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.

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.