Difficulties in the use of medications by elderly people followed up in a cohort study in Southern Brazil. / Dificuldades no uso de medicamentos por idosos acompanhados em uma coorte do Sul do Brasil.

OBJECTIVE: This study aimed to assess the need for help by elderly people to take their medications, the difficulties related to this activity, the frequency of forgotten doses, and factors associated. METHODS: Cross-sectional study conducted with a cohort of elderly people (60 years and over - "COMO VAI?" [How do you do?] study), where the need for help to properly take medication and the difficulties faced in using them were evaluated. The Poisson regression model was used to estimate the crude and adjusted prevalence ratios (PR) of the outcomes and respective 95% confidence intervals according to the characteristics of the sample. RESULTS: In total, 1,161 elderly people were followed up. The prevalence of participants who reported requiring help with medication was 15.5% (95%CI 13.5-17.8), and the oldest subjects, with lower educational levels, in worse economic situations, on four or more medications and in bad self-rated health were the ones who needed help the most. Continuous use of medication was reported by 83.0% (95%CI 80.7-85.1) of the sample and most participants (74.9%; 95%CI 72.0-77.5) never forgot to take their medications. CONCLUSION: The need for help to use medications was shown to be influenced by social and economic determinants. Studies assessing the difficulties in medication use by the elderly are important to support policies and practices to improve adherence to treatment and the rational use of medications.

OBJETIVO: Este estudo visou avaliar a necessidade de ajuda dos idosos para tomar seus medicamentos, bem como as dificuldades relacionadas com a sua utilização, e a frequência de esquecimento de doses. Ainda, avaliar fatores associados à necessidade de ajuda dos idosos com os medicamentos. MÉTODOS: Corte transversal em uma coorte de idosos (60 anos ou mais ­ estudo "COMO VAI?"), em que foi avaliada a necessidade de ajuda para tomar medicamentos de forma adequada e as dificuldades apresentadas na sua utilização. Utilizou-se regressão de Poisson para estimar as razões de prevalência (RP) brutas e ajustadas dos desfechos e seus intervalos de confiança de 95% (IC95%) de acordo com as características da amostra. RESULTADOS: Participaram 1.161 idosos. A prevalência de idosos que relataram necessidade de ajuda com os medicamentos foi de 15,5% (IC95% 13,5­17,8), sendo que os mais idosos, com menor escolaridade e em pior situação econômica, em uso de quatro medicamentos ou mais e com pior autoavaliação de saúde foram os que mais necessitaram de ajuda. O uso contínuo de medicamentos foi referido por 83,0% (IC95% 80,7­85,1) e a maioria (74,9%; IC95% 72,0­77,5) nunca se esqueceu de tomar seus medicamentos. CONCLUSÃO: Observou-se a influência de determinantes sociais e econômicos e de saúde sobre a necessidade de ajuda para a utilização dos medicamentos. Estudos que estimem as dificuldades no uso de medicamentos por idosos são importantes para subsidiar políticas e práticas norteadoras de ações para melhorar a adesão e o uso racional de medicamentos.

Dificuldades no uso de medicamentos por idosos acompanhados em uma coorte do Sul do Brasil / Difficulties in the use of medications by elderly people followed up in a cohort study in Southern Brazil

RESUMO Objetivo: Este estudo visou avaliar a necessidade de ajuda dos idosos para tomar seus medicamentos, bem como as dificuldades relacionadas com a sua utilização, e a frequência de esquecimento de doses. Ainda, avaliar fatores associados à necessidade de ajuda dos idosos com os medicamentos. Métodos: Corte transversal em uma coorte de idosos (60 anos ou mais — estudo "COMO VAI?"), em que foi avaliada a necessidade de ajuda para tomar medicamentos de forma adequada e as dificuldades apresentadas na sua utilização. Utilizou-se regressão de Poisson para estimar as razões de prevalência (RP) brutas e ajustadas dos desfechos e seus intervalos de confiança de 95% (IC95%) de acordo com as características da amostra. Resultados: Participaram 1.161 idosos. A prevalência de idosos que relataram necessidade de ajuda com os medicamentos foi de 15,5% (IC95% 13,5-17,8), sendo que os mais idosos, com menor escolaridade e em pior situação econômica, em uso de quatro medicamentos ou mais e com pior autoavaliação de saúde foram os que mais necessitaram de ajuda. O uso contínuo de medicamentos foi referido por 83,0% (IC95% 80,7-85,1) e a maioria (74,9%; IC95% 72,0-77,5) nunca se esqueceu de tomar seus medicamentos. Conclusão: Observou-se a influência de determinantes sociais e econômicos e de saúde sobre a necessidade de ajuda para a utilização dos medicamentos. Estudos que estimem as dificuldades no uso de medicamentos por idosos são importantes para subsidiar políticas e práticas norteadoras de ações para melhorar a adesão e o uso racional de medicamentos.

ABSTRACT Objective: This study aimed to assess the need for help by elderly people to take their medications, the difficulties related to this activity, the frequency of forgotten doses, and factors associated. Methods: Cross-sectional study conducted with a cohort of elderly people (60 years and over — "COMO VAI?" [How do you do?] study), where the need for help to properly take medication and the difficulties faced in using them were evaluated. The Poisson regression model was used to estimate the crude and adjusted prevalence ratios (PR) of the outcomes and respective 95% confidence intervals according to the characteristics of the sample. Results: In total, 1,161 elderly people were followed up. The prevalence of participants who reported requiring help with medication was 15.5% (95%CI 13.5-17.8), and the oldest subjects, with lower educational levels, in worse economic situations, on four or more medications and in bad self-rated health were the ones who needed help the most. Continuous use of medication was reported by 83.0% (95%CI 80.7-85.1) of the sample and most participants (74.9%; 95%CI 72.0-77.5) never forgot to take their medications. Conclusion: The need for help to use medications was shown to be influenced by social and economic determinants. Studies assessing the difficulties in medication use by the elderly are important to support policies and practices to improve adherence to treatment and the rational use of medications.

[Expenditures on childbirth care: a comparison of the 2004 and 2015 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil]. / Gastos com a assistência ao parto: comparação entre as coortes de nascimento de Pelotas dos anos de 2004 e 2015, Rio Grande do Sul, Brasil.

Although most childbirth care in Brazil is financed by the Brazilian Unified National Health System (SUS), there are out-of-pocket expenditures (private personal costs) involved in births. This study aims to compare maternal out-of-pocket expenditures in births of children from the Pelotas Birth Cohorts of 2004 and 2015. The study drew on information collected right after birth and at three months of age. The target variables include sociodemographic and economic data, private health plan coverage, and expenditures related to the birth. Values from 2004 were adjusted to 2015 by the general price index. There was an increase in private health plan coverage from 33.4% (95%CI: 31.9-34.9) to 45.1% (95%IC: 43.6-46.7) in the target period, directly associated with the families' socioeconomic status (p < 0.001). There was an increase in mean expenditures on hospitalization for the birth, from BRL 60.38 (SD = 288.66) to BRL 171.15 (SD = 957.07), and in additional medical expenditures, from BRL 191.60 (SD = 612.86) to BRL 1,424.80 (SD = 4,459.16) among mothers admitted to hospital under their private health plans (and there was no significant difference in these expenditures for mothers that opted for direct payment). There was an important increase in expenditures for childbirth care, especially among mothers admitted to hospital under private health plans.

Gastos com a assistência ao parto: comparação entre as coortes de nascimento de Pelotas dos anos de 2004 e 2015, Rio Grande do Sul, Brasil / Expenditures on childbirth care: a comparison of the 2004 and 2015 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil / Gastos con la asistencia al parto: comparación entre las cohortes de nacimientos de Pelotas (Rio Grande do Sul, Brasil) desde el año 2004 y 2015

Resumo: Apesar de a maioria dos partos no Brasil ser financiada pelo Sistema Único de Saúde (SUS), existem gastos diretos (pessoais privados) envolvidos no nascimento. Este estudo visa a comparar o desembolso materno para financiar os partos das crianças pertencentes às coortes de nascimento de Pelotas de 2004 e 2015. Foram utilizadas informações coletadas logo após o nascimento e aos três meses de idade. As variáveis analisadas incluem informações sociodemográficas, econômicas, cobertura por plano privado de saúde e despesas relacionadas ao parto. Os valores de 2004 foram ajustados pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA). Observou-se aumento na posse de planos de saúde de 33,4% (IC95%: 31,9-34,9) para 45,1% (IC95%: 43,6-46,7) no período analisado e este esteve diretamente associado à posição econômica das famílias (p < 0,001). Ocorreu um aumento na média dos gastos com hospitalização para o parto de R$ 60,38 (DP = 288,66) para R$ 171,15 (DP = 957,07), e nos gastos adicionais com médicos de R$ 191,60 (DP = 612,86) para R$ 1.424,80 (DP = 4.459,16) entre as mães que se internaram pelo plano privado de saúde (e não houve diferença significativa nestes gastos entre as mães que optaram pelo parto particular). Houve aumento importante no gasto com a assistência ao parto principalmente entre as mães que se internaram pelo plano privado de saúde.

Abstract: Although most childbirth care in Brazil is financed by the Brazilian Unified National Health System (SUS), there are out-of-pocket expenditures (private personal costs) involved in births. This study aims to compare maternal out-of-pocket expenditures in births of children from the Pelotas Birth Cohorts of 2004 and 2015. The study drew on information collected right after birth and at three months of age. The target variables include sociodemographic and economic data, private health plan coverage, and expenditures related to the birth. Values from 2004 were adjusted to 2015 by the general price index. There was an increase in private health plan coverage from 33.4% (95%CI: 31.9-34.9) to 45.1% (95%IC: 43.6-46.7) in the target period, directly associated with the families' socioeconomic status (p < 0.001). There was an increase in mean expenditures on hospitalization for the birth, from BRL 60.38 (SD = 288.66) to BRL 171.15 (SD = 957.07), and in additional medical expenditures, from BRL 191.60 (SD = 612.86) to BRL 1,424.80 (SD = 4,459.16) among mothers admitted to hospital under their private health plans (and there was no significant difference in these expenditures for mothers that opted for direct payment). There was an important increase in expenditures for childbirth care, especially among mothers admitted to hospital under private health plans.

Resumen: A pesar de que la mayoría de los partos en Brasil esté financiado por el Sistema Único de Salud, existen gastos directos (personales privados) implicados en el nacimiento. Este estudio tiene como objetivo comparar el desembolso materno para financiar los partos de los niños, pertenecientes a las cohortes de nacimientos de Pelotas desde el 2004 al 2015. Se utilizó información recogida tras el nacimiento y a los tres meses de edad. Las variables analizadas incluyen información sociodemográfica, económica, cobertura con plan privado de salud y gastos relacionados con el parto. Los valores de 2004 se ajustaron por el Índice Nacional de Precios al Consumidor Amplio. Se observó un aumento en la posesión de planes de salud de un 33,4% (IC95%: 31,9-34,9) a un 45,1% (IC95%: 43,6-46,7) durante el período analizado y este se mostró directamente asociado a la posición económica de las familias (p < 0,001). Se produjo un aumento en la media de los gastos con hospitalización para el parto de BRL 60,38 (DE = 288,66) a BRL 171,15 (DE = 957,07), y en los gastos adicionales con médicos, de BRL 191,60 (DE = 612,86) a BRL 1.424,80 (DE = 4.459,16) entre las madres que estaban internadas por el plan privado de salud (y no hubo diferencia significativa en estos gastos entre las madres que optaron por el parto particular). Hubo un aumento importante en el gasto con asistencia al parto, principalmente, entre madres que estuvieron internadas para el parto mediante un plan privado de salud.

Use of antibiotics in the health care unit: 2015 Pelotas Birth Cohort.

OBJECTIVE: To estimate the use of the first dose of antibiotics in the health care unit in children from the 2015 Pelotas Birth Cohort at 24 months. METHODS: A total of 4,014 children were monitored. We used descriptive statistics and Poisson regression to analyze the association between socioeconomic and demographic variables, participation in daycare units, in the activities of the Pastoral da Criança and in the Primeira Infância Melhor program, low birth weight, hospitalization between 12 and 24 months, place of medical appointment, prevalence of medical appointment in the last 30 days, prescription of antibiotics, and administration of the first dose in the health care unit. RESULTS: A total of 1,044 children had medical appointments in the last 30 days, of which 45% were prescribed antibiotics and only 10.5% were administered the first dose of this medication in the health care unit. Children with brown, yellow or indigenous skin color were administered 2.5 times more antibiotics than white children. Children whose mothers had 12 years or more of education were administered 83.0% fewer antibiotics than those whose mothers had up to 4 years of education. Among those who were hospitalized for 12 to 24 months, the use of antibiotics was almost four times higher than among those who were not. Among the children served by the Brazilian Unified Health System (SUS), only 15.3% were administered the first dose of antibiotic in the health care unit. When compared with children served by private health care or health plan, administration of the first dose in the SUS was 76.0% higher. CONCLUSIONS: Despite the efforts related to the Pastoral da Criança campaign "Antibiotic: first dose immediately," adherence to the provision of antibiotics in the health care unit is still low. Strategies are necessary and urgent so children have access to the first dose of antibiotics in the health care unit.

Repeated high blood pressure at 6 and 11 years at the Pelotas 2004 birth cohort study.

BACKGROUND: We evaluated the prevalence and the factors associated with repeated high systolic (SBP) and diastolic blood pressure (DBP) at 6- and 11-year follow-ups of children from the Pelotas (Brazil) 2004 Birth Cohort. METHODS: All live births to mothers living in the urban area of Pelotas were enrolled in the cohort. Blood pressure (BP) values were transformed into Z-scores by sex, age, and height. High SBP and DBP were defined as repeated systolic and diastolic BP Z-scores on the ≥95th percentile at the two follow-ups. Prevalence (95% confidence interval) of repeated high SBP, DBP, and both (SDBP) were calculated. Associations with maternal and child characteristics were explored in crude and adjusted logistic regression analyses. RESULTS: A total of 3182 cohort participants were analyzed. Prevalence of repeated high SBP, DBP and SDBP was 1.7% (1.2-2.1%), 2.3% (1.8-2.9%) and 1.2% (0.9-1.6%), respectively. Repeated high SBP was associated with males, gestational diabetes mellitus (2.92; 1.13-7.58) and obesity at 11 years (2.44; 1.29-4.59); while repeated high DBP was associated with females, family history of hypertension from both sides (3.95; 1.59-9.85) and gestational age < 34 weeks (4.08; 1.52-10.96). Repeated high SDBP was not associated with any of the characteristics investigated. CONCLUSION: Prevalence of repeated high SBP, DBP, and SDBP were within the expected distribution at the population level. Nonetheless, gestational diabetes mellitus, obesity, family history of hypertension, and prematurity increased the risk of repeated high blood pressure measured at two occasions 5 years apart.

Use of antibiotics in the health care unit: 2015 Pelotas Birth Cohort / Uso de antibióticos no local do atendimento: Coorte de Nascimentos de Pelotas de 2015

ABSTRACT OBJECTIVE To estimate the use of the first dose of antibiotics in the health care unit in children from the 2015 Pelotas Birth Cohort at 24 months. METHODS A total of 4,014 children were monitored. We used descriptive statistics and Poisson regression to analyze the association between socioeconomic and demographic variables, participation in daycare units, in the activities of the Pastoral da Criança and in the Primeira Infância Melhor program, low birth weight, hospitalization between 12 and 24 months, place of medical appointment, prevalence of medical appointment in the last 30 days, prescription of antibiotics, and administration of the first dose in the health care unit. RESULTS A total of 1,044 children had medical appointments in the last 30 days, of which 45% were prescribed antibiotics and only 10.5% were administered the first dose of this medication in the health care unit. Children with brown, yellow or indigenous skin color were administered 2.5 times more antibiotics than white children. Children whose mothers had 12 years or more of education were administered 83.0% fewer antibiotics than those whose mothers had up to 4 years of education. Among those who were hospitalized for 12 to 24 months, the use of antibiotics was almost four times higher than among those who were not. Among the children served by the Brazilian Unified Health System (SUS), only 15.3% were administered the first dose of antibiotic in the health care unit. When compared with children served by private health care or health plan, administration of the first dose in the SUS was 76.0% higher. CONCLUSIONS Despite the efforts related to the Pastoral da Criança campaign "Antibiotic: first dose immediately," adherence to the provision of antibiotics in the health care unit is still low. Strategies are necessary and urgent so children have access to the first dose of antibiotics in the health care unit.

RESUMO OBJETIVO Estimar o uso da primeira dose do antibiótico no local de atendimento nas crianças da Coorte de Nascimentos de Pelotas de 2015 aos 24 meses. MÉTODOS Foram acompanhadas 4.014 crianças. A associação entre variáveis socioeconômicas e demográficas, participação em creche, nas ações da Pastoral da Criança e no programa Primeira Infância Melhor, baixo peso ao nascer, internação entre 12 e 24 meses, local da consulta, prevalência de consulta nos últimos 30 dias, prescrição de antibióticos e recebimento da primeira dose no local de atendimento foi analisada por meio de estatística descritiva e regressão de Poisson. RESULTADOS Tiveram consulta nos últimos 30 dias 1.044 crianças, das quais 45% receberam prescrição de antibiótico e apenas 10,5% receberam a primeira dose dessa medicação no local de atendimento. Crianças de cor da pele parda, amarela ou indígena tiveram um uso de antibiótico 2,5 vezes maior que o das brancas. Já as crianças cujas mães tinham 12 anos ou mais de escolaridade usaram 83,0% menos antibióticos que aquelas cujas mães tinham até quatro anos de estudo. Entre aquelas que foram internadas entre 12 e 24 meses, o uso de antibiótico foi quase quatro vezes maior do que entre as que não foram. Entre as crianças atendidas pelo Sistema Único de Saúde (SUS), apenas 15,3% receberam a primeira dose do antibiótico no local de atendimento. Quando comparado com o de crianças atendidas por financiamento particular ou convênio, o recebimento da primeira dose no SUS chegou a ser 76,0% superior. CONCLUSÕES Apesar dos esforços relacionados à campanha da Pastoral da Criança "Antibiótico: primeira dose imediata", ainda é baixa a adesão ao fornecimento de antibióticos no local de atendimento. Estratégias são necessárias e urgentes para que as crianças tenham acesso à primeira dose de antibióticos no local de atendimento.

Estilos de vida saudável e autoavaliação de saúde como boa: uma análise dos dados da PNS/2013 / Healthy lifestyles and self-rated health as good: an analysis of the PNS/2013

Objetivo: Avaliar a influência de cinco estilos de vida sobre a autoavaliação da saúde como boa no Brasil. Métodos: Estudo transversal utilizando dados da Pesquisa Nacional de Saúde (PNS) realizada em 2013, com amostra de 46.785 indivíduos. O desfecho principal foi a autoavaliação de saúde como boa e utilizou-se a regressão logística para analisar os estilos de vida saudáveis associados a melhor autoavaliação de saúde. Resultados: Encontramos que o tabagismo, o consumo de álcool, a atividade física e a alimentação saudável são comportamentos que estão associados à autoavaliação de saúde. Pessoas que apresentam múltiplos comportamentos saudáveis apresentam chances maiores de avaliar positivamente sua saúde. Conclusão: Políticas de conscientização devem ser realizadas informando a população dos benefícios da adoção de hábitos de vida saudáveis.

Objective: Evaluating the influence of five lifestyles on health self-assessment as good in Brazil. Methods: Cross-sectional descriptive study using data from the National Health Survey (PNS 2013) conducted in 2013, with a sample of 46,785 individuals. The main outcome was self-rated health as good and logistic regression was used to analyze healthy lifestyles associated with better self-rated health. Results: We found that smoking, drinking, physical activity and healthy eating are behaviors that are associated with self-rated health. People who have multiple healthy behaviors are more likely to positively evaluate their health. Conclusion: Awareness policies should be carried out to inform the population of the benefits of adopting a healthy lifestyle.

Impact of interventions to promote the use of generic drugs: a systematic review. / Impacto de intervenções para promoção do uso de medicamentos genéricos: revisão sistemática.

The need to increase access to medicines, coupled with the limited acceptance of generics has sparked the search for effective interventions to promote it. This systematic review aimed to conduct a survey on interventions to promote the use of generic drugs and its impact. Randomized clinical trials, non-randomized controlled trials, controlled before-after studies and interrupted time series were included. The analysis of the impact of interventions and quality of evidence followed Cochrane's guidelines. Impact of interventions was rated from "very large" to "very small" and the quality of evidence was rated from "high" to "very low". Seventeen papers addressing prescribers, pharmacists and users were selected. There were educational, financial incentives and use of electronic prescription and managerial interventions. Interventions applied to prescribers had little to medium impact, with very low-to-low quality evidence. Interventions applied to pharmacists had small impact with very low quality evidence. Interventions applied to users had medium and large impact with very low-to-low quality evidence. Further studies with good quality addressing interventions are required.

Assessment of Pharmaceutical Services in a Southern Brazilian City. / Avaliação da Assistência Farmacêutica em um município no Sul do Brasil.

INTRODUCTION:: Well-planned and executed pharmaceutical services (PS) are important for proper treatment of the population's health needs, thus enabling the access to essential drugs and promoting their rational use. OBJECTIVE:: To assess the situation of PS in the city of Uruguaiana (State of Rio Grande do Sul), Brazil. METHODS:: This cross-sectional study was applied to 650 interviews between June and September of 2013 in 11 Basic Health Units (UBS) and in the Main Pharmacy of the city. The indicators of prescription, of patient's care, and of service, were assessed according to the recommendations of the World Health Organization (WHO).The Instrument of Self-Assessment for Pharmaceutical Services Planning (IAPAF) from the Brazilian Department of Health was used to assess the management and planning capacity of the PS, which was then applied in the Main Pharmacy and in the medicine stockroom. RESULTS:: The number of drugs per prescription varied from 1 to 10 (mean = 1.7). The percentages of prescribed drugs by generic name, and included in the City List of Essential Drugs (REMUME) were, respectively, 75.5 and 67.7%; antibiotics were prescribed in 9.7% of the medical appointments. The average time of medical appointment was 6 minutes; 51.4% of the users obtained their prescription; only 18.9% of the patients completely understood their prescriptions. Of the 24 items analyzed in the IAPAF, 12 were found in stage 1 (worst rating), 12 in stage 2, and none in stage 3 (ideal situation). CONCLUSION:: Results seem to show the lack of PS in Uruguaiana with regard to planning, management, and patient's care. The absence of effective management may result in waste and incorrect use of drugs.

Impacto de intervenções para promoção do uso de medicamentos genéricos: revisão sistemática / Impact of interventions to promote the use of generic drugs: a systematic review

Resumo A necessidade de aumento do acesso aos medicamentos, aliada à limitada aceitação dos genéricos, tem suscitado a busca de intervenções eficazes para a sua promoção. Esta revisão sistemática realizou levantamento de intervenções voltadas à promoção do uso dos medicamentos genéricos e seus impactos. Foram incluídos ensaios randomizados, ensaios controlados não randomizados, estudos tipo antes e depois e séries temporais interrompidas. As análises quanto ao impacto das intervenções e qualidade das evidências seguiram as orientações da Cochrane. A classificação do impacto das intervenções variou de muito grande a muito pequeno e da qualidade da evidência de alta a muito baixa. Selecionou-se 17 artigos com público alvo de prescritores, farmacêuticos e usuários. As intervenções utilizadas foram educativas, de incentivo financeiro, uso de prescrição eletrônica e gerencial. Intervenções aplicadas aos prescritores tiveram impacto pequeno a médio, com qualidade muito baixa a baixa; aos farmacêuticos, impacto pequeno e qualidade muito baixa; aos usuários mostraram impacto médio e grande com qualidade muito baixa e baixa. São necessários mais estudos de boa qualidade abordando as intervenções.

Abstract The need to increase access to medicines, coupled with the limited acceptance of generics has sparked the search for effective interventions to promote it. This systematic review aimed to conduct a survey on interventions to promote the use of generic drugs and its impact. Randomized clinical trials, non-randomized controlled trials, controlled before-after studies and interrupted time series were included. The analysis of the impact of interventions and quality of evidence followed Cochrane's guidelines. Impact of interventions was rated from "very large" to "very small" and the quality of evidence was rated from "high" to "very low". Seventeen papers addressing prescribers, pharmacists and users were selected. There were educational, financial incentives and use of electronic prescription and managerial interventions. Interventions applied to prescribers had little to medium impact, with very low-to-low quality evidence. Interventions applied to pharmacists had small impact with very low quality evidence. Interventions applied to users had medium and large impact with very low-to-low quality evidence. Further studies with good quality addressing interventions are required.

Factors influencing the preference for purchasing generic drugs in a Southern Brazilian city.

OBJECTIVE: The objective of this study is to identify factors associated with the preference for purchasing generic drugs in a medium-sized municipality in Southern Brazil. METHODS: We have analyzed data from a population-based cross-sectional study conducted in 2012 with a sample of 2,856 adults (≥ 20 years old). The preference for purchasing generic drugs was the main outcome. The explanatory variables were the demographic and socioeconomic variables. Statistical analyses included Poisson regressions. RESULTS: The preference for purchasing generic drugs was 63.2% (95%CI 61.4-64.9). The variables correlated with this preference in the fully adjusted models were: male (prevalence ratio [PR] = 1.08; 95%CI 1.03-1.14), age of 20-39 years (PR = 1.10; 95%CI 1.02-1.20), low socioeconomic status (PR = 1.15; 95%CI 1.03-1.28), and good knowledge about generic drugs (PR= 4.66; 95%CI 2.89-7.52). Among those who preferred to purchase generic drugs, 55.1% have reported accepting to replace the prescribed drug (if not a generic) with the equivalent generic drug. Another correlate of the preference for purchasing generic drugs was because individuals consider their quality equivalent to reference medicines (PR = 2.15; 95%CI 1.93-2.41). CONCLUSIONS: Knowledge about generic drugs was the main correlate of the preference for purchasing generic drugs. The greater the knowledge or positive perception about generic drugs, the greater is the preference to purchase them. Therefore, educational campaigns for healthcare professionals and consumers appear to be the best strategy for expanding the use of generic drugs in Brazil.

Avaliação da Assistência Farmacêutica em um município no Sul do Brasil / Assessment of Pharmaceutical Services in a Southern Brazilian City

RESUMO: Introdução: A Assistência Farmacêutica (AF) bem planejada e conduzida é importante para o adequado atendimento às necessidades de saúde da população, facilitando o acesso aos medicamentos essenciais e promovendo seu uso racional. Objetivo: Avaliar a situação da AF no município de Uruguaiana (RS). Métodos: Estudo transversal, com realização de 650 entrevistas, entre junho e setembro de 2013, em 11 Unidades Básicas de Saúde (UBS) e na Farmácia Central. Os indicadores de prescrição, de assistência ao paciente e de serviço foram avaliados de acordo com as recomendações da Organização Mundial da Saúde (OMS). Para avaliar a capacidade gerencial e de planejamento da AF, foi utilizado o Instrumento de Autoavaliação para o Planejamento da Assistência Farmacêutica (IAPAF) do Ministério da Saúde, o qual foi aplicado na Farmácia Central e no almoxarifado de medicamentos. Resultados: O número de medicamentos por prescrição variou de 1 a 10 (média = 1,7). Os percentuais de medicamentos prescritos pelo nome genérico e que constam na Relação Municipal de Medicamentos Essenciais (REMUME) foram de 75,5 e 67,7%, respectivamente; em 9,7% das consultas médicas foram prescritos antibióticos. O tempo médio de consulta médica foi de 6 minutos; 51,4% dos usuários tiveram sua prescrição atendida; apenas 18,9% dos pacientes compreenderam totalmente a prescrição. Dos 24 itens analisados no IAPAF, 12 encontravam-se no estágio 1 (pior avaliação), 12 no estágio 2 e nenhum no estágio 3 (situação considerada ideal). Conclusão: Os resultados encontrados parecem demonstrar a deficiência da AF em Uruguaiana quanto ao planejamento, à gerência e à assistência ao paciente. A ausência de gestão efetiva pode resultar em desperdícios e no uso incorreto de medicamentos.

ABSTRACT: Introduction: Well-planned and executed pharmaceutical services (PS) are important for proper treatment of the population's health needs, thus enabling the access to essential drugs and promoting their rational use. Objective: To assess the situation of PS in the city of Uruguaiana (State of Rio Grande do Sul), Brazil. Methods: This cross-sectional study was applied to 650 interviews between June and September of 2013 in 11 Basic Health Units (UBS) and in the Main Pharmacy of the city. The indicators of prescription, of patient's care, and of service, were assessed according to the recommendations of the World Health Organization (WHO).The Instrument of Self-Assessment for Pharmaceutical Services Planning (IAPAF) from the Brazilian Department of Health was used to assess the management and planning capacity of the PS, which was then applied in the Main Pharmacy and in the medicine stockroom. Results: The number of drugs per prescription varied from 1 to 10 (mean = 1.7). The percentages of prescribed drugs by generic name, and included in the City List of Essential Drugs (REMUME) were, respectively, 75.5 and 67.7%; antibiotics were prescribed in 9.7% of the medical appointments. The average time of medical appointment was 6 minutes; 51.4% of the users obtained their prescription; only 18.9% of the patients completely understood their prescriptions. Of the 24 items analyzed in the IAPAF, 12 were found in stage 1 (worst rating), 12 in stage 2, and none in stage 3 (ideal situation). Conclusion: Results seem to show the lack of PS in Uruguaiana with regard to planning, management, and patient's care. The absence of effective management may result in waste and incorrect use of drugs.

Factors influencing the preference for purchasing generic drugs in a Southern Brazilian city

ABSTRACT OBJECTIVE The objective of this study is to identify factors associated with the preference for purchasing generic drugs in a medium-sized municipality in Southern Brazil. METHODS We have analyzed data from a population-based cross-sectional study conducted in 2012 with a sample of 2,856 adults (≥ 20 years old). The preference for purchasing generic drugs was the main outcome. The explanatory variables were the demographic and socioeconomic variables. Statistical analyses included Poisson regressions. RESULTS The preference for purchasing generic drugs was 63.2% (95%CI 61.4-64.9). The variables correlated with this preference in the fully adjusted models were: male (prevalence ratio [PR] = 1.08; 95%CI 1.03-1.14), age of 20-39 years (PR = 1.10; 95%CI 1.02-1.20), low socioeconomic status (PR = 1.15; 95%CI 1.03-1.28), and good knowledge about generic drugs (PR= 4.66; 95%CI 2.89-7.52). Among those who preferred to purchase generic drugs, 55.1% have reported accepting to replace the prescribed drug (if not a generic) with the equivalent generic drug. Another correlate of the preference for purchasing generic drugs was because individuals consider their quality equivalent to reference medicines (PR = 2.15; 95%CI 1.93-2.41). CONCLUSIONS Knowledge about generic drugs was the main correlate of the preference for purchasing generic drugs. The greater the knowledge or positive perception about generic drugs, the greater is the preference to purchase them. Therefore, educational campaigns for healthcare professionals and consumers appear to be the best strategy for expanding the use of generic drugs in Brazil.

[Perception, knowledge, and use of generic drugs in southern Brazil: what changed from 2002 to 2012?]. / Percepção, conhecimento e uso de medicamentos genéricos no Sul do Brasil: o que mudou entre 2002 e 2012?

This study compared the perception, knowledge, and use of generic drugs by adults in Pelotas, Rio Grande do Sul State, Brazil, using two cross-sectional population-based studies from 2002 and 2012. Study outcomes were: (a) prevalence of use of generics; (b) generics as a proportion of all medication; (c) users' perceptions of prices and quality; (d) users' knowledge of generics; and (e) strategies for acquisition of medicines. Prevalence of generics use increased from 3.6% (95%CI: 3.0-4.3) to 26.1% (95%CI: 24.5-27.7) in the 10-year period. Perceptions of prices and quality of generics remained stable, identification of characteristics that distinguish generics from other drugs improved (p < 0.001), and drug classification errors decreased (p < 0.001). There was a significant increase in acquiring medication by replacing prescribed drugs with generics. Between 2002 and 2012 there was an increase in knowledge and use of generics, while perception of lower prices and equivalent quality remained high.

Percepção, conhecimento e uso de medicamentos genéricos no Sul do Brasil: o que mudou entre 2002 e 2012? / Perception, knowledge, and use of generic drugs in southern Brazil: what changed from 2002 to 2012? / Percepción, conocimiento y uso de medicamentos genéricos en el Sur de Brasil: ¿qué ha cambiado entre 2002 y 2012?

Resumo: Este estudo compara a percepção, conhecimento e uso de medicamentos genéricos em adultos de Pelotas, Rio Grande do Sul, Brasil, por meio de dois estudos transversais de base populacional realizados em 2002 e 2012. Os desfechos estudados foram: (a) prevalência de utilização de medicamentos genéricos; (b) proporção de uso de medicamentos genéricos entre os demais medicamentos; (c) percepção dos usuários sobre preço e qualidade dos medicamentos genéricos; (d) conhecimento dos usuários sobre medicamentos genéricos; e (e) estratégias de aquisição de medicamentos. A prevalência de uso de medicamentos genéricos aumentou de 3,6% (IC95%: 3,0-4,3) para 26,1% (IC95%: 24,5-27,7) no período de dez anos. A percepção sobre preço e qualidade dos medicamentos genéricos se manteve estável, a identificação das características que diferenciam os medicamentos genéricos dos demais medicamentos melhorou (p < 0,001) e o erro de classificação de medicamento diminuiu (p < 0,001). Houve um aumento significativo na estratégia de aquisição de medicamentos pela substituição do medicamento prescrito pelo medicamento genérico. Entre 2002 e 2012, aumentou o conhecimento e uso de medicamentos genéricos, enquanto a percepção quanto ao menor preço e qualidade equivalente mantiveram-se elevadas.

Abstract: This study compared the perception, knowledge, and use of generic drugs by adults in Pelotas, Rio Grande do Sul State, Brazil, using two cross-sectional population-based studies from 2002 and 2012. Study outcomes were: (a) prevalence of use of generics; (b) generics as a proportion of all medication; (c) users' perceptions of prices and quality; (d) users' knowledge of generics; and (e) strategies for acquisition of medicines. Prevalence of generics use increased from 3.6% (95%CI: 3.0-4.3) to 26.1% (95%CI: 24.5-27.7) in the 10-year period. Perceptions of prices and quality of generics remained stable, identification of characteristics that distinguish generics from other drugs improved (p < 0.001), and drug classification errors decreased (p < 0.001). There was a significant increase in acquiring medication by replacing prescribed drugs with generics. Between 2002 and 2012 there was an increase in knowledge and use of generics, while perception of lower prices and equivalent quality remained high.

Resumen: Este estudio compara la percepción, conocimiento y uso de medicamentos genéricos en adultos de Pelotas, Río Grande do Sul, Brasil, a través de dos estudios transversales de base poblacional, realizados en 2002 y 2012. Los resultados estudiados fueron: (a) prevalencia de utilización de medicamentos genéricos; (b) proporción de uso de medicamentos genéricos entre los demás medicamentos; (c) percepción de los usuarios sobre el precio y calidad de los medicamentos genéricos; (d) conocimiento de los usuarios sobre medicamentos genéricos y (e) estrategias de adquisición de medicamentos. La prevalencia de uso de medicamentos genéricos aumentó de 3,6% (IC95%: 3,0-4,3) a 26,1% (IC95%: 24,5-27,7) en un período de 10 años. La percepción sobre el precio y calidad de los medicamentos genéricos se mantuvo estable, la identificación de las características que diferencian los medicamentos genéricos de los demás medicamentos mejoró (p < 0,001) y el error de clasificación de medicamentos disminuyó (p < 0,001). Hubo un aumento significativo en la estrategia de adquisición de medicamentos, a través de la sustitución del medicamento prescrito por el medicamento genérico. Entre 2002 y 2012 aumentó el conocimiento y uso de medicamentos genéricos, mientras que la percepción en lo referente al menor precio y calidad equivalente, se mantuvieron elevadas.

Início da vida sexual entre adolescentes (10 a 14 anos) e comportamentos em saúde / Sexual initiation among adolescents (10 to 14 years old) and health behaviors

OBJETIVO: Avaliar a prevalência de início da vida sexual até os 14 anos de idade e fatores sociodemográficos e comportamentais relacionados à sua ocorrência. MÉTODOS: Em 2008, 4.325 adolescentes dos 5.249 pertencentes ao estudo de coorte de nascimentos de Pelotas, Rio Grande do Sul (1993) foram entrevistados. O início da vida sexual foi definido como primeira relação sexual ocorrida até os 14 anos. As informações foram obtidas através de questionários durante o acompanhamento de 2008, com entrevistas realizadas nos domicílios. As varáveis analisadas foram: cor da pele, índice de bens, escolaridade materna e do adolescente, uso experimental de cigarro e de álcool, episódio de embriaguez, uso de alguma droga ilícita pelo adolescente ou pelos amigos e envolvimento em brigas no último ano. Além dessas, foram analisados o uso de preservativos e contraceptivos, número de parceiros(as) e idade de iniciação sexual. RESULTADOS: A prevalência de iniciação sexual foi de 18,6%, sendo maior no sexo masculino, nos adolescentes com menor escolaridade, de baixo nível econômico e naqueles cujas mães tinham baixa escolaridade e tiveram filhos na adolescência. A prática sexual esteve relacionada às variáveis comportamentais analisadas. Na última relação sexual, 30% das entrevistadas não haviam usado métodos contraceptivos e 18% não usaram preservativos. Meninos referiram maior número de parceiros(as) sexuais do que meninas. CONCLUSÃO: Resultados apontam uma relação entre iniciação sexual (≤ 14 anos) e comportamentos vulneráveis à saúde. O não uso de preservativos e contraceptivos pode torná-los vulneráveis a experimentarem situações não desejadas. Estratégias educativas e socioculturais em saúde devem ser praticadas desde o início da adolescência. .

OBJECTIVE: To assess the prevalence of sexual initiation until the age of 14 years old, as well as sociodemographic and behavioral factors. METHODS: In 2008, 4,325 from the 5,249 adolescents of the 1993 birth cohort in Pelotas, Rio Grande do Sul, were interviewed. Sexual initiation was defined as the first intercourse up to the age of 14 years old. The information was obtained by interviewing adolescents in their houses, during the 2008 follow-up. The analyzed variables were: skin color, asset index, maternal and adolescents' schooling, experimental use of tobacco and alcohol, drunkenness episode, use of any illicit drug, illegal drug use by friends and involvement in fights during the past year. Use of condoms and contraceptive methods, number of partners and the age of sexual initiation were also analyzed. RESULTS: The prevalence of sexual initiation by the age of 14 was of 18.6%. Lower schooling, asset index and maternal education were related to higher prevalence of sexual initiation until the age of 14, as well as being male or being born to adolescent mothers. Sexual intercourse was also related to the behavioral variables analyzed. Among adolescent girls who had intercourse up to the age of 14, 30% did not use contraception and 18% did not use condoms in the last sexual intercourse. Boys reported a higher number of sexual partners than girls. CONCLUSION: The results suggest a relationship between sexual intercourse (≤ 14 years) and some health-risk behaviors. The non-use of condoms and contraceptives may make them vulnerable to experiencing unwanted situations. Education and sociocultural strategies for health should be implemented from the beginning of adolescence. .

Sexual initiation among adolescents (10 to 14 years old) and health behaviors.

OBJECTIVE: To assess the prevalence of sexual initiation until the age of 14 years old, as well as sociodemographic and behavioral factors. METHODS: In 2008, 4,325 from the 5,249 adolescents of the 1993 birth cohort in Pelotas, Rio Grande do Sul, were interviewed. Sexual initiation was defined as the first intercourse up to the age of 14 years old. The information was obtained by interviewing adolescents in their houses, during the 2008 follow-up. The analyzed variables were: skin color, asset index, maternal and adolescents' schooling, experimental use of tobacco and alcohol, drunkenness episode, use of any illicit drug, illegal drug use by friends and involvement in fights during the past year. Use of condoms and contraceptive methods, number of partners and the age of sexual initiation were also analyzed. RESULTS: The prevalence of sexual initiation by the age of 14 was of 18.6%. Lower schooling, asset index and maternal education were related to higher prevalence of sexual initiation until the age of 14, as well as being male or being born to adolescent mothers. Sexual intercourse was also related to the behavioral variables analyzed. Among adolescent girls who had intercourse up to the age of 14, 30% did not use contraception and 18% did not use condoms in the last sexual intercourse. Boys reported a higher number of sexual partners than girls. CONCLUSION: The results suggest a relationship between sexual intercourse (≤ 14 years) and some health-risk behaviors. The non-use of condoms and contraceptives may make them vulnerable to experiencing unwanted situations. Education and sociocultural strategies for health should be implemented from the beginning of adolescence.

Randomized controlled trial to evaluate the impact of pharmaceutical care on therapeutic success in HIV-infected patients in Southern Brazil.

A non-blinded randomized controlled trial evaluated efficacy of pharmaceutical care (PC) (Dáder method) on self-reported antiretroviral adherence and undetectable plasma viral load (UPVL), compared with usual care (UC) in HIV-positive patients in Brazil. Most were male (63 %), mean age 40.3 years (SD = 10). After 12 months, 79.8 % of those receiving PC versus 73.8 % in UC were adherent (RR 1.05, 95 % CI 0.95-1.15, P = 0.35), and 50.3 versus 49.8 % (PC vs. UC, respectively) had UPVL (RR 1.08, 95 % CI 0.97-1.20, P = 0.15). Factors associated with self-reported adherence were regular employment, UPVL, no depressive symptoms, and lower pill load in the treatment regimen. Older age, education, CD4 count <200 cells/mm(3), and shorter treatment duration were associated with UPVL. Of 94 reported drug-related problems, 43 % resolved. In subgroup analyses of patients who experienced therapeutic failure and who were non-adherent at the beginning of the trial (N = 50), no differences were found in UPVL (HR 1.35, 95 % CI 0.57-3.19). Only education level (>12 years) was independently predictive of viral suppression (HR 7.47, 95 % CI 1.69-32.91). In conclusion, PC was not associated with increased self-reported adherence to ART or UPVL in patients treated at a health care facility in southern Brazil. The study suggests, however, that PC could be effective for the subgroup of patients with poor adherence.

Predictors of non-adherence to clinical follow-up among patients participating in a randomized trial of pharmaceutical care intervention in HIV-positive adults in Southern Brazil.

Pharmaceutical care (PC) has been shown to improve adherence to therapeutic interventions as well as improve clinical outcomes. We assessed the predictors of non-adherence to clinical follow-up (i.e., not attending three scheduled routine clinical visits over a 1 year period) among patients who participated in a clinical trial of PC intervention on adherence to HIV antiretroviral therapy uptake (the PC-HIV trial). A total of 332 patients participated: median age was 39 years, 63 % were male, 76 % had CD4 count ≥200 cells/mm³, and 52 % had undetectable viral load. About half, 52.7 %, were non-adherent to clinical follow-up. Identified risk factors for non-adherence were male gender, age <40 years, and being in the trial's "control" group (adjusted odds ratio [AOR] 1.67, 95 % CI 1.05-2.66; AOR 2.21, 95 % CI 1.42-3.47; AOR 1.67, 95 % CI 1.07-2.61, respectively). Younger, male patients may benefit from interventions such as PC, which facilitates engagement in care.