both early identification of medicines optimization and peri-operative drug management issues in surgical patients, and potentially reduces the overall length of stay.

Projected Prevalence of Actionable Pharmacogenetic Variants and Level A Drugs Prescribed Among US Veterans Health Administration Pharmacy Users.

Importance: Implementation of pharmacogenetic testing to guide drug prescribing has potential to improve drug response and prevent adverse events. Robust data exist for more than 30 gene-drug pairs linking genotype to drug response phenotypes; however, it is unclear which pharmacogenetic tests, if implemented, would provide the greatest utility for a given patient population. Objectives: To project the proportion of veterans in the US Veterans Health Administration (VHA) with actionable pharmacogenetic variants and evaluate how testing might be associated with prescribing decisions. Design, Setting, and Participants: This cross-sectional study included veterans who used national VHA pharmacy services from October 1, 2011, to September 30, 2017. Data analyses began April 26, 2018, and were completed February 6, 2019. Exposures: Receipt of level A drugs based on VHA pharmacy dispensing records. Main Outcomes and Measures: Projected prevalence of actionable pharmacogenetic variants among VHA pharmacy users based on variant frequencies from the 1000 Genomes Project and veteran demographic characteristics; incident number of level A prescriptions, and proportion of new level A drug recipients projected to carry an actionable pharmacogenetic variant. Results: During the study, 7 769 359 veterans (mean [SD] age, 58.1 [17.8] years; 7 021 504 [90.4%] men) used VHA pharmacy services. It was projected that 99% of VHA pharmacy users would carry at least 1 actionable pharmacogenetic variant. Among VHA pharmacy users, 4 259 153 (54.8%) received at least 1 level A drug with 1 188 124 (15.3%) receiving 2 drugs, and 912 189 (11.7%) receiving 3 or more drugs. The most common incident prescriptions during the study were tramadol (923 671 new recipients), simvastatin (533 928 new recipients), citalopram (266 952 new recipients), and warfarin (205 177 new recipients). Gene-drug interactions projected to have substantial clinical impacts in the VHA population include the interaction of SLCO1B1 with simvastatin (1 988 956 veterans [25.6%]), CYP2D6 with tramadol (318 544 veterans [4.1%]), and CYP2C9 or VKORC1 with warfarin (7 163 349 veterans [92.2%]). Conclusions and Relevance: Clinically important pharmacogenetic variants are highly prevalent in the VHA population. Almost all veterans would carry an actionable variant, and more than half of the population had been exposed to a drug affected by these variants. These results suggest that pharmacogenetic testing has the potential to affect pharmacotherapy decisions for commonly prescribed outpatient medications for many veterans.

Impact of a pharmacist in improving quality measures that affect payments to physicians.

OBJECTIVES: The objective was to assess the impact of a pharmacist embedded within a primary care practice on quality measures of the Merit-Based Incentive Payment System (MIPS) and patient-centered medical home (PCMH) by characterizing (1) measure achievement after pharmacist involvement in care and (2) measure achievement separately for patients seen by the pharmacist and patients not seen by the pharmacist. SETTING: Multidisciplinary primary care practice in Charlotte, North Carolina. PRACTICE DESCRIPTION: Pharmacists from an independent community pharmacy are highly integrated into the clinic. Pharmacists work alongside providers to furnish comprehensive care with a team-based approach. The initial focus for the pharmacist was on the Medicare annual wellness visits (AWV) and chronic care management (CCM). PRACTICE INNOVATION: Quality measure achievement during face-to-face AWV, telephone-call CCM, or both. EVALUATION: From January 1, 2017, to February 2, 2018, 193 patients had an AWV, CCM, or both from the pharmacist. Measure achievement was characterized with the use of descriptive statistics. RESULTS: When characterizing quality measures before, during, and after pharmacist intervention for the clinic population, achievement of some measures improved and others worsened. However, for every measure evaluated, the cohort of patients seen by the pharmacist had a greater proportion of patients achieving the quality measure than the cohort of patients not seen by the pharmacist. The greatest differences were observed for influenza vaccination (41% of pharmacist cohort vs. 10% of nonpharmacist cohort), hemoglobin A1C control less than 9% (94% of pharmacist cohort vs. 67% of nonpharmacist cohort), and colorectal cancer screening (55% of pharmacist cohort vs. 28% of nonpharmacist cohort). CONCLUSION: Pharmacist provision of clinical services may increase the likelihood of quality measure achievement. The pharmacist integration model addressed gaps in care that appeared to positively affect MIPS and PCMH quality measures. This has the potential to increase reimbursement through value-based payment models.

Factors Influencing Prescription Drug Synchronization: The Complex Role of Number of Medications.

BACKGROUND: Despite the well-documented association of medication refill synchronization with medication adherence, little is known about how best to measure synchronization at pharmacy visits or about its relationship to number of medications. OBJECTIVE: To examine the relationship of a commonly cited synchronization measure with the number of prescription medications. METHODS: Using a cohort of women aged 66-90 years with stage 0-3 hormone receptor-positive breast cancer from the Surveillance, Epidemiology and End Result (SEER)-Medicare data, we identified women with pharmacy claims for at least 1 endocrine therapy prescription and at least 1 other medication fill. Twelve-month medication refill synchronization was calculated as the quotient of the number of pharmacy visits and the number of filled medications subtracted from 1. Multiple linear regression (including polynomials) was then used to assess the relationship between refill synchronization, number of medications, and other potentially influential factors. RESULTS: Over 47% of cohort subjects took more than 10 unique medications. Subjects made an average (SD) of 29.9 (18.0) pharmacy visits, resulting in a mean (SD) synchronization of 0.28 (0.18, range = 0.0-0.92). The number of medications, including powers through to the fourth, was strongly associated with refill synchronization, with a rapid initial rise followed by a gradual increase after 10 medications. Although patient age and race/ethnicity were not associated with synchronization, there was a significant positive association of receipt of a low-income subsidy and residence in rural areas with synchronization. CONCLUSIONS: There is a complex relationship between refill synchronization and number of prescribed medications, and future research into synchronization should account for this. DISCLOSURES: This study was supported by the National Institute on Minority Health and Health Disparities under grant R01 MD010728. The authors have nothing to disclose. This study was presented as an oral abstract at the Society of General Internal Medicine Meeting; April 13, 2018; Denver, CO.

Adherence and Concomitant Medication Use among Patients on Warfarin Therapy: Insight from a Large Pharmacy Dispensing Database in Japan.

Warfarin is a drug used for anticoagulation management, with a narrow therapeutic range and multiple drug-drug interactions. Adherence and proper use of concomitant medication are thus fundamental to the efficacy and safety of warfarin therapy. In 2012, we retrospectively analyzed data from three large-scale pharmacy chains in Japan. We included all adults (≥ 20 years old) with at least one record of warfarin dispensation. We examined patient demographic data, adherence as measured by medication possession ratio (MPR), and co-dispensation focusing on the number of concomitant dispensations and concurrent use of medications that increase bleeding risk. Thresholds of underadherence and overadherence were set at <0.9 and >1.1, considering the narrow therapeutic window. We reviewed 443007 warfarin dispensation records of 71340 individuals (median age, 73 years; 62% male). The MPR was 1.0 (interquartile range: 0.96-1.0), and underadherence and overadherence was found in 16.3 and 1.9% of individuals, respectively. The median number of co-dispensed drugs was eight at each pharmacy encounter, which did not differ by age group. Drugs associated with a high bleeding risk were dispensed in 40.0% of encounters and accounted for 16.4% of all co-dispensed drugs. In summary, we found optimal overall adherence, as assessed by MPR, among our Japanese study population, even when defining a strict cut-off value. However, polypharmacy was common in all age groups and medications with a high bleeding risk profile were often co-dispensed with warfarin. Future research addressing how these dispensation patterns affect patient outcome is warranted.

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.