Herbal medicines from the industry in the unified health system: challenge faced by medical professionals

Abstract The World Health Organization recognized the use of herbal medicines as a therapeutic resource and its application in the primary attention to heath. The begin of this expansion was in 2006, with the National Policy on Integrative and Complementary practices of the Unified Health System (SUS). This research aimed to evaluate the questionnaires applied to doctors, who may have prescribed industrialized herbal medicines and to identify the difficulties involved with the implementation of this therapy as an integrative and complementary practice. It is a quantitative, observational and transversal study conducted in the municipality of Pinhais/Brazil. The questionnaire applied had as themes the experience of personal use of industrialized herbal medicines, improvement after their use. Forty-four individuals from four different nationalities: Brazilian (88.64%), Cuban (6.82%), Mexican (2.27%) and Argentinian (2.27%), ages between 25 and 69 years, mainly male sex (54.55%) answered the questionnaire. According to the study, the doctors consider herbal medicines an alternative to the conventional treatment and these medical professionals have already prescribed some industrialized herbal medications. Despite the difficulties faced by medical doctors with the prescription of herbs, it is possible to define strategies to assist these professionals, such as the incentive the actions by the governments.

Legal demands of the tiotropium bromide for treatment of chronic obstructive pulmonary disease and their financial impact for the State of Paraná, Brazil / Demandas judiciais do uso de brometo tiotrópio para o tratamento da doença pulmonar obstrutiva crônica e o impacto financeiro para o Estado do Paraná, Brasil

ABSTRACT Objective To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. Methods We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. Results Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. Conclusion Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.

RESUMO Objetivo Analisar as demandas judiciais do brometo de tiotrópio para tratar a doença pulmonar obstrutiva crônica. Métodos Foram considerados dados secundários dos sistemas gerenciais de assistência farmacêutica, disponibilizados pelo Centro de Medicamentos do Paraná. Resultados Ações civis públicas e ações ordinárias, de procedimento comum, entre outras, foram as mais praticadas pelos pacientes para obter o medicamento. Duas Regionais de Saúde do Paraná (Londrina e Umuarama) concentraram mais de 50% das ações. Quanto à especialidade dos médicos prescritores, 33,8% eram pneumologistas. Verificou-se discreto impacto financeiro do brometo de tiotrópio nos gastos gerais com medicamentos pelo Centro de Medicamentos do Paraná. Entretanto, também houve relevante impacto financeiro individual, pois uma unidade do medicamento consome 38% do salário mínimo. Conclusão O estudo aponta para a necessidade de incorporação deste medicamento da classe broncodilatadores anticolinérgicos de longa duração, no Sistema Único de Saúde.

Use of industrialized herbal medicines by patients attended at the basic health units in the County of Pinhais, Paraná, Brazil / Uso de medicamentos fitoterápicos industrializados por pacientes atendidos en unidades básicas de salud en el municipio de Pinhais, Paraná, Brasil

The present article studied the use of industrialized phytotherapies by patients attended at the basic health units in Pinhais county, located in the metropolitan region of Curitiba, Paraná, Brazil. This is a quantitative, observational and cross-sectional study that was conducted by semi-structured questionnaire interviews that were used as a data collection instrument. The population sample consisted of 267 patients from basic health care organizations. Regardless of gender or age, 56.2% of the interviewed participants reported using industrialized herbal medicines, of which 21.3% acquired their drugs from drugstores from around the county. Patients reported positive results using industrialized herbal medicines (89.33%), of whom women were predominant, making up (80%) (p<0.05). Among the drugs used by all the patients, "guaco" syrup was the most frequent (34%). The present study demonstrates the good acceptance by patients of treatments that involve integrative practices, such as herbal medicine, but when a drug has a vegetal origin, the idea that these products do not cause adverse effects persists.

El presente articulo se estudio el uso de hierbas medicinales procesadas por pacientes tratados en unidades básicas de salud del município de Pinhais, en la región metropolitana de Curitiba, Paraná, Brasil. Se trata de un estudio cuantitativo, observacional y transversal, realizado por medio de entrevistas que utilizan como instrumento de recolección de datos un cuestionario semi-estructurado. La población de la muestra consistió en 267 pacientes de atención básica a la salud. Independiente del sexo o de la edad, 56.2% de los entrevistados relató hacer uso de fitoterápicos industrializados, siendo que de los 21.3% hizo la adquisición en las farmacias de las unidades de salud del municipio. Los pacientes reportaron resultados positivos con el tratamiento realizado con fitoterápicos industrializados (89.33%). Entre ellos predominan las mujeres (80%) (p<0.05). Entre los medicamentos citados por los pacientes, el jarabe de guaco se mostró el más frecuente (34%). El presente estudio demuestra la buena aceptación por parte de los pacientes en realizar tratamientos que implican prácticas integrativas como la fitoterapia, pero, por poseer origen vegetal, todavía existe la idea de que estos productos no tienen la capacidad de causar efectos adversos.