Transplante de células-tronco hematopoiéticas: iniquidades na distribuição em território brasileiro, 2001 a 2020 / Hematopoietic stem-cell transplants in Brazil: inequities in the distribution in Brazilian territory, 2001 to 2020

Resumo O objetivo deste artigo é descrever a distribuição de Centros Transplantadores (CTs) e transplantes de células-tronco hematopoiéticas (TCTH) no território brasileiro. Estudo descritivo, que reúne informações sobre a distribuição CTs e o número de procedimentos realizados entre 2001 e 2020, a partir das fontes dos dados: Sociedade Brasileira de Terapia celular e Transplantes de Medula Óssea (SBTMO); Associação Brasileira de Transplante de Órgãos (ABTO); Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS); e Ministério da Saúde (MS). Foram identificados 86 CTs, com predominância na região Sudeste do país (64%). A região Norte não possui CTs. No período contabilizaram-se mais de 30 mil procedimentos, concentrados nas regiões Sudeste e Sul. O TCTH do tipo alogênico foi prevalente. Constataram-se divergências entre os números de transplantes realizados a depender da fonte consultada. Apesar do crescimento do número de procedimentos no período do estudo, tanto a distribuição de CTs quanto o número de TCTHs se concentrou em regiões mais desenvolvidas. Essa heterogeneidade pode ter propiciado iniquidades no acesso ao tratamento pela população.

Abstract The scope of this article is to describe the distribution of Transplant Centers (TCs) and hematopoietic stem-cell transplants (HSCTs) in the Brazilian territory. It is a descriptive study, which brings together information on the distribution of TCs and the number of procedures performed between 2001 and 2020, based on the following data sources: the Brazilian Cell Therapy and Bone Marrow Transplant Society of (SBTMO); the Brazilian Organ Transplant Association (ABTO); the Hospital Information System of the Unified Health System (SIH/SUS); and the Ministry of Health (MS). A total of 86 TCs were identified, predominantly in the Southeastern region of the country (64%). There are no TCs in the Northern region. Throughout the period, there were more than 30,000 procedures, concentrated in the Southeastern and Southern regions. The allogeneic type of HSCT was prevalent. Differences were found between the numbers of transplants performed depending on the source consulted. Despite the increase in the number of procedures during the period studied, both the distribution of TCs and the number of HSCTs were concentrated in more developed regions. This heterogeneity may have led to inequities in the access of the population to treatment.

[Hematopoietic stem-cell transplants in Brazil: inequities in the distribution in Brazilian territory, 2001 to 2020]. / Transplante de células-tronco hematopoiéticas: iniquidades na distribuição em território brasileiro, 2001 a 2020.

The scope of this article is to describe the distribution of Transplant Centers (TCs) and hematopoietic stem-cell transplants (HSCTs) in the Brazilian territory. It is a descriptive study, which brings together information on the distribution of TCs and the number of procedures performed between 2001 and 2020, based on the following data sources: the Brazilian Cell Therapy and Bone Marrow Transplant Society of (SBTMO); the Brazilian Organ Transplant Association (ABTO); the Hospital Information System of the Unified Health System (SIH/SUS); and the Ministry of Health (MS). A total of 86 TCs were identified, predominantly in the Southeastern region of the country (64%). There are no TCs in the Northern region. Throughout the period, there were more than 30,000 procedures, concentrated in the Southeastern and Southern regions. The allogeneic type of HSCT was prevalent. Differences were found between the numbers of transplants performed depending on the source consulted. Despite the increase in the number of procedures during the period studied, both the distribution of TCs and the number of HSCTs were concentrated in more developed regions. This heterogeneity may have led to inequities in the access of the population to treatment.

O objetivo deste artigo é descrever a distribuição de Centros Transplantadores (CTs) e transplantes de células-tronco hematopoiéticas (TCTH) no território brasileiro. Estudo descritivo, que reúne informações sobre a distribuição CTs e o número de procedimentos realizados entre 2001 e 2020, a partir das fontes dos dados: Sociedade Brasileira de Terapia celular e Transplantes de Medula Óssea (SBTMO); Associação Brasileira de Transplante de Órgãos (ABTO); Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS); e Ministério da Saúde (MS). Foram identificados 86 CTs, com predominância na região Sudeste do país (64%). A região Norte não possui CTs. No período contabilizaram-se mais de 30 mil procedimentos, concentrados nas regiões Sudeste e Sul. O TCTH do tipo alogênico foi prevalente. Constataram-se divergências entre os números de transplantes realizados a depender da fonte consultada. Apesar do crescimento do número de procedimentos no período do estudo, tanto a distribuição de CTs quanto o número de TCTHs se concentrou em regiões mais desenvolvidas. Essa heterogeneidade pode ter propiciado iniquidades no acesso ao tratamento pela população.

The Costs of Burn Victim Hospital Care around the World: A Systematic Review.

BACKGROUND: Burn injuries are very common and fire-related burns account for over 300,000 deaths per year globally. The costs of the treatment of these patients change around the world. The aim of the present study was to conduct a systematic literature review to identify the costs related to hospital stays of burn victims in countries with different Human Development Index (HDIs). METHODS: PubMed, CINAHL and BVIS databases were searched using the following terms: "burn," treatment" and "costs". The review included articles that presented cost studies or economic assessments of burn victims in which the costs were reported, and published between 2012 and 2019. The quality of the evidence was assessed using the Consensus on Health Economic Criteria. This review presents register in Prospero (CRD42019137580). RESULTS: The review included 19 economic studies conducted in 13 countries, most with a very high HDIs. Most studies estimated direct acute burn care costs through bottom-up costing and institutional data. Total hospital care costs ranged from US$ 10.58 to US$ 125,597.86 per patient, the cost of 1% of total body surface area burned ranged from US$ 2.65 to US$ 11,245.04, and the cost of hospital care per day, from US$ 24.23 to US$ 4,125.50. CONCLUSION: The costs are high and show wide discrepancies among countries. Medical costs and other losses caused by fatal and non-fatal burn injuries differ considerably among demographic groups, care protocols, and country HDIs.

A framework for action to improve patient and public involvement in health technology assessment.

BACKGROUND: Patient and public involvement (PPI) in the Brazilian Health Technology Assessment (HTA) process occurs in response to a legislative mandate for "social participation." This resulted in some limited patient participation activities, and, therefore, a more systematic approach was needed. The study describes the development of a suggested framework for action to improve PPI in HTA. METHODS: This work used formal methodology to develop a PPI framework based on three-phase mixed-methods research with desktop review of Brazilian PPI activities in HTA; workshop, survey, and interviews with Brazilian stakeholders; and a rapid review of international practices to enact effective patient involvement. Patient partners reviewed the draft framework. RESULTS: According to patient group representatives, their involvement in the Brazilian HTA process is important but could be improved. Different stakeholders perceived barriers, identified values, and made suggestions for improvement, such as expansion of communication, capacity building, and transparency, to support more meaningful patient involvement. The international practices identified opportunities for earlier, more active, and collaborative PPI during all HTA stages, based on values and principles that are relevant for Brazilian patients and the public. These findings were synthesized to design a framework that defines and systematizes actions to support PPI in Brazil, highlighting the importance of evaluating these strategies. CONCLUSIONS: Since the publication of this framework, some of its suggestions are being implemented in the Brazilian HTA process to improve PPI. We encourage other HTA organizations to consider a systematic and planned approach with regular evaluation when pursuing or strengthening involvement practices.

Solid organ transplantation in Brazil: a descriptive study of distribution and access inequalities across the Brazilian territory, 2001-2017. / Transplantes de órgãos sólidos no Brasil: estudo descritivo sobre desigualdades na distribuição e acesso no território brasileiro, 2001-2017.

OBJECTIVE: to describe the distribution of solid organ transplants in Brazil, as well as information about the waiting list (demand) and origin of transplant patients by organ type and Federative Unit, from 2001 to 2017. METHODS: this was a descriptive study using data from State Transplantation Centers, the Brazilian Organ Transplant Association, and the Brazilian National Health System Hospital Information System (SIH/SUS). RESULTS: 153 transplant units were identified in 2017, with only 11.8% located in the Northern and Midwest regions; within the study period, 99,805 transplants were performed, ranging from 3,520 (2001) to 8,669 (2017); the highest number of transplants was concentrated in the Southern and Southeastern regions. CONCLUSION: there are inequalities in transplantation access, possibly due to lack of uniformity in service distribution.

Transplantes de órgãos sólidos no Brasil: estudo descritivo sobre desigualdades na distribuição e acesso no território brasileiro, 2001-2017 / Trasplantes de órganos sólidos en Brasil: estudio descriptivo sobre desigualdades en la distribución y acceso en el territorio brasileño, 2001-2017 / Solid organ transplantation in Brazil: a descriptive study of distribution and access inequalities across the Brazilian territory, 2001-2017

Objetivo: descrever a distribuição dos transplantes de órgãos sólidos no Brasil, bem como informações da lista de espera (demanda) e origem dos pacientes transplantados, por tipo de órgão e Unidade da Federação, de 2001 a 2017. Métodos: estudo descritivo, com dados das Centrais Estaduais de Transplantes, da Associação Brasileira de Transplantes de Órgãos e do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). Resultados: 153 centros de transplante foram identificados em 2017, apenas 11,8% deles localizados nas regiões Norte e Centro-Oeste; no período em estudo, foram realizados 99.805 transplantes, variando de 3.520 (2001) a 8.669 (2017); as regiões Sul e Sudeste concentraram o maior número de transplantes. Conclusão: existem desigualdades regionais na realização dos transplantes, possivelmente por não haver uniformidade na distribuição dos serviços.

Objetivo: describir la distribución de los trasplantes de órganos sólidos en Brasil, así como informaciones de la lista de espera (demanda) y origen de los pacientes trasplantados por tipo de órgano y unidad federativa, entre 2001 y 2017. Métodos: estudio descriptivo usando datos extraídos de Centrales Estatales de Trasplantes, Asociación Brasileña de Trasplantes de Órganos y Sistema de Informaciones Hospitalarias del Sistema Único Nacional de Salud (SIH/SUS). Resultados: 153 centros de trasplante identificados en 2017, solamente 11,8% están ubicados en las regiones Norte y Centro-Oeste; se realizaron 99.805 trasplantes, desde 3.520 (2001) hasta 8.669 (2017); Sur y Sudeste concentran el mayor número de trasplantes. Conclusión: hay desigualdad en el acceso a los trasplantes, posiblemente debido a la falta de uniformidad en la distribución de los servicios.

Objective: to describe the distribution of solid organ transplants in Brazil, as well as information about the waiting list (demand) and origin of transplant patients by organ type and Federative Unit, from 2001 to 2017. Methods: this was a descriptive study using data from State Transplantation Centers, the Brazilian Organ Transplant Association, and the Brazilian National Health System Hospital Information System (SIH/SUS). Results: 153 transplant units were identified in 2017, with only 11.8% located in the Northern and Midwest regions; within the study period, 99,805 transplants were performed, ranging from 3,520 (2001) to 8,669 (2017); the highest number of transplants was concentrated in the Southern and Southeastern regions. Conclusion: there are inequalities in transplantation access, possibly due to lack of uniformity in service distribution.

Horizon scanning in Brazil: outputs and repercussions.

OBJECTIVE: To describe the four types of horizon scanning (HS) outputs developed by the National Committee for Health Technology Incorporation (CONITEC) and show their main repercussions on the decision-making processes of the Brazilian Ministry of Health (MH). METHODS: Descriptive study based on participant observation and document analysis of HS outputs (internal reports, alert reports, briefs and sections for CONITEC recommendation reports) developed between January 2014 and July 2018. RESULTS: Fifteen internal reports, six alert reports, two briefs and 57 HS sections were produced. Each output has a specific structure according to its purpose. The methodological approach adopted for developing HS outputs in Brazil is described by EuroScan International Network. The outputs had institutional and international repercussions. The activities resulted in the inclusion of HS as a tool for reducing health lawsuits in the legal framework of the MH. One of the internal reports on a high-cost drug not approved in Brazil for a rare disease was requested by the Health Technology Assessments Network for the Americas (RedETSA), showing the international relevance of the outputs. The HS sections in recommendation reports influenced discussions about incorporating technologies into the Unified Health System. CONCLUSIONS: The developed outputs have purposes ranging from helping build arguments for defense of the MH in cases of health judicialization to inform decision-making processes. In addition, HS sections in recommendation reports have grown in importance recently. CONITEC's HS system has been structured, and its role as a tool to inform health managers has shown to be been relevant.

Social participation in the health technology incorporation process into Unified Health System.

OBJECTIVE: To describe the current process of social participation in the incorporation of health technologies in Brazil, within the context of the Unified Health System (SUS). METHODS: A descriptive study was conducted based on the analysis of official records of the actions of the National Committee for Health Technology Incorporation into Unified Health System and its website, from the beginning of its activities in January 2012 until December 2017. RESULTS: The findings indicate that, in Brazil, there are legal instruments related to social participation in health, including the health technology assessment (HTA) field. However, its implementation is relatively recent and has been carried out gradually. In addition to the legal instruments (National Health Council representative, public consultation and public hearing forecast), other information and transparency strategies have been shown to be allied to social participation in the incorporation of health technologies. However, activities such as legally provided public hearings have not yet been carried out. CONCLUSIONS: Several actions to foster social participation were developed over the analyzed period, but they need to be evaluated in order to maintain or improve them. In addition, there is a need for more qualified social participation in the various existing spaces, including those prescribed by law.

Self-medication and adherence to drug treatment: assessment of participants of the Universidade do Envelhecer (the University of Aging) program / Automedicação e adesão ao tratamento medicamentoso: avaliação dos participantes do programa Universidade do Envelhecer

Objectives : to evaluate the use of medication (for continuous use and self-medication) and adherence to treatment among elderly and non-elderly participants of the Universidade do Envelhecer (UniSer). Method : an observational, quantitative and cross-sectional study, using the interview technique, was carried out at UniSer with 215 subjects. A structured instrument was used for the collection of sociodemographic variables and self-medication data. The 1986 Morisky-Green-Levine Scale (MGL) and the Brief Medication Questionnaire (BMQ) regimen screening tool were used to assess adherence. Descriptive analyzes of the data were performed, and the chi-squared Test and Fisher's Exact Test were applied to evaluate the association between variables of interest. Results : of the participants, 127 (59.1%) were elderly (< 60 years old), of whom 81.9% were women. Regarding self-medication, 22.9% of elderly and 21.7% of non-elderly persons practiced it in the previous seven days (p=0.848), even if they considered it dangerous (p=0.472). A total of 45.8% of the elderly and 55.6% of the non-elderly irrationally self-medicated within the analyzed period, while 76.4% of the elderly and 64.8% of the non-elderly used medications of continuous use (p=0.063). A total of 78.8% of the elderly and 76.1% of the non-elderly were not adherent to treatment (p=0.719) according to the MGL scale, while the BMQ Regimen Screen found that 36.7% of the elderly and 41.1% of the non-elderly were not adherent (p=0.595). Conclusion : these findings demonstrate that there were no significant differences between the groups studied and health education actions should be carried out with an emphasis on guidelines on adherence and the rational use of medicines.

Objetivo : avaliar o uso de medicamentos de forma contínua e por automedicação e a adesão ao tratamento entre os participantes idosos e não idosos da Universidade do Envelhecer (UniSer). Método : estudo observacional, quantitativo e transversal, com emprego da técnica de entrevista, realizado na UniSer com 215 sujeitos. Foi utilizado um instrumento estruturado que permitiu a coleta de variáveis sociodemográficas e automedicação. Foram utilizados a Escala de Morisky-Green-Levine (MGL), de 1986, e o Brief Medication Questionnaire (BMQ) domínio regime na análise de adesão. Foram realizadas análises descritivas dos dados, além do teste qui-quadrado e do exato de Fisher para avaliar associação entre as variáveis de interesse. Resultados : dos entrevistados, 127 (59,1%) foram idosos (>60 anos), sendo 81,9% mulheres. Em relação à automedicação, 22,9% dos idosos e 21,7% dos não idosos a praticaram nos últimos sete dias (p=0,848), mesmo que considerem perigosa (p=0,472). Entre estes, 45,8% dos idosos e 55,6% dos não idosos realizaram automedicação irracional dentro do período analisado. Tem-se que 76,4% dos idosos e 64,8% dos não idosos utilizavam medicamentos de uso contínuo (p=0,063). Ao analisar a adesão ao tratamento medicamentoso, 78,8% dos idosos e 76,1% dos não idosos não eram aderentes ao tratamento (p=0,719) segundo a escala MGL; já pelo BMQ domínio Regime 36,7% dos idosos e 41,1% dos não idosos não eram aderentes (p=0,595). Conclusão: estes achados demonstram que não houve diferenças significativas entre os grupos estudados e as ações de educação em saúde devem ser realizadas com ênfase nas orientações sobre adesão e uso racional de medicamentos.

Management of pharmaceutical services in the Brazilian primary health care.

OBJECTIVE: To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS: This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS: We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS: Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

Characterization of the selection of medicines for the Brazilian primary health care.

OBJECTIVE: To characterize the process of selection of medicines for primary health care in the Brazilian regions. METHODS: This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. RESULTS: The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. CONCLUSIONS: As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.

Characterization of the selection of medicines for the Brazilian primary health care / Caracterização da seleção de medicamentos para a atenção primária no Brasil

ABSTRACT OBJECTIVE To characterize the process of selection of medicines for primary health care in the Brazilian regions. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. RESULTS The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. CONCLUSIONS As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.

RESUMO OBJETIVO Caracterizar o processo de seleção de medicamentos na atenção primária à saúde, nas regiões brasileiras. MÉTODOS Artigo integrante da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços 2015, um estudo transversal que envolveu o levantamento de informações numa amostra de municípios das cinco regiões do Brasil. Os dados utilizados foram coletados por meio de entrevistas com os responsáveis pela assistência farmacêutica (n = 506), profissionais que realizam a dispensação de medicamentos (n = 1.139) e médicos (n = 1.558). Para avaliar a diferença entre as proporções foi adotado o teste do qui-quadrado para amostras complexas. As diferenças entre as médias foram analisadas em modelos lineares generalizados, com teste F com correção de Bonferroni para comparações múltiplas. Foram significativas as análises com valores de p ≤ 0,05. RESULTADOS Os responsáveis da assistência farmacêutica relataram não haver Comissão de Farmácia e Terapêutica formalmente constituída (12,5%). Eles afirmaram possuir uma Lista de Medicamentos Essenciais (85,3%) atualizada (80,4%), e serem participantes deste processo (88,2%). Contudo, na percepção dos entrevistados a Lista atende apenas parcialmente (70,1%) as demandas de saúde. Dos profissionais que realizam a dispensação de medicamentos entrevistados, apenas 16,6% eram farmacêuticos, mesmo assim, 47,8% referiram conhecer os procedimentos para mudança da lista. Na perspectiva da maior parte desses profissionais (70,9%), a lista atende as demandas de saúde do município. Dentre os médicos apenas 27,2% declararam ter conhecimento dos procedimentos para mudança da lista, mas 76,5% teriam alguma reivindicação de alteração. A maior parte reporta que baseia suas reivindicações em experiências clínicas (80,0%); para 13,0% deles, a lista atende às demandas de saúde. CONCLUSÕES Por tratar-se da primeira pesquisa nacional de caracterização do processo de seleção de medicamentos no âmbito da atenção primária à saúde, traz dados inéditos para a avaliação das políticas relacionadas com medicamentos no Brasil.

Management of pharmaceutical services in the Brazilian primary health care / Gestão da assistência farmacêutica na atenção primária no Brasil

ABSTRACT OBJECTIVE To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

RESUMO OBJETIVO Identificar fatores condicionantes da gestão da assistência farmacêutica na atenção primária no âmbito do Sistema Único de Saúde. MÉTODOS Estudo com dados obtidos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM) - Serviços, realizada por meio de entrevistas com responsáveis pela assistência farmacêutica em municípios, em 2015. Para identificar os fatores condicionantes da gestão foram considerados indicadores organizacionais, operacionais e de sustentabilidade da gestão. Para as análises consideraram-se os pesos amostrais e a estrutura do plano de análise para amostras complexas. Os resultados foram expressos por meio de frequências e medidas de tendência central com intervalo de confiança de 95%, por regiões geográficas do Brasil. RESULTADOS Foram identificados os fatores condicionantes: a ausência da assistência farmacêutica no organograma da secretaria (24%) e no plano de saúde (18%), a não participação dos gestores no conselho de saúde e a não referência desse tema na pauta das reuniões (58,4%), falta de autonomia financeira (61,5%) e conhecimento dos valores disponíveis (81,7%), falta de adoção de procedimentos operacionais em cerca de 50% para seleção, programação e aquisição e o fato da maioria avaliar a organização da assistência farmacêutica como boa e ótima (58,8%), apesar dos indicadores preocupantes apontados. CONCLUSÕES A gestão da assistência farmacêutica encontra-se respaldada em um arcabouço legal e político, que deveria nortear e contribuir para melhoria da assistência farmacêutica na atenção primária no Sistema Único de Saúde. No entanto, há um descompasso entre os objetivos fixados por essas normativas e o que se observa na realidade.

Uma abordagem econômica de processos judiciais de medicamentos impetrados contra um município do sul do Brasil / An economic analysis of the lawsuits filed against municipality in southern Brazil

Objetivo: Apresentar uma análise econômica dos processos judiciais impetrados contra um município de médio porte. Métodos: Estudo descritivo retrospectivo com base na análise de documentos dos processos judiciais impetrados no ano de 2010 contra o município. Resultados: A maioriados processos era representada por advogados particulares e continha prescrição de médicos provenientes do sistema privado. A antecipação de tutela foi concedida em 88,8% dos casos. O gasto por medicamento por paciente pela via judicial foi em torno de 200 vezes maior do que o gastocom medicamentos do Componente Básico da Assistência Farmacêutica. 50,0% do custo total de medicamentos adquiridos pela via judicial foram gastos com agentes antineoplásicos e imunomoduladores, mas estes foram disponibilizados a apenas 8,0% dos pacientes litigantes. Medicamentospresentes no componente especializado da Assistência Farmacêutica e medicamentos inovadores representaram, respectivamente, 36,8% e 16,0% do custo total. Conclusões: A solicitação de medicamentos via judicial tem um custo médio por paciente muito mais elevado do que os medicamentosdo Componente Básico da Assistência Farmacêutica e parte significativa deste custo está associado à solicitação de medicamentos novos, bem como a antineoplásicos e imunossupressores.

Objective: To present an economic analysis of the lawsuits filed against medium-sized municipality. Methods: A retrospective descriptive study based on documents analysis from lawsuits filed in 2010 against a municipality. Results: Most of legal actions were represented by private attorneys and contained prescriptions provided by private physicians. Advance relief was granted to 88.8% of these actions. The drug/patient cost through the courts was around 200 times higher than expenses with basic component drugs of pharmaceutical care. 50.0% of the total cost with drugs acquired throughthe courts were represented by antineoplastic agents and immunomodulators drugs, which were provided to only 8.0% of the litigant patients. Drugs present in the specialized pharmaceutical assistance component and innovative drugs represented, respectively, 36.8% and 16.0% of the total cost. Conclusions: Drugs requested by legal proceedings have an average cost per patient much higher if compared to the basic component of pharmaceutical care. Significant portion of this cost isrelated to the new drug application, as well as antineoplastic agents and immunomodulator drugs

Fatores associados à compreensão da prescrição médica no Sistema Único de Saúde de um município do Sul do Brasil / Factors associated with the understanding of medical prescriptions in the Unified Health System in a city in southern Brazil

Com o objetivo de identificar a associação entre os indicadores de prescrição e o perfil do paciente à compreensão de prescrições de medicamentos de pacientes atendidos no Sistema Único de Saúde do município de Tubarão (Santa Catarina), foi realizado um estudo transversal por meio de entrevista. Coletou-se informações sobre o perfil dos usuários do Serviço, indicadores da prescrição médica da Organização Mundial da Saúde e sobre a compreensão da prescrição. Os fatores associados foram identificados através do teste qui-quadrado. Foram entrevistados 300 sujeitos. Entre estes, 59,3% conseguiam ler a prescrição ou sabiam o nome dos medicamentos, 80,7% conheciam a indicação, 73,7% sabiam a dose, 72,3% sabiam a frequência entre as doses e 72,7% conheciam a duração do tratamento. No entanto, compreenderam totalmente a prescrição 46,3% dos entrevistados. Verificou-se que dos indicadores de prescrição apenas o número de medicamentos está associado à compreensão, por outro lado, a idade do paciente menor que 49 anos, ter estudado mais que oito anos, pertencer a classe econômica C1 ou superior e ser mulher associam-se de forma significativa com a compreensão da prescrição.

A cross-sectional study via interviews was conducted in the city of Tubarão in the state of Santa Catarina in order to identify the association between prescription indicators and the profile of the healthcare users and their understanding of medical prescriptions among patients attended by the Unified Health System. Information was collected on the profile of the healthcare users, the prescription indicators recommended by the World Health Organization and the understanding of drug prescriptions. Three hundred subjects were interviewed and the associated factors were identified using the Chi-square test. Of the respondents, 59.3% were able to read the prescription or knew the drug names, 80.7% knew the drug indication, 73.7% knew the dosage, 72.3% knew the dosage intervals and 72.7% knew the duration of treatment. However, only 46.3% of the respondents fully understood the prescription. Between the prescriptions indicators only the number of drugs in prescriptions was significantly associated with understanding. On the other hand, having up to eight years of schooling, belonging to socioeconomic class C1, being under 49 years of age and being female were significantly associated with the understanding of the drug prescription.

[Factors associated with the understanding of medical prescriptions in the Unified Health System in a city in Southern Brazil]. / Fatores associados à compreensão da prescrição médica no Sistema Único de Saúde de um município do Sul do Brasil.

A cross-sectional study via interviews was conducted in the city of Tubarão in the state of Santa Catarina in order to identify the association between prescription indicators and the profile of the healthcare users and their understanding of medical prescriptions among patients attended by the Unified Health System. Information was collected on the profile of the healthcare users, the prescription indicators recommended by the World Health Organization and the understanding of drug prescriptions. Three hundred subjects were interviewed and the associated factors were identified using the Chi-square test. Of the respondents, 59.3% were able to read the prescription or knew the drug names, 80.7% knew the drug indication, 73.7% knew the dosage, 72.3% knew the dosage intervals and 72.7% knew the duration of treatment. However, only 46.3% of the respondents fully understood the prescription. Between the prescriptions indicators only the number of drugs in prescriptions was significantly associated with understanding. On the other hand, having up to eight years of schooling, belonging to socioeconomic class C1, being under 49 years of age and being female were significantly associated with the understanding of the drug prescription.

Avaliação dos indicadores de prescrição e da demanda atendida de medicamentos no Sistema Único de Saúde de um município do Sul do Estado de Santa Catarina / Assessment of prescribing indicators and patients? access to medicines in the national public health care system in a town in southern Santa Catarina (Brazil)

Com o objetivo de avaliar a demanda atendida a medicamentos no Sistema Único de Saúde e o perfil de prescrição de medicamentos sob a ótica dos indicadores da Organização Mundial da Saúde, foi realizada uma pesquisa com delineamento transversal, a qual ocorreu entre março e abril de 2009 em um município do Sul de Santa Catarina, baseada na técnica de entrevista, sendo realizada com os usuários do Serviço da Farmácia Central no momento da dispensação. Foram analisadas 100 prescrições; o número de medicamentos por prescrição foi em média 2,4 (±1,3). Dos 235 medicamentos prescritos, 86,8% foram pela nomenclatura genérica. Em relação aos medicamentos presentes nas prescrições, 91,5% faziam parte da Relação Municipal de Medicamentos e 80,9% constavam na Relação Nacional de Medicamentos Essenciais. Entre as prescrições, 19,0% possuíam antibióticos e 3,0% continham injetáveis. As classes farmacoterapêuticas mais prevalentes verificadas nas prescrições, segundo a classificação Anatomical Therapeutic Chemical, foram do sistema nervoso, com 49,4%, seguido do aparelho digestivo e metabolismo, que representou 11,9%. A demanda atendida de medicamentos na Farmácia Central no período investigado foi de 67,8%. Os resultados obtidos apontam que indicadores de prescrição estão de acordo com os recomendados pela Organização Mundial da Saúde, com exceção da prescrição por nome genérico. A demanda atendida dos medicamentos está abaixo do esperado, que seria, neste caso, de 91,5%, ou seja, a mesma proporção de medicamentos prescritos que faziam parte da relação municipal, indicando a necessidade do desenvolvimento de estratégias na gestão da Assistência Farmacêutica Municipal

In order to assess patients access to medicines prescribed in the National Public Health System and study the profile of drug prescriptions from the perspective of the World Health Organization (WHO) indicators, a cross-sectional study was perfomed between March and April 2009 in a town in southern Brazil, based on interviews carried out with users at the Central Pharmacy at the moment of dispensing. One hundred prescriptions were analyzed; the average number of drugs per prescription was 2.4 (±1.3). Of the 235 medicines prescribed, 86.8% were identified by generic names. Regarding the drugs named in the prescriptions, 91.5% belonged to the municipal list and 80.9% to the National List of Essential Drugs. Antibiotics were included in 19% of the prescriptions and injectable medicines in 3%. The most widely used therapeutic classes, according to the Anatomical Therapeutic Chemical Classification, were medications for the nervous system (49.4%), followed by those for the alimentary tract and metabolism (11.9%). The results showed that the prescribing indicators were consistent with the values recommended by the WHO, with the exception of prescription by generic name, for which 100% is suggested. The access to medicines was lower than expected, as 67.8% of those prescribed were dispensed. In this case it should be 91.5%, the same proportion of prescribed drugs that were part of the municipal list, indicating the need to develop strategies for the management of the Municipal Pharmaceutical Service.

Prescrições pediátricas em uma Unidade Básica de Saúde do Sul de Santa Catarina: avaliação do uso de antibacterianos / Pediatric prescriptions in a Basic Health Unit in southern Santa Catarina: evaluation of the use of antibacterial drugs

Objetivo: Determinar o perfil de prescrição de medicamentos direcionados a pacientes pediátricos em uma Unidade Básica de Saúde, com vistas a analisar o uso de antibacterianos. Métodos: Adotou-se um estudo transversal baseado em entrevista com os responsáveis pelas crianças com até 12 anos de idade, no momento da saída do consultório médico. Resultados: Foram coletadas informações de 277 crianças, com média de idade de 4,4 anos (±3,61). Em 91,3% dos casos a procura de atendimento ocorreu por problemas de saúde. Do total de crianças, 83,8% receberam prescrições médicas, sendo que o fato de ter procurado o Serviço por problemas de saúde interfere significativamente (p=0,0158) na prescrição. As classes farmacológicas prevalentes foram os antibacterianos e os medicamentos que atuam no sistema respiratório, sendo que os primeiros estavam presentes em 39,7% das prescrições. Apenas em 37,3% das prescrições a dose do antibacteriano conferiu com a recomendação da literatura. Crianças mais jovens (0,0204) e com menor peso (0,0253) estão mais propensas a receber sobredoses. Conclusões: A procura pelo Serviço de saúde foi, em especial, por problemas relacionados ao aparelho respiratório, resultando em prescrições na maioria das situações. Os antibacterianos são bastante prescritos em doses que, em grande parte, não estão de acordo com a literatura. Estes dados sugerem a necessidade de ações que promovam o uso racional de medicamentos, em especial dos antibacterianos.

Objective: To determine the profile of drug prescription directed to pediatric patients in a Basic Health Unit, aiming at examining the use of antibacterials. Methods: A cross-sectional study was adopted, based on interviews with the guardians of children under 12 years of age, at the moment they were leaving the doctor’s office. Results: Information was collected from 277 children, the mean age was 4.4 years (± 3.61). In 91.3% of the cases, a demand for care occurred because of health problems. Of the total, 83.8% of the children received medical prescriptions; the fact of seeking health services because of health problems interfered significantly (p = 0.0158) with the prescription. The most prevalent drugs were antibacterials and those that act on the respiratory system; the former were present in 39.7% of the prescriptions. Only 37.3% of antibacterial prescriptions were in accordance with the doses recommended in the literature. Younger children (0.0204) with lower weight (0.0253) were more likely to receive overdoses. Conclusion: The demand for health services is due, in particular, to health problems related to the respiratory tract, resulting in drug prescription in most cases. Prescribed antibacterial doses, in most cases, are not in accordance with the literature. The data suggest the need for actions to promote the rational use of medicines, especially antibacterials.