[Variability in Drug Procurement within Group 1B of the Pharmaceutical Specialized Scheme in Brazil]. / Variabilidade de preços de aquisição de medicamentos do grupo 1B do Componente Especializado da Assistência Farmacêutica.

In the Brazilian Health System (SUS), drugs covered by the Specialized Pharmaceutical Scheme (CEAF) receive federal funding and can be procured either centrally (Group 1A) or by individual states (Federal Units - UF) (Group 1B). Unlike other countries where national procurement prices are negotiated centrally by the government, public procurement in Brazil follows a public auction procedure, potentially resulting in varying purchase prices. To facilitate price comparisons, it is a legal requirement to register public acquisitions in the Health Prices Registry (BPS). This study aimed to assess the variability in the procurement prices for Group 1B drugs across the 27 Brazilian states during 2021. Data on the acquisitions of Group 1B drugs by the 27 Health Secretariats were obtained from the BPS. Drugs with no reported reimbursement prices as of December 2021 were excluded from the analysis. The total reimbursement amount for each state was sourced from the SUS Ambulatory Information System. The findings revealed significant variability in drug procurement prices both across and within states. The study underscored a potential disparity in CEAF access, favoring wealthier states (those with larger populations and higher economic status) by securing lower drug prices.

No Sistema Único de Saúde os medicamentos do grupo 1 do Componente Especializado da Assistência Farmacêutica (CEAF) são financiados pela União e adquiridos de forma centralizada (grupo 1A) ou por cada Unidade Federativa (UF) (grupo 1B). Diferentemente de outros países onde se negocia um preço fixo a ser praticado no sistema público, no Brasil as aquisições são realizadas por licitação, o que pode levar a diferentes preços. Para permitir a comparação de preços, foi pactuada a obrigatoriedade de registro das aquisições públicas no Banco de Preços em Saúde (BPS). O estudo teve como objetivo analisar a variabilidade dos preços de medicamentos do grupo 1B adquiridos pelas UF do Brasil em 2021. Foram obtidas as aquisições de medicamentos do grupo 1B realizadas pelas Secretarias de Estado das 27 UF por consulta ao BPS excluindo-se os medicamentos sem preço de ressarcimento estabelecido em dezembro/2021. Foi obtido do Sistema de Informações Ambulatoriais o ressarcimento para cada UF. Verificou-se grande variabilidade dos preços de aquisição para cada medicamento entre as UF e dentro da mesma UF. O estudo demonstrou potencial iniquidade de acesso ao CEAF, privilegiando com menores preços UF mais favorecidas (maior população e riqueza).

Variabilidade de preços de aquisição de medicamentos do grupo 1B do Componente Especializado da Assistência Farmacêutica / Variability in Drug Procurement within Group 1B of the Pharmaceutical Specialized Scheme in Brazil

Resumo No Sistema Único de Saúde os medicamentos do grupo 1 do Componente Especializado da Assistência Farmacêutica (CEAF) são financiados pela União e adquiridos de forma centralizada (grupo 1A) ou por cada Unidade Federativa (UF) (grupo 1B). Diferentemente de outros países onde se negocia um preço fixo a ser praticado no sistema público, no Brasil as aquisições são realizadas por licitação, o que pode levar a diferentes preços. Para permitir a comparação de preços, foi pactuada a obrigatoriedade de registro das aquisições públicas no Banco de Preços em Saúde (BPS). O estudo teve como objetivo analisar a variabilidade dos preços de medicamentos do grupo 1B adquiridos pelas UF do Brasil em 2021. Foram obtidas as aquisições de medicamentos do grupo 1B realizadas pelas Secretarias de Estado das 27 UF por consulta ao BPS excluindo-se os medicamentos sem preço de ressarcimento estabelecido em dezembro/2021. Foi obtido do Sistema de Informações Ambulatoriais o ressarcimento para cada UF. Verificou-se grande variabilidade dos preços de aquisição para cada medicamento entre as UF e dentro da mesma UF. O estudo demonstrou potencial iniquidade de acesso ao CEAF, privilegiando com menores preços UF mais favorecidas (maior população e riqueza).

Abstract In the Brazilian Health System (SUS), drugs covered by the Specialized Pharmaceutical Scheme (CEAF) receive federal funding and can be procured either centrally (Group 1A) or by individual states (Federal Units - UF) (Group 1B). Unlike other countries where national procurement prices are negotiated centrally by the government, public procurement in Brazil follows a public auction procedure, potentially resulting in varying purchase prices. To facilitate price comparisons, it is a legal requirement to register public acquisitions in the Health Prices Registry (BPS). This study aimed to assess the variability in the procurement prices for Group 1B drugs across the 27 Brazilian states during 2021. Data on the acquisitions of Group 1B drugs by the 27 Health Secretariats were obtained from the BPS. Drugs with no reported reimbursement prices as of December 2021 were excluded from the analysis. The total reimbursement amount for each state was sourced from the SUS Ambulatory Information System. The findings revealed significant variability in drug procurement prices both across and within states. The study underscored a potential disparity in CEAF access, favoring wealthier states (those with larger populations and higher economic status) by securing lower drug prices.

Cost of Illness in Patients With COVID-19 Admitted in Three Brazilian Public Hospitals.

OBJECTIVES: The severity and transmissibility of COVID-19 justifies the need to identify the factors associated with its cost of illness (CoI). This study aimed to identify CoI, cost predictors, and cost drivers in the management of patients with COVID-19 from hospital and Brazil's Public Health System (SUS) perspectives. METHODS: This is a multicenter study that evaluated the CoI in patients diagnosed of COVID-19 who reached hospital discharge or died before being discharged between March and September 2020. Sociodemographic, clinical, and hospitalization data were collected to characterize and identify predictors of costs per patients and cost drivers per admission. RESULTS: A total of 1084 patients were included in the study. For hospital perspective, being overweight or obese, being between 65 and 74 years old, or being male showed an increased cost of 58.4%, 42.9%, and 42.5%, respectively. From SUS perspective, the same predictors of cost per patient increase were identified. The median cost per admission was estimated at US$359.78 and US$1385.80 for the SUS and hospital perspectives, respectively. In addition, patients who stayed between 1 and 4 days in the intensive care unit (ICU) had 60.9% higher costs than non-ICU patients; these costs significantly increased with the length of stay (LoS). The main cost driver was the ICU-LoS and COVID-19 ICU daily for hospital and SUS perspectives, respectively. CONCLUSIONS: The predictors of increased cost per patient at admission identified were overweight or obesity, advanced age, and male sex, and the main cost driver identified was the ICU-LoS. Time-driven activity-based costing studies, considering outpatient, inpatient, and long COVID-19, are needed to optimize our understanding about cost of COVID-19.

Enfrentamento da Covid-19 nas unidades de assistência farmacêutica na Secretaria de Saúde do Paraná / Emergency response actions to Covid-19 from a pharmaceutical assistance perspective in the Paraná Secretary of Health

A chegada da epidemia de Covid-19 ao Paraná tornou necessária a adoção de medidas pela Assistência Farmacêutica da Secretaria de Estado da Saúde que reduzisse a circulação de pessoas e reorientasse os trabalhos nas farmácias das Regionais de Saúde. Cerca de 112 mil usuários são atendidos nessas farmácias para recebimento de medicamentos do Componente Especializado e elenco complementar. Dentre as estratégias para diminuição de circulação de usuários estão entrega antecipada de medicamentos, renovações automáticas do tratamento, ferramenta para cadastro online de novos usuários e ampliação do serviço de entrega em casa. A entrega antecipada de medicamentos, o cadastro online e a entrega domiciliar proporcionaram jun-tos uma redução da presença de cerca de 80 mil usuários nas farmácias das RS entre março e julho de 2020. As ações adotadas foram efetivas na redução da circulação de pessoas protegendo usuários e equipe da AF. (AU)

The arrival of the Covid-19 epidemic in Paraná required the Pharmaceutical Assistance Department (AF) of the Paraná Secretary of Health to adopt measures to reduce people's circulation and redirect the efforts of the pharmacies of all Regional Health Offices (RS). About 112 thousand users count on these pharmacies to receive medicines included in the Specialized Component and Complementary medicines list. Among the strategies to reduce the circulation of users are early delivery of medicines; automated renewals of treatment; a tool for online registration of new users and expansion of the home delivery service. The early delivery of medicines, online registration and home delivery together made it possible for 80 thousand users not to have to physically visit RS pharmacies between March 2020 and July of the same year, protecting not only the users themselves but also AF people. (AU)

Inovação em serviços farmacêuticos clínicos no componente especializado da assistência farmacêutica do Estado do Paraná / Innovating in clinical pharmacy services at the specialized component of pharmaceutical management in the state of Paraná

A implementação de serviços farmacêuticos clínicos, seja em âmbito público ou privado, não tem alcançado os níveis desejados. Uma das explicações para esse fato pode residir no desenho desses serviços que por vezes são serviços amplos, complexos e com objetivos demasiado ambiciosos. A partir de processos de reengineering, uma carteira de serviços farmacêuticos clínicos no âmbito do Componente Especializado da Assistência Farmacêutica (CEAF) da Secretaria de Estado da Saúde do Paraná (SES/PR), está sendo desenhada com intuito de melhorar os desfechos clínicos resultantes do uso de medicamentos desse componente. A proposta é implementar vários serviços com objetivos específicos utilizando a seleção de pacientes guiada por dados (data driven). Implementar esses serviços e torná-los sustentáveis é o desafio que se apresenta à Assistência Farmacêutica da SES/PR para os próximos anos com o objetivo de contribuir para melhoria da saúde dos pacientes e para a racionalização de recursos do sistema de saúde. (AU)

Clinical pharmacy services implementation, either in public or private sectors, has not reached desirable levels. A potential explanation for this poor implementation may be a poor service design, which is frequently too comprehensive and complex, with too ambitious objectives. By using reengineering processes, the Specialized Component of the Public Pharmaceutical Management (CEAF) of the State Secretary of Health (SES/PR) in the state of Paraná, a portfolio of clinical pharmacy services, is being designed to improve patients' clinical outcomes resulting from the use of the medicines from this component. The concept is based on the creation of several different services with specific objectives using a data-driven patient selection process. Implementing these services and making them sustainable is the challenge that CEAF will face at SES/PR in the following years, aiming at improving individuals' health and rationalizing public Health System resources. (AU)

[Economic evaluation of pharmacotherapeutic follow-up in type 2 diabetes mellitus patients in community pharmacies]. / Avaliação econômica do seguimento farmacoterapêutico em pacientes com diabetes melito tipo 2 em farmácias comunitárias.

OBJECTIVE: Assess economics results of Pharmacotherapeutic Follow-up (PF) in patients with diabetes mellitus type 2 in community pharmacies from additional Health system. METHODS: In a prospective clinic study, 161 patients were divided into two groups, of which only one group received PF for 12 months. From the results, we calculated data of effectiveness and costs. The primary endpoint was the economic evaluation PF by using an indicator of effectiveness (changes in glycated hemoglobin), which was related to the costs of pharmaceutical care. Secondary endpoints were values of blood pressure, waist circumference and body mass index of patients, also related to costs of pharmaceutical care. RESULTS: A real reduction of 1.3% of HbA1 was observed in the PF group, in comparison to control group. The annual cost of the reduction in 1% in HbA1 values in the PF group patients was $45.15. This feature to improve the control of type 2 diabetic patients can be implemented with annual investments of about $225.76 per patient, using PF and monitoring of blood glucose test. CONCLUSIONS: It is possible to reduce the HbA1 values to desired levels by using PF. This can be considered an additional resource for the attainment of metabolic control, resulting in this study a cost of $37.62 per patient, per year, to reduce 1% in the HbA1 values.

Avaliação econômica do seguimento farmacoterapêutico em pacientes com diabetes melito tipo 2 em farmácias comunitárias / Economic evaluation of pharmacotherapeutic follow-up in type 2 diabetic mellitus patients in community pharmacies

OBJETIVO: Avaliar os resultados econômicos do seguimento farmacoterapêutico (SFT) em pacientes com diabetes melito tipo 2 em farmácias comunitárias privadas do sistema suplementar de Saúde. MÉTODOS: Foi realizado estudo clínico prospectivo com 161 pacientes separados em dois grupos, dos quais somente um recebeu SFT durante 12 meses. A partir dos resultados, foram calculados os dados de efetividade e os custos. O desfecho primário foi a avaliação econômica do SFT por meio da utilização de um indicador de efetividade (variação de hemoglobina glicada), relacionada aos custos do atendimento farmacêutico. Os desfechos secundários foram os valores de pressão arterial, circunferência abdominal e índice de massa corporal dos pacientes, que foram utilizados e relacionados a custos do atendimento do farmacêutico. RESULTADOS: Foi observada uma redução adicional de 1,3 por cento da HbA1 no grupo que recebeu SFT em comparação ao grupo controle. Os custos anuais por paciente do grupo SFT relacionados à redução de 1 por cento nos valores da HbA1 foram de R$ 78,83. Para melhoria no controle dos pacientes diabéticos tipo 2, esse recurso pode ser implementado com o investimento anual médio de R$ 456,05 por paciente, utilizando SFT e monitorização com testes de glicemia. CONCLUSÕES: É possível obter redução da HbA1 para níveis desejados por meio da utilização do SFT. Este pode ser considerado um recurso adicional para o alcance do controle metabólico, resultando, nesse estudo, em um custo de R$ 76,00 paciente/ano, para redução de 1 por cento nos valores da HbA1.

OBJECTIVE: Assess economics results of Pharmacotherapeutic Follow-up (PF) in patients with diabetes mellitus type 2 in community pharmacies from additional Health system. METHODS: In a prospective clinic study, 161 patients were divided into two groups, of which only one group received PF for 12 months. From the results, we calculated data of effectiveness and costs. The primary endpoint was the economic evaluation PF by using an indicator of effectiveness (changes in glycated hemoglobin), which was related to the costs of pharmaceutical care. Secondary endpoints were values of blood pressure, waist circumference and body mass index of patients, also related to costs of pharmaceutical care. RESULTS: A real reduction of 1.3 percent of HbA1 was observed in the PF group, in comparison to control group. The annual cost of the reduction in 1 percent in HbA1 values in the PF group patients was $45.15. This feature to improve the control of type 2 diabetic patients can be implemented with annual investments of about $225.76 per patient, using PF and monitoring of blood glucose test. CONCLUSIONS: It is possible to reduce the HbA1 values to desired levels by using PF. This can be considered an additional resource for the attainment of metabolic control, resulting in this study a cost of $37.62 per patient, per year, to reduce 1 percent in the HbA1 values.

[Patient satisfaction with pharmacy services: translation and validation of the Pharmacy Services Questionnaire for Brazil]. / Satisfação dos usuários com serviços da farmácia: tradução e validação do Pharmacy Services Questionnaire para o Brasil.

The aim of this study was to translate into Portuguese and validate the Pharmacy Services Questionnaire (PSQ). The instrument includes 20 questions that measure user satisfaction with pharmacy services, and is organized according to two factors. It uses a Likert scale of answers from 1 (poor) to 5 (excellent). The PSQ-Brazil was applied to 137 diabetics from 31 to 89 years of age (60.6% women), clients of private pharmacies, mostly users of public health services (65.7%), with low education (67.9% elementary schooling or less), and who used an average of 4.3 medicines per person. Overall score in the sample was 3.6 (SD = 1.1 [95%CI 3.4-3.8]). After factor analysis, 'pleasant exposure' and 'treatment management' included 8 and 12 items, respectively, and were significantly correlated with each other (r = 0.92, p < 0.001) and with the overall score. The instrument obtained a Cronbach's alpha of 0.98 for the overall score. The pleasant exposure and treatment management variables showed alphas of 0.94 and 0.98. PSQ-Brazil shows adequate reliability and validity for use in the country.

Satisfação dos usuários com serviços da farmácia: tradução e validação do Pharmacy Services Questionnaire para o Brasil / Patient satisfaction with pharmacy services: translation and validation of the Pharmacy Services Questionnaire for Brazil

Este estudo teve por objetivo traduzir e validar para o português o Pharmacy Services Questionnaire (PSQ). O instrumento possui 20 questões que medem a satisfação dos usuários com serviços da farmácia, organizadas em dois domínios. Utiliza uma escala de respostas Likert de 1 (ruim) a 5 (excelente). O Questionário de Satisfação com os Serviços da Farmácia (QSSF) foi aplicado a 137 diabéticos entre 31 e 89 anos (60,6 por cento mulheres), clientes de farmácias privadas, em sua maioria usuários de serviços públicos de saúde (65,7 por cento), com baixa escolaridade (67,9 por cento até ensino fundamental) e utilizando em média 4,3 medicamentos por pessoa. O escore geral na população estudada foi de 3,6 [DP = 1,1 (IC95 por cento: 3,4-3,8)]. Após análise fatorial, os domínios "exposição agradável" e "manejo da terapia" incluíram 8 e 12 itens, respectivamente, e se correlacionaram significativamente entre si (r = 0,92; p < 0,001) e com o escore geral. O instrumento obteve um a de Cronbach de 0,98 para o escore geral. Os domínios exposição agradável e manejo da terapia mostraram um a de 0,941 e 0,980. O QSSF apresenta aspectos de confiabilidade e validade adequados para sua utilização.

The aim of this study was to translate into Portuguese and validate the Pharmacy Services Questionnaire (PSQ). The instrument includes 20 questions that measure user satisfaction with pharmacy services, and is organized according to two factors. It uses a Likert scale of answers from 1 (poor) to 5 (excellent). The PSQ-Brazil was applied to 137 diabetics from 31 to 89 years of age (60.6 percent women), clients of private pharmacies, mostly users of public health services (65.7 percent), with low education (67.9 percent elementary schooling or less), and who used an average of 4.3 medicines per person. Overall score in the sample was 3.6 (SD = 1.1 [95 percentCI 3.4-3.8]). After factor analysis, "pleasant exposure" and "treatment management" included 8 and 12 items, respectively, and were significantly correlated with each other (r = 0.92, p < 0.001) and with the overall score. The instrument obtained a Cronbach's alpha of 0.98 for the overall score. The pleasant exposure and treatment management variables showed alphas of 0.94 and 0.98. PSQ-Brazil shows adequate reliability and validity for use in the country.

[Translation to portuguese and validation of the Diabetes Quality Of Life Measure (DQOL-Brazil)]. / Tradução para o português e validação do instrumento Diabetes Quality of Life Measure (DQOL-Brasil).

OBJECTIVE: To evaluate the psychometric properties of Brazilian version of Diabetes Quality of Life measure (DQoL-Brazil). METHODS: The DQOL was translate to Portuguese, following a recommended protocol, and applied to 121 subjects (56.2% females) with average diagnostic to type 2 diabetes of 8.1 (SD=7.13) years, (range 32-89 years old). RESULTS: The translated measure showed high internal consistency (Cronbach's alpha = 0.92). A positive correlation (p < 0.01) was found between all the items and their scales and the total score of instrument, except in the items 18 and 35. These items were excluded from the translated version of DQoL. In concurrent validity analysis, patients with HbA1C higher than 9% presented a significantly higher (p = 0.01) total score for DQoL. CONCLUSION: DQoL-Brazil presents reliability and validity to be used in type 2 diabetes adult patients.

Validation of the short form of the Spanish hypertension quality of life questionnaire (MINICHAL) for Portuguese (Brazil).

BACKGROUND: The assessment of quality of life has been considered an essential parameter in understanding the impact of arterial hypertension. OBJECTIVE: To translate into portuguese, cross-culturally adapt and validate the questionnaire specific for the assessment of quality of life known as "Mini Cuestionario de Calidad de Vida en Hipertensión Arterial" (MINICHAL). METHODS: Two independent translations of MINICHAL were made into brazilian portuguese. Later, these two translations were harmonized yielding a version that was back-translated into the source language. This version was revised by a committee of judges and the new version was tested in a pilot study. After the cross-cultural adaptation, the final version of the instrument was administered to a sample of 300 patients. The psychometric properties of the questionnaire such as reliability and construct validity were analyzed. The internal consistency of the instrument was measured by Cronbachs alpha coefficient. RESULTS: In the brazilian version of MINICHAL, Cronbachs alpha coefficients of internal consistency reliability were 0.88 for the Mental Status domain and 0.85 for the Somatic Manifestations domain. As to content validity, the judges assessment attained a high level of agreement (75.44%). The factor analysis confirmed both domains, with differences in one item which was included in factor 2. The control group presented significant differences relative to hypertensive patients (t=4.86, gl=276.8, p< 0.001). CONCLUSION: The brazilian version of MINICHAL was successfully validated and represents a useful and reliable instrument for assessing the quality of life of brazilian hypertensive patients.

Tradução para o português e validação do instrumento Diabetes Quality of Life Measure (DQOL-Brasil) / Translation to portuguese and validation of the Diabetes Quality Of Life Measure (DQOL-Brazil)

OBJETIVO: Avaliar as propriedades psicométricas da versão brasileira do questionário de medida da qualidade de vida em diabetes (DQOL). MÉTODOS: O DQOL foi traduzido ao português segundo protocolo e aplicado em 121 indivíduos (56,2 por cento mulheres), com tempo diagnóstico médio de diabetes melito tipo 2 de 8,1 ± 7,13 anos e na faixa etária de 32 a 89 anos. RESULTADOS: O instrumento apresentou consistência interna total (alfa de Cronbach = 0,92). Todas as questões apresentaram correlação positiva (p < 0,01) com seus domínios e com o escore geral do questionário, exceto as questões 18 e 35, que requereram exclusão da versão traduzida. O instrumento foi capaz de diferenciar pacientes com HbA1c acima e abaixo de 9 por cento (p = 0,01). CONCLUSÃO: O DQOL-Brasil apresenta aspectos de confiabilidade e validade adequados para sua utilização em pacientes adultos com diabetes tipo 2.

OBJECTIVE: To evaluate the psychometric properties of Brazilian version of Diabetes Quality of Life measure (DQoL-Brazil). METHODS: The DQOL was translate to Portuguese, following a recommended protocol, and applied to 121 subjects (56.2 percent females) with average diagnostic to type 2 diabetes of 8.1 (SD=7.13) years, (range 32-89 years old). RESULTS: The translated measure showed high internal consistency (Cronbach’s alpha = 0.92). A positive correlation (p < 0.01) was found between all the items and their scales and the total score of instrument, except in the items 18 and 35. These items were excluded from the translated version of DQoL. In concurrent validity analysis, patients with HbA1C higher than 9 percent presented a significantly higher (p = 0.01) total score for DQoL. CONCLUSION: DQoL-Brazil presents reliability and validity to be used in type 2 diabetes adult patients.

Perfil dos farmacêuticos e farmácias em Santa Catarina: indicadores de estrutura e processo / Pharmacist's and pharmacies profiles in Santa Catarina: structure and process indicators

Este estudo teve por objetivo avaliar indicadores de estrutura e processo em farmácias comunitárias de Santa Catarina e as atitudes e percepções dos farmacêuticos referentes à atenção farmacêutica e satisfação profissional. Estudo transversal em 10 por cento das farmácias do estado, selecionadas aleatoriamente. Foram entrevistadas 258 farmácias. Os farmacêuticos estavam presentes em 88,4 por cento delas, tinham média de idade de 31 anos (DP=8,1) e eram em sua maioria mulheres (68 por cento). A média de farmacêuticos por farmácia foi de 1,4 (DP=0,7) e de balconistas de 3,8 (DP=4,5). Somente 11,4 por cento das farmácias dispunham de estrutura para atendimento privado de pacientes. Apesar de possuírem em média mais de duas fontes terciárias sobre medicamentos por farmácia, estas eram de baixa qualidade. As atividades relatadas pela maior parte dos farmacêuticos foram a dispensação (98,2 por cento), o registro de medicamentos controlados (90,8 por cento), aplicações de medicamentos injetáveis (85,1 por cento) e atendimentos de clientes no caixa (84,2 por cento). A maioria das farmácias de Santa Catarina não possui estrutura adequada à implantação de serviços de atenção farmacêutica. As barreiras identificadas para implementação destas mudanças não são diferentes das encontradas em outros países.

The present study aimed to assess structure and process quality indicators in community pharmacies in Santa Catarina (Brazil), and also the profile of pharmacists regarding their attitudes and perceptions of pharmaceutical care and professional satisfaction. A cross-sectional study was performed in 10 percent of Santa Catarina pharmacies randomly chosen. 258 community pharmacies were surveyed. 88.5 percent pharmacists were in office in the time of the interview. In average, they were 31 years old (SD=8.1) and mainly women (68 percent). A ratio of 1.4 (SD=0.7) pharmacists per pharmacy and 3.8 (SD=4.5) assistants existed. Only 11.4 percent pharmacies had an adequate structure for private caring patients. Despite having an average of more than 2 tertiary drug information sources, most of them were low quality. Activities mentioned by the majority of pharmacists were dispensing (98.2 percent), recording controlled drugs (90.8 percent), injections administration (85.1 percent), and helping patients on cash line (84.2 percent). Most of pharmacies in Santa Catarina (Brazil) do not have the adequate structure for implementing pharmaceutical care services. Barriers identified to implement those services were not different to those communicated in other countries.

Validação do mini-questionário de qualidade de vida em hipertensão arterial (MINICHAL) para o português (Brasil) / Validation of the short form of the spanish hypertension quality of life questionnaire (MINICHAL) for portuguese (Brazil)

FUNDAMENTO: A avaliação da qualidade de vida tem sido considerada um parâmetro fundamental na compreensão do impacto causado pela hipertensão arterial. OBJETIVO: Traduzir, adaptar culturalmente e validar para a língua portuguesa o questionário específico para avaliação de qualidade de vida em hipertensão denominado "Mini-Cuestionario de Calidad de Vida em Hipertensión Arterial" (MINICHAL). MÉTODOS: Foram realizadas duas traduções independentes do MINICHAL para o português do Brasil. Posteriormente, as duas traduções foram harmonizadas gerando uma versão que foi retrotraduzida. Essa versão foi revisada por um comitê de juízes e a versão gerada foi testada em um ensaio piloto. Após a adaptação transcultural, a versão final do instrumento foi aplicada em uma amostra de 300 pacientes. Foram analisadas as propriedades psicométricas do questionário, como confiabilidade e validade de constructo. A consistência interna do instrumento foi verificada pelo coeficiente Alpha de Cronbach. RESULTADOS: A versão brasileira do MINICHAL apresentou na análise da consistência interna valores de Alpha de Cronbach de 0,88 para o domínio Estado Mental e 0,86 para Manifestações Somáticas. Na análise de validade de conteúdo a avaliação dos juízes apresentou alto índice de concordância (75,44 por cento). A análise fatorial confirmou os dois fatores, com diferenças em um item, o qual foi incluído no fator 2. O grupo controle apresentou diferenças significativas com relação aos hipertensos t=4,86, gl=276,8, p<0,001. CONCLUSÃO: A versão brasileira do MINICHAL foi validada com sucesso e representa um instrumento útil para avaliação da qualidade de vida de pacientes hipertensos brasileiros.

BACKGRAOUND: The assessment of quality of life has been considered an essential parameter in understanding the impact of arterial hypertension. OBJECTIVE: To translate into portuguese, cross-culturally adapt and validate the questionnaire specific for the assessment of quality of life known as "Mini Cuestionario de Calidad de Vida en Hipertensión Arterial" (MINICHAL). METHODS: Two independent translations of MINICHAL were made into brazilian portuguese. Later, these two translations were harmonized yielding a version that was back-translated into the source language. This version was revised by a committee of judges and the new version was tested in a pilot study. After the cross-cultural adaptation, the final version of the instrument was administered to a sample of 300 patients. The psychometric properties of the questionnaire such as reliability and construct validity were analyzed. The internal consistency of the instrument was measured by Cronbach’s alpha coefficient. RESULTS: In the brazilian version of MINICHAL, Cronbach’s alpha coefficients of internal consistency reliability were 0.88 for the Mental Status domain and 0.85 for the Somatic Manifestations domain. As to content validity, the judges’ assessment attained a high level of agreement (75.44 percent). The factor analysis confirmed both domains, with differences in one item which was included in factor 2. The control group presented significant differences relative to hypertensive patients (t=4.86, gl=276.8, p< 0.001). CONCLUSION: The brazilian version of MINICHAL was successfully validated and represents a useful and reliable instrument for assessing the quality of life of brazilian hypertensive patients.

Actitudes y conocimientos de los farmacéuticos comunitarios al dispensar medicamentos a embarazadas / Community pharmacists’ attitudes and knowledge on dispensing drugs to pregnant women

Este trabajo tuvo como objetivo evaluar los conocimientos y actitudes de los farmacéuticos durante la dispensación de medicamentos a gestantes. Métodos: Estudio transversal en 150 farmacias comunitarias aleatoriamente seleccionadas de Curitiba (Brasil). Se aplicó un cuestionario cerrado con 25 preguntas, incluyendo escenarios de dispensación que contenían medicamento de riesgo A, B, D o X y preguntas sobre la interacción del farmacéutico con las gestantes, médicos y la disponibilidad de fuentes de información. Resultados: Los farmacéuticos decidieron la opción correcta en el 53% en la interpretación de los casos. Los menores índices de acierto estaban relacionados con la prednisona y el captopril (24,8% en ambos) y los casos que generaron mayor indecisión fueron relativos al captopril (31,7%) y simvastatina (30,7%). La mayoría de A afirmó haber indicado medicamentos para gestantes o contactado con el médico para discutir algo al respecto de una prescripción relativa a este tema. La mayor parte de los farmacéuticos (64,4%)dijo que no se sentía capaz de interpretar la clasificación de riesgo de la FDA y no disponía de fuentes de información fiables en la farmacia. Concusiones: Los farmacéuticos actuando en la dispensación de medicamentos en Curitiba no se sienten aptos para interpretar informaciones sobre el uso de medicamentos en gestantes y no disponen e fuentes de información fiables sobre el tema. Aún así, actúan en la orientación e indicación de medicamentos para embarazadas y discuten con el prescriptor estrategias terapéuticas (AU)

The present study aimed to assess knowledge and attitudes of the pharmacists on dispensing drugs to pregnant women. Methods: Cross-sectional study in 150 community pharmacies randomly selected in Curitiba (Brazil). A closed end questionnaire with 25 questions were used, including dispensing scenarios containing risk types A, B, D or X and questions on pharmacist interaction with pregnant women, physicians, and information sources availability. Results: Pharmacists performed appropriately in 53% of the encounters. Lower success were associated to prednison and captopril (24.8% in both), end cases producing more doubts were captopril (31.7%) and simvastatin (30.7%). Most of the pharmacists state have advised drugs to pregnant women or contact to the physician to discuss about a prescription related with this issue. A Majority (64.4%) did not feel able to understand FDA risk classification and did not have trustable information sources in pharmacy. Conclusions: Pharmacists dispensing drugs in Curitiba are not able to interpret information on the use of drugs in pregnant women, and they don have reliable information sources on the use of dugs in pregnancy. However, they advice and counsel drugs to pregnant women and discuss with physicians therapeutic strategies (AU)