Admission of alumni from Multiprofessional Residency Programs into the SUS / Inserção de egressos de Programas de Residência Multiprofissional no SUS

ABSTRACT INTRODUCTION: The Multiprofessional Health Residency Programs (PRMS) were set up as a strategy for training workforce for the Brazilian Unified Health System (SUS). OBJECTIVE: To investigate the proportion of alumni from Primary Health Care Multiprofessional Residency Programs admitted into the SUS and associated factors. METHODS: This is a sectional study developed with alumni from Primary Health Care Multiprofessional Residency Programs from all over Brazil, encompassing the period from 2015 to 2019. Participants answered an online questionnaire with general personal information, admission into stricto sensu graduate school, the labor market and, specifically, the SUS. We applied Pearson's chi-square test for bivariate analyses and Poisson's regression for multiple analysis. RESULTS: A total of 365 alumni from Programs from all Brazilian regions participated in the study. Of those, 80.2% reported entry into the labor market and 47.9% reported being employed in the SUS. Admission into the SUS has been associated with the professions that make up the Reference Team for Primary Health Care (PHC) (PR = 1.87; 95% CI 1.54-2.28) and non-admission into stricto sensu graduate programs (PR = 0.77; 95% CI 0.61-0.97). Regarding admission characteristics, the PHC scenario (47.4%) and work focused on health care (84.9%) were prevalent. Almost 40% of alumni who entered the SUS are working with unstable contracts. Besides, being a residency alumnus is often undervalued in recruitment (56.9%). Among those admitted into the SUS, 8.7% reported being selected to work in the Covid-19 pandemic effort. CONCLUSIONS: The results of this study reinforce the need for a policy to encourage the maintenance, creation and valorization of the PRMS. They also warn about the possibility that admission into the SUS for workers is increasingly difficult due to the current underfunding of the health system.

RESUMO INTRODUÇÃO: Os Programas de Residência Multiprofissional em Saúde (PRMS) configuram-se como estratégia para a formação de força de trabalho para o Sistema Único de Saúde (SUS). OBJETIVO: Investigar a proporção de egressos de PRMS voltados à Atenção Primária à Saúde (APS) inseridos no SUS e fatores associados. MÉTODOS: Trata-se de um estudo seccional desenvolvido com egressos de PRMS voltados à APS de todo o Brasil, referente ao período de 2015 a 2019. Os participantes responderam a um questionário on-line com informações pessoais gerais, inserção na pós-graduação stricto sensu, no mercado de trabalho e especificamente no SUS. Foram aplicados o teste qui-quadrado de Pearson, para análises bivariadas, e Regressão de Poisson, para a análise múltipla. RESULTADOS: Participaram do estudo 365 egressos de Programas de todas as regiões brasileiras. Destes, 80,2% relataram inserção no mercado de trabalho e 47,9% informaram estar trabalhando no SUS. A inserção no SUS esteve associada às profissões que compõem a Equipe de Referência para a APS (RP = 1,87; IC95% 1,54-2,28) e à não inserção em programas de pós-graduação stricto sensu (RP = 0,77; IC95% 0,61-0,97). Quanto às características de inserção, prevaleceram o cenário da APS (47,4%) e o trabalho voltado à atenção à saúde (84,9%). Quase 40% dos egressos inseridos no SUS estão trabalhando por intermédio de vínculos instáveis, além de frequente não valorização do título da residência no recrutamento (56,9%). Entre os inseridos no SUS, 8,7% relataram terem sido selecionados para o enfrentamento da pandemia de covid-19. CONCLUSÕES: Os resultados deste estudo reforçaram a necessidade de política de incentivo à manutenção, criação e valorização dos PRMS e alertaram para possível aumento da dificuldade de inserção das categorias profissionais, frente ao cenário de desfinanciamento da saúde.

Research on the Work Status Quo and Countermeasures of Pharmacists in Public Hospitals of Chongqing under the Backgro und of“New Medical Reform ” / 中国药房

OBJECTIVE： To investigate the current status of pharmacists in public hospitals from Chongqing after the comprehensive reform of public hospitals， to put forward countermeasures and suggestions. METHODS： In questionnaire survey， pharmacists were selected from 33 public hospitals of secondary grade and above in Chongqing as survey objects. The current status of pharmacists in public hospitals of Chongqing from Sept. to Aug. 2018 was collected and surveyed in respects of the basic situation of pharmacists， the impact of medical reform policies， acceptance and professional development requirements of pharmacists. RESULTS： Totally 33 medical institutions included 13 third-grade hospitals and 20 secondary hospitals. A total of 838 questionnaires were distributed and 702 questionnaires were effectively recovered with effective recovery rate of 83.8％. According to the survey results， the majority of pharmacists in public hospitals of Chongqing were 25-35 years old （50.6％）； 8 （1.1％） had doctor’s degree， 86 （12.3％） had master’s degree， and 25.9％ had junior college and technical secondary schools. The number of master’s and doctor’s degrees in third-grade hospitals was higher than that of secondary hospitals， but there were still junior college and technical secondary school degrees in third-grade hospitals. Pharmacists were mainly referred to as middle and junior titles， 217 of which were middle-level titles （30.9％）， and 434 were primary titles（61.8％）； the majors were mainly pharmacy （64％）， followed by traditional Chinese pharmacology （18.7％）. Most of the working years were within 10 years （54.9％）. There were 274 people （39.0％） with an annual income of less than 50 000 yuan， 342 people （48.7％） with an annual income of 50 000- 100 000 yuan and only 86 people （12.3％） with an annual income of more than 100 000 yuan. After the implementation of new medical reform， 430 people （61.3％） thought that the workload had increased significantly or slightly， 99 people （14.1％） thought that the scope of work was significantly expanded， and 433 people thought that the annual income after medical reform was slightly reduced or significantly reduced （61.7％）； 253 people （36.0％） believed that hospital leaders did not pay attention to and did not pay much attention to pharmacists； 294 （41.9％） believed that medical staffs relatively accepted or highly accepted pharmacists. The reasons why pharmaceutical staffs thought that they were not valued mainly included five aspects， including that patients did not understand them； clinical medical staff did not agree with them； leaders did not pay attention to them； corresponding systems and regulations lacked； professional quality lacked. The main work content of pharmacists was mainly based on drug dispensing， and there were fewer people carrying out clinical pharmaceutical care， pharmacy management， pharmaceutical administration and quality control， preparation， pharmaceutical research. The jobs that they hoped to engage in were clinical pharmaceutical care， drug dispensing， pharmaceutical administration and quality monitoring， etc. Pharmacists believed that drug dispensing and delivery， reviewing medical orders， medication education guidance， consultation and medication counseling， drug management were important skills. The pharmaceutical staffs were good at skills， such as medical order review， medication education guidance， drug management. CONCLUSIONS： At present， the pharmacists in public hospitals of Chongqing have some problems， such as low education level， few clinical pharmaceutical professionals， low overall income and not recognized. It is suggested to protect the role and position of pharmacists in the medical treatment process from the perspective of introducing highly educated personnel of clinical pharmacy， improving the professional and educational structure of pharmacists， changing the pharmaceutical care mode， and improving their own ability and treatment.

Work Status and Development Strategy of Clinical Pharmaceutics of Chinese Medicine / 中国药师

Objective:To analyze the work status, existing problems and development strategy of clinical pharmaceutics of Chinese medicine. Methods:The literatures on clinical pharmaceutics of Chinese medicine in recent years were comprehensively analyzed to summarize the present situation, find out the existing problems and difficult points and put forward the development strategy. Results:At present, the main work performed in clinical pharmaceutics of Chinese medicine was as follows:clinical pharmacist of Chinese med-icine made the rounds of the wards in clinics, wrote the medication records, studied the pharmacokinetics of traditional Chinese medi-cine ( TCM) and monitored the therapeutic drugs, monitored and intervened the adverse reactions of TCM, carried out the prescription comment on TCM, studied the boiling, administration and processing methods of TCM, performed the clinical pharmaceutical service and pharmaceutical information service of TCM, and researched the pharmaceutical economics and evidence-based medicine of TCM. Conclusion:Significant achievement and development in clinical pharmaceutics of Chinese medicine have been achieved. However, some problems and deficiency still exist, which should be improved and standardized. The paper puts forward some strategies and thoughts for the improvement of clinical pharmaceutics of Chinese medicine for the purpose of providing reference for the comprehensive development of clinical pharmaceutics of Chinese medicine.