Avaliação da judicialização de medicamentos no setor público de saúde do Rio Grande do Sul de 2010 a 2019 / Evaluation of the judicialization of medicines in the public health sector in Rio Grande do Sul State, Brazil, from 2010 to 2019 / Evaluación de la judicialización de drogas en el sector de la salud pública en Rio Grande do Sul, Brasil,de 2010 a 2019

Objetivo: identificar os dez medicamentos mais demandados judicialmente no estado do Rio Grande do Sul (RS) e investigar a evolução dos gastos, de 2010 a 2019, com a judicialização de medicamentos, comparando os dados com a implementação das políticas públicas de medicamentos no Brasil nesse período. Metodologia: trata-se de um estudo descritivo, transversal, retrospectivo, utilizando dados de relatórios do sistema de Administração de Medicamentos da Secretaria Estadual de Saúde do RS e dados públicos do Portal da Transparência do RS. Resultados: destacam-se na lista dos medicamentos mais judicializados o brometo de tiotrópio 2,5 mcg, que apareceu em todos os anos na primeira posição, desde 2011; citalopram 20 mg, venlafaxina 75 mg e duloxetina 60 mg foram os antidepressivos mais demandados, além de sulfato de glicosamina 500 mg em associação com condroitina 400 mg e rivaroxabana 20 mg. Os antineoplásicos foram os responsáveis pelo maior impacto no orçamento do estado. Entre 2010 e 2019, o RS aumentou o gasto em 773,1% com a judicialização de medicamentos. Conclusão: o fenômeno da judicialização de medicamentos no RS demonstrou um crescimento considerável no período em estudo e a adoção de políticas públicas de assistência farmacêutica não demonstrou ter influenciado o acesso a medicamentos por meio da judicialização.

Objective: identify the ten most legally demanded medicines in the State of Rio Grande do Sul, Brazil, and study the evolution of expenditures related to the judicialization of medicines from 2010 to 2019, comparing the data with the implementation of public policies on medicines in Brazil during this period. Methods: this is a descriptive, retrospective, cross-sectional study using data from reports of the Medicines Management System of the Health Office and public data from the Transparency Portal, both from the State of Rio Grande do Sul. Results: tiotropium bromide 2.5 mcg topped the list of most frequently court-ordered medications and has topped this list every year since 2011. Citalopram 20 mg, venlafaxine 75 mg, and duloxetine 60 mg were the most frequently requested antidepressants, as were glucosamine sulfate 500 mg in association with chondroitin 400 mg, and rivaroxaban 20 mg. Antineoplastics were responsible for the largest state budget impact. Between 2010 and 2019, the State of Rio Grande do Sul's expenditures increased by 773.1% due to the judicialization of pharmaceuticals. Conclusion: the phenomenon of judicialization of medicines in the State of Rio Grande do Sul has experienced significant growth during the period studied, and the adoption of public policies of pharmaceutical support does not seem to have affected access to medicines through judicialization.

Objetivo: identificar las diez drogas más demandadas legalmente en el estado de Rio Grande do Sul, Brasil, e investigar la evolución de los gastos, de 2010 a 2019, con la judicialización de las drogas, comparando los datos con la implementación de políticas públicas de drogas en Brasil en este periodo. Metodología: se trata de un estudio descriptivo, transversal, retrospectivo, utilizando datos de informes del sistema de Administración de Medicamentos de la Secretaría de Estado de Salud de Rio Grande do Sul y datos públicos del Portal de Transparencia de Rio Grande do Sul. Resultados: el bromuro de tiotropio 2,5 mcg destaca en la lista de las drogas más judicializadas, que aparece en la primera posición todos los años desde 2011; citalopram 20 mg, venlafaxina 75 mg y duloxetina 60 mg fueron los antidepresivos más demandados, además de sulfato de glucosamina 500 mg en associación con condroitina 400 mg y rivaroxabán 20 mg. Los antineoplásicos fueron los responsables del mayor impacto en el presupuesto estatal. Entre 2010 y 2019, el estado de Rio Grande do Sul aumentó el gasto en un 773,1% con la judicialización de medicamentos. Conclusión: el fenómeno de la judicialización de medicamentos en Rio Grande do Sul mostró un crecimiento considerable en el período de estudio y la adopción de políticas públicas para la asistencia farmacéutica no pareció haber influido en el acceso a los medicamentos a través de la judicialización.

Bleeding associated with self-medication in warfarin users: A prospective observational study in Ijuí (Brazil)

Abstract Warfarin has been associated with bleeding and venous thromboembolism. Objective: This study aimed to estimate the association between bleeding and concomitant self-medication, and the incidence of adverse drug reactions in patients using warfarin. Setting: the public health network of Ijuí, a municipality in southern Brazil. This was an open prospective cohort, conducted for a period of 18 months with users of warfarin, treated at the public health service. The association between bleeding and self-medication was evaluated by means of the Cox Model with left truncation, using the time variable. Main outcome measurement: bleeding reported in the follow-up. Cases of thromboembolism and death were also registered. All patients treated with warfarin in the public health system of the municipality (98) were identified. Sixty-eight were interviewed and followed up, of whom 63 completed follow-up and five died during the study. Bleeding rates of 37.7 /100 patients/year, thromboembolism of 4.8/100 patients / year and deaths of 4.8 /100 patients / year were observed. The results showed that patients, who take warfarin and self-medicated present a two-fold increased bleeding, compared with those who do not self-medicate. The bleeding risk associated with self-medication ranged from 2.001 to 2.685; those values maintained their significance even when adjusted for number of interactions, CYP polymorphism, TTR and age in COX analysis. These results greatly suggest the need for providing greater assistance to patients who take anticoagulant medications with the purpose of reducing self-medication and consequently, adverse reactions.

Polymorphism of the CYP2C9 and VKORC1 genes in patients on the public health system of a municipality in Southern Brazil / Polimorfismo dos genes CYO2C9 e VKORC1 em pacientes do Sistema Público de Saúde em um município do Sul do Brasil

Abstract Background Genetic factors can be responsible for part of the populational and interindividual differences observed in warfarin users. Objectives To identify occurrence of polymorphisms of the CYP2C9 and VKORC1 genes in patients taking warfarin and relate these profiles to their medication dosages and the Time in Therapeutic Range (TTR). Methods Monthly interviews were conducted for data collection. Data were collected on demographic characteristics and medications in use, especially warfarin, including reason for prescription and weekly dose. TTR was calculated as the percentage of days with international normalized ratio (INR) between 2 and 3. The CYP2C9 and VKORC1 genes were analyzed at a Human Genetics Laboratory. Results 49 patients (74.2%) had polymorphisms of the CYP2C9 and/or VKORC1 genes; the remaining 17 (25.8%) did not have these polymorphisms. The average weekly dose of warfarin was lower among those who had a polymorphism for any of the genes compared to those who did not, with a significant difference (p = 0.035). The mean TTR was also lower among patients with polymorphism. However, the difference between the two groups was not significant for this variable (p = 0.438). Conclusions An association was observed between the polymorphisms and the warfarin doses taken by the patients. However, there was no association with adverse events or the time spent within the therapeutic range in this sample.

Resumo Contexto Fatores genéticos podem ser responsáveis por parte das diferenças populacionais e interindividuais observadas em usuários de varfarina. Objetivos Identificar a ocorrência de polimorfismo dos genes CYP2C9 e VKORC1 em pacientes em uso de varfarina e relacionar esses perfis com a dose do medicamento e o tempo no intervalo terapêutico. Métodos Foram realizadas entrevistas mensais para a coleta de dados. Foram reunidos dados sobre características demográficas e medicamentos em uso, principalmente sobre varfarina, como motivo da prescrição e dose semanal. O tempo no intervalo terapêutico foi calculado como a porcentagem de dias com razão normalizada internacional entre os valores 2 e 3. Os genes CYP2C9 e VKORC1 foram analisados em laboratório de Genética Humana. Resultados Entre os participantes, 49 pacientes (74,2%) apresentaram polimorfismo dos genes CYP2C9 e/ou VKORC1; os 17 restantes (25,8%) não apresentaram esses polimorfismos. A dose média semanal de varfarina foi menor entre os que apresentaram polimorfismo para algum dos genes em comparação aos que não apresentaram, com diferença significativa (p = 0,035). O tempo no intervalo terapêutico médio também foi menor entre os pacientes com polimorfismo. Porém, não houve diferença significativa entre os dois grupos para essa variável (p = 0,438). Conclusões Foi observada associação entre os polimorfismos e a dose de varfarina utilizada pelos pacientes; no entanto, não houve associação com eventos adversos e o tempo de permanência na faixa terapêutica nessa amostra.

Polymorphism of the CYP2C9 and VKORC1 genes in patients on the public health system of a municipality in Southern Brazil / Polimorfismo dos genes CYO2C9 e VKORC1 em pacientes do Sistema Público de Saúde em um município do Sul do Brasil

Abstract Background Genetic factors can be responsible for part of the populational and interindividual differences observed in warfarin users. Objectives To identify occurrence of polymorphisms of the CYP2C9 and VKORC1 genes in patients taking warfarin and relate these profiles to their medication dosages and the Time in Therapeutic Range (TTR). Methods Monthly interviews were conducted for data collection. Data were collected on demographic characteristics and medications in use, especially warfarin, including reason for prescription and weekly dose. TTR was calculated as the percentage of days with international normalized ratio (INR) between 2 and 3. The CYP2C9 and VKORC1 genes were analyzed at a Human Genetics Laboratory. Results 49 patients (74.2%) had polymorphisms of the CYP2C9 and/or VKORC1 genes; the remaining 17 (25.8%) did not have these polymorphisms. The average weekly dose of warfarin was lower among those who had a polymorphism for any of the genes compared to those who did not, with a significant difference (p = 0.035). The mean TTR was also lower among patients with polymorphism. However, the difference between the two groups was not significant for this variable (p = 0.438). Conclusions An association was observed between the polymorphisms and the warfarin doses taken by the patients. However, there was no association with adverse events or the time spent within the therapeutic range in this sample.

Resumo Contexto Fatores genéticos podem ser responsáveis por parte das diferenças populacionais e interindividuais observadas em usuários de varfarina. Objetivos Identificar a ocorrência de polimorfismo dos genes CYP2C9 e VKORC1 em pacientes em uso de varfarina e relacionar esses perfis com a dose do medicamento e o tempo no intervalo terapêutico. Métodos Foram realizadas entrevistas mensais para a coleta de dados. Foram reunidos dados sobre características demográficas e medicamentos em uso, principalmente sobre varfarina, como motivo da prescrição e dose semanal. O tempo no intervalo terapêutico foi calculado como a porcentagem de dias com razão normalizada internacional entre os valores 2 e 3. Os genes CYP2C9 e VKORC1 foram analisados em laboratório de Genética Humana. Resultados Entre os participantes, 49 pacientes (74,2%) apresentaram polimorfismo dos genes CYP2C9 e/ou VKORC1; os 17 restantes (25,8%) não apresentaram esses polimorfismos. A dose média semanal de varfarina foi menor entre os que apresentaram polimorfismo para algum dos genes em comparação aos que não apresentaram, com diferença significativa (p = 0,035). O tempo no intervalo terapêutico médio também foi menor entre os pacientes com polimorfismo. Porém, não houve diferença significativa entre os dois grupos para essa variável (p = 0,438). Conclusões Foi observada associação entre os polimorfismos e a dose de varfarina utilizada pelos pacientes; no entanto, não houve associação com eventos adversos e o tempo de permanência na faixa terapêutica nessa amostra.

Comparing the efficacy and safety of duloxetine and amitriptyline in the treatment of fibromyalgia: overview of systematic reviews

Abstract Background: Duloxetine and amitriptyline are antidepressants used in the treatment of fibromyalgia. In published systematic reviews, there is no agreement about which drug is more effective and safer. This study aimed to compare evidence of the efficacy and safety of duloxetine compared with amitriptyline in the treatment of adult patients with fibromyalgia. This work contributes to guiding clinicians on the use of duloxetine or amitriptyline for the treatment of fibromyalgia and provides information for public health decision-makers. Methods: Overview of systematic reviews of clinical trials comparing duloxetine and amitriptyline in the treatment of fibromyalgia. The reviews were screened in Cochrane, PubMed, EMBASE, and SRDR with no restrictions on language and year of publication, considering that the research was conducted in July 2018 and updated until May 2020. The selection was based on the following criteria: adult patients with a diagnosis of fibromyalgia treated with duloxetine or amitriptyline, comparing the efficacy and safety in pain, fatigue, sleep, and mood disorder symptoms and quality of life, in addition to the acceptability of these antidepressants. The methodological quality and strength of evidence were assessed using the AMSTAR and GRADE instruments. Results: Eight systematic reviews were selected. Amitriptyline had low evidence for pain, moderate evidence for sleep and fatigue, and high evidence for quality of life. Duloxetine had high quality of evidence in patients with mood disorders. With low evidence, duloxetine has higher acceptability, but is safer in older patients, while amitriptyline is safer for non-elderly individuals. Conclusion: Both antidepressants are effective in the treatment of fibromyalgia, differing according to the patient's symptoms and profile. Registration: PROSPERO: CRD42019116101.(AU)

Drug interactions and adverse events in a cohort of Warfarin users attending Public Health Clinics / Interações medicamentosas e eventos adversos em uma coorte de usuários de varfarina que freqüentam clínicas de saúde pública

Background: Warfarin is an oral anticoagulant involved in important interactions with foods and other drugs. Objectives: To evaluate the occurrence of adverse events reported by warfarin users and their relationship with drug interactions. Methods: This was an open cohort, prospective study conducted in an 18-month period with warfarin users attending public health clinics of the city of Ijuí, Brazil. Data were collected by means of interviews administered at patients' home every month. Patients' responses were confirmed by review of medical records when patients sought medical care. Data were analyzed by descriptive statistics. Potential drug interactions were evaluated in a database and vitamin K consumption was quantified using a validated method. Results: A total of 68 patients were followed-up; 63 completed the study and 5 died in the study period. Mean number of medications taken by the patients was 9.6 ± 4.5, and mean number of interactions involving warfarin was 2.91 ± 1.52. Most potential interactions increased the risk of bleeding, 61 of them severe interactions and 116 moderate interactions. Eighty-seven episodes of bleeding and 4 episodes of thrombosis were reported by a total of 37 and 4 patients, respectively. At the occurrence of these events, 56.5% of warfarin users were also taking omeprazole, 35.9% were taking simvastatin and 25.0% paracetamol. Most patients had a low vitamin K intake. Conclusions: A high frequency of potential interactions between warfarin and other drugs was detected, but a low intake of foods that could possibly affect the effects of warfarin was observed. Based on our results, it seems prudent to follow patients on warfarin therapy for drug-drug interactions, aiming to control adverse effects and to promote a safe and effective therapy

Therapeutic itinerary: trajectory for resolution of adverse events of patients using warfarin in Southern Brazil

Warfarin is the most used anticoagulant in primary health care. Due to the narrow therapeutic index, its users are more susceptible to adverse events. The objective of this study was to describe the itinerary of the public health sector patients for resolution of adverse events related to warfarin. It is a prospective open cohort, held for a period of 18 months with warfarin users of the Brazilian public health system. Data were collected by monthly interviews and from patient records. Results: Sixty nine patients were interviewed, 64 of them completed monitoring and five died. Bleeding and venous thromboembolism were more frequent in patients starting treatment. It was observed that when adverse events have occurred, in most cases the patient held self-care at home (57%). During the follow-up, five patients were hospitalized for bleeding. Approximately half of the patients did not present their INR exams to the doctor. Conclusions: This study demonstrates weaknesses in caring for these patients and the need to accompany them, aiming to standardize and guide the itinerary of the anticoagulated patient to solve their problems and improve safety in drug treatment, with less cost to the public health system.

Profile of drug spend among elderly individuals from different socioeconomic groups / Perfil de gastos com medicamentos entre idosos em diferentes grupos socioeconômicos

Abstract The increase in the elderly population is associated with increased health care costs. The objective of the present study was to describe the results of research conducted in groups of elderly persons from different socioeconomic classes in Porto Alegre in the state of Rio Grande do Sul, and to compare the drugs spending profiles of different groups. A cross-sectional study was performed using a sample of individuals aged 60 years or older who participated in community groups. Analysis of variance (ANOVA) and the Tukey test were used to analyze the difference in costs of drugs among different socioeconomic classes. A total of 225 seniors were interviewed and females were predominant in all classes. The most common chronic diseases included hypertension, which occurred in 21.0%, 36.0% and 38.0% of elderly persons in social classes A, C and E, respectively. The average number of medications was 5.34 (±2.64) in social class A, 4.07 (±2.73) in social class C and 4.28 (±2.39) in social class E. The share of household income spent on medication for elderly persons in classes A, C and E was 4.0%, 5.7% and 10.0%, respectively. The drugs with the highest monthly cost for each patient in class A, C and E, respectively, were antipsychotic and anti-Parkinson's medication, diabetes medicine, and medication for the treatment of bone disease. It was concluded that there are specific differences in the cost and expenses incurred on spending on medication for the elderly of different socioeconomic classes. AU

Resumo O aumento da população idosa está associado a um aumento dos custos de saúde. Este estudo objetivou apresentar os resultados da pesquisa realizada em grupos de idosos de diferentes classes socioeconômicas, em Porto Alegre-RS, bem como comparar os perfis de gastos com medicamentos entre estes grupos. Trata-se de estudo transversal, com amostra composta por pessoas de 60 anos ou mais de idade, participantes de grupos de convivência. Para analisar a diferença nas despesas entre as classes socioeconômicas foram utilizados a análise de variância (ANOVA) e o teste de Tukey. Foram entrevistados 225 idosos. Em todas as classes o sexo feminino foi predominante. A doença crônica mais comuns foi a hipertensão, que ocorreu em 21,0%, 36,0% e 38,0% dos idosos nas classes A, C e E, respectivamente. Na classe A, o número médio de medicamentos foi 5,34 (±2,64), na classe C 4,07 (±2,73) e na classe E 4,28 (±2,39). A parcela da renda familiar mensal gasta com medicamentos para os idosos nas classes A, C e E foi 4,0%, 5,7% e 10,0%, respectivamente. Os medicamentos que representaram o maior custo mensal para cada paciente nas classes A, C e E, respectivamente, foram: antiparkinson e antipsicóticos, medicamentos para diabetes e medicamento para o tratamento de doença óssea. Concluiu-se que existem diferenças específicas em relação ao custo e as despesas incorridas com medicamentos para os idosos de diferentes classes socioeconômicas. AU

Conhecimento dos pacientes sobre medicamentos prescritos por odontólogos no sul do Brasil / Patients’ knowledge regarding medication prescribed by dentists in southern Brazil

Resumo Este estudo objetivou caracterizar o nível de conhecimento dos pacientes em relação aos medicamentos prescritos em serviços odontológicos públicos de Porto Alegre, verificar existência de prescrições verbais e fontes individuais de informação sobre os mesmos. Com delineamento transversal, um questionário era aplicado após consulta em dois serviços de urgência odontológica. Dos 286 entrevistados, 164 (57%) eram do sexo feminino, com média de idade de 35 anos e de renda familiar de 3,5 salários mínimos. Observou-se um índice de aproximadamente 10% de prescrições verbais. Em relação às prescrições escritas (n = 258), 86% dos pacientes sabiam o nome do medicamento, 85% a frequência de doses, 66% a indicação terapêutica e 65% a dose. Apenas 20% e 9% sabiam informar sobre precauções e efeitos adversos, respectivamente. Através do escore utilizado, 55% da amostra apresentou um nível de conhecimento regular, 34% insuficiente e 11% bom. A principal fonte de informação sobre medicamentos foi a bula (40,7%). A maioria dos pacientes apresentou um nível de conhecimento suficiente a respeito das informações principais do tratamento, porém teriam dificuldade de conduzi-lo de forma adequada frente a alguma intercorrência.

Abstract This study sought to establish the degree of patients’ knowledge regarding medication prescribed by public dental services in Porto Alegre and verify the frequency of verbal prescription by dentists and individual sources of information on medication. It involved a cross-sectional study conducted in two emergency services using a structured questionnaire applied after dental consultation. Of the 286 respondents, 164 (57%) were female, with an average age of 35 and mean family income of 3.5 minimum salaries. It was revealed that 10% of the patients received a verbal prescription and, of the 258 who were questioned regarding knowledge of medication from written prescriptions, 86% knew the name of the medication, 85% knew the dosage frequency, 66% knew the therapeutic indication and 65% the correct dosage. Only 20% and 9%, respectively, were aware of contra-indications and side effects. Based on the scoring system used, 55% of the patients displayed fair knowledge, 34% insufficient awareness and 11% good knowledge of the treatment. The main source of information about medication was the leaflet (40.7%). Most patients revealed a satisfactory level of knowledge about the core information regarding the treatment, but would have difficulty deciding precisely what to do in the event of complications.

Conhecimento aos profissionais de saúde sobre o uso de varfarina em ambiente hospitalar / Health professionals' knowledge on the use of warfarin in hospital settings

OBJETIVO: Identificar o conhecimento de profissionais da saúde sobre o uso da varfarina no âmbito hospitalar. MÉTODOS: Trata-se de um estudo transversal, qualitativo, realizado em um hospital do Estado do Rio Grande do Sul, com 18 profissionais. RESULTADOS: A maioria dos entrevistados possui pouco conhecimento sobre as interações varfarina-medicamento, as quais poderiam ser fornecidas pela equipe de farmácia. As interações medicamentosas podiam representar riscos ao indivíduo e aumento de gastos ao sistema de saúde. Os profissionais também desconheciam a interação da varfarina com alimentos ricos em vitamina K, que podiam interferir no controle adequado da anticoagulação. CONCLUSÃO: As informações sobre seu uso e manejo estão descritas na literatura, mas os profissionais não têm como reter todas elas. Assim, verifica-se a importância das instituições de saúde implementarem programas específicos para manejo desses pacientes, como base em trabalho conjunto da equipe de saúde multiprofissional.

OBJECTIVE: To identify health professionals' knowledge about the use of warfarin in hospitals. METHODS: This is a crosssectional, qualitative study, conducted in a hospital of the state of Rio Grande do Sul, Brazil, with 18 professionals. RESULTS: It was found that most interviewees have little knowledge about warfarin drug interactions, and this information could be provided to professionals by the pharmacy staff. Drug interactions may pose risks to the patient and increase costs for the health system. These professionals also ignore warfarin interaction with food rich in vitamin K, which can interfere with the proper control of anticoagulation. CONCLUSION: The information on use and handling of this product is widely described in the literature, but health professionals are not able to remember all of them. Thus, it is important that healthcare institutions implement specific programs for these patients' management, based on joint work of a multidisciplinary health team.

Studies published in indexed journals on lawsuits for medicines in Brazil: a systematic review / Estudios publicados en revistas indexadas acerca de decisiones judiciales para el acceso a los medicamentos en Brasil: una revisión sistemática / Estudos publicados em periódicos indexados sobre decisões judiciais para acesso a medicamentos no Brasil: uma revisão sistemática

The aim of this systematic review was to identify and characterize articles in indexed scientific journals with quantitative data surveys on administrative or legal proceedings for access to medicines. The SciELO, LILACS, MEDLINE via PubMed, Embase, and Scopus databases were used. We identified 45 articles, of which 17 were selected. The larger studies, each covering between 2,000 and 2,927 lawsuits, were done in the states of São Paulo, Rio de Janeiro, and Santa Catarina, Brazil. Eleven studies specified the type of legal representation, of which six examined cases with public attorneys and five with private attorneys. Only two studies reported whether the lawsuit was individual or class action, and in both the claims were individual. Since the majority of the medicines requested in the lawsuits were medium to high-cost, the review indicates that lawsuits contributed to the incorporation of these drugs into current pharmaceutical care in Brazil.

El objetivo de esta revisión sistemática fue identificar y caracterizar los artículos disponibles en revistas científicas indexadas en bases de datos electrónicas, que llevaron a cabo un estudio cuantitativo de datos, procedimientos administrativos o judiciales sobre la cuestión del acceso a los medicamentos a través de demandas judiciales. Los estudios fueron localizados en las bases de datos SciELO, LILACS, MEDLINE vía PubMed, Embase, Scopus. Se identificaron 45 artículos, de los cuales se seleccionaron 17. Los estudios que se llevaron a cabo engloban de 2.000 a 2.927 procesos judiciales en São Paulo, Río de Janeiro y Santa Catarina, Brasil. En once estudios se realizaron encuestas a los representantes legales de la acción judicial. En seis estudios predominó la representación pública legal y en cinco abogados privados. Sólo dos estudios examinaron si la acción era individual o colectiva y en los dos hubo prevalencia de acciones individuales. Como la mayoría de los medicamentos estaba involucrada en acciones legales de medio y alto coste, se cree que las demandas han contribuido a la incorporación de fármacos en la política pública actual.

O objetivo desta revisão sistemática foi identificar e caracterizar artigos disponíveis em periódicos científicos indexados em bases eletrônicas, que realizaram levantamento de dados quantitativo, em processos administrativos ou judiciais, sobre a questão do acesso a medicamentos por meio de ações judiciais. Foram usadas as bases de dados SciELO, LILACS, MEDLINE via PubMed, Embase e Scopus. Identificamos 45 artigos, dos quais foram selecionados 17 artigos. Os estudos com faixa de 2.000 a 2.927 processos foram conduzidos em São Paulo, Rio de Janeiro e Santa Catarina, Brasil. Em 11 estudos foram pesquisadas qual a representação jurídica da ação. Em seis estudos predominaram a representação de advogados públicos e em cinco particulares. Somente dois estudos observaram se a ação era coletiva ou individual, sendo que nas duas pesquisas a prevalência era de ações individuais. Como a maioria dos medicamentos envolvidos nas ações é de médio e alto custo, acredita-se que as demandas judiciais tenham contribuído para incorporação de medicamentos nas ações de assistência farmacêutica atuais.

Caracterização do entendimento sobre técnicas de adminsitração de medicamentos inalatórios por pacientes do Programa da Asma de um Centro de Saúde em Porto Alegre, Brasil / Characterization of the understanding of inhaler technique by patients attending the Asthma Program at a Health Centre in Porto Alegre, Brazil

Este estudo teve por objetivo descrever o entendimento do tratamento e memorização da técnica de administração dos medicamentos inalatórios dos pacientes cadastrados no Programa de Asma de um Centro de Saúde em Porto Alegre/RS. Trata-se de um estudo transversal, realizado em duas etapas, na Farmácia Distrital de um Centro de Saúde em Porto Alegre/RS. Foram coletadas informações sobre os pacientes a partir do cadastro do Programa de Asma, do prontuário e do registro de dispensação de medicamentos da Farmácia. Para identificar possíveis problemas na utilização de medicamentos usados no tratamento da asma, foi realizada uma entrevista com 83 pacientes ou cuidadores. Nas entrevistas, 36,1% não descreveram corretamente a técnica de uso do inalatório; 13,3% consideram que o broncodilatador de curta ação é o medicamento de prevenção e usam a beclometasona nos momentos de crise. A baixa escolaridade esteve significativamente relacionada ao não cumprimento da posologia (p = 0,009). Os dados sugerem dificuldades relacionadas à identificação dos medicamentos e à técnica de administração, evidenciando a necessidade da equipe de saúde fornecer orientações complementares que auxiliem os pacientes no automanejo da doença.

The aim of this study was to describe the level of understanding of the treatment and memorization of the medication inhaling technique among patients registered with the Asthma Program at a Health Center in Porto Alegre (RS, Brazil). This cross-sectional study was carried out in two stages, in a pharmacy of the public health system in the city of Porto Alegre. Patients’ data were collected from the Asthma Program register, medical records and a spreadsheet program for the dispensing of inhaled medications. To identify potential problems in the use of medicines to treat asthma, we interviewed 83 patients or caregivers. Of the interviewees, 36.1% did not correctly describe the technique for inhaling medication and 13.3% thought that short-acting bronchodilator medication is used for prevention and used beclomethasone in times of crisis. The low educational level was significantly related to non-compliance with correct dosage (p = 0.009). The data suggest difficulties in identification of drugs and inhaler technique, highlighting a need for the healthcare team to provide further guidance to assist patients in self-management of the disease.

Educational level, socio-economic status and relationship with quality of life in elderly residents of the city of Porto Alegre/RS, Brazil

The objective of this study was to verify the index of quality of life of elderly individuals belonging to groups, from different socioeconomic strata in the city of Porto Alegre, Rio Grande do Sul State. The research adopted a transversal model, used to collect data from the SF-36 questionnaire. The sampling is the intentional type and comprised: 61 elderly people in Class A, 80 in Class C, and 84 in Class E. The research was approved by the Committee of Ethics in Research/UFRGS. In relation to the quality of life, Class A presented higher scores than did Classes C and E on the pain, vitality, social aspect and mental health areas. The results also showed a significant difference in quality of life among university educated individuals versus the other schooling groups, on the pain, vitality, mental health and social aspect fields. Quality of life is a complex concept to study, but essential to improve the perception of health and welfare by the elderly.

O objetivo deste trabalho foi verificar o índice de qualidade de vida de idosos participantes de grupos de convivência, de diferentes estratos socioeconômicos do município de Porto Alegre/RS. A pesquisa seguiu um modelo de estudo transversal e utilizou para coleta de dados o questionário SF-36. A amostragem foi do tipo intencional e foi composta por: 61 idosos na classe A, 80 na classe C e de 84 na classe E. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da UFRGS. Em relação à qualidade de vida, a classe A apresentou escores melhores que a classe C e E nos domínios dor, vitalidade, aspecto social e saúde mental. Houve diferença significativa de qualidade de vida no ensino superior completo, em relação aos demais estratos de escolaridade, nos domínios dor, vitalidade, saúde mental e aspecto social. A qualidade de vida é um conceito complexo de ser estudado, mas essencial para que haja melhora na percepção de saúde e do bem-estar pelos idosos.

O medicamento na rotina de trabalho dos agentes comunitários de saúde da unidade básica de saúde Santa Cecília, em Porto Alegre, RS, Brasil / Medicines in the work routine of community healthcare workers from Santa Cecília basic healthcare unit in Porto Alegre, RS, Brazil

Desde o estabelecimento do Sistema Único de Saúde (SUS), busca-se enfatizar a atenção básica e a saúde familiar. Uma das estratégias que vem sendo utilizada é o Programa de Saúde da Família (PSF) constituído por equipes de profissionais que incluem os agentes comunitários de saúde. Entre os diversos problemas enfrentados pelas equipes de saúde da família está o uso irracional dos medicamentos. Este trabalho teve o objetivo de examinar o papel do medicamento na rotina dos agentes, estabelecer sua percepção em relação aos serviços da farmácia de uma unidade básica de saúde e identificar as necessidades de informação sobre medicamentos para elaboração de treinamento. Para tanto, foi realizada uma sessão utilizando-se a técnica grupo nominal, em que oito de onze agentes de saúde participaram respondendo a quatro perguntas. O medicamento foi considerado importante, com valorização das ações preventivas. A percepção em relação aos serviços da farmácia foi positiva. Segundo os agentes, as dúvidas sobre medicamentos, freqüentemente relatadas pela população, refletem falhas na consulta e na aquisição dos medicamentos. O agente de saúde é reconhecido pela população como o profissional que pode auxiliá-la no uso de medicamentos, promovendo o seu uso racional.

Since the establishment of Brazil's National Health System (SUS), focus has been given to basic and family healthcare. One of the programs in progress has been the Family Health Project, performed by teams of professionals including Community Health Workers. Among the various problems faced by the family healthcare teams is the irrational use of medicines. This paper aims to examine the role of medicines in the workers' routine, establishing how they perceive the pharmacy service in a Basic Healthcare Unit, and identifying information needs about medicines, all these with the purpose of training design. To do so, a session using the nominal group technique was held, in which eight out of eleven healthcare workers participated, answering 4 questions. Medicines were considered important, and preventive actions were highly valued. Their perception regarding the pharmacy service was positive as well. Workers report population's questions on medicines as being frequent, and this reflects gaps in the medical visit and in obtaining the medicines. The healthcare agent is seen by the population as the professional who can help them use the medicines and thus, he/she may have an essential role in promoting their rational use.