The perspectives of pharmacy student preceptors on a service-learning program in primary health care: A qualitative study.

Background: There are a few studies about preceptorship in primary health care settings, but they didn't assess all possible contributions of this experience, such as preceptor behavioral changes and impact on health services. Objective: This study aimed to analyze the perspective of pharmacy student preceptors on a service-learning program carried out in a primary health care setting. Methods: This was a qualitative descriptive study, with semi-structured interviews and thematic analysis. The themes were defined deductively, according to levels of Kirkpatrick's theory about the impact of educational activities. Results: The preceptors showed positive and negative reactions to the structure of the service-learning program, developed their knowledge, changed behaviors such as collaborative interprofessional practice, and reported improvements in the health units. Conclusions: From the perspective of pharmacy student preceptor preceptors, the service-learning program had an impact on all levels expected for an educational activity according to Kirkpatrick's theory: reaction, learning, behavior, and results. These findings may inform the design of service-learning programs.

[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.

Free access to medicines among older adults in primary care: a cross-sectional study.

BACKGROUND: Access to medicines is an important indicator of healthcare system quality and capacity to resolve problems. The healthcare system needs to ensure free access to medicines for elderly people, in order to provide greater effectiveness of disease control, thus reducing morbidity and mortality, and improving health and quality of life. OBJECTIVES: To analyze the frequency of free access to medication among older adults within primary care and determine the factors associated with free access. DESIGN AND SETTING: Cross-sectional study at two primary care units. METHODS: Free access was defined as provision of all medicines through pharmacies within the Brazilian National Health System and through the Brazilian program for free medicines in private pharmacies. We investigated the sociodemographic, clinical, functional and pharmacotherapeutic characteristics of older adults. Multivariate logistic regression was performed to identify factors associated with free access to medicines. RESULTS: This study included 227 older adults, among whom 91 (40.1%) had free full access to prescription drugs. A direct association with age ≤ 70 years and indirect associations with polypharmacy and multimorbidity (P < 0.05) were found. CONCLUSIONS: Age ≤ 70 years increases the likelihood of having free full access to medicines, and older adults with multimorbidity and polypharmacy use have a lower likelihood of access. Identification of factors associated with free access to medicines among elderly people provides elements to guide the Brazilian National Health System in implementing access improvement actions.

Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria.

BACKGROUND: Potentially inappropriate medications (PIM) for the older adults are those with an unfavorable risk-benefit ratio when more effective and safe therapeutic alternatives are available and is an important public health problem. PURPOSE: To analyze the factors associated with the use of PIM by the older adults and to investigate the agreement of PIM use frequency using the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - 2015 AGS Beers Criteria, the Brazilian consensus on potentially inappropriate medication for older adults (BCPIM) and the European union list of potentially inappropriate medications - EU (7)-PIM List. METHODS: This is a cross-sectional study conducted in two primary health care centers in southeastern Brazil. The 2015 AGS Beers Criteria, BCPIM, and EU (7)-PIM List were used for the classification of PIM. The association between PIM use and independent variables was assessed by multiple logistic regression. The level of agreement of PIM use among the three criteria was measured with the Cohen's kappa coefficient. RESULTS: A total of 227 patients ≥60 years of age were included in the study. The frequency of PIM use was 53.7% for 2015 AGS Beers, 55.9% for BCPIM and 63.4% for the EU (7)-PIM List. The agreement between 2015 AGS Beers and BCPIM and between this and the EU (7)-PIM List was high, and moderate between the 2015 AGS Beers and the EU (7)-PIM List. Logistic regression showed association of PIM use with polypharmacy, self-reported neuropsychiatric and musculoskeletal diseases, age ≤70 years, preserved cognition and positive self-perception of health. CONCLUSION: The frequency of PIM use by the older adults of health centers investigated is high. Strategies for improving the pharmacotherapy of the older adults in primary health care should be implemented.

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.

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.

[Out-of-pocket drug expenditures by retirees and pensioners 60 years and older in Belo Horizonte, Minas Gerais, Brazil]. / Composição dos gastos privados com medicamentos utilizados por aposentados e pensionistas com idade igual ou superior a 60 anos em Belo Horizonte, Minas Gerais, Brasil.

The aim of this study was to analyze the structure of private drug expenditures by individuals 60 years and older in Belo Horizonte, Minas Gerais, Brazil. The study population consisted of a representative sample of retirees under the National Social Security Institute (INSS) in the city of Belo Horizonte, interviewed through a household survey. Monthly out-of-pocket drug expenditures were calculated, and a drug cost structure analysis was performed according to drug characteristics. 667 elders answered the survey. Mean drug expenditures per month were US$ 38.91. The therapeutic groups representing the majority of drug expenditures were: cardiovascular system (26%), nervous system (24%), and digestive/metabolic system (15%). Considering drug registration categories, brand-name drugs accounted for the majority of expenditures (54%). The results of this study can support policies to improve both access to medicines and overall health conditions for the Brazilian elderly population.

[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.

[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.

Prescribing indicators in primary health care in Belo Horizonte, Brazil: associated factors.

Background The prescription is one of the factors that influences rational use of medicines. The evaluation of prescribing indicators should contribute to organization of primary health care services. Objective The aim of this study was to evaluate prescribing indicators and associated factors in primary health care in the northeast health district, Belo Horizonte, Brazil. Setting Twenty primary health care units in the Northeast Health District, Belo Horizonte, Brazil. Method The study was cross sectional. Indicators proposed by World Health Organization were used to evaluate rational use of medicines. Main outcome measure Indicators evaluated were average number of medicines per prescription, proportion of medicines with antibiotic, injectable, medicines prescribed by generic name and medicines present in the essential medicines list. Results Three hundred and ninety-nine patients were interviewed. The average number of medicines per prescription was 3.5 (SD 2.2). The proportion of medicines with antibiotic, injectable, medicines prescribed by generic name and medicines present in the essential medicines list was 17.8, 9.8, 94.9, 91.4%, respectively. Patient age ≥60 years was positively associated with number of medicines per prescription (P = 0.00). Conclusion In the northeast health district of Belo Horizonte, the proportion of prescriptions of antibiotics and injections, the adoption of prescribing by generic name and the prescribing of essential medicines were satisfactory in this study considering reference values for these indicators and international scientific literature. However, the mean number of prescribed medicines requires a more in-depth evaluation.

Perceptions of Pharmacy students about their competences for professional practice in community pharmacy

Abstract Pharmaceutical education should enable the development of competences for community pharmacy practice, which is an important field for the pharmacist workforce. The aim of this study was to evaluate the competences perceived by pharmacy interns from a Brazilian pharmacy school for community pharmacy practice. This study adopted a combined quantitative and qualitative approach. The study cohort included undergraduate students who undertook internships in community pharmacy in the final year of the pharmacy course. Students responded to an 11-item structured questionnaire according to a five-point Likert scale that included perceptions of their competences for community pharmacy practice. Among the 693 possible answers, 605 (87.3%) agreed that the course promoted the development of competences for professional practice in community pharmacy. Less than 70% of students perceived themselves as prepared to respond to symptoms and provide non-prescription medicines. Qualitative analysis of the comments revealed three themes: the need to improve patient information skills, improve practice as a member of a health care team, and improve dispensing according to legal requirements. These findings may support improvements in undergraduate pharmacy programs, such as the inclusion of experiential learning, active learning methods, interprofessional education, and development of clinical skills.

Potentially inappropriate medication use in a comprehensive therapy management service: clinical outcomes and interventions

Abstract This study aimed to describe potentially inappropriate medication (PIM) use according to the Beers criteria among older adults followed in a comprehensive medication management (CMM) service, the pharmacists´ interventions, and the clinical outcomes of PIM use. All older adults in a CMM service delivered in the Brazilian public primary care system were included in the study (n = 389). Two methodological approaches were developed: (I) cross-sectional - prevalence of PIM use and associated factors were identified (univariate analysis - Pearson's chi-square; multivariate - logistic regression); (II) documental analysis of the negative clinical outcomes potentially associated with PIM use and pharmacists' interventions. The prevalence of PIM use was 48.3%, and it was independently and positively associated with the use of ≥ 5 drugs. For 21.3% of PIMs, a potential negative clinical outcome was identified. The most common negative clinical outcome was hypotension (35.1% of the negative outcomes), fractures or diagnosis of osteoporosis (21.1%), and hypoglycemia (14.0%). For most of them (78.9%), an intervention was performed to mitigate harm or discontinue use. A high prevalence of PIM was detected and was associated with polypharmacy. A significant proportion of PIM showed potential negative clinical outcomes that were identified by clinical pharmacists, and the majority of pharmacists' interventions aimed at its mitigation or deprescription. Overall, our findings reinforce the potential of CMM services for reducing PIM use and the occurrence of negative outcomes.

Quality of life and associated characteristics: application of WHOQOL-BREF in the context of Primary Health Care. / Qualidade de vida e características associadas: aplicação do WHOQOL-BREF no contexto da Atenção Primária à Saúde.

This study aimed to identify the characteristics associated to quality of life (QOL) in users of four Basic Health Units (Unidades Básicas de Saúde, UBS) in Belo Horizonte, Minas Gerais. We conducted a cross-sectional study with 930 adult users enrolled in the selected UBS, using a questionnaire containing the WHOQOL-bref instrument and questions about sociodemographic characteristics, lifestyle and health conditions. Following descriptive analysis, we performed simple and multiple linear regression to evaluate the association between the exposure variables and the QOL domains. The highest mean values of QOL were observed in the social relationships domain. The lowest means were observed in the environment domain, with a statistically significant difference between some of the UBS. The worst perceptions of QOL were related to worse health, housing, education and income conditions, as well as problems in social relationships and psychological conditions. Actions are needed to improve QOL in Primary Health Care users through actions promoted by both health professionals and public managers.

Indicators related to the rational use of medicines and its associated factors.

OBJECTIVE: To evaluate indicators related to the rational use of medicines and its associated factors in Basic Health Units. METHOD: This is a cross-sectional study carried out in a representative sample of Brazilian cities included in the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). The data were collected by interviews with users, medicine dispensing professionals, and prescribers; and described by prescription, dispensing, and health services indicators. We analyzed the association between human resources characteristics of pharmaceutical services and dispensing indicators. RESULTS: At national level, the average number of medicines prescribed was 2.4. Among the users, 5.8% had antibiotic prescription, 74.8% received guidance on how to use the medicines at the pharmacy and, for 45.1% of users, all prescribed medicines were from the national list of essential medicines. All the indicators presented statistically significant differences between the regions of Brazil. The dispensing professionals that reported the presence of a pharmacist in the unit with a working load of 40 hours or more per week presented 1.82 more chance of transmitting information on the way of using the medicines in the dispensing process. CONCLUSION: The analysis of prescription, dispensing, and health services indicators in the basic health units showed an unsatisfactory proportion of essential medicines prescription and limitations in the correct identification of the medicine, orientation to the patients on medicines, and availability of therapeutic protocols in the health services.

An evaluation of elderly people's understanding of pharmacotherapy among those treated in the Primary Healthcare System in Belo Horizonte, Brazil. / Avaliação da compreensão da farmacoterapia entre idosos atendidos na Atenção Primária à Saúde de Belo Horizonte, MG, Brasil.

There are a greater number of elderly people with diseases which has led to a greater use in medication and complexity in pharmacotherapy. The aim of this study was to understand the level of understanding on pharmacotherapy amongst the elderly and associated factors. An analytical transversal study was carried out in the Primary Health Care Units. Sociodemographic, clinical, and functional characteristics relative to the use of medication were explored. The level of understanding was obtained after a concordance analysis had been done based on the responses from the interviewees and the information on the medical prescriptions such as: name of medication, dosage, frequency, indication, precautions and side effects. The global level of understanding was classified as insufficient in cases where the discordance was ≥ 30%. Of the 227 elderly people interviewed, 51.1% showed an insufficient understanding in relation to their medication. We carried out multivariate logistic regression to observe the factors associated with an understanding of pharmacotherapy. We noted that those with a low level of education and a dependency on the use of medication showed insufficient understanding. (p < 0,05). It is necessary to implement strategies to increase the quality of the guidance given to the elderly and to ensure compliance.

Analysis of Lip Print in University Students from Vale do Jequitinhonha / Análise da Impressão dos Lábios em Universitários do Vale do Jequitinhonha

Cheiloscopy is the analysis of the lip prints, grooves, thicknesses, angles, and other structures of the lips that differentiate each individual in a similar way to biometrics. This study aimed to observe these lips characteristics and to verify if there is a labial pattern among the students of the UFVJM Dentistry course of that distinguishes them in genders. Fifty students were selected, photographed, and had their samples collected by printing their lips on transparent tape with wine 01 lipstick, evenly distributed with the aid of a flexible rod and attached on white paperboard and later classified for obtaining the data required for statistical analysis. When analyzing lip thickness, it was found that most of the students had thick lips - 78%, whereas regarding the position of the labial commissure, 50% of the students presented horizontal disposition. Through the classification system of Suzuki and Tsuchihashi the types of furrows were classified, type II being the most common in this research. Despite the evidence that, among the volunteering students , female lips are thinner than male lips, there were no statistically significant differences between men and women. However, there is a need for more studies that seek to validate and disseminate this technique in a standardized way so that it is a complementary tool in Forensic Dentistry. (AU)

Queiloscopia é a análise das impressões labiais, sulcos, espessuras, ângulos e demais estruturas dos lábios, que diferenciam cada indivíduo de forma similar à biometria. Este estudo teve como objetivo observar as características labiais e verificar se existe um padrão labial entre os estudantes matriculados no curso de Odontologia da UFVJM que os distingue em gênero. Para isto, cinquenta alunos foram selecionados, fotografados e tiveram deus dados coletados por meio da impressão labial em fita adesiva transparente com batom vinho 01, distribuído uniformemente com o auxílio de uma haste flexível e anexada em cartolina branca e, posteriormente, classificadas para obtenção dos dados necessários à análise estatística. Ao analisar a espessura labial, constatou-se que a maioria dos estudantes possuíam lábios grossos - 78%, já em relação a posição da comissura labial 50% dos alunos apresentaram disposição horizontal. Através do sistema de classificação de Suzuki e Tsuchihashi foram classificados os tipos de sulcos, sendo o tipo II o mais comum entre os sujeitos da pesquisa. Apesar da comprovação de que, entre os estudantes voluntários, os lábios femininos possuem menor espessura que os masculinos, não existindo diferenças estatisticamente significantes entre homens e mulheres. Contudo, existe a necessidade de mais estudos que busquem validar e difundir esta técnica de forma padronizada para que seja uma ferramenta complementar na Odontologia Forense. (AU)

Qualidade de vida, ansiedade e depressão após um programa de cessação de tabagismo / Quality of life, anxiety and depression after a smoking cessation program

O objetivo deste trabalho é descrever a qualidade de vida, ansiedade e depressão de usuários pré e pós exposição a um programa de cessação do tabagismo em duas unidades básicas de saúde do município de Belo Horizonte (MG). Trata-se de um estudo de coorte prospectivo, em que 76 usuários foram entrevistados antes e após a participação no programa por meio de questionários, em que foi empregada a escala Hospital Anxiety and Depression Scale para avaliar níveis de ansiedade e depressão, a escala WHOQOL-bref para verificar qualidade de vida, além de itens relativos ao uso de tabaco. A proporção de cessação do tabagismo ao fim do programa foi de 85,5%. Observou-se aumento significativo no escore da qualidade de vida geral (p = 0,041) e diminuição nos níveis de depressão (p ˂ 0,001). Desse modo, após a participação no programa, observou-se melhoria na qualidade de vida e no nível de depressão dos pacientes.

Objective to describe quality of life, anxiety and depression in patients before and after participating in a smoking cessation program in two Basic Health Units in the municipality of Belo Horizonte, State of Minas Gerais. This was a prospective cohort study, in which 76 patients were interviewed before and after participating in the program, through questionnaires with items about anxiety and depression measured through Hospital Anxiety and Depression Scale, and about quality of life evaluated by the WHOQOL-bref scale and abouttobacco use. The proportion of smoking cessation after the program was 85.5%. There was a significant increase in score for overall quality of life (p=0.041) and a decrease in depression levels (p˂0.001). After the program, there was an improvement in patients' quality of life and depression levels.

[Community health workers' knowledge on tuberculosis, control measures, and directly observed therapy]. / Conhecimento dos agentes comunitários de saúde sobre a tuberculose, suas medidas de controle e tratamento diretamente observado.

This study assessed community health workers' (CHW) knowledge on tuberculosis (TB), TB control measures, and directly observed therapy (DOT) in Belo Horizonte, Minas Gerais State, Brazil. This was a cross-sectional study that applied a questionnaire in a random and representative sample of 489 CHW. The overall proportion of correct answers was 74.6%. The mean proportions of correct answers in the domains for TB, TB control measures, and DOT were 81%, 84.1%, and 59.4%, respectively. The study showed knowledge gaps in the identification of patients with pulmonary TB, the target public for DOT, and adequate technique for treatment supervision. Better knowledge was associated with time working as a CHW (OR = 2.3) and follow-up of cases in the 12 months prior to the interview (OR = 1.7). The study provided new scientific data on level of knowledge among CHW concerning DOT and can support strategies to improve TB control activities.

Free access to medicines among older adults in primary care: a cross-sectional study

ABSTRACT BACKGROUND: Access to medicines is an important indicator of healthcare system quality and capacity to resolve problems. The healthcare system needs to ensure free access to medicines for elderly people, in order to provide greater effectiveness of disease control, thus reducing morbidity and mortality, and improving health and quality of life. OBJECTIVES: To analyze the frequency of free access to medication among older adults within primary care and determine the factors associated with free access. DESIGN AND SETTING: Cross-sectional study at two primary care units. METHODS: Free access was defined as provision of all medicines through pharmacies within the Brazilian National Health System and through the Brazilian program for free medicines in private pharmacies. We investigated the sociodemographic, clinical, functional and pharmacotherapeutic characteristics of older adults. Multivariate logistic regression was performed to identify factors associated with free access to medicines. RESULTS: This study included 227 older adults, among whom 91 (40.1%) had free full access to prescription drugs. A direct association with age ≤ 70 years and indirect associations with polypharmacy and multimorbidity (P < 0.05) were found. CONCLUSIONS: Age ≤ 70 years increases the likelihood of having free full access to medicines, and older adults with multimorbidity and polypharmacy use have a lower likelihood of access. Identification of factors associated with free access to medicines among elderly people provides elements to guide the Brazilian National Health System in implementing access improvement actions.

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.