Patients in insulin analogues use via judicial litigation: do they use the Brazilian Public Health System (SUS)? / Pacientes em uso de análogos de insulina via ação judicial: eles utilizam o Sistema Único de Saúde (SUS)?

Abstract Background Studies show that among the drugs most commonly used in judicial litigation in Brazil, are those used to treat diabetes mellitus, especially insulin analogues. Objective Evaluate the use of the Unified Health System (SUS) by patients with type 1 diabetes mellitus (T1DM), who receive insulin analogues through judicial action, before and after this process. Method In a retrospective longitudinal observational study, secondary data was used from these patients in Minas Gerais, Brazil, in 2018. Socio-demographic information was collected and related to the follow-up of these patients in the SUS. The McNemar χ2 test was used to compare the proportions of the variables. Results Of the 89 patients analyzed, women (53.9%) were predominant. Most patients were aged between 20 and 39 years (52.8%), and more than half, 55.1%, use only a private health system. After the judicial action, there was a significant increase (p <0.05) in the number of patients who had consultations in primary health care (from 19.1% to 30.3%) and emergency medical appointments (from 1.1% to 9.0%). Conclusion It is observed that the majority of patients with T1DM via judicial action in the SUS are not monitored by this health system through examinations, consultations, and hospitalizations.

Resumo Introdução Estudos mostram que, dentre os medicamentos mais adquiridos via ação judicial, estão os utilizados para o tratamento do Diabetes Mellitus, especialmente os análogos de insulina. Objetivo Avaliar a utilização do Sistema Único de Saúde (SUS) pelos pacientes com Diabetes Mellitus tipo 1 (DM1), que recebem insulina por meio de judicialização, antes e após este processo. Método Em um estudo observacional longitudinal retrospectivo, foram utilizados dados secundários de pacientes com DM1, que adquiriram insulinas por processos judiciais em Divinópolis-MG, Brasil, em 2018. Foram coletadas informações sociodemográficas e referentes ao acompanhamento destes pacientes no SUS Realizou-se o teste χ2 de McNemar para a comparação das proporções das variáveis utilizadas para a avaliação do acompanhamento antes e após a judicialização. Resultados Dos 89 pacientes analisados, predominou-se o sexo feminino (53,9%), com idade entre 20 e 39 anos (52,8%). 55,1% destes utilizam apenas o sistema privado de saúde. Após a judicialização, houve um aumento significativo (p< 0,05) no número de pacientes que realizaram consultas na atenção primária à saúde (de 19,1% para 30,3%) e consultas médicas de emergência (de 1,1% para 9,0%). Conclusão A maioria dos pacientes com DM1 que judicializam medicamentos no SUS não são acompanhados por este sistema de saúde através de realização de exames, consultas e hospitalizações.

Assistência Farmacêutica e governança global da saúde em tempos de Covid-19 / Pharmaceutical Services and global health governance in times of COVID-19

RESUMO Este ensaio aborda como e em que níveis a Assistência Farmacêutica é atravessada pela dinâmica da governança global da saúde, e como se relaciona com aspectos geopolíticos e socioeconômicos. Tenta-se ir além do acesso a medicamentos e produtos para saúde, abordando também o uso racional de medicamentos, seu impacto na resistência aos antimicrobianos e na saúde dos povos. Além disso, discute como a Assistência Farmacêutica pode ser vista nesse contexto.

ABSTRACT This essay addresses how and at what levels Pharmaceutical Services is affected by the dynamics of global health governance, and how it correlates with geopolitical and socioeconomic aspects. It attempts to go beyond access to medicines and health products, as well as to address the rational use of medicines, the impact in antimicrobial resistance and in people's health. Furthermore, it debates how Pharmaceutical Services can be seen in this context.

Clinical pharmaceutical services of primary health care of the Federal District: A discussion based on the SWOT matrix

Abstract In the epistemic field, several studies demonstrate the importance of pharmaceutical services in health care networks. Nonetheless, literature still addresses the strengths and barriers present in the provision of these services in an incipient way. Thus, this study aimed to understand these contexts in the development of clinical services for primary health care in the Federal District, Brazil. A qualitative study adopted the technique of open-script interview, structured based on the logic of the SWOT matrix. Pharmacists reported weaknesses such as precariousness and scarcity of physical infrastructure, material, and human resources. As threats, they discussed the lack of social recognition, discontinuities of government actions, and lack of preparation of the pharmacist for the provision of clinical services. Regarding themes pertaining to the service's strengths and opportunities, the advances in propositions and executions of public policies, actions, and governmental programs that have expanded the pharmaceutical workforce in primary care and that are impelling the accomplishment of clinical services were listed. This study contributes to understanding the scenario of the development of clinical pharmaceutical services, and consequently provides subsidies for the actions of planning, evaluation and qualification of health services.

Clinical pharmaceutical services in primary health care of the Federal District: Performance frequency and conditioning factors

Abstract Pharmaceutical services correspond to a set of actions that aim to guarantee the integral access and rational use of drugs by the population. In this sense, this study aimed to identify the frequency and conditioning factors for clinical services of primary care in the Federal District, Brazil. A quantitative cross-sectional study was conducted, in which 34 pharmacists were interviewed. The most frequently developed clinical pharmaceutical services were dispensing, pharmaceutical guidance for users, and technical-pedagogical activities for the health team. There is a greater frequency of operation of clinical services by pharmacists working in pharmacies with physical infrastructure, with better levels of adequacy, greater support from management and health staff, and the inclusion in Family Health Support Nucleus activities. Although the clinical pharmaceutical services in primary care are incipient, the study raises important data for the reorientation and qualification of these actions.

The clinical pharmacist's role in a high-cost medicine pharmacy: Patient-centered care

Abstract In Brazil, medicine dispensing is a pharmacy service provided within the national health system that allows the pharmacist to interact directly with the patient in order to prevent, detect and solve problems related to pharmacotherapy and health needs. However, it is known that most dispensing services provided in the country are still limited to supplying medications and, at their finest, offering advice on medication utilization. Attempts to change this scenario present new challenges the area of pharmacy, which involve the need for a patient-centered pharmaceutical service model. This paper describes the patient-centered pharmaceutical service of high-cost medicine dispensing performed at a pharmacy linked to the Brazilian Unified Health System. In the model described here, the medicine-dispensing activity is the pharmacist's main field of practice, which consists of identifying patient needs related to health care itself and medication utilization. It also aims to introduce the instrument developed (a Pharmaceutical Care Protocol) that contributed to implementing this clinical service provided by the pharmacist. The protocols guide and qualify the service by providing information that helps in evaluating the effectiveness and safety of treatments and in the preparation of the care plan and can be used as a basis for other services that intend to adopt clinical pharmacy practices.

Rising drug prices in Brazil during COVID-19 pandemic: another threat to people's health

Abstract The COVID-19 pandemic puts the healthcare systems at risk due to the still uncertain operational and financial impacts of it. The difficult economic conditions of the population also call for more attention from government officials to define strategies that guarantee access to health services and products. Maintaining the supply chain of pharmaceutical products is not only paramount to cover the immediate medical response but will be fundamental to reducing disruption of the healthcare system. Increasing drug prices during the pandemic is definitely not a strategy that contributes to access. In this sense, this commentary presents a criticism of a decision by the Brazilian government that may impact the availability in health services and the population's access to medicines necessary for the maintenance of life.

Transformando incertezas em regulamentação legitimadora? As decisões das agências NICE e CONITEC para doenças raras / Transforming uncertainties into legitimate regulation? NICE and CONITEC agencies' decisions on rare diseases

Resumo A avaliação de tecnologias em saúde (ATS), enquanto prática científica e tecnológica é, ao mesmo tempo, um desafio, a fim de determinar o valor das tecnologias a serem incorporadas. Este estudo teve como objetivo explorar e comparar os resultados e elementos técnicos das avaliações emitidas para doenças raras, entre a agência inglesa (NICE) e a brasileira (CONITEC). A primeira etapa do estudo envolveu a busca sistemática das avaliações no período de 2013 a 2019. Na segunda etapa, os relatórios foram analisados com base em: (i) revisão narrativa descritiva e (ii) cálculo da frequência absoluta e relativa de acordo com cada domínio e componente (elemento) aplicado do modelo da rede Europeia de ATS. O total de 24 medicamentos foram distintamente avaliados no período do estudo. Por meio de 126 questões (elementos) distribuídas entre nove domínios, a análise revelou que 67 (53,2%) e 44 (35,0%) estavam descritas nos relatórios, 42 (33,3%) e 59 (47,0%) foram consideradas apenas parcialmente e 17 (13,5%) e 23 (18,0%) não foram consideradas nos relatórios do NICE e da CONITEC, respectivamente. Foi constatado uma concordância relativamente baixa da agência brasileira em relação à inglesa nos relatórios emitidos para doenças raras. Permanece indeterminado se as agências são capazes de capturar os diversos valores desses medicamentos, bem como gerenciar as incertezas nas avaliações.

Abstract As a scientific and technological practice, the evaluation of health technologies (HTA) is, at the same time, a challenge to determine the value of the technologies to be incorporated. This study aimed to explore and compare the results and technical elements of the evaluations issued for rare diseases between the English (NICE) and the Brazilian agency (CONITEC). The first part of the study involved the systematic search for evaluations from 2013 to 2019. In the second stage, the reports were analyzed based on: (i) descriptive narrative review; and (ii) calculation of the absolute and relative frequency according to each domain and component (element) applied in the European HTA network model. Twenty-four medicines were distinctly assessed during the study period. Through 126 questions (elements) distributed among nine domains, the analysis revealed that 67 (53.2%) and 44 (35.0%) were described in the reports, 42 (33.3%) and 59 (47.0 %) were only considered partially, and 17 (13.5%) and 23 (18.0%) were not considered in the NICE and CONITEC reports, respectively. We identified a relatively low agreement between the Brazilian agency with the English agency in the reports issued for rare diseases. It remains to be seen whether the agencies are able to capture the various values ​​of these medicines, as well as manage uncertainties in the evaluations.

Desafios na gestão de medicamentos de alto preço no SUS: avaliação da Assistência Farmacêutica em São Paulo, Brasil / Challenges in the management of high-priced drugs in the SUS: evaluation of Pharmaceutical Policy in São Paulo, Brazil

Resumo O objetivo deste estudo foi avaliar a capacidade de gestão do Componente Especializado da Assistência Farmacêutica (CEAF) no estado de São Paulo (ESP), sob os aspectos organizacional, operacional e sustentabilidade. O desenho do estudo foi uma investigação avaliativa, com adaptação de um modelo teórico e protocolo de indicadores desenvolvido para aplicação em âmbito nacional, e validado (Grupo Nominal e Comitê Tradicional) para a aplicação na realidade do ESP. A coleta de dados, em 35 unidades, foi realizada em 2017 e 2018 e contemplou todas as áreas que participam da gestão/execução do CEAF do estado, em seu âmbito central e regional. A avaliação da capacidade de gestão foi fundamentada na análise crítica dos resultados obtidos, analisando suas fragilidades e as potencialidades. Verificou-se que a capacidade de gestão foi positiva na dimensão operacional, com desafios concentrados nas demais dimensões. Os resultados demonstraram maiores investimentos e desenvolvimento em aspectos técnicos da assistência farmacêutica, mas deficitárias em relação a aspectos como: monitoramento de resultados clínicos, regulamentação, infraestrutura e comunicação com os atores envolvidos.

Abstract The aim of this study is to evaluate the management capacity of the Specialized Component of Pharmaceutical Services (CEAF, in Portuguese) in the state of São Paulo (SP), according to the organizational, operational and sustainability aspects. The study was designed as an evaluative investigation, with the adoption of a theoretical model and protocol of indicators developed for application at the national level and validated (Nominal Group and Traditional Committee) for application in the reality of the SP. The data collection in the 35 CEAF units was carried out in 2017 and 2018, and covered all technical areas that participate in the management/execution of CEAF, in both its central and regional scopes. The assessment of management capacity was based on a critical analysis of the obtained results, analyzing their strengths and weaknesses. After collecting data from 35 CEAF units, it was found that the management capacity was positive in the operational dimension with challenges concentrated in the other dimensions. The results showed greater investments and development in the technical aspects of pharmaceutical services, but deficiencies in such areas as the monitoring of clinical results, infrastructure, regulation, and communication with the actors involved.

Acesso a medicamentos de alto preço: desigualdades na organização e resultados entre estados brasileiros / Access to high-priced medicines: inequalities in the organization and the results among Brazilian states

Resumo Este estudo de caso visou caracterizar a organização do Componente Especializado da Assistência Farmacêutica (CEAF) em quatro estados, de diferentes regiões do país. A coleta de dados foi realizada junto a representantes da gestão do CEAF, os quais responderam um questionário com 20 perguntas sobre: abrangência, organização, financiamento, barreiras e facilitadores. Essas informações foram complementadas com dados de inquéritos nacionais de saúde, do DataSUS, os valores investidos e indicadores socioeconômicos. Observaram-se diferenças entre os estados em questões como a proporção de usuários e a descentralização dos serviços. Estas características parecem estar relacionadas com o grau de desenvolvimento em termos dos indicadores socioeconômicos utilizados. Destacaram-se avanços no acesso a medicamentos, apesar das dificuldades para o cumprimento dos objetivos do CEAF, como a insuficiência de recursos, de qualificação da força de trabalho e da oferta de consultas e exames necessários. Os resultados indicam avanços, diferentes formas de organização e destacam a necessidade de estudos mais aprofundados relativos aos resultados clínicos e econômicos alcançados, como uma estratégia para traçar soluções para o atendimento integral e equânime dos usuários.

Abstract This case study aimed to characterize the Specialized Component of Pharmaceutical Services (CEAF) organization in four Brazilian states from diverse regions of the country. Data were collected with representatives of CEAF management from states in different regions, who answered a 21-question questionnaire on scope, organization, financing, hurdles, and facilitators. This information was complemented with data from national health surveys, DataSUS, the applied resources, and socioeconomic indicators. Differences were observed between states on issues such as the proportion of users and the decentralization of services. These characteristics seem to be related to the level of development concerning the socioeconomic indicators used. Advances in access to medicines were highlighted, despite the difficulties complying with the CEAF's objectives, such as insufficient resources, the qualification of human resources, and the provision of necessary visits and exams. The results point to advances, different forms of organization and highlight the need for more in-depth studies on the clinical and economic outcomes achieved as a strategy to outline solutions to achieve the comprehensive and equal care for users.

Projeto Integra: fortalecimento da participação social na agenda das políticas, serviços e tecnologias em saúde / Integra Project: strengthening social participation in the agenda of health policies, services, and technologies

Resumo A 16ª Conferência Nacional de Saúde demonstrou o interesse do controle social em intervir sobre as políticas públicas a fim de garantir o direito às tecnologias de saúde. O projeto Integra - Integração das Políticas de Vigilância em Saúde, Assistência Farmacêutica, Ciência, Tecnologia e Inovação em Saúde -, nasce da parceria entre o Conselho Nacional de Saúde, a Escola Nacional dos Farmacêuticos e a Fundação Oswaldo Cruz (Fiocruz), com apoio da Organização Pan-Americana de Saúde (OPAS) com objetivo de fortalecimento da participação e engajamento social na temática e a integração das políticas e práticas de saúde em diferentes setores da sociedade (movimentos sociais, controle social e profissionais de saúde), tendo as diversas etapas relacionadas ao acesso aos medicamentos (pesquisa, incorporação, produção nacional e serviços) como mote principal, no cenário da pandemia de COVID-19. Oferta-se, neste projeto, capacitação para grupos de lideranças nas regiões de saúde e atividades de grande abrangência nacional e política. Espera-se alcançar o estabelecimento de uma rede intersetorial, integrada de lideranças capazes de atuar colaborativamente para a defesa do desenvolvimento da ciência, das políticas públicas, da soberania nacional e do controle social da saúde.

Abstract The 16th National Health Conference illustrated the interest of health councils to intervene in public policies in order to guarantee the right to health technologies. The INTEGRA project (Integration of policies for Health Surveillance, Pharmaceutical Care, Science, Technology, and Innovation in Health) is a partnership among the National Health Council, the National School of Pharmacists, and the Oswaldo Cruz Foundation (Fiocruz), with support from the Pan American Health Organization (PAHO), with the goal of strengthening participation and social engagement in the theme, as well as the integration of health policies and practices within different sectors of society (social movements, health councils, and health professionals), with the various stages related to the access to medicines (research, incorporation, national production, and services) being the main theme in the context of the COVID-19 pandemic. It seeks to offer training for leadership groups in the health regions and activities with a broad national and political scope, and it hopes to establish an intersectorial and integrated network of leaders capable of acting collaboratively to defend the development of science, public policies, national sovereignty, and social control of health.

Serviços farmacêuticos clínicos na atenção primária à saúde do brasil / Clinical pharmaceutical services in brazil's primary health care / Servicios farmacéuticos clínicos en la atención primaria de salud en brasil

Resumo O farmacêutico executa importante papel no cuidado ao usuário da atenção primária, ao proporcionar ações emancipadoras de autocuidado, educação em saúde, promoção da saúde e do uso racional de medicamentos. Nesse contexto, este estudo, por meio de uma revisão integrativa da literatura, objetivou analisar os tipos e os benefícios dos serviços farmacêuticos clínicos desenvolvidos na atenção primária à saúde do Brasil. Foram recrutados, no SciELO e no PubMed/MEDLINE, artigos que tratavam dos serviços farmacêuticos clínicos desenvolvidos na atenção primária no Brasil publicados nos idiomas português, inglês ou espanhol no período de 2007 a 2017. O seguimento farmacoterapêutico é o serviço mais estudado, enquanto a dispensação e a orientação são as atividades realizadas com maior frequência pelos farmacêuticos da atenção primária. Já na esteira dos benefícios, a literatura demonstra a coexistência, a importância e a multidimensionalidade dos serviços farmacêuticos clínicos na promoção da saúde e do uso racional de medicamentos pela comunidade adstrita.

Abstract The pharmacist plays an important role in the care for the users of primary health care by providing emancipatory self-care actions, education in health, promotion of health and of the reasonable use of medications. In this context, the present study, through an integrative review of the literature, had the goal of analyzing the types and benefits of the clinical pharmaceutic services developed in primary health care in Brazil. In the SciELO and PUBMED/MEDLINE databases, we gathered articles on the clinical pharmaceutic services developed in primary health care in Brazil published in Portuguese, English and Spanish between 2007 and 2017. The pharmacotherapeutic follow-up is the most studied service, while dispensation and guidance are the activities most often performed by the primary health care pharmacists. Regarding the benefits, the literature shows the coexistence, the importance and the multidimensionality of the clinical pharmaceutic services in the promotion of health and in the reasonable use of medications by the circumscribed community.

Resumen El farmacéutico ejecuta un importante papel en el cuidado al usuario de la atención primaria, al proporcionar acciones emancipadoras de autocuidado, educación en salud, promoción de la salud y del uso racional de medicamentos. En ese contexto, este estudio, por medio de una revisión integrante de la literatura, tuvo el objetivo de analizar los tipos y los beneficios de los servicios farmacéuticos clínicos desarrollados en la atención primaria de salud en Brasil. Buscamos, en las bases de datos SciELO y PubMed/MEDLINE, artículos que trataban de los servicios farmacéuticos clínicos desarrollados en la atención primaria de salud en Brasil publicados en los idiomas portugués, inglés o español entre 2007 y 2017. El seguimiento farmacoterapéutico es el servicio más estudiado, mientras la dispensación y la orientación son las actividades realizadas con más frecuencia por los farmacéuticos de la atención primaria. Con relación a los beneficios, la literatura demuestra la coexistencia, la importancia y la multidimensionalidad de los servicios farmacéuticos clínicos en la promoción de la salud y del uso racional de medicamentos por la comunidad circunscripta.

Fatores relacionados à adesão ao tratamento sob a perspectiva da pessoa idosa / Factors related to adherence to treatment from the perspective of the old person

Resumo A adesão ao tratamento é fundamental para o sucesso da farmacoterapia da pessoa idosa. A respeito desse fenômeno, o objetivo deste estudo foi identificar e compreender os fatores associados à adesão ao tratamento medicamentoso. Para isso, foi realizado um estudo qualitativo com os idosos considerados não aderentes pelo instrumento de Morisky, Green e Levine. O cenário de pesquisa ocorreu no Hospital Universitário de Brasília no período de março a agosto de 2015. A relação das pessoas idosas com a adesão ao tratamento mostrou-se complexa e englobou os seguintes fatores: alterações na rotina, acesso aos medicamentos e aos serviços de saúde, polifarmácia, desdobramentos dos efeitos medicamentosos, medicalização e relações com os profissionais de saúde. Para os idosos considerados não aderentes, foram observadas intencionalidades e condutas de adesão ao tratamento. Ou seja, a "adesão" e a "não adesão" são fenômenos experienciados pelas pessoas idosas de forma simultânea, acompanhando a dinâmica de vida dos indivíduos. Não obstante, o reconhecimento e a compreensão dos fatores discutidos foram importantes para o aprofundamento do conhecimento acadêmico sobre o tema, além de subsidiar o levantamento de informações cruciais para a qualificação da assistência farmacêutica local.

Abstract Adherence to treatment is essential for the success of pharmacotherapy for old people. Regarding this phenomenon, the objective of this study was to identify and understand the factors associated with adherence to drug treatment. For this, a qualitative study was carried out with the old people considered non-adherent by the instrument of Morisky, Green and Levine. The research scenario took place at the Hospital Universitário de Brasília from March to August 2015. The relationship between the old people and treatment adherence proved to be complex and included the following factors: changes in routine, access to medicines and health services health, polypharmacy, consequences of medication effects, medicalization and relationships with health professionals. For the old people considered non-adherent, intentions and conduct of adherence to treatment were observed. In other words, "adherence" and "non-adherence" are phenomena experienced by old people simultaneously, following the life dynamics of individuals. Nevertheless, the recognition and understanding of the factors discussed were important for the deepening of academic knowledge on the topic, in addition to supporting the gathering of crucial information for the qualification of local pharmaceutical assistance.

Access and use of medicines by elderly individuals with dementia

The objective is to reveal the difficulties concerning the access and use of medicines by elderly individuals with dementia, reported by their caregivers. This qualitative study applied the participant observation method during pharmaceutical appointments performed in a specialized geriatrics service of the University Hospital of Brasília. Caregivers reported facing difficulties regarding the itinerary for medicines access in public pharmacies, as well as the high cost of these technologies in private establishments. Psychiatric symptoms, cognitive deficits, behavioral changes, apraxia, dysphagia, among other clinical manifestations of dementia syndromes, incapacitates the elderly for self-responsibility concerningthe use of drugs, which accentuates the complexity of medicines administration within the care process. In conclusion, it is fundamental to recognize caregivers' role in promoting the rational use of medicines, and so this theme should be highlighted within the pharmaceutical services context.

Strategic situational planning and management of pharmaceutical services and supply: The experience of a municipality in the State of São Paulo with regard to optimizing spending on medicinal lawsuits

One of the actions taken was to offer training on pharmaceuticals via the distance education model (EAD) with the course titled Pharmaceutical Services and Supply Management Course (PSSMC). PSSMC, which was based on the idea of expanded management, is guided by Strategic Situational Planning (PES) concepts, and structured around an Operational Plan (OP) that serves as a practical didactic tool. The aim of this study is to report and analyze a case study based on the implementation of the Operational Plan in a municipality in the State of São Paulo, while focusing on the judicialization of access to medicines and health products. Since judicialization is an important topic, the problem chosen for resolution with the PES was attendance at the issuance of court orders by the municipality for items of medium and high complexity. The PES allows researchers to analyze reality through different points of view, of which participation is a key aspect. With the OP, it was possible to disseminate a proposal for expanded planning, to advance resolution of the problem, achieve positive results, and reduce expenses associated with the municipality's legal actions.

E-learning in Pharmacy Education: what do we know about it?

The increase and flexibilization of e-learning in Brazil has generated concern about the low capacity to ensure the quality of institutions and courses. The objective is to identify the literature on experiences of pharmaceutical e-learning. A scope review was carried out, mapping key concepts and evidence. The selected articles, without period restriction, from the Scielo, Pubmed and Scopus databases provided data on the educational level of experience, modality, workload, content delivery method, instruments used, types of topics, evaluation information and purpose of the study. There were 87 articles on preparation for subsequent classes; feedback or continuation of previous classes; to specific training; the comparison between face-to-face and distance education modalities; and distance learning. Among the subjects treated, 51.8% involved pharmaceutical clinic and 42.5% basic science. Positive student assessment was found in more than 92% of cases. Isolation, and deficits in social and analytical skills were negative points. Technology infrastructure can impact learning. In Brazil, the health area has manifested opposition to the use of distance education in undergraduate studies. There is no evidence on the organization of undergraduate distance courses, but there are elements indicating risks to the results of training and development of professional skills in this modality.

Necessidade e dinâmica da força de trabalho na Atenção Básica de Saúde no Brasil / Needs and dynamics of the Primary Healthcare workforce in Brazil

Resumo A Atenção Básica e a Força de Trabalho em Saúde podem ser consideradas os grandes desafios do SUS, principalmente nas duas últimas décadas. Este artigo teve como objetivo descrever o crescimento e a distribuição regional das profissões de nível superior cadastradas em UBS. Estudo descritivo, de abordagem quantitativa, sobre as catorze profissões de nível superior nas cinco regiões brasileiras, de 2008 a 2013. Entre as categorias profissionais com as maiores taxas de crescimento nacional estão os professores de educação física, os nutricionistas, os terapeutas ocupacionais, os fisioterapeutas e os farmacêuticos. No Norte, a fisioterapia, o serviço social e a fonoaudiologia se destacaram com as maiores taxas de crescimento; no Nordeste, a educação física, a fisioterapia e a terapia ocupacional; no Centro-Oeste, os destaques são a nutrição e a fisioterapia; no Sudeste, nutrição e farmácia; e a educação física apresentou crescimento proeminente no Sul. As maiores perdas ocorreram nas profissões biólogo e médico veterinário, em todas as regiões. De modo geral, as categorias profissionais que podem compor o NASF apresentaram crescimento superior aos enfermeiros e médicos.

Abstract Primary care and the healthcare workforce can be considered the greatest challenges of SUS (Sistema Único de Saúde), principally in recent decades. This article aims to describe the growth and regional distribution of the professions requiring higher education registered in the primary healthcare units. This descriptive study with a quantitative approach is concerned with the 14 accredited professions in the five major regions of Brazil from 2008 to 2013. The data was collected from the national database of the Ministry of Health. Among the professional categories with the greatest rates of national growth are physical education teachers, nutritionists, occupational therapists, physiotherapists, and pharmacists. In the North region of Brazil, physiotherapy, social work, and speech therapy stand out as having the greatest growth rates; in the Northeast, physical education, physiotherapy, and occupational therapy; and in the Center-West, nutrition and physiotherapy; in the Southeast, nutrition and pharmacology; and physical education showed prominent growth in the South. The major losses occurred in the professions of biologist and veterinary doctors in all regions. In general, the professional categories that comprise the Family Health Support Nuclei, NASF, demonstrate greater growth rates than nurses and doctors.

Concepção do direito à saúde na perspectiva do profissional técnico de nível médio do Sistema Único de Saúde / Conception of the right to health of mid-level technical professionals of the mid-level of the Unified Health System in Brazil

INTRODUCTION: The right to health, one of the achievements guaranteed by the Citizen Constitution promulgated in 1988, came in response to the citizens' struggle for health reform in 1986. The guarantee of this right is established in the Unified Health System. OBJECTIVE: To analyze the conception of the right to health of middle level proffesionals of Unified Health System. METHODS: Qualitative approach research, through 2 focus groups involving 9 graduates of a Health Technical School of the SUS in the north of Brazil, from the courses of clinical analysis, dental hygiene and nursing, working in the Unified Health System. RESULTS: Three categories show the results obtained concluding concepts of health, the right to health and health conceptions; Health practices and access to care; and topics of training, health care and humanization. CONCLUSION: The participants of this study have a conception of the right to health directed to the legislation, their concepts of health approach elements of Unified Health System policy, among others, promotion, prevention, humanization; their conceptions of health are strongly focused on the biomedical model centered on disease and medicine.

INTRODUÇÃO: O Direito à saúde, uma das conquistas garantidas pela Constituição Cidadã promulgada em 1988, veio em resposta aos movimentos de luta dos cidadãos pela Reforma Sanitária em 1986. Na proposta do Sistema Único de Saúde a garantia desse direito está estabelecida. OBJETIVO: Analisar a concepção de direito à saúde no contexto do profissional de nível médio do SUS. MÉTODO: Pesquisa de abordagem qualitativa, através de 2 grupos focais envolvendo 9 egressos de uma Escola Técnica em Saúde do Sistema Único de Saúde do norte do Brasil, dos cursos de análises clínicas, higiene dental e enfermagem, atuando no Sistema Único de Saúde. O tratamento dos dados foi por análise de conteúdo proposta por Bardin (2009), com a definição de 3 categorias RESULTADOS: Três categorias retratam os resultados obtidos congregando conceitos de saúde e de direito à saúde e concepções de saúde; práticas de saúde e acesso à atenção; e ainda, conteúdos da formação, cuidado sanitário e humanização. CONCLUSÃO: Os participantes desse estudo demonstram uma concepção de direito à saúde voltada ao legislado e seus conceitos de saúde abordam elementos da política do SUS, dentre outros, promoção, prevenção, humanização; suas concepções de saúde estão marcadamente voltadas ao modelo biologicista, focado na doença e no medicamento.

Avaliação da capacidade de gestão do componente especializado da assistência farmacêutica / An evaluation of governance capacity of the specialized component of pharmaceutical services in Brazil

Resumo Este artigo apresenta a aplicação de um protocolo de indicadores para a avaliação da capacidade de gestão do Componente Especializado da Assistência Farmacêutica (CEAF) em um estado do Sul do Brasil. A escolha do referencial teórico de capacidade de governo de Carlos Matus, refletido no conceito de capacidade de gestão e de gestão da assistência farmacêutica, tem por base a necessidade de superar a fragmentação e a redução tecnicista imposta à área. A aplicação do protocolo envolveu a coleta de dados em 74 unidades (municipais ou estaduais). Os resultados das análises indicam que a capacidade de gestão necessita de avanços nas três dimensões avaliadas, principalmente em relação aos aspectos que visam à sustentabilidade da gestão. O modelo e o protocolo utilizados trazem avanços para a gestão da assistência farmacêutica ao propor uma mudança do foco técnico-logístico, para as ações de natureza estratégica e política, ou que fomentem maior participação e autonomia. De posse dos resultados poder-se-á desenvolver estratégias para a qualificação do acesso a medicamentos no SUS, no sentido de que o CEAF se torne capaz de garantir a integralidade dos tratamentos medicamentosos.

Abstract This paper presents application of an indicator protocol to assessment of current levels of governance capacity of the Specialized Component of Pharmaceutical Services (CEAF) in a state of the South of Brazil. We chose the theoretical referential of 'governance capacity' proposed by Carlos Matus, which reflects in the concepts of management capacity and pharmaceutical service management, due to the perception of a need to overcome the fragmentation and technicist reductionism that we believe has been imposed on the area of pharmaceutical services. Data was collected using the protocol in 74 municipal or state units. The results of the analysis indicate that the currently existing governance capacity needs improvement in all three dimensions that were evaluated, principally in relation to the aspects that seek sustainability of the governance. The model and the protocol used indicate a way forward for governance of pharmaceutical service by proposing a change from the technicist-logistical focus to an emphasis on strategic and political actions, or ones which foster greater participation and autonomy. With these results in hand, it will be possible to develop strategies for improvement of access to medicines in the SUS, in the sense that the CEAF becomes able to guarantee integrality of medicines treatments.

Registro e incorporação de tecnologias no SUS: barreiras de acesso a medicamentos para doenças da pobreza? / The regulation and adoption of health technologies under Brazil´s Unified Health System: barriers to access to medicines for diseases of poverty?

Resumo O presente trabalho buscou verificar os aspectos relacionados ao registro sanitário e à incorporação de tecnologias no SUS para as doenças da pobreza. Trata-se de estudo exploratório, descritivo, desenvolvido entre janeiro e maio de 2016, em que foram realizados levantamentos e análises de documentos nos sítios eletrônicos da Anvisa, FDA, EMA, Conitec e Sistema Saúde Legis. Verificou-se um total de 132 medicamentos elencados na Rename 2014 para atendimento específico das doenças da pobreza, sendo que mais de um terço (49) possuem apenas um produtor nacional e outros 24 não possuem registro no país. No período de 2006 a 2014 houve crescimento de 46% do número de medicamentos na Rename para tais doenças. Apesar dos avanços do SUS nos campos da regulação e incorporação de tecnologias, dado o desinteresse de mercado e a condição de negligência para as doenças da pobreza, a atuação do Estado é imprescindível para garantir o acesso às melhores terapias disponíveis, visando à redução das iniquidades em saúde. Infere-se que o Brasil precisa avançar na regulação e incorporação de medicamentos sem interesse mercadológico, agenda inconclusa que pode gerar barreiras de acesso às tecnologias para as populações vulneráveis.

Abstract The study aimed to examine the regulation and adoption of health technologies for the diseases of poverty in the Brazil’s Unified Health System (SUS). An exploratory, descriptive study was conducted between January and May 2016 consisting of the search and analysis of relevant documents on the websites of Brazil’s National Health Surveillance Agency, the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), the National Commission for the Adoption of Technologies by the SUS, and Saúde Legis (the Ministry of Health’s Legislation System). The 2014 version of the Brazilian National List of Essential Medicines (RENAME, acronym in Portuguese) contained 132 medicines for diseases of poverty. Over one-third of these (49) had only one national producer, while 24 were not registered in the country. The number of medicines contained in the RENAME dedicated to this group of diseases increased by 46% between 2006 and 2014. Despite advances in the regulation and incorporation of technologies by the SUS, given the lack of market interest and neglect of diseases of poverty, the government has a vital role to play in ensuring access to the best available therapies in order to reduce health inequalities. It therefore follows that Brazil needs to improve the regulation of medicines that do not attract market interest.