The Impact of Psychotropic Drug Costs on the Brazilian Family Budget: An Analysis of the Family Budget Surveys of 2003 and 2009.

OBJECTIVE: To estimate the cost of psychotropic drugs and its impact on the Brazilian family budget in 2003 and 2009 comparatively. METHODS: This study had a cross-sectional design. Data were obtained from the Family Budget Surveys conducted in 2003 and 2009, including interviews in 48,470 and 55,970 homes of all Brazilian regions, respectively. The main measures are prevalence of psychotropic drug acquisition, monetary and nonmonetary expenses with psychotropic drugs, total spending on drugs, spending on health, total household spending, and estimated mean monthly household income. All incomes and expenses from the 2003 survey were adjusted by inflation. RESULTS: There was a reduction in the prevalence of psychotropic drug acquisition by Brazilian households from 13.0% in 2003 to 11.2% in 2009. The mean monthly household spending on psychotropic drugs, however, rose from R $54.38 in 2003 to R $78.73 in 2009. The percentage of spending on psychotropic drugs from the expenses with health increased 27%. CONCLUSIONS: The increase in spending on psychotropic drugs can be due to a rise in their prices, the acquisition of more modern or more expensive drugs, or the increase in the number of drugs used. Proportionally, spending on psychotropic drugs grew more than did spending on health by Brazilian families.

Association between drug prescribing and quality of life in primary care.

OBJECTIVE: To evaluate quality of life among patients of Family Health Strategy Units and how it relates to the prescribing complexity and to the number of psychotropic medications prescribed, including adjustments for sociodemographic characteristics. SETTING: Family Health Strategy Units in a municipality in the Brazilian state of Rio Grande do Sul. METHOD: Cross-sectional study using face-to-face interviews and prescribing analysis among users of Family Health Strategy Units. Patients were recruited by consecutive sampling. Multiple linear regression models were fitted to the different domains of quality of life in the WHOQOL-Bref questionnaire. The response rate for the patients who completed the interview was 97%. The prescribed medication data and sociodemographic characteristics of the sample were included as covariates. Prescribing complexity was analyzed by means of the Medication Regimen Complexity Index. The assumptions in the estimated models were tested and the models were validated. MAIN OUTCOME MEASURE: Quality of life among patients of Family Health Strategy Units. RESULTS: At total, 336 patients answered the questionnaire. Through multiple linear regression, it was observed that higher prescribing complexity was associated with significantly low scores in the physical (-2.01, 95% CI = -2.89 to -1.35) and overall (-1.93, 95% CI = -2.81 to -0.99) quality of life domains. Greater amounts of psychotropic medications prescribed were associated with significantly low scores in the physical (-1.02, 95% CI = -1.29 to -0.56), psychological (-2.52, 95% CI = -3.15 to -1.65) and overall (-0.97, 95% CI = -2.06 to -0.33) domains of the interviewees' quality of life. The estimated models were adjusted for the sociodemographic characteristics of the sample and presented good predictive capacity. CONCLUSIONS: The evaluated aspects of the prescribed medication (complexity and presence of psychotropic medications) were associated with low scores in the physical, psychological and overall quality of life domains. This may be an intrinsic characteristic of the interviewed patients, like having the quality of life at such a low level before starting the treatment, that the medication could not improve it to normal levels. Also, it can be a demonstration of the ineffectiveness of these treatments within primary health care.

Initial impact and cost of a nationwide population screening campaign for diabetes in Brazil: a follow up study.

BACKGROUND: In 2001 Brazilian citizens aged 40 or older were invited to participate in a nationwide population screening program for diabetes. Capillary glucose screening tests and procedures for diagnostic confirmation were offered through the national healthcare system, diagnostic priority being given according to the severity of screening results. The objective of this study is to evaluate the initial impact of the program. METHODS: Positive testing was defined by a fasting capillary glucose >or= 100 mg/dL or casual glucose >or= 140 mg/dL. All test results were tabulated locally and aggregate data by gender and clinical categories were sent to the Ministry of Health. To analyze individual characteristics of screening tests performed, a stratified random sample of 90,106 tests was drawn. To describe the actions taken for positive screenees, a random sub-sample of 4,906 positive screenees was actively followed up through home interviews. Main outcome measures considered were the number of diabetes cases diagnosed and cost per case detected and incorporated into healthcare. RESULTS: Of 22,069,905 screening tests performed, we estimate that 3,417,106 (95% CI 3.1 - 3.7 million) were positive and that 346,168 (290,454 - 401,852) new cases were diagnosed (10.1% of positives), 319,157 (92.2%) of these being incorporated into healthcare. The number of screening tests needed to detect one case of diabetes was 64. As many cases of untreated but previously known diabetes were also linked to healthcare providers during the Campaign, the estimated number needed screen to incorporate one case into the healthcare system was 58. Total screening and diagnostic costs were US$ 26.19 million, the cost per diabetes case diagnosed being US$ 76. Results were especially sensitive to proportion of individuals returning for diagnostic confirmation. CONCLUSION: This nationwide population-based screening program, conducted through primary healthcare services, demonstrates the feasibility, within the context of an organized national healthcare system, of screening campaigns for chronic diseases. Although overall costs were significant, cost per new case diagnosed was lower than previously reported. However, cost-effectiveness analysis based on more clinically significant outcomes needs to be conducted before this screening approach can be recommended in other settings.

Composiçäo da demanda de uma unidade sanitária em área rural, Viamäo, Brasil, 1987 / Composition of the demand in a rural state primary health care clinic, Viamäo, Brazil, 1987

O trabalho analisa a composiçäo da demanda que procurou uma unidade de assistência primária a saúde em área rural durante 1987. Os cinco motivos de consulta mais freqüentes foram: exame médico e avaliaçäo de saúde, febre, tosse, dor de cabeça e grupe (classificados segundo a Internacional Classification of Primary Care). Os cinco problemas de saúde mais comuns foram: infecçäo de vias aéreas superiores, transtorno e estado de ansiedade, hipertensäo näo complicada (primária e secundária), enterobíase e todas outras helmintíases e cistite e infecçäo urinária (classificados segundo a International Classification of Health Problems in Primary Care - ICHPPC 2). Pacientes do sexo feminino foram responsáveis por 64,3% dos motivos de consulta e 61,8% dos problemas de sáude diagnosticados