Efficacy and safety of therapeutic strategies for human brucellosis: A systematic review and network meta-analysis.

BACKGROUND: Human brucellosis is a neglected, re-emerging, and endemic zoonosis in many countries. The debilitating and disabling potential of the disease is a warning about its morbidity, generating socioeconomic impact. This review aims to update the current evidence on the efficacy and safety of therapeutic options for human brucellosis using the network meta-analysis (NMA). METHODOLOGY: A systematic search was conducted in four different databases by independent reviewers to assess overall therapy failure, adverse events, and time to defervescence associated with different therapies. Randomized clinical trials (RCTs) evaluating any therapeutic drug intervention were selected, excluding non-original studies or studies related to localized forms of the disease or with less than 10 participants. Data were analyzed by frequentist statistics through NMA by random effects model. The risk of bias and certainty of evidence was assessed, this review was registered at PROSPERO. RESULTS: Thirty-one (31) RCTs involving 4167 patients were included. Three networks of evidence were identified to evaluate the outcomes of interest. Triple therapy with doxycycline + streptomycin + hydroxychloroquine for 42 days (RR: 0.08; CI 95% 0.01-0.76) had a lower failure risk than the doxycycline + streptomycin regimen. Doxycycline + rifampicin had a higher risk of failure than doxycycline + streptomycin (RR: 1.96; CI 95% 1.27-3.01). No significant difference was observed between the regimens when analyzing the incidence of adverse events and time to defervescence. In general, most studies had a high risk of bias, and the results had a very low certainty of evidence. CONCLUSIONS: This review confirmed the superiority of drugs already indicated for treating human brucellosis, such as the combination of doxycycline and aminoglycosides. The association of hydroxychloroquine to the dual regimen was identified as a potential strategy to prevent overall therapy failure, which is subject to confirmation in future studies.

Diagnosis of human brucellosis: Systematic review and meta-analysis.

BACKGROUND: Brucellosis, a widely spread zoonotic disease, poses significant diagnostic challenges due to its non-specific symptoms and underreporting. Timely and accurate diagnosis is crucial for effective patient management and public health control. However, a comprehensive comparative review of available diagnostic tests is lacking. METHODOLOGY/PRINCIPAL FINDINGS: This systematic review addressed the following question: 'What is the accuracy of the available tests to confirm human brucellosis?' Two independent reviewers examined articles published up to January 2023. The review included original studies reporting symptomatic patients with brucellosis suspicion, through any index test, with sensitivity and/or specificity as outcomes. As exclusion criteria were considered: sample size smaller than 10 patients, studies focusing on complicated brucellosis, and those lacking essential information about index or comparator tests. Sensitivity and specificity were assessed, with consideration for the index test, and 'culture' and 'culture and standard tube agglutination test (SAT)' were used as reference standards. Bias assessment and certainty of evidence were carried out using the QUADAS-2 and GRADE tools, respectively. A total of 38 studies reporting diagnostic test performance for human brucellosis were included. However, the evidence available is limited, and significant variability was observed among studies. Regarding the reference test, culture and/or SAT are deemed more appropriate than culture alone. Rose Bengal, IgG/IgM ELISA, and PCR exhibited equally high performances, indicating superior overall diagnostic accuracy, with very low certainty of the evidence. CONCLUSIONS/SIGNIFICANCE: This systematic review underscores the potential of the Rose Bengal test, IgG/IgM ELISA, and PCR as promising diagnostic tools for brucellosis. However, the successful implementation and recommendations for their use should consider the local context and available resources. The findings highlight the pressing need for standardization, improved reporting, and ongoing advancements in test development to enhance the accuracy and accessibility of brucellosis diagnosis.

Implementation of health technologies in Brazil: analysis of federal guidelines for the public health system. / Implementação de tecnologias em saúde no Brasil: análise de orientações federais para o sistema público de saúde.

This study aimed to identify the regulatory framework and federal guidelines that support the process of implementing health technologies in the Unified Health System (SUS) through analysis of documents and legislation related to the National Health Technology Management Policy, published between 2009 and 2021. The search and selection of documents and subsequent data extraction were carried out. The documents were grouped into three categories: structural regulatory documents, recommendations on evaluation of technologies, and recommendations on clinical guidelines. In 38.8% of the regulatory documents, citations to implementation related mainly to SUS clinical guidelines were identified; however, no document dedicated to guiding implementation actions was identified. Recommendations related to implementations were identified in 27.1% of the reports and 66.1% of the guidelines, although without standardization and, in general, in little detail, focusing on resources and actions needed for making technology available rather than on methods and interventions for its implementation. The results evidence a gap in formal guidelines to guide the implementation process in Brazil, representing an opportunity for the development of models aligned with the reality of the SUS.

O objetivo foi identificar o arcabouço regulatório e as orientações federais que sustentam o processo de implementação de tecnologias em saúde no Sistema Único de Saúde (SUS), por meio da análise de documentos e legislações relacionados à Política Nacional de Gestão de Tecnologias de Saúde, publicados entre 2009 e 2021. Foi realizada busca e seleção dos documentos e posterior extração de dados, agrupados por três categorias: normativas estruturantes, recomendações na avaliação de tecnologias e recomendações nas diretrizes clínicas. Em 38,8% das normativas, foram identificadas citações à implementação relacionadas principalmente às diretrizes clínicas do SUS, mas nenhum documento dedicado a orientar as ações de implementação. As recomendações relacionadas às implementações foram identificadas em 27,1% dos relatórios e em 66,1% das diretrizes, mas sem padronização e, de modo geral, pouco detalhadas, com foco em recursos e ações necessárias para a disponibilização da tecnologia, ao invés de métodos e intervenções para implementação. Os resultados confirmam a existência de uma lacuna de diretrizes formais para guiar o processo de implementação no Brasil, o que se constitui em oportunidade para o desenvolvimento de modelos alinhados à realidade do SUS.

Management of pharmaceutical services in the fight against COVID-19 in universal public health systems: a rapid review.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic brought new challenges and lessons were learnt for health services. In the field of pharmaceutical care, several interventions have been proposed to optimize and expand the response capacity of services. OBJECTIVE: To identify and characterize interventions performed in the management of pharmaceutical services during the COVID-19 pandemic in universal public health systems. METHODS: A rapid literature review was conducted and registered in PROSPERO (CRD42022360902). Systematic searches in the MEDLINE (PubMed), Embase, and Virtual Health Library databases were conducted to identify interventions and practices adopted for the management of pharmaceutical care during the COVID-19 pandemic. RESULTS: Thirteen articles reporting interventions developed in six countries were included. The interventions were summarized under three major themes: actions for continuous access to medicines, logistical measures for acquisition and storage, and organizational strategies. Telepharmacy services stand out as a typical action adopted in different services, which highlights the use and consolidation of digital technologies in these services. Strategies for process management were described and focused on the reorganization of the internal service of pharmacies, flow of services, and people management. CONCLUSIONS: Many interventions were developed during the pandemic, some of which have already been incorporated into routine service delivery. Although the studies did not measure the effect of each intervention, the strategies developed are a source of information for the future delivery of care. Studies should be conducted to evaluate the potential of similar interventions in other health emergency contexts.

Implementação de tecnologias em saúde no Brasil: análise de orientações federais para o sistema público de saúde / Implementation of health technologies in Brazil: analysis of federal guidelines for the public health system

Resumo O objetivo foi identificar o arcabouço regulatório e as orientações federais que sustentam o processo de implementação de tecnologias em saúde no Sistema Único de Saúde (SUS), por meio da análise de documentos e legislações relacionados à Política Nacional de Gestão de Tecnologias de Saúde, publicados entre 2009 e 2021. Foi realizada busca e seleção dos documentos e posterior extração de dados, agrupados por três categorias: normativas estruturantes, recomendações na avaliação de tecnologias e recomendações nas diretrizes clínicas. Em 38,8% das normativas, foram identificadas citações à implementação relacionadas principalmente às diretrizes clínicas do SUS, mas nenhum documento dedicado a orientar as ações de implementação. As recomendações relacionadas às implementações foram identificadas em 27,1% dos relatórios e em 66,1% das diretrizes, mas sem padronização e, de modo geral, pouco detalhadas, com foco em recursos e ações necessárias para a disponibilização da tecnologia, ao invés de métodos e intervenções para implementação. Os resultados confirmam a existência de uma lacuna de diretrizes formais para guiar o processo de implementação no Brasil, o que se constitui em oportunidade para o desenvolvimento de modelos alinhados à realidade do SUS.

Abstract This study aimed to identify the regulatory framework and federal guidelines that support the process of implementing health technologies in the Unified Health System (SUS) through analysis of documents and legislation related to the National Health Technology Management Policy, published between 2009 and 2021. The search and selection of documents and subsequent data extraction were carried out. The documents were grouped into three categories: structural regulatory documents, recommendations on evaluation of technologies, and recommendations on clinical guidelines. In 38.8% of the regulatory documents, citations to implementation related mainly to SUS clinical guidelines were identified; however, no document dedicated to guiding implementation actions was identified. Recommendations related to implementations were identified in 27.1% of the reports and 66.1% of the guidelines, although without standardization and, in general, in little detail, focusing on resources and actions needed for making technology available rather than on methods and interventions for its implementation. The results evidence a gap in formal guidelines to guide the implementation process in Brazil, representing an opportunity for the development of models aligned with the reality of the SUS.

Use of Psychotropic Drugs during the COVID-19 pandemic in Minas Gerais, Brazil.

OBJECTIVE: To describe the profile of dispensation of mental health drugs by analyzing trends in use before and during the COVID-19 pandemic within the Unified Health System (Sistema Único de Saúde [SUS]). METHODS: Pharmacoepidemiological study based on the retrospective analysis of records regarding the dispensation of psychotropic medicines in the SUS database in the state of Minas Gerais between 2018 and 2021, considering the periods before (2018-2019) and during the COVID-19 pandemic (2020-2021). A database with the records of dispensation of municipalities was created, and the consistency of releases was verified using the Analysis of Variance (ANOVA) test. Medicine consumption was measured in a defined daily dose (DDD) per 1,000 inhabitants/day for SUS, and the difference between periods was evaluated using Student's t-test. RESULTS: During the COVID-19 pandemic, there was an increase in the consumption of psychotropic drugs in SUS-MG. The most consumed medicines were fluoxetine hydrochloride, diazepam and phenobarbital sodium (DDD=5.89; 3.42; 2.49) in the Basic Pharmaceutical Services Component(CBAF), and olanzapine, risperidone and quetiapine hemifumarate (DDD=0.80; 0.47; 0.38) in the Specialized Pharmaceutical Services Component (CEAF). The highest percentage increase in consumption was attributed to clonazepam (75.37%) and lithium carbonate (35.35%), in CBAF, and levetiracetam (3,000.00%) and memantine hydrochloride (340.0%) in CEAF. CONCLUSION: The change in the psychotropic drug dispensation profile during the COVID-19 pandemic highlights the need to produce more studies to complete, confirm or rule out this profile and monitor the use of psychotropic drugs by the population in the post-pandemic context.

How to improve the dissemination of clinical practice guidelines in the Brazilian Unified Health System? Report of a pilot project.

In Brazil, there have been some initiatives to improve the development of Ministry of Health clinical protocols and therapeutic guidelines (PCDTs in Portuguese, and clinical practice guidelines-CPGs, in English) and their implementation so that best practices can be disseminated and adopted at multiple levels of health systems. One of the initiatives was to conduct a pilot project to improve the format of these CPGs. The objective of this article is to present the processes and results of the pilot project, including the development of a new standardized format for CPGs to promote national dissemination and uptake. The pilot project was designed in three phases: identification and selection of strategies to effectively implement clinical practice guidelines, definition of the ideal characteristics for the format of CPGs, and development and implementation of the new format. Initially, an overview of systematic reviews was conducted to map the global evidence on the effectiveness of dissemination and implementation strategies of CPGs. Among the most effective interventions, a low-cost strategy was selected to improve the format of CPGs, namely a full format and a short format. The two formats were evaluated for usefulness and acceptability by professionals who use or develop CPGs, and after several reiterations, the formats were finalized, considering the progression of care (from diagnosis of the disease to treatment, including specific technologies indicated in each stage of the disease). Related to the technical aspects, the visual presentation of the CPGs was improved, ensuring that key information was easily identified for decision-making by end users. The initial phase of implementation involved 33 clinical conditions, equating to approximately 20% of published CPGs. It is anticipated that disseminating the CPGs in the new formats will promote the accessibility of information and implementation of standardized CPGs by health professionals in the public health sector (servicing more than 210 million Brazilians). Further research should be considered to determine the impact of the use of the new CPGs formats, contributing to the knowledge base related to the implementation of guidelines in Brazil and internationally.

Use of Psychotropic Drugs during the COVID-19 pandemic in Minas Gerais, Brazil / Perfil de utilização de psicofármacos durante a pandemia de COVID-19 em Minas Gerais, Brasil

ABSTRACT Objective: To describe the profile of dispensation of mental health drugs by analyzing trends in use before and during the COVID-19 pandemic within the Unified Health System (Sistema Único de Saúde [SUS]). Methods: Pharmacoepidemiological study based on the retrospective analysis of records regarding the dispensation of psychotropic medicines in the SUS database in the state of Minas Gerais between 2018 and 2021, considering the periods before (2018-2019) and during the COVID-19 pandemic (2020-2021). A database with the records of dispensation of municipalities was created, and the consistency of releases was verified using the Analysis of Variance (ANOVA) test. Medicine consumption was measured in a defined daily dose (DDD) per 1,000 inhabitants/day for SUS, and the difference between periods was evaluated using Student's t-test. Results: During the COVID-19 pandemic, there was an increase in the consumption of psychotropic drugs in SUS-MG. The most consumed medicines were fluoxetine hydrochloride, diazepam and phenobarbital sodium (DDD=5.89; 3.42; 2.49) in the Basic Pharmaceutical Services Component(CBAF), and olanzapine, risperidone and quetiapine hemifumarate (DDD=0.80; 0.47; 0.38) in the Specialized Pharmaceutical Services Component (CEAF). The highest percentage increase in consumption was attributed to clonazepam (75.37%) and lithium carbonate (35.35%), in CBAF, and levetiracetam (3,000.00%) and memantine hydrochloride (340.0%) in CEAF. Conclusion: The change in the psychotropic drug dispensation profile during the COVID-19 pandemic highlights the need to produce more studies to complete, confirm or rule out this profile and monitor the use of psychotropic drugs by the population in the post-pandemic context.

RESUMO Objetivo: Descrever o perfil de dispensação de medicamentos da saúde mental analisando o uso antes e durante a pandemia de COVID-19 no âmbito do Sistema Único de Saúde (SUS). Métodos: Estudo farmacoepidemiológico a partir da análise retrospectiva dos registros de dispensação de psicofármacos na base de dados do SUS no estado de Minas Gerais (MG) nos períodos antes (2018-2019) e durante a pandemia de COVID-19 (2020-2021). Um banco de dados com os registros de dispensação dos municípios foi elaborado, sendo verificada a consistência de lançamento pelo teste de Análise de Variância (ANOVA). O consumo dos medicamentos foi mensurado em dose diária definida (DDD) por 1.000 habitantes/dia para o SUS, sendo a diferença entre os períodos avaliada pelo teste estatístico t de Student. Resultados: Durante a pandemia de COVID-19 houve aumento no consumo de psicofármacos no SUS-MG. Os medicamentos mais consumidos foram cloridrato fluoxetina, diazepam e fenobarbital sódico (DDD=5,89; 3,42; 2,49) no componente básico (CBAF), e olanzapina, risperidona e hemifumarato de quetiapina (DDD=0,80; 0,47; 0,38) no componente especializado da Assistência Farmacêutica (CEAF). Os maiores aumentos percentuais no consumo foram atribuídos ao clonazepam (75,37%) e carbonato de lítio (35,35%) no CBAF e levetiracetam (3.000,00%) e cloridrato de memantina (340,00%) no CEAF. Conclusão: A alteração do perfil de dispensação de psicotrópicos durante a pandemia de COVID-19 alerta quanto à necessidade de produção de mais estudos a fim de completar, confirmar ou afastar este perfil e monitorar o uso de psicofármacos pela população no contexto pós-pandêmico.

The cure rate after different treatments for mucosal leishmaniasis in the Americas: A systematic review.

BACKGROUND: Mucosal or mucocutaneous leishmaniasis is the most severe form of tegumentary leishmaniasis due to its destructive character and potential damage to respiratory and digestive tracts. The current treatment recommendations are based on low or very low-quality evidence, and pentavalent antimonial derivatives remain strongly recommended. The aim of this review was to update the evidence and estimate the cure rate and safety profile of the therapeutic options available for mucosal leishmaniasis (ML) in the Americas. METHODOLOGY: A systematic review was conducted in four different databases and by different reviewers, independently, to evaluate the therapeutic efficacy and toxicity associated with different treatments for ML. All original studies reporting cure rates in more than 10 patients from American regions were included, without restriction of design, language, or publication date. The risk of bias was assessed by two reviewers, using different tools according to the study design. The pooled cure rate based on the latest cure assessment reported in the original studies was calculated grouping all study arms addressing the same intervention. The protocol for this review was registered at the International Prospective Register of Systematic Reviews, PROSPERO: CRD42019130708. PRINCIPAL FINDINGS: Twenty-seven original studies from four databases fulfilled the selection criteria. A total of 1,666 patients with ML were treated predominantly with pentavalent antimonials in Brazil. Other interventions, such as pentamidine, miltefosine, imidazoles, aminosidine sulfate, deoxycholate and lipidic formulations of amphotericin B (liposomal, lipid complex, colloidal dispersion), in addition to combinations with pentoxifylline, allopurinol or sulfa were also considered. In general, at least one domain with a high risk of bias was identified in the included studies, suggesting low methodological quality. The pooled cure rate based on the latest cure assessment reported in the original studies was calculated grouping all study arms addressing the same intervention. It was confirmed that antimony is still the most used treatment for ML, with only moderate efficacy (possibly increased by combining with pentoxifylline). There is already evidence for the use of miltefosine for ML, with a cure rate similar to antimony, as observed in the only direct meta-analysis including 57 patients (OR: 1.2; 0.43-3.49, I2 = 0). It was possible to gather all descriptions available about adverse events reported during ML treatment, and the toxicity reflected the pattern informed in the manufacturers' technical information. CONCLUSIONS: This study provides an overview of the clinical experience in the Americas related to ML treatment and points out interventions and possible combinations that are eligible to be explored in future well-designed studies.

[Drug use in Psychosocial Care Centers: analysis of prescriptions and the profile of users in different modalities of the service]. / Uso de medicamentos nos Centros de Atenção Psicossocial: análise das prescrições e perfil dos usuários em diferentes modalidades do serviço.

The scope of this article was to identify the profile of users and the prescription of drugs in the Psychosocial Care Centers (CAPS) in a region of Minas Gerais, Brazil. A cross-sectional study was conducted in 11 CAPS of 5 different modalities. Sociodemographic data and information about drug use were obtained through interviews with users and analysis of prescriptions and medical records, using a semi-structured questionnaire. The mean number of drugs prescribed per user in CAPS was 3.38 (± 1.76) and the amounts were 4.08 (± 1.56), 3.54 (± 1.64) and 2.00 (± 1.66) for CAPS Alcohol and Drugs (CAPS ad), CAPS II and III and CAPS for children (CAPSi), respectively. The most prescribed therapeutic class was antipsychotics, with emphasis on haloperidol. Users in the economically active age group attended larger units (24h) or the CAPS ad modality and reported that in the past they had used drugs inappropriately and had a higher prevalence of prescriptions containing 5 drugs or more. The profile of drug use in the CAPS differed according to the modality of the service, and a greater degree of utilization was observed in the CAPS ad units. The differences revealed may subsidize discussion of the strategies for promoting the rational use of drugs.

O objetivo deste artigo foi identificar o perfil dos usuários e a prescrição de medicamentos nos Centros de Atenção Psicossocial (CAPS) em uma região de Minas Gerais, Brasil. Foi realizado um estudo transversal em 11 CAPS de 5 diferentes modalidades. Dados sociodemográficos e informações sobre o uso de medicamentos foram obtidas por meio de entrevistas com os usuários, análise de prescrições e prontuários utilizando um formulário semiestruturado. O número médio de medicamentos prescritos por usuário dos CAPS foi de 3,38 (±1,76) e os valores foram 4,08 (±1,56), 3,54 (±1,64) e 2,00 (±1,66) para as modalidades de CAPS álcool e Drogas (CAPS ad), CAPS II e III e CAPS infantil, respectivamente. A classe terapêutica mais prescrita foi de antipsicóticos. Usuários que estavam na faixa etária economicamente ativa, frequentavam serviços de maior porte (24h) ou modalidade CAPS ad e relataram que já utilizaram os medicamentos de maneira inadequada, apresentaram maior prevalência de prescrições com 5 ou mais medicamentos. O uso de medicamentos nos CAPS diferiu segundo a modalidade do serviço, tendo sido observado um maior grau de utilização nos CAPS ad. As diferenças encontradas podem subsidiar a discussão de estratégias para a promoção do uso racional de medicamentos.

Clinical practice guidelines in Brazil - developing a national programme.

In Brazil, governmental and non-governmental organisations develop practice guidelines (PGs) in order to optimise patient care. Although important improvements have been made over the past years, many of these documents still lack transparency and methodological rigour. In order to conduct a critical analysis and define future steps in PG development in Brazil, we carried out a structured assessment of strengths, weaknesses, opportunities and threats (SWOT analysis) for the development of a national guideline programme. Participants consisted of academia, methodologists, medical societies and healthcare system representatives. In summary, the PG development process has improved in Brazil and current investments in methodological research and capacity-building are ongoing. Despite the centralised processes for public PGs, standardised procedures for their development are not well established and human resources are insufficient in number and capacity to develop the amount of trustworthy documents needed. Brazil's capacity could be strengthened and initial efforts have been made such as the adoption of standards proposed by world-renowned institutions in PG development and enhancement of the involvement of key stakeholders. Further steps involve the alignment between health technology assessment and PG processes for synergy and the development of a national network to promote the interaction between groups involved in the development of PGs. The lessons learned from this paper could be used to foster debate on guideline development, especially for countries facing similar threats on this topic.

Brazilian Mental Health Services Assessment: user satisfaction and associated factors. / Avaliação de Serviços de Saúde Mental Brasileiros: satisfação dos usuários e fatores associados.

Patient satisfaction is an important criterion for assessing the quality of Brazilian mental health services at Psychosocial Care Centers (CAPS - from the Portuguese 'Centro de Atenção Psicossocial'). The aim of this study was to evaluate the satisfaction of users at the main CAPS in a region of Minas Gerais state, Brazil, as well as associated factors. This was a cross-sectional study with 11 CAPS. Patients were interviewed using the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and a semi-structured questionnaire containing sociodemographic and clinical variables. The users were satisfied with the CAPS, particularly in terms of staff competence and the welcome received and care provided. The physical facilities and comfort at the centers obtained the lowest satisfaction scores on the scale. Almost half of the users were unfamiliar with basic aspects of their drug therapy, such as the name of medicines, and one-third reported inappropriate use of medications. Users of midsize CAPS and those providing treatment for alcohol and drug addiction were more satisfied than patients at mental health or 24-hour CAPS. Although this study identified a need for improvement in physical facilities, mechanisms of participation and patient empowerment, the users were satisfied with the CAPS care model.

A satisfação dos usuários é um importante critério para avaliar a qualidade dos Centros de Atenção Psicossocial (CAPS). O objetivo foi avaliar a satisfação de usuários dos principais CAPS de uma região de Minas Gerais e seus fatores associados. Foi realizado um estudo transversal em 11 CAPS, os usuários foram entrevistados para aplicação da Escala de Avaliação da Satisfação dos Usuários com os Serviços de Saúde Mental e um formulário semi-estruturado com variáveis sociodemográficas e clínicas. Os usuários estavam satisfeitos com os CAPS, sobretudo quanto à competência dos profissionais, acolhida e ajuda recebida no serviço. Condições físicas e conforto do serviço obtiveram os menores escores na escala de avaliação de satisfação. Verificou-se que quase metade dos usuários não conhecia aspectos básicos de sua terapia medicamentosa, como o nome dos medicamentos em uso, e um terço relatou que já fez uso inadequado destes. Os usuários dos CAPS álcool e drogas ou de serviços de médio porte estavam mais satisfeitos que os dos CAPS saúde mental ou serviços com funcionamento 24h. Os usuários estão satisfeitos com o modelo de atenção praticado nos CAPS, embora detectada a necessidade de melhorias na estrutura física, mecanismos de participação e empoderamento dos usuários.

Pharmaceutical interventions in mental health: A review of the literature to support evidence-informed policymaking.

BACKGROUND: Pharmaceutical interventions may have an impact on different treatment aspects, such as therapy adherence, reducing the number of different medications in use and lowering treatment costs. OBJECTIVE: Identify pharmaceutical interventions in the mental health field and their possible application in Brazilian public mental health services, considering the evidence-based model to establish implementation options. METHODS: A structured search of the literature was performed in the Pubmed (Medline), Cochrane, PsycINFO and Lilacs databases to identify the main pharmaceutical intervention studies conducted in the mental health area. The articles selected were evaluated according to the quality of the evidence. The current laws and public database were researched to collect information on services and procedures provided by the Brazilian units, known as CAPS, and the number the pharmacists allocated to them. The proposal to synthesize the results of pharmaceutical interventions in Brazil was based on SUPPORT methodology items to prepare evidence-based policies. RESULTS: A total of 1442 studies were identified, 18 of which were included. Several interventions are reported in the literature, educational interventions being frequently cited. However, there is a need for further studies with more methodological rigor. The number of pharmacists working in the CAPS is insufficient to cover all the services, since only 26.5% of CAPS employ pharmacists, who work an average of 29 (±11.1) hours a week. Three options were formulated to implement interventions in the Brazilian context that consider including pharmacists on the basic team of CAPS professionals and educational interventions through pharmacist training. CONCLUSIONS: The present study could support the establishment of health policies, based on a synthesis of the evidence, contextualization of the current situation, given the absence of local evidence, and a discussion of the options available to implement pharmaceutical interventions in the Brazilian health system. Organizational changes in CAPS are needed to broaden pharmacist participation on the multidisciplinary team.

Avaliação de Serviços de Saúde Mental Brasileiros: satisfação dos usuários e fatores associados / Brazilian Mental Health Services Assessment: user satisfaction and associated factors

Resumo A satisfação dos usuários é um importante critério para avaliar a qualidade dos Centros de Atenção Psicossocial (CAPS). O objetivo foi avaliar a satisfação de usuários dos principais CAPS de uma região de Minas Gerais e seus fatores associados. Foi realizado um estudo transversal em 11 CAPS, os usuários foram entrevistados para aplicação da Escala de Avaliação da Satisfação dos Usuários com os Serviços de Saúde Mental e um formulário semi-estruturado com variáveis sociodemográficas e clínicas. Os usuários estavam satisfeitos com os CAPS, sobretudo quanto à competência dos profissionais, acolhida e ajuda recebida no serviço. Condições físicas e conforto do serviço obtiveram os menores escores na escala de avaliação de satisfação. Verificou-se que quase metade dos usuários não conhecia aspectos básicos de sua terapia medicamentosa, como o nome dos medicamentos em uso, e um terço relatou que já fez uso inadequado destes. Os usuários dos CAPS álcool e drogas ou de serviços de médio porte estavam mais satisfeitos que os dos CAPS saúde mental ou serviços com funcionamento 24h. Os usuários estão satisfeitos com o modelo de atenção praticado nos CAPS, embora detectada a necessidade de melhorias na estrutura física, mecanismos de participação e empoderamento dos usuários.

Abstract Patient satisfaction is an important criterion for assessing the quality of Brazilian mental health services at Psychosocial Care Centers (CAPS - from the Portuguese 'Centro de Atenção Psicossocial'). The aim of this study was to evaluate the satisfaction of users at the main CAPS in a region of Minas Gerais state, Brazil, as well as associated factors. This was a cross-sectional study with 11 CAPS. Patients were interviewed using the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and a semi-structured questionnaire containing sociodemographic and clinical variables. The users were satisfied with the CAPS, particularly in terms of staff competence and the welcome received and care provided. The physical facilities and comfort at the centers obtained the lowest satisfaction scores on the scale. Almost half of the users were unfamiliar with basic aspects of their drug therapy, such as the name of medicines, and one-third reported inappropriate use of medications. Users of midsize CAPS and those providing treatment for alcohol and drug addiction were more satisfied than patients at mental health or 24-hour CAPS. Although this study identified a need for improvement in physical facilities, mechanisms of participation and patient empowerment, the users were satisfied with the CAPS care model.

Prescrições em serviços de saúde mental: aspectos legais e indicadores do uso racional de medicamentos / Prescriptions in mental health services: legal aspects and indicators of rational drug use

OBJETIVOS: Avaliar os aspectos legais e indicadores do uso racional de medicamentos em prescrições emitidas nos serviços de saúde mental. MÉTODOS: Foram avaliadas prescrições de farmácias/unidades de dispensação dos Centros de Atenção Psicossocial eleitos como referência para o atendimento de usuários da saúde mental, localizados na região denominada Médio Paraopeba, Minas Gerais, Brasil. Foi elaborado um formulário semiestruturado para a coleta de dados, que incluiu os indicadores de prescrição da Organização Mundial da Saúde e os critérios de adequação das prescrições em relação aos requisitos exigidos pela Portaria nº 344/1998 da Secretaria de Vigilância em Saúde. RESULTADOS: Foram analisadas 390 prescrições, cujo número médio de medicamentos prescritos em cada uma foi de 2,17. Observou-se que 96,78% dos medicamentos foram prescritos pelo nome genérico e 97,13% deles estavam na lista de medicamentos essenciais dos municípios. Aspectos legais das prescrições foram atendidos para diversos critérios: 99,23% das prescrições apresentaram assinatura do prescritor, 98,97% apresentaram data e 97,69% continham informações mínimas para compreensão do usuário sobre o uso do medicamento. Em nenhum dos serviços as prescrições dispensadas apresentaram registro completo de todos os dados dos pacientes e as informações referentes aos medicamentos dispensados, conforme previsto na legislação. CONCLUSÕES: A maioria das prescrições analisadas apresentou adequação aos requisitos legais da prescrição e níveis satisfatórios nos valores dos indicadores relacionados ao uso racional de medicamentos. No entanto, informações sobre o controle e registro da dispensação dos medicamentos estavam incompletas nos serviços avaliados, apontando deficiências na identificação dos pacientes e rastreabilidade dos medicamentos dispensados.

AIMS: To evaluate the legal aspects and indicators of rational drug use in prescriptions issued by mental health services. METHODS: Prescriptions dispensed by pharmacies of reference of the Psychosocial Care Centers located in the Medio Paraopeba region, Minas Gerais, Brazil, were evaluated. A semi-structured questionnaire was developed for the collection of data, including the World Health Organization prescribing indicators and the criteria for compliance of prescriptions with the Brazilian legislation. RESULTS: A total of 390 prescriptions were analyzed, and the average number of drugs in each prescription was 2.17. It was observed that 96.78% of the drugs were prescribed by their generic names and that 97.13% were on the essential medicines list of municipalities. Legal aspects of the prescriptions were met for several criteria: 99.23% of the prescriptions had the prescriber's signature, 98.97% showed the date of issue, and 97.69% contained minimum information for the user regarding the use of the medications. None of the assessed health centers issued prescriptions with all the necessary patient data and with information about the dispensed medications, as required by law. CONCLUSIONS: The study indicated that most of the prescriptions analyzed complied with the legal requirements and that the indicators of rational medication use were satisfactory. However, information on dispensing control and records of users was incomplete, demonstrating problems with patient identification and with the traceability of dispensed medicines.

[Pharmaceutical Assistance in Mental Health: a diagnosis of Psychosocial Care Centers]. / Assistência Farmacêutica na Saúde Mental: um diagnóstico dos Centros de Atenção Psicossocial.

The study evaluated the conditions of Pharmaceutical Assistance (PA) in Psychosocial Care Centers (CAPS) through a cross-sectional study in 15 CAPS located in the Médio Paraopeba region of the State of Minas Gerais. Data collection was conducted through direct observation of CAPS and interviews with pharmacists and managers of PA. The instruments were based on indicators proposed by the WHO, technical documents for the organization of PA, from legislation and recommendations seeking pharmaceutical Best Practices. There were 13 dispensing units, nine of them within the CAPS. The services presented updated lists of essential medicines with high availability of the main drugs used in mental health treatment. All of the cities participated in an inter-municipal consortium for the purchase of medicines. The complete identification of drugs was present in only seven services and all had failings in traceability of medicines dispensed. In the CAPS there is only one pharmacist during part of the operating period. The need for greater participation of the pharmacist was observed in the control and standardization of the activities of CAPS and especially in care activities comprising the benchmark team in Mental Health.

Assistência Farmacêutica na Saúde Mental: um diagnóstico dos Centros de Atenção Psicossocial / Pharmaceutical Assistance in Mental Health: a diagnosis of Psychosocial Care Centers

Resumo O estudo avaliou as condições da Assistência Farmacêutica (AF) nos Centros de Atenção Psicossocial (CAPS) por meio de um estudo transversal em 15 CAPS na região do Médio Paraopeba, Minas Gerais. A coleta de dados foi realizada por meio de observação direta dos CAPS e entrevistas com farmacêuticos e gestores da AF. Os instrumentos foram baseados em indicadores propostos pela OMS, documentos técnicos para organização da AF, na legislação e recomendações que visam as Boas Práticas Farmacêuticas. Foram identificadas 13 unidades de dispensação, sendo nove delas internas aos CAPS. Os serviços apresentaram listas de medicamentos essenciais atualizadas e alta disponibilidade dos principais utilizados nos tratamentos da saúde mental. Todas as cidades participavam de um consórcio intermunicipal para aquisição de medicamentos. A identificação completa dos medicamentos estava presente em apenas sete serviços e todos apresentaram falhas na rastreabilidade dos que foram dispensados. Nos CAPS há apenas um profissional farmacêutico em parte do período de funcionamento e foi identificada apenas uma atividade direcionada aos usuários relacionada ao uso de medicamentos em um dos CAPS. Verificou-se a necessidade de maior participação do farmacêutico no controle e padronização das atividades dos CAPS e principalmente nas atividades assistenciais compondo a equipe de referência em Saúde Mental.

Abstract The study evaluated the conditions of Pharmaceutical Assistance (PA) in Psychosocial Care Centers (CAPS) through a cross-sectional study in 15 CAPS located in the Médio Paraopeba region of the State of Minas Gerais. Data collection was conducted through direct observation of CAPS and interviews with pharmacists and managers of PA. The instruments were based on indicators proposed by the WHO, technical documents for the organization of PA, from legislation and recommendations seeking pharmaceutical Best Practices. There were 13 dispensing units, nine of them within the CAPS. The services presented updated lists of essential medicines with high availability of the main drugs used in mental health treatment. All of the cities participated in an inter-municipal consortium for the purchase of medicines. The complete identification of drugs was present in only seven services and all had failings in traceability of medicines dispensed. In the CAPS there is only one pharmacist during part of the operating period. The need for greater participation of the pharmacist was observed in the control and standardization of the activities of CAPS and especially in care activities comprising the benchmark team in Mental Health.

Avaliação da estrutura dos Centros de Atenção Psicossocial da região do Médio Paraopeba, Minas Gerais / Evaluation of Psychosocial Care Centers' structure in the region of Médio Paraopeba, Minas Gerais, Brazil / Evaluación de la estructura de los Centros de Atención Psicosocial de la región Médio Paraopeba, Minas Gerais, Brasil

Objetivo: avaliar as instalações físicas, recursos humanos e atividades desenvolvidas nos Centros de Atenção Psicossocial (CAPS) da região do Médio Paraopeba, Minas Gerais, Brasil, em 2014. Métodos: estudo de avaliação sobre aspectos das dimensões de estrutura e processo propostos por Donabedian, baseado nas recomendações do Ministério da Saúde e legislação vigente, por meio de formulários semiestruturados para entrevista com gestores e observação direta nos CAPS. Resultados: em 12 dos 14 CAPS estudados, foram encontradas todas as estruturas físicas mínimas recomendadas, equipe de profissionais completa e em número superior ao estipulado pela legislação; a utilização de espaços comunitários, comunicação e troca de informações com os demais pontos da rede de atenção era deficiente em grande parte dos serviços. Conclusão: embora houvesse adequação na maioria dos aspectos, observaram-se deficiências; a definição de critérios e a atualização de legislações são necessárias para melhoria dos serviços e atendimento da proposta de trabalho em rede.

Objective: to evaluate the physical facilities, human resources and activities developed in the Psychosocial Care Centers (CAPS) in the region of Médio Paraopeba, Minas Gerais, Brazil, in 2014. Methods: this is an evaluation study of the dimensions of structure and processes proposed by Donabedian, based on recommendations of the Ministry of Health and current laws; semi-structured forms were used to interview health managers; direct observation of mental health services was performed. Results: in 12 of the 14 CAPS studied, it was found the minimum recommended of physical facilities and full professional staff and in greater number than established by law; the use of community spaces, communication and exchange of information with other units of health care network was deficient in most of the centers. Conclusion: although most of the aspects were suitable, some deficiencies were observed; criteria definition and legislation updates are necessary to improve health services and to accomplish the proposal of network service.

Objetivos: evaluar las instalaciones físicas, los recursos humanos y las actividades desarrolladas en los Centros de Atención Psicosocial (CAPS) en la región Médio Paraopeba, Minas Gerais, Brasil, en 2014. Métodos: estudio descriptivo que evaluó aspectos de las dimensiones de estructura y procesos propuestas por Donabedian, basadas en recomendaciones del Ministerio de Salud y las leyes existentes a través de un cuestionario semi-estructurado para entrevistar los gerentes y la observación directa de CAPS. Resultados: en 12 de los 14 CAPS incluidos en el estudio se encontraron todas las estructuras físicas mínimas recomendadas, y personal profesional completo en mayor número de lo que la ley estipula; el uso de los espacios comunitarios, la comunicación y el intercambio de información con otros puntos de la red de atención es deficiente en la mayoría de los servicios. Conclusión: aun cuando existía una adecuación en la mayoría de los aspectos evaluados, observamos deficiencias; la definición de criterios y actualización de legislaciones son necesarias para mejorar los servicios y atención de la propuesta de trabajo en la red.

[Evaluation of Psychosocial Care Centers' structure in the region of Médio Paraopeba, Minas Gerais, Brazil]. / Avaliação da estrutura dos Centros de Atenção Psicossocial da região do Médio Paraopeba, Minas Gerais.

OBJECTIVE: to evaluate the physical facilities, human resources and activities developed in the Psychosocial Care Centers (CAPS) in the region of Médio Paraopeba, Minas Gerais, Brazil, in 2014. METHODS: this is an evaluation study of the dimensions of structure and processes proposed by Donabedian, based on recommendations of the Ministry of Health and current laws; semi-structured forms were used to interview health managers; direct observation of mental health services was performed. RESULTS: in 12 of the 14 CAPS studied, it was found the minimum recommended of physical facilities and full professional staff and in greater number than established by law; the use of community spaces, communication and exchange of information with other units of health care network was deficient in most of the centers. CONCLUSION: although most of the aspects were suitable, some deficiencies were observed; criteria definition and legislation updates are necessary to improve health services and to accomplish the proposal of network service.