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1.
BMC Public Health ; 20(1): 24, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914972

RESUMO

BACKGROUND: Increasing medicines availability and affordability is a key goal of Brazilian health policies. "Farmácia Popular" (FP) Program is one of the government's key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability. METHODS: Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012). RESULTS: FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$ = reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget. CONCLUSIONS: FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS.

2.
Health Policy Plan ; 34(Supplement_3): iii27-iii35, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31816070

RESUMO

This article aims to describe the inappropriate use of medicines in the Brazilian urban population and to identify associated factors. We conducted a data analysis of a household survey carried out in Brazil in 2013-14. The sampling plan was done by clusters with representativeness of the urban population and large regions of the country, according to gender and age domains. For this analysis, we considered a sample of adults (≥20 years) who reported having chronic non-communicable diseases, medical indication for drug treatment and medicine use (n = 12 283). We evaluated the prevalence of inappropriate use in the domains: non-adherence, inappropriate use behaviour and inadequate care with medicines, all verified in the following groups of independent variables: demographic and socio-economic characteristics, health and pharmaceutical care, health status and use of medicines. Crude and adjusted prevalence ratios were obtained using robust Poisson regression. It was found 46.1% of people having at least one behaviour of inappropriate use of medicines. The worst results were found for the domain of inappropriate use behaviour, a situation of 36.6% of the users, which included unauthorized prescriber, inadequate source of information and indication of the medicines by non-authorized prescribers. The best result was found for the lack of medicines care, informed by only 4.6% of users who kept expired drugs at home. The inappropriate use of medicines was associated with gender (female), region of residence (Northeast), not visiting the doctor regularly or visiting more than one doctor, not having free access to medicines and using of five or more medicines. There was a high prevalence of inappropriate use, which was associated with both individual and health system characteristics pointing out the need to set priorities as for health education and public interventions.

3.
Rev Saude Publica ; 53: 94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644724

RESUMO

OBJECTIVE: To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS: This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS: Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS: Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.


Assuntos
Anti-Hipertensivos/uso terapêutico , Comércio/tendências , Serviços Comunitários de Farmácia/tendências , Medicamentos Genéricos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Programas Nacionais de Saúde/tendências , Brasil , Comércio/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Diabetes Mellitus/tratamento farmacológico , Política de Saúde , Humanos , Hipertensão/tratamento farmacológico , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Programas Nacionais de Saúde/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmácias/tendências , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Estudos Retrospectivos , Fatores de Tempo
4.
Cien Saude Colet ; 24(3): 1007-1020, 2019 Mar.
Artigo em Português | MEDLINE | ID: mdl-30892521

RESUMO

This study sought to evaluate the associations between health conditions and sociodemographic characteristics in relation to quality of life (QoL) in the Brazilian population; as well as to assess the main factors associated with higher chances of a better QoL among diabetics. This is a study with data from a population-based survey conducted in Brazil in 2008. A total of 12,423 Brazilians aged ≥ 20 years were analyzed, of which 935 were diabetic. QoL outcomes were measured using the summary components of the SF-36 instrument. QoL scores were classified as "above" and "below average" to obtain binary outcomes both for the general population and diabetics. Logistic regressions were performed to obtain prevalence ratios adjusted to the odds of above average QoL by adjusting for sociodemographic and health variables. Results indicate that female diabetics aged ≥ 65 years old, with a sedentary lifestyle, belonging to D/E social class and with more morbidities had greater chances of a worse physical and mental QoL. Regarding the general population, in addition to these factors, not having a partner and being illiterate were also responsible for worse QoL. Sedentary lifestyle and D/E social class had greater influence for worse QoL among diabetics when compared to the general population.


Assuntos
Diabetes Mellitus/epidemiologia , Qualidade de Vida , Comportamento Sedentário , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Sexuais , Classe Social , Inquéritos e Questionários , Adulto Jovem
5.
Cien Saude Colet ; 24(3): 1051-1063, 2019 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30892525

RESUMO

The objective was to measure the Quality of Life (QoL) of the patients treated in Primary Health Care in the city of Rio de Janeiro and its own association with CMD, alcohol consumption and socio-demographic aspects. This is a cross-sectional study involving 624 patients in 2012/2013, using: General Health Questionnaire, Hospital Anxiety and Depression Scale, Screening for Somatoform Symptoms, Alcohol Use Disorder Identification Test e World Health Organization Quality of Life Instrument (bref version). There were conducted a bivariate analysis and a multiple linear regressions for each domain of QOL. The QoL score for the domains, physical, psychological, social relationships and environment were: 61,2; 62,6; 66 and 50,9. In multivariate analysis, the QOL was negatively associated to the CMD, especially in the psychological domain (ß = -15,75; p-value = 0,00), and the dependence on physical (ß = -5,38; p-value = 0,05). There was a positive and significant association of the QoL with the risk consumption (ß = 5,77) and the harmful consumption (ß = 6,15) in the environment domain, and with the first in the psychological domain (ß = 7,08). CMD and alcohol dependence are associated with the loss of QOL, but other patterns of consumption, even being harmful are associated with higher QOL.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Transtornos Mentais/epidemiologia , Qualidade de Vida , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Atenção Primária à Saúde , Inquéritos e Questionários
6.
Ciênc. Saúde Colet ; 24(3): 1051-1063, mar. 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-989590

RESUMO

Resumo Objetivou-se mensurar a Qualidade de Vida (QV) de pacientes da Atenção Primária em Saúde do município do Rio de Janeiro e verificar sua associação com Transtornos Mentais Comuns (TMC), uso de álcool e aspectos sociodemográficos. Trata-se de um estudo transversal com 624 pacientes em 2012/2013 e aplicação dos instrumentos: "General Health Questionnaire", "Hospital Anxiety and Depression Scale", "Screening for Somatoform Symptoms", "Alcohol Use Disorder Identification Test" e "World Health Organization Quality of Life Instrument (bref version)". Realizou-se análise bivariada (Teste-t) e regressões lineares múltiplas para cada domínio de QV. Os escores QV para os domínios físico, psicológico, relações sociais e meio-ambiente foram: 61,2; 62,6; 66 e 50,9. Na análise multivariada, a QV associou-se negativamente aos TMC, principalmente no domínio psicológico (β = -15,75; p-valor = 0,00), e a dependência no domínio físico (β = -5,38; p-valor = 0,05). Houve associação positiva e significativa da QV com consumo de risco (β = 5,77) e nocivo (β = 6,15) no domínio meio ambiente, e com o primeiro no domínio psicológico (β = 7,08). TMC e a dependência de álcool estão associados à perda da QV, porém outros padrões de consumo, mesmo sendo nocivos, se associaram a maior QV.


Abstract The objective was to measure the Quality of Life (QoL) of the patients treated in Primary Health Care in the city of Rio de Janeiro and its own association with CMD, alcohol consumption and socio-demographic aspects. This is a cross-sectional study involving 624 patients in 2012/2013, using: General Health Questionnaire, Hospital Anxiety and Depression Scale, Screening for Somatoform Symptoms, Alcohol Use Disorder Identification Test e World Health Organization Quality of Life Instrument (bref version). There were conducted a bivariate analysis and a multiple linear regressions for each domain of QOL. The QoL score for the domains, physical, psychological, social relationships and environment were: 61,2; 62,6; 66 and 50,9. In multivariate analysis, the QOL was negatively associated to the CMD, especially in the psychological domain (β = -15,75; p-value = 0,00), and the dependence on physical (β = -5,38; p-value = 0,05). There was a positive and significant association of the QoL with the risk consumption (β = 5,77) and the harmful consumption (β = 6,15) in the environment domain, and with the first in the psychological domain (β = 7,08). CMD and alcohol dependence are associated with the loss of QOL, but other patterns of consumption, even being harmful are associated with higher QOL.

7.
Ciênc. Saúde Colet ; 24(3): 1007-1020, mar. 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-989594

RESUMO

Resumo Buscou-se avaliar as associações entre condições de saúde e características sociodemográficas em relação à qualidade de vida (QV) na população brasileira; bem como estimar os principais fatores associados às chances de uma melhor QV entre diabéticos. Trata-se de um estudo com dados obtidos do inquérito de base populacional realizado no Brasil, em 2008. Foram analisados 12.423 brasileiros, com idade ≥ 20 anos, cujos 935 eram diabéticos. Os desfechos de QV foram mensurados por meio dos componentes sumários do instrumento SF-36. Tanto para a população geral quanto para diabéticos, a QV teve seus escores agrupados em "acima" e "abaixo da média" para configurar desfechos binários. Foram realizadas regressões logísticas para obtenção das razões de prevalências ajustadas às chances de QV acima da média, controlando por variáveis sociodemográficas e de saúde. Resultados apontaram que as mulheres diabéticas com ≥ 65 anos, sedentárias, pertencentes à classe D/E e com mais morbidades apresentam maiores chances de uma pior QV física e mental. Para a população geral além desses fatores, não ter um companheiro e ser analfabeto proporcionou uma pior QV. O sedentarismo e a classe D/E apresentaram maior influência para pior QV entre diabéticos quando comparado à população total.


Abstract This study sought to evaluate the associations between health conditions and sociodemographic characteristics in relation to quality of life (QoL) in the Brazilian population; as well as to assess the main factors associated with higher chances of a better QoL among diabetics. This is a study with data from a population-based survey conducted in Brazil in 2008. A total of 12,423 Brazilians aged ≥ 20 years were analyzed, of which 935 were diabetic. QoL outcomes were measured using the summary components of the SF-36 instrument. QoL scores were classified as "above" and "below average" to obtain binary outcomes both for the general population and diabetics. Logistic regressions were performed to obtain prevalence ratios adjusted to the odds of above average QoL by adjusting for sociodemographic and health variables. Results indicate that female diabetics aged ≥ 65 years old, with a sedentary lifestyle, belonging to D/E social class and with more morbidities had greater chances of a worse physical and mental QoL. Regarding the general population, in addition to these factors, not having a partner and being illiterate were also responsible for worse QoL. Sedentary lifestyle and D/E social class had greater influence for worse QoL among diabetics when compared to the general population.

8.
Rev. saúde pública (Online) ; 53: 94, jan. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1043318

RESUMO

ABSTRACT OBJECTIVE To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.

9.
Rev. bras. med. fam. comunidade ; 13(40): 1-14, jan.-dez. 2018.
Artigo em Português | LILACS-Express | ID: biblio-969409

RESUMO

Objetivo: Descrever o perfil sociodemográfico dos pacientes atendidos na Estratégia Saúde da Família de quatro capitais brasileiras (Rio de Janeiro, São Paulo, Porto Alegre e Fortaleza) com dor lombar e investigar a associação entre dor lombar e depressão, ansiedade e somatização. Métodos: Estudo de corte transversal com 1857 pacientes atendidos nos anos de 2009 (setembro a novembro) e 2010 (junho a agosto). Instrumentos: rastreio de somatização (SOMS-2), avaliação de ansiedade e depressão (HAD), Questionário Geral do Paciente, para dados sociodemográficos e o Formulário do Profissional Assistente, com as informações referentes as consultas. A dor lombar foi analisada a partir da frequência de três diferentes formas de apresentação: queixa autorreferida pelo paciente, sintoma registrado pelo médico e diagnóstico de lombalgia confirmado pelo médico. Resultados: 77,3% eram mulheres com mais de quatro anos de estudo e renda per capita inferior a um salário mínimo e meio. Encontramos associação significativa de queixa de dor lombar com ansiedade (OR=1,5, 95% IC 1,02-2,16) e somatização (OR=1,8, 95% IC 1,12-2,88), mas não com depressão. Pacientes que apresentavam queixa de dor lombar, porém sem registro do sintoma pelo médico, apresentaram associações ainda mais fortes com ansiedade (OR=1,6, 95% IC 1,03-2,63) e somatização (OR=2,3, 95% IC 1,33-3,99). A confirmação do diagnóstico de dor lombar pelo médico não se associou significativamente com nenhum transtorno. Conclusão: Considerando a dor lombar como uma das queixas de maior prevalência na Atenção Primária e sua associação significativa com ansiedade e somatização, recomenda-se a abordagem da ansiedade e somatização em pacientes com queixa de dor lombar.


Objective: To describe the demographic profile of the patients assisted in the Family Health Strategy of four Brazilian capitals (Rio de Janeiro, São Paulo, Porto Alegre and Fortaleza) with low back pain and investigate the association between low back pain and depression, anxiety and somatization. Methods: Cross-sectional study with 1857 patients served in the years 2009 (September to November) and 2010 (June to August). Instruments: Screening of somatization (SOMS-2), evaluation of anxiety and depression (HAD), General Questionnaire of the Patient, for sociodemographic data and the Form of the Professional Assistant, with the information regarding the consultations. The low back pain was analyzed from the frequency of three different forms of presentation: auto reference complaint by the patient, symptom recorded by the doctor and diagnosis of backache confirmed by the doctor. Results: 77.3% were women with more than four years of study and per capita income less than a minimum wage and a half. We found significant association of low back pain complaints with anxiety (OR=1.5, 95% IC 1,02-2,16) and somatization (OR=1.8, 95% IC 1,12-2,88) but not with depression. Patients who complained of low back pain, but there was no record of the symptom by the doctor, presented even stronger associations with anxiety (OR=1.6, 95% IC 1,03-2,63) and somatization (OR=2.3, 95% IC 1,33-3,99). Confirmation of the diagnosis of low back pain by the doctor has not been associated significantly with any disorder. Conclusion: Considering low back pain as one of the most prevalence complaints in Primary Care and its significant association with anxiety and Somatization, it is recommended to approach anxiety and somatization in patients with a complaint of low back pain.


Objetivo: Describir el perfil demográfico de los pacientes asistidos en la Estrategia Salud de la Familia de cuatro capitales brasileño (Rio de Janeiro, São Paulo, Porto Alegre y Fortaleza) con dolor lumbar e investigar la asociación entre el dolor lumbar y la depresión, ansiedad y somatización. Métodos: Estudio transversal con 1857 pacientes atendidos en los años 2009 (septiembre a noviembre) y 2010 (junio a agosto). Instrumentos: seguimiento de la somatización (SOMS-2), evaluación de la ansiedad y depresión (HAD), Cuestionario General del Paciente, para datos sociodemográficas y el Reporte del Profesional Asistente, con la información relativa a las consultas. El dolor lumbar fue analizado a partir de la frecuencia de tres diversas formas de presentación: queja auto-referida por el paciente, síntoma registrado por el médico y diagnosis del lumbago confirmado por el médico. Resultados: 77,3% fueron mujeres con más de cuatro años de estudio y renta per cápita menos de un salario mínimo y medio. Encontramos la asociación significativa de queja del dolor lumbar con la ansiedad (RM=1,5, el 95% IC 1,02-2,16) y somatización (RM=1,8, el 95% IC 1,12-2,88) pero no con la depresión. Los pacientes que se quejaron de dolor lumbar, pero no había registro del síntoma por el médico, presentaron asociaciones incluso más fuertes con la ansiedad (RM=1,6, el 95% IC 1,03-2,63) y somatización (RM=2,3, el 95% IC 1,33-3,99). La confirmación del diagnóstico de dolor lumbar por el médico no se ha asociado significativamente con ningún trastorno. Conclusión: Considerando el dolor lumbar como una de las quejas prevalentes de la mayoría en la Atención Primaria y su asociación significativa con la ansiedad y la somatización, se recomienda abordar a la ansiedad y a la somatización en pacientes con quejas de dolor lumbar.

10.
Cien Saude Colet ; 23(7): 2339-2350, 2018 Jul.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30020386

RESUMO

The social support network is a health protective factor involving physical, mental and psychological aspects, providing a better quality of life, favoring better adaptation to adverse conditions, promoting resilience and mobilizing resources for a more effective coping with negative life events that can lead to illness. We aimed to analyze the association between physical diseases, common mental disorders and the social support network of patients serviced at primary care facilities in the cities of Rio de Janeiro and São Paulo through a cross-sectional study with 1,466 patients in the 18-65 years age group. We used the Social Network Index (SNI) to assess the support network through the categories of isolation and integration. The doctor/nurse completed the questionnaire to evaluate the physical disease diagnosis, while the Hospital Anxiety and Depression Scale was used to detect mental disorders. We found that the pattern of social support was different depending on the presence of physical diseases or mental disorders. Negative associations were found between diabetes and isolation; integration and anxiety; integration and depression. Positive associations were identified between isolation and anxiety and isolation and depression.


Assuntos
Transtornos Mentais/terapia , Atenção Primária à Saúde , Qualidade de Vida , Apoio Social , Adaptação Psicológica , Adolescente , Adulto , Idoso , Brasil , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Isolamento Social/psicologia , Inquéritos e Questionários , Adulto Jovem
11.
Cien Saude Colet ; 23(7): 2383-2392, 2018 Jul.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30020390

RESUMO

This study aimed to describe and analyze factors associated with emergency care and hospitalization of hypertensive and diabetic patients in the municipality of Rio de Janeiro, especially those related to the use of medicines. This is across-sectional study using secondary database from a household survey that approached hypertensive and diabetic patients. The outcome variables were: 1) seek for emergency careasa resultof complications related to hypertension and diabetes in the 12months preceding the interviews; 2) hospitalizationin the same period andfor the same reasons. Uni and bivariate analysis between exposure variables and each of the outcomes were performed using chi-square test at a significance level of 10%, which originated multivariate logistic regression analysis. Negative self-evaluation of health status was associated with both outcomes in the multivariate analysis. Having stopped taking the medications was associated with hospitalization and having missed a medical appointment in the last six months was associated with search for emergency care.


Assuntos
Diabetes Mellitus/terapia , Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hipertensão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Diabetes Mellitus/fisiopatologia , Autoavaliação Diagnóstica , Serviço Hospitalar de Emergência , Feminino , Nível de Saúde , Humanos , Hipertensão/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inquéritos e Questionários , Adulto Jovem
12.
Ciênc. Saúde Colet ; 23(7): 2383-2392, jul. 2018. tab
Artigo em Português | LILACS-Express | ID: biblio-952682

RESUMO

Resumo Este estudo teve como objetivo descrever e analisar os fatores associados à busca de atendimento de emergência e internação por portadores de hipertensão arterial (HA) e Diabetes Mellitus (DM) no município do Rio de Janeiro, sobretudo aqueles ligados ao uso de medicamentos. Trata-se de estudo transversal utilizando dados de base secundária referentes à abordagem em nível domiciliar em que foram realizadas entrevistas diretamente com portadores de HA/DM. As variáveis de desfecho foram: 1) procura por atendimento de emergência como decorrência de complicações relacionadas à HA/DM nos 12 meses anteriores à entrevista; 2) Internação no mesmo período e pelo mesmo motivo. Foi feita análise uni e bivariada entre as variáveis de exposição e cada um dos desfechos utilizando-se teste qui-quadrado ao nível de significância de 10%, dando origem a modelos de regressão logística multivariada. A autoavaliação negativa do estado de saúde associou-se a ambos desfechos na análise multivariada. Ter deixado de tomar os medicamentos associou-se à internação e ter faltado nos seis meses precedentes à consulta agendada associou-se à busca por emergência.


Abstract This study aimed to describe and analyze factors associated with emergency care and hospitalization of hypertensive and diabetic patients in the municipality of Rio de Janeiro, especially those related to the use of medicines. This is across-sectional study using secondary database from a household survey that approached hypertensive and diabetic patients. The outcome variables were: 1) seek for emergency careasa resultof complications related to hypertension and diabetes in the 12months preceding the interviews; 2) hospitalizationin the same period andfor the same reasons. Uni and bivariate analysis between exposure variables and each of the outcomes were performed using chi-square test at a significance level of 10%, which originated multivariate logistic regression analysis. Negative self-evaluation of health status was associated with both outcomes in the multivariate analysis. Having stopped taking the medications was associated with hospitalization and having missed a medical appointment in the last six months was associated with search for emergency care.

13.
Ciênc. Saúde Colet ; 23(7): 2339-2350, jul. 2018. tab
Artigo em Português | LILACS-Express | ID: biblio-952685

RESUMO

Resumo A rede de apoio é considerada um agente protetor da saúde em seus aspectos físico, mental e psicológico, proporcionando melhor qualidade de vida, favorecendo adaptação à condições adversas, promovendo resiliência e a mobilização de recursos no enfrentamento de eventos de vida negativos que podem levar ao adoecimento. O nosso objetivo foi estudar a relação entre doenças físicas, transtorno mental comum e a rede de apoio social dos pacientes atendidos na Atenção Primária à Saúde no Rio de Janeiro e São Paulo em um estudo de corte transversal com 1466 pacientes entre 18 e 65 anos. Para aferir o tipo de rede de apoio foi utilizado o Índice de Rede Social por meio das categorias: isolamento e integração. Para aferir o diagnóstico de doença física foi utilizado o questionário pelo médico/enfermeiro e para detecção dos transtornos mentais foi utilizado o Hospital Anxiety and Depression Scale. Verificou-se que o padrão da rede de apoio foi diferente entre as doenças físicas e os transtornos mentais. Foram detectadas associações negativas entre diabetes e isolamento; integração e ansiedade; integração e depressão e associações positivas do isolamento com ansiedade e isolamento e depressão.


Abstract The social support network is a health protective factor involving physical, mental and psychological aspects, providing a better quality of life, favoring better adaptation to adverse conditions, promoting resilience and mobilizing resources for a more effective coping with negative life events that can lead to illness. We aimed to analyze the association between physical diseases, common mental disorders and the social support network of patients serviced at primary care facilities in the cities of Rio de Janeiro and São Paulo through a cross-sectional study with 1,466 patients in the 18-65 years age group. We used the Social Network Index (SNI) to assess the support network through the categories of isolation and integration. The doctor/nurse completed the questionnaire to evaluate the physical disease diagnosis, while the Hospital Anxiety and Depression Scale was used to detect mental disorders. We found that the pattern of social support was different depending on the presence of physical diseases or mental disorders. Negative associations were found between diabetes and isolation; integration and anxiety; integration and depression. Positive associations were identified between isolation and anxiety and isolation and depression.

14.
Trab. educ. saúde ; 16(1): 337-360, jan.-abr. 2018. tab
Artigo em Português | LILACS | ID: biblio-904492

RESUMO

Resumo A pesquisa que deu origem a este artigo teve como objetivo analisar a efetividade de um curso sobre envelhecimento na implementação da Política Nacional de Saúde da Pessoa Idosa com base na percepção dos profissionais de saúde egressos. Aplicou-se questionário eletrônico autorrespondido por 414 de 1.561 egressos da primeira à terceira ofertas do curso, de julho a outubro de 2015. A variável-desfecho para medir a efetividade do curso foi a declaração de melhora no desempenho dos profissionais egressos em pelo menos cinco de dez atividades relacionadas à saúde do idoso previstas na referida política. Houve melhora na realização de todas essas atividades, com variação de 1,3 a 2,6 vezes mais quanto ao pré e ao pós-curso. Formação profissional, tempo de trabalho com saúde do idoso e implementação prática do aprendizado obtido no curso foram os aspectos que explicaram de modo mais justo a melhora nas atividades da política (via modelo de regressão logística multivariada). O estudo procurou reforçar a importância da educação permanente como ferramenta para formação/capacitação dos profissionais que atuam no Sistema Único de Saúde, tendo se mostrado uma efetiva estratégia para implementação de atividades da mencionada política destinada à pessoa idosa.


Abstract This article aims to analyse the effectiveness of a course in aging and health of elderly people as part of the implementation of the Brazilian National Elderly Health Policy (PNSPI), from the perception of health professionals egressed from the course. A self-responded electronic questionnaire was applied from July to October 2015, answered by 414 in 1,561 egresses. The outcome variable to measure the course effectiveness was the improvement in the performance of egresses in at least five in ten activities related to health of elderly as provided for in PNSPI. There was improvement in all PNPSI activities varying between 1.3 to 2.6 times pre and post course. Professional background, time working with elderly health and actual implementation of learning from the course were the aspects that explained better the improvement in PNSPI activities (trough logistic regression model). The course proved have been effective for the implementation of PNSPI activities, showing the potential of continuing education to enforce public policies.


Resumen Este artículo tiene como objetivo analizar la efectividad del curso de perfeccionamiento en envejecimiento y salud de la tercera edad para la implementación de la Política Nacional de Salud para la Vejez, teniendo en cuenta la percepción de profesionales egresos. Un cuestionario electrónico de respuesta automática fue implementado de Julio a Octubre 2015, completado por 414 de los 1,561 egresos. La variable para medir el impacto del curso fue la mejora en el desempeño de los egresos en al menos 5 de las 10 actividades recomendadas en la Política Nacional de Salud para la Vejez. Hubo mejora en la realización de todas las actividades, variando de 1.3 a 2.6 veces pre y pos curso. Formación profesional, tiempo de trabajo con salud de majores, y implementación práctica del aprendizaje obtenido en el curso fueron los aspectos que mejor explicaron la mejora en las actividades de la política (por modelo logístico de regresión). El curso se mostró una estrategia efectiva para la implementación de las actividades de la política asi como el potencial de la educación continuada en fortalecer políticas públicas.


Assuntos
Humanos , Saúde do Idoso , Educação a Distância , Educação Continuada
15.
BMJ Open ; 7(11): e017308, 2017 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-29101135

RESUMO

OBJECTIVES: 'Farmácia Popular' (FP) programme was launched in 2004, expanded in 2006 and changed the cost sharing for oral hypoglycaemic (OH) and antihypertensive (AH) medicines in 2009 and in 2011. This paper describes patterns of usage and continuity of coverage for OH and AH medicines following changes in patient cost sharing in the FP. STUDY DESIGN: Interrupted time series study using retrospective administrative data. METHODS: Monthly programme participation (PP) and proportion of days covered (PDC) were the two outcome measures. The open cohort included all patients with two or more dispensings for a given study medicine in 2008-2012. The interventions were an increase in patient cost sharing in 2009 and zero patient cost sharing for key medicines in 2011. RESULTS: A total of 3.6 and 9.5 million patients receiving treatment for diabetes and hypertension, respectively, qualified for the study. Before the interventions, PP was growing by 7.3% per month; median PDC varied by medicine from 50% to 75%. After patient cost sharing increased in 2009, PP reduced by 56.5% and PDC decreased for most medicines (median 60.3%). After the 2011 free medicine programme, PP surged by 121 000 new dispensings per month and PDC increased for all covered medicines (80.7%). CONCLUSION: Cost sharing was found to be a barrier to continuity of treatment in Brazil's private sector FP programme. Making essential medicines free to patients appear to increase participation and continuity of treatment to clinically beneficial levels (PDC >80%).


Assuntos
Anti-Hipertensivos/economia , Custo Compartilhado de Seguro , Custos de Medicamentos/estatística & dados numéricos , Hipoglicemiantes/economia , Adulto , Idoso , Brasil , Diabetes Mellitus/tratamento farmacológico , Medicamentos Essenciais/economia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Análise de Séries Temporais Interrompida , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Cien Saude Colet ; 22(8): 2501-2512, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28793067

RESUMO

This paper aims to analyse changes in the retail pharmaceutical market following policy changes in the Farmácia Popular Program (FP), a medicines subsidy program in Brazil. The retrospective longitudinal analyses focus on therapeutic class of agents acting on the renin-angiotensin system. Data obtained from QuintilesIMS (formerly IMS Health) included private retail pharmacy sales volume (pharmaceutical units) and sales values from 2002 to 2013. Analyses evaluated changes in market share following key FP policy changes. The therapeutic class was selected due to its relevance to hypertension treatment. Market share was analysed by therapeutic sub-classes and by individual company. Losartan as a single product accounted for the highest market share among angiotensin II antagonists. National companies had higher sales volume during the study period, while multinational companies had higher sales value. Changes in pharmaceutical market share coincided with the inclusion of specific products in the list of medicines covered by FP and with increases in or exemption from patient copayment.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Comércio/estatística & dados numéricos , Indústria Farmacêutica/economia , Bloqueadores do Receptor Tipo 1 de Angiotensina II/economia , Anti-Hipertensivos/economia , Anti-Hipertensivos/farmacologia , Brasil , Custo Compartilhado de Seguro/economia , Política de Saúde , Humanos , Hipertensão/tratamento farmacológico , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Losartan/economia , Losartan/uso terapêutico , Sistema Renina-Angiotensina/efeitos dos fármacos , Estudos Retrospectivos
17.
Ciênc. Saúde Colet ; 22(8): 2501-2512, Ago. 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-890425

RESUMO

Abstract This paper aims to analyse changes in the retail pharmaceutical market following policy changes in the Farmácia Popular Program (FP), a medicines subsidy program in Brazil. The retrospective longitudinal analyses focus on therapeutic class of agents acting on the renin-angiotensin system. Data obtained from QuintilesIMS (formerly IMS Health) included private retail pharmacy sales volume (pharmaceutical units) and sales values from 2002 to 2013. Analyses evaluated changes in market share following key FP policy changes. The therapeutic class was selected due to its relevance to hypertension treatment. Market share was analysed by therapeutic sub-classes and by individual company. Losartan as a single product accounted for the highest market share among angiotensin II antagonists. National companies had higher sales volume during the study period, while multinational companies had higher sales value. Changes in pharmaceutical market share coincided with the inclusion of specific products in the list of medicines covered by FP and with increases in or exemption from patient copayment.


Resumo Este artigo visa analisar as mudanças no mercado de varejo farmacêutico, seguindo as alterações de diretiva no Programa Farmácia Popular (FP), que realiza subvenção de medicamentos no Brasil, em parceria pública privada. Foi realizada análise longitudinal retrospectiva dos medicamentos da classe terapêutica dos agentes que atuam sobre o sistema renina-angiotensina. Os dados obtidos do QuintilesIMS incluíram o varejo farmacêutico em termos do volume e valores de vendas de 2002 a 2013. Análises realizadas consideraram intervenções e reformas ocorridas no FP e seu impacto no mercado farmacêutico da classe terapêutica selecionada, devido a sua relevância para o tratamento da hipertensão. Também se examinou o comportamento do mercado tomando por base as empresas farmacêuticas produtoras. Losartan monodroga representou a maior fatia de mercado entre os antagonistas de angiotensina II. Empresas nacionais obtiveram maior volume de vendas durante o período de estudo, enquanto as empresas multinacionais exibiram maior valor de vendas. Mudanças no mercado farmacêutico coincidiram com a inclusão de produtos específicos na lista de medicamentos abrangidos pelo FP e com aumentos ou isenção de copagamento pelos pacientes.

18.
Cien Saude Colet ; 22(7): 2367-2374, 2017 Jul.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28724018

RESUMO

This work discusses the relationship between hypertension, diabetes, anxiety, depression, and social support in primary health care. This research aimed to identify the association between physical disease, mental disease, support network and perceived social support in the research sample. This is a cross-sectional study inserted in a larger research project funded by the Pan American Health Organization and carried out in 2002 in Petrópolis, RJ. The sample consisted of 714 patients with ages ranging from 18 to 65 years old. Results showed association between variables from support network either with evidence of hypertension or diabetes, or with the existence of common mental disorders, but with different patterns. Associations with the perceived support were positive in patients with hypertension and diabetes; Common Mental Disorder patients showed negative associations, inversely associated to the level of mental disease.


Assuntos
Diabetes Mellitus/terapia , Hipertensão/terapia , Transtornos Mentais/terapia , Apoio Social , Adolescente , Adulto , Idoso , Brasil , Estudos Transversais , Diabetes Mellitus/psicologia , Feminino , Humanos , Hipertensão/psicologia , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Atenção Primária à Saúde/métodos , Adulto Jovem
19.
Ciênc. Saúde Colet ; 22(7): 2367-2374, Jul. 2017. tab
Artigo em Português | LILACS-Express | ID: biblio-890395

RESUMO

Resumo Este trabalho discute a relação entre hipertensão, diabetes, ansiedade, depressão e apoio social no contexto da atenção primária. O objetivo desta pesquisa foi detectar, na amostra pesquisada, a associação entre: adoecimento físico, adoecimento psíquico, rede de apoio e apoio social percebido. Este estudo é um corte transversal inserido numa pesquisa maior financiada pela Organização Panamericana da Saúde e realizada no município de Petrópolis (RJ) em 2002. A amostra foi constituída de 714 pacientes com idade entre 18 e 65 anos. Os resultados demonstraram associação entre variáveis da rede de apoio tanto com a presença de hipertensão ou diabetes, como de transtornos mentais comuns, porém com padrões distintos. Enquanto nos pacientes portadores de hipertensão e diabetes, as associações com o apoio percebido foram positivas, naqueles portadores de Transtorno Mental Comum elas foram negativas, associadas de forma invertida ao grau de adoecimento psíquico.


Abstract This work discusses the relationship between hypertension, diabetes, anxiety, depression, and social support in primary health care. This research aimed to identify the association between physical disease, mental disease, support network and perceived social support in the research sample. This is a cross-sectional study inserted in a larger research project funded by the Pan American Health Organization and carried out in 2002 in Petrópolis, RJ. The sample consisted of 714 patients with ages ranging from 18 to 65 years old. Results showed association between variables from support network either with evidence of hypertension or diabetes, or with the existence of common mental disorders, but with different patterns. Associations with the perceived support were positive in patients with hypertension and diabetes; Common Mental Disorder patients showed negative associations, inversely associated to the level of mental disease.

20.
Rev Bras Epidemiol ; 20(1): 16-29, 2017.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28513791

RESUMO

Objective:: To estimate the prevalence of self-reported diabetes mellitus (DM) and its associated factors among the Brazilian adult population. Methods:: The prevalence of DM was assessed in the Survey on Social Dimensions of Inequalities, a national survey with macro-regions representativeness carried out in 2008. Data were collected by a personal face-to-face interview with 12,423 individuals of both sexes, aged over 20 years. The χ2 test at 5.0% was performed in order to identify associated factors, and logistic regression was used to estimate adjusted odds ratios. Results:: The prevalence of DM in Brazil was 7.5%. After adjusting for potential confounders, diabetes remained associated with age (≥ 40 years), education (< 8 years of study), marital status (non-married), obesity, sedentary lifestyle, comorbidity with hypertension and hypercholesterolemia, as well as the demand for health services. Conclusion:: Results indicate a high prevalence of DM and its associated preventable factors in Brazil. Thus, they highlight the need for a behavioral change as a strategy for prevention and control of diabetes and its complications.


Assuntos
Diabetes Mellitus/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Autorrelato , Adulto Jovem
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