Boletín de establecimientos farmacéuticos DIGEMID: Junio 2023 - Primer semestre / DIGEMID pharmaceutical establishments bulletin: June 2023 - First semester

El presente boletín busca generar conocimiento sobre información de los establecimientos farmacéuticos autorizados privados, que comercializan productos farmacéuticos, incorporando temas de disponibilidad según categoría de establecimiento y rango de pobreza monetaria a nivel distrital

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.

Mapping community pharmacy services in Brazil: a scoping review

Abstract The delivery of clinical pharmacy services has been growing in Brazilian community pharmacies, and it is necessary to have a comprehensive understanding of the topic. This scoping review aimed to provide an overview of Brazilian studies about clinical pharmacy services in community pharmacies. Original research articles, with no restriction of time, study design, or patient's health condition, were included. Searches were conducted in PubMed, Scopus, Web of Science, Scielo, and Lilacs. Two reviewers conducted the screening, full-text reading, and data extraction independently. ROB and ROBINS-I were used for the assessment of quality. Charts and tables were built to summarise the data. Seventy-two articles were included. A diversity of study designs, number of participants, terms used, and outcomes was found. São Paulo and Sergipe States had the highest number of studies (n=10). Pharmacists' interventions were not fully reported in 65% of studies, and most studies presented an unclear risk of bias. Studies were very diverse, impairing the comparisons between the results and hindering their reproducibility. This review suggests using guidelines and checklists for better structuration of pharmacists' interventions as well as reporting results and measuring fidelity in future research.

Skills and practices of pharmacy staff for dispensing of drugs with fiscalized substances in drugstores and pharmacies

ABSTRACT OBJETIVE To evaluate the skills and practices of pharmacy staff during the dispensing of tramadol (drug with fiscalized substance) in drugstores and pharmacies in Medellin, Colombia. METHODS A cross-sectional study was performed. The simulated patient technique was used. The main outcomes included the information provided on the dispensed drug (tramadol), the use of tools to provide information, and the information provided on drug precautions and use recommendations. RESULTS We visited 305 drugstores and pharmacies. The average dispensing time was 2.3 min (SD 1.1 min). In nine drugstores and pharmacies (3.0%), tramadol was not dispensed because it was not in stock. In 17 drugstores and pharmacies (5.7%), the simulated patients were actively informed by the dispensing pharmacy staff; of these, 16 provided oral information and one provided oral and written information. Eight patients (2.7%) received information regarding tramadol use. However, 99% of patients were not informed about tramadol side effects such as dependence, sedation, or hypnosis, and none of the simulated female patients were informed on the precautions related to tramadol use during pregnancy or lactation. CONCLUSIONS Communication skills and appropriate practices of pharmacy staff are critical to patient self-care. However, this study shows their difficulty in counseling about precautions and use recommendations of drugs with fiscalized substances. These outcomes could inform future studies focusing on the rational use of these drugs in drugstores and pharmacies. It is necessary to improve the pharmacy staff competencies through continuing education programs, to facilitate access to information and training.

Prevalência de uso e fontes de obtenção de medicamentos anti-hipertensivos no Brasil: análise do inquérito telefônico VIGITEL / Prevalence of use and sources of antihypertensive medicine in Brazil: an analysis of the VIGITEL telephone survey

RESUMO: Objetivo: A prevalência de hipertensão arterial no Brasil e no mundo vem aumentando nas últimas décadas, sendo o uso de medicamentos uma das estratégias utilizadas no controle da doença. O objetivo deste estudo foi estimar a prevalência de uso e identificar as fontes de obtenção de anti-hipertensivos no Brasil, segundo variáveis sociodemográficas, comparando três períodos: 2011, 2014 e 2017. Métodos: Foram utilizados dados de indivíduos com idade ≥20 anos que referiram diagnóstico médico de hipertensão arterial, entrevistados pelo Vigitel nos anos de 2011, 2014 e 2017. Foi estimada a distribuição de frequências e as prevalências de uso de medicamentos, segundo variáveis sociodemográficas, de acordo com as fontes de obtenção, com intervalos de confiança de 95%. As diferenças entre as proporções foram verificadas pelo teste χ2 de Pearson (Rao-Scott), com nível de significância de 5%. Resultados: A prevalência de uso manteve-se estável (80%). Quanto às fontes de obtenção observou-se variação no período, indicando diminuição na obtenção por meio das Unidades de Saúde do SUS (44,2% em 2011; 30,5% em 2017). Esse decréscimo esteve acompanhado do aumento na obtenção pela Farmácia Popular (16,1% em 2011; 29,9% em 2017). A prevalência de obtenção por meio de farmácias privadas/drogarias mostrou estabilidade no período. Conclusões: A prevalência de uso de medicamentos se manteve alta e houve modificação no padrão de utilização segundo fontes de obtenção, evidenciando migração entre Unidades de Saúde do SUS para a Farmácia Popular, sugerindo redução da disponibilidade dos medicamentos pelas farmácias públicas de forma universal e gratuita.

ABSTRACT: Objective: The prevalence of hypertension in Brazil and worldwide has been increasing in recent decades, and drug therapy is one of the strategies used to control this condition. The objective of this study was to estimate the prevalence of use and identify the sources for obtaining antihypertensive drugs in Brazil, according to sociodemographic variables, comparing three periods: 2011, 2014 and 2017. Methods: Data from individuals aged ≥20 years who reported a medical diagnosis of hypertension, interviewed by Vigitel in 2011, 2014 and 2017 were used. Frequency and prevalence of drug use in addition to the sources for obtaining medication were estimated by sociodemographic variables, with 95% confidence intervals. The differences between proportions were verified by Pearson's chi-square test (Rao-Scott), with a significance level of 5%. Results: The prevalence of antihypertensive drug use remained stable (80%). Regarding the sources for obtaining these medicines, there was variation in the period, indicating a decrease in usage through the Brazilian Unified Health System (SUS) (44.2% in 2011; 30.5% in 2017). This decrease was accompanied with increase in PFPB (16.1% in 2011; 29.9% in 2017). The prevalence of other sources for obtaining medicine (private pharmacies/drugstores) showed stability in the period. Conclusions: The prevalence of medication use remained high and there was a change in the pattern of use according to sources, demonstrating migration between SUS pharmacies to the PFPB, and suggesting a reduction in the availability of medicines from public pharmacies universally, and for free.

Brazilian generics market change after Farmácia Popular program

ABSTRACT OBJECTIVE To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.

Satisfacción percebida del servicio de farmacias comunitarias independientes de la ciudad de Sucre / Perceived satisfaction of the independent community pharmacy service of the city of Sucre

El objetivo del presente trabajo fue determinar el grado de satisfacción percibida del cliente interno y externo de las farmacias comunitarias privadas de la Ciudad de Sucre 2019. Se trata de un estudio cuantitativo, correlacional, transversal realizado en 53 farmacias, distribuidos en los diferentes distritos de la ciudad de Sucre, realizándose la entrevista a 1 cliente interno por farmacia y 108 clientes externos mayores de 18 años. Entre los resultados se tiene que la mayoría de los clientes externos son del sexo femenino (61,11%), así como la mayoría señala que es buena la localización y facilidad de acceso a la farmacia (53,7%), el horario de atención (59,26%), el trato y amabilidad del personal farmacéutico (56,48%), sin embargo califican de regular la sala de espera (43,52%). La percepción de los clientes internos sobre la sala de espera es Buena en 41,51%, así como en la información que Brinda al cliente externo (49,06%). En conclusión se puede señalar que los clientes externos se sientes satisfechos por la atención recibida y los clientes internos de la misma manera.

The objective of this work was to determine the degree of perceived satisfaction of the internal and external customer of the private community pharmacies of the City of Sucre 2019. It is a quantitative, correlational, cross-sectional study conducted in 53 pharmacies, distributed in the different districts of the city of Sucre, conducting the interview with 1 internal customer per pharmacy and 108 external clients over 18 years. Among the results is that most of the external clients are female (61.11%), as well as the majority indicates that the location and ease of access to the pharmacy (53.7%), the opening hours are good attention (59.26%), the treatment and friendliness of the pharmaceutical staff (56.48%), however they qualify to regulate the waiting room (43.52%). The perception of internal customers about the waiting room is good at 41.51%, as well as the information provided to the external customer (49.06%). In conclusion, it can be noted that external clients are satisfied with the attention received and internal clients in the same way.

Comparative analysis of private retail community pharmacies' participation in the national health insurance scheme of Nigeria and Ghana: implications for access to essential medicines

BACKGROUND: Frequent stock-out of drugs in the public hospitals causes National Health Insurance Scheme (NHIS) enrollees to purchase most of their medicines out-of-pocket in community pharmacies, thereby imposing financial constraints on them against the main objective of the scheme. The objectives of this study were to determine and compare the level of participation of private retail community pharmacies (PRCPs) in the NHIS of Nigeria and Ghana, to describe their spatial distribution, and to highlight from literature major factors that would influence the participation of these pharmacies in the scheme. METHODS: PRCPs data were collected from the Nigerian NHIS active secondary healthcare providers list of 1st July 2017 and the Ghanaian NHIS active providers online list of 2018. PRCPs densities at the national levels were calculated from last published national coverage data for each country. RESULTS: The total number of PRCP accredited by NHIS of both Nigeria and Ghana is 964(639[66.3% versus 325[33.7%]). NHIS accredited PRCPs densities for Nigeria and Ghana were 1 PRCP per 9, 390 enrollees and 1 PRCP per 33, 108 enrollees respectively. Across the Nigerian States, it was noted that Lagos State has the highest proportion (21.4%, n = 137) of community pharmacy participation in the scheme whereas, in Ghan, Greater Accra Region has the highest participation (34.2%, n = 111). CONCLUSION: This study revealed low participation of PRCPs and skewed spatial distribution between urban and rural areas of both countries, although there was higher participation of these pharmacies in Nigeria due to Nigerian lower NHIS coverage data compared to Ghana

Nível de satisfação dos usuários e verificação do conhecimento dos farmacêuticos em farmácias públicas do Espírito Santo, Brasil / Satisfaction levels of users and verification of the knowledge of pharmacists in public pharmacies in the State of Espírito Santo, Brazil

Resumo O objetivo do presente estudo foi determinar o nível de satisfação dos usuários de farmácias públicas e verificar o conhecimento dos farmacêuticos com relação à dispensação de medicamentos. Trata-se de um estudo descritivo, realizado em municípios de uma mesma região, no interior do Estado do Espírito Santo, no período de maio a agosto de 2013. Os dados foram coletados por meio de questionário estruturado. Para a análise estatística, foi utilizado o Software SPSS20. Para os dados que apresentaram distribuição normal foram aplicados o teste t student ou ANOVA, enquanto que para os demais foram aplicados os testes Mann-Whitney ou Kruskal -Wallis. A correlação de Spearman foi utilizada para avaliar a satisfação do paciente em relação ao tempo de atendimento e ao tempo de espera. O nível de significância adotado para os testes foi de 5%. Os principais resultados obtidos foram o alto nível de insatisfação por parte dos usuários e a correlação com o tempo de espera até o atendimento. Além disso, o conhecimento dos farmacêuticos em relação à dispensação foi classificado como satisfatório/regular. Conclui-se que são necessárias medidas na gestão de serviços farmacêuticos para atender as expectativas dos usuários na dispensação de medicamentos.

Abstract The scope of this study was to determine the satisfaction levels of users of public pharmacies and verify the knowledge of pharmacists in relation to dispensing of medicines. This is a descriptive study, conducted in municipalities in the State of Espírito Santo, in the period from May to August 2013. Data were collected using a structured questionnaire and SPSS20 software was used for statistical analysis. The Student t or ANOVA test was used for data with normal distribution, while the Mann-Whitney or Kruskal-Wallis test was applied for data without normal distribution. The Spearman correlation was used to evaluate patient satisfaction with the service time and the waiting time. The significance level for the tests was 5%. The main results obtained were the high level of dissatisfaction among users and the correlation with the waiting time to be attended. Apart from this, the knowledge of pharmacists in relation to the medication dispensed was classified as satisfactory/regular. The conclusion drawn is that actions are necessary in the management of pharmaceutical service to address the expectations of users in the dispensation of drugs.

Impact of a drug dispensing model at a Community Pharmacy in Goiânia, Goiás, Brazil

Although dispensing of medication has been addressed by theoretical models, studies that confirm the impact of this service are still needed. The objective was to evaluate the impact of a new model of medicine dispensing system on patients' medication knowledge, adherence to treatment and satisfaction. One hundred and four patients attending the dispensing service of a community pharmacy between 21 January 2013 and 20 April 2013 were included in this intervention study. The impact of the service on patients' medication knowledge, adherence to treatment and satisfaction was assessed by using validated questionnaires at two time points: at the moment of medication dispensing and 30 days thereafter by telephone contact. Statistical analysis was performed by McNemar's test, and a p<0.05 was set as statistically significant. The number of patients showing insufficient knowledge about medications decreased by 50% (p < 0.05), and the number of those showing sufficient knowledge was three times greater (p < 0.05) after medicine dispensing. A high level of satisfaction was observed. Improvement of medication adherence, however, was not observed. The proposed system model for drug dispensing improved patients' knowledge about medication and satisfaction

Analise da completude das prescrições médicas de antimicrobianos dispensadas em farmácia comunitária de Jequié, Bahia / Analysis of the completeness of antimicrobial medical prescriptions dispensed in coommunity pharmacy of Jequié, Bahia / Análisis de la completud de las prescrpiciones medicas de antimicrobianos dispensadas en una farmacia comunitaria em Jequié, Bahia

A prescrição médica é um documento legal e segue critérios padronizados para a sua execução. A ilegibilidade associada com a incompletude de dados na prescrição de antimicrobianos pode levar a erros de medicação e a lesões ao paciente, além de promover a resistência bacteriana. O objetivo deste estudo foi avaliar o perfil das prescrições médicas de antimicrobianos tópicos e sistêmicos dispensadas em uma Farmácia Comunitária após a publicação da RDC n. 20/2011, bem como verificar sua adequação à legislação vigente. Este estudo transversal e descritivo analisou 600 prescrições médicas de antimicrobianos recolhidas em uma farmácia comunitária de uma cidade do interior da Bahia, referentes aos meses de janeiro a março de 2012, e as interpretou por meio de um formulário estruturado, verificando a sua adequação legal, ética e técnica, de forma inédita, após a publicação da RDC n. 20, de 2011. Os resultados mostraram a ausência total dos quesitos endereço, idade e sexo, e somente uma prescrição apresentou o peso do paciente. Verificou-se a ausência da concentração em 44,0% das prescrições, da duração do tratamento em 34,3%, da via de administração em 23,5%, da forma farmacêutica em 22,7% e de informações complementares em 92,7%. Concluiu-se que todas as prescrições de antimicrobianos avaliadas estavam inadequadas do ponto de vista legal e sanitário, o que pode levar a um insucesso da terapia e ao desencadeamento da resistência bacteriana.

The medical prescription is a legal document that follows standardized criteria for its execution. The illegibility associated to incomplete antimicrobials prescription data may lead to medication errors and patient injury, as well, as promote bacterial resistance. The objective of this study was to evaluate the profile of topical and systemic antimicrobials medical prescriptions dispensed in a Community Pharmacy after the publication of RDC n. 20/2011, as well as to verify its suitability to the current legislation. This descriptive cross-sectional study analyzed 600 prescriptions of antibiotics collected in a community pharmacy in a city in Bahia, from January to March 2012. Data was interpreted through a structured form, verifying their legal, ethic and technic, compliance in an unprecedented manner after the publication of the RDC 20/2011. The results showed the total absence of address, age and sex, and only one prescription presented the weight of the patient. There was no concentration in 44.0% of the prescriptions, treatment duration in 34.3%, route of administration in 23.5%, of the pharmaceutical form 22.7% and of additional information in 92.7%. In conclusion, all the antimicrobial prescriptions were evaluated as inadequate regarding legal and health points of view, which may lead to therapy failure and to the onset of bacterial resistance.

La prescripción médica es un documento legal y sigue criterios estandarizados para su ejecución. La ilegibilidad asociada con la no completitud de datos en la prescripción de antimicrobianos puede llevar a errores de medicación y a lesiones al paciente, además de promover la resistencia bacteriana. El objetivo de este estudio fue evaluar el perfil de las prescripciones médicas de antimicrobianos tópicos y sistémicos dispensadas en una Farmacia Comunitaria después de la publicación de la RDC n. 20/2011, así como verificar su adecuación a la legislación. Ese estudio transversal y descriptivo analizó 600 prescripciones médicas de antimicrobianos recogidos en una farmacia comunitaria en una ciudad de Bahia, referentes a los meses de enero a marzo de 2012 y las interpretó a través de un formulario estructurado, verificando su adecuación legal, ética y técnica, de una manera sin precedentes, después de la publicación de la RDC 20/2011. Se destacó la ausencia total de los ítems dirección, edad y sexo, y solamente una prescripción presentó el peso del paciente. Se verificó la ausencia de la concentración en el 44,0% de las prescripciones, de la duración del tratamiento en el 34,3%, de la vía de administración en el 23,5%, de la forma farmacéutica en el 22,7% y de las informaciones complementares en el 92,7%. Se concluyó que todas las recetas de antimicrobianos estudiadas resultaron inadecuadas desde el punto de vista jurídico y de la salud, lo que puede conducir a un fracaso del tratamiento y a la promoción de la resistencia bacteriana.

Coordinación entre servicios farmacéuticos para una farmacoterapia integrada: el caso de Cataluña / Coordination between pharmaceutical services for integrated pharmacotherapy: the case of Catalonia

Resumen Las políticas farmacéuticas han sido consideradas como estratégicas para contribuir con la garantía de la coordinación asistencial y la integración clínica. El presente estudio tiene como objetivo describir los servicios farmacéuticos desarrollados en diferentes niveles asistenciales en la red de salud de Cataluña, así como identificar y analizar los mecanismos e instrumentos que actúan como facilitadores y/o barreras para la coordinación de la farmacoterapia. Se trata de un estudio descriptivo de 12 casos de los servicios farmacéuticos hospitalarios, atención primaria y oficinas de farmacia comunitarias. Se identifica avances que relacionan la percepción, formalización y la coordinación asistencial y clínica de los servicios farmacéuticos. Sin embargo, se identifican también fragilidades y situaciones mejorables en cuanto a la coordinación. Se concluyó que las diferentes herramientas e instrumentos implantados, parece facilitar una mayor posibilidad de integración entre servicios farmacéuticos y de éstos con la red de salud para contribuir con una farmacoterapia integrada.

Abstract Pharmaceutical policies have been considered strategies to contribute to the guarantee of care coordination and clinical integration. This study sought to describe the pharmaceutical services developed at different levels of care in the health network in Catalonia, as well as to identify and analyze the mechanisms and instruments that act as facilitators and/or barriers to the coordination of pharmacotherapy. This is a descriptive study of 12 cases of hospital pharmacy services, primary care and community pharmacies. Advances related to the perception, formalization and clinical and assistance coordination of the pharmaceutical services were identified. However, weaknesses and potential improvements in coordination were observed. The conclusion drawn was that the different tools and instruments implemented appear to facilitate a greater possibility of integration between pharmaceutical services and the latter with the health services network to contribute to integrated pharmacotherapy.

Resultados de seguimento farmacoterapêutico a pacientes hipertensos em farmácia comunitária privada na Bahia / Results of hypertensive patients pharmacotherapeutic follow up in a private community pharmacy in Bahia

A Hipertensão Arterial Sistêmica é uma doença de alta prevalência e grande morbidade, quando não tratada de forma correta. A adesão ao tratamento medicamentoso é um fator determinante no controle da doença. O objetivo deste estudo foi discutir o papel do farmacêutico, por meio dos resultados encontrados, no tratamento de pacientes hipertensos, na adesão à farmacoterapia e sua influência nos níveis pressóricos, na qualidade de vida e na satisfação dos pacientes. Foi realizada a análise dos dados obtidos por meio do seguimento farmacoterapêutico de 60 pacientes atendidos em uma farmácia comunitária privada, no município de Vitória da Conquista, Bahia. Esta análise permitiu observar uma redução significativa dos níveis de pressão arterial dos pacientes, assim como resultados positivos na satisfação com o serviço e na possibilidade de remuneração pela prestação de serviços de Atenção Farmacêutica

Resultados de seguimento farmacoterapêutico a pacientes hipertensos em farmácia comunitária privada do interior da Bahia / Results of hypertensive patients pharmacotherapeutic follow up in a private community pharmacy in Bahia / Resultados del seguimiento farmacoterapéutico a pacientes hipertensos en una farmacia comunitaria privada en Bahia

A Hipertensão Arterial Sistêmica é uma doença de alta prevalência e grande morbidade, quando não tratada de forma correta. A adesão ao tratamento medicamentoso é um fator determinante no controle da doença. O objetivo deste estudo foi discutir o papel do farmacêutico, por meio dos resultados encontrados, no tratamento de pacientes hipertensos, na adesão à farmacoterapia e sua influência nos níveis pressóricos, na qualidade de vida e na satisfação dos pacientes. Foi realizada a análise dos dados obtidos por meio do seguimento farmacoterapêutico de 60 pacientes atendidos em uma farmácia comunitária privada, no município de Vitória da Conquista, Bahia. Esta análise permitiu observar uma redução significativa dos níveis de pressão arterial dos pacientes, assim como resultados positivos na satisfação com o serviço e na possibilidade de remuneração pela prestação de serviços de Atenção Farmacêutica.

Hypertension is a disease of high prevalence and high morbidity, if not treated correctly. Adherence to therapy is an important factor in controlling the progression of this disease. The objective of this study was to discuss the role of the pharmacist in the treatment of hypertensive patients, and their influence on adherence to pharmacotherapy, blood pressure control, quality of life and patient satisfaction. Data of 60 patients from a pharmaceutical care program in a private community pharmacy in the city of Vitória da Conquista, Bahia were analyzed. From this analysis, a significant reduction on blood pressure levels, as well as positive results regarding satisfaction with the service, and the possibility of compensation for the provision of pharmaceutical care were observed.

La Hipertensión Arterial Sistémica es una enfermedad de alta prevalencia y gran morbilidad, cuando no tratada de forma correcta. La adhesión al tratamiento farmacológico es un factor determinante en el control de la enfermedad. El objetivo de este estudio fue discutir el papel del farmacéutico, por medio de los resultados encontrados, en el tratamiento de pacientes hipertensos, en la adhesión a la terapia farmacológica, y su influencia en los niveles de presión arterial, en la calidad de vida, y en la satisfacción de los pacientes. Fue realizado un análisis de los datos obtenidos por medio del seguimiento farmacoterapéutico de 60 pacientes, atendidos en una farmacia comunitaria privada, en el municipio de Vitória da Conquista, Bahia. Este análisis, permitió observar una reducción significativa de los niveles de Presión Arterial de los pacientes, así como resultados positivos en la satisfacción con el servicio, y la posibilidad de remuneración por la prestación de servicios de Atención Farmacéutica.

Quality indicators of pharmacists' services in community pharmacies in Paraná State, Brazil

ABSTRACT Pharmacists and their pharmacies have been evolving in their roles as health promoters in Brazil. Some examples are the recent legislation reaffirming the role of Brazilian pharmacies as health institutions, rather than having only a commercial profile, giving greater clarity to pharmacists about their roles as health care providers. This evolution came with the recognition that is already seen in other developed countries, confirming the need for the pharmacist as a health promoter, and not simply a dispenser of drugs in society. This study has obtained the profile and activities of community pharmacists, as well as the quality indicators of private community pharmacies throughout the State of Paraná through the application of an online survey sent to pharmacists in the state. Out of all pharmacists surveyed, 533 were part of the final analysis, being the pharmacists to complete the survey in full. Participants were mostly female (69.4%) and were, on average, 35.2 ± 9.2 years old. Of these, 60% worked in pharmacy chains and just 37% of all pharmacist respondents were issuing the Declaration of Pharmaceutical Services. The current study showed that many pharmaceutical services are not adopted by pharmacies as these services bring no significant financial reward. Regarding the structure, the Paraná State showed that pharmacies present a good overall structure. The kind of pharmacy (chain or independent) influenced the pharmaceutical services provided and the available structure, where the independent pharmacies provide a wider range of services and have better structure. This study was able to identify the profile and behaviors of pharmacists and also the quality indicators of pharmacies in Paraná State.

Purchase of prescription and OTC medicines in Slovakia: factors influencing patients' expectations and satisfaction

ABSTRACT Slovakia is a country where the purchase of OTC (over the counter) medicines outside the pharmacy is not allowed by the government. This study aimed at evaluating patients' satisfaction and acceptance of community pharmacists. Customer's behaviour and expectations influencing the purchase of prescription and OTC medicines were analyzed. A structured questionnaire having 15 multiple-choice questions was used to analyze the descriptive parameters. Data collection lasted from January to February 2014. The sample size consisted of 357 high-school educated individuals under 40 years of age. The survey showed that the prescription and OTC medicines were bought equally. The participants reported a 96.0%, 96.3% and 90.2% satisfaction rate with willingness and approach of the community pharmacist, pharmacy services and provision of drug information respectively. As for the OTC medicines, 89.5% people considered the pharmacist an expert: 88.2% purchased medicines with pharmacist's recommendation, 97.8% needed a professional counselling and 97.2% required a pharmacist's guidance. As for the prescription drugs, only 72.1% considered the pharmacist an expert: 96.3% suggested that physician's prescription was significant and 88.3% considered pharmacist's guidance in the process of selection of prescription medicines nonessential. A comprehensible and respectable conversation was highly expected in regards to both the OTC and prescription medicines.

Factores relacionados con la adquisición de medicamentos / Factors related with the acquisition of medication / Fatores relacionados com a aquisição de medicamentos

Objetivo: identificar los factores relacionados con la adquisición de medicamentos, de los usuarios de droguerías. Materiales y Métodos: estudio descriptivo de corte transversal. La muestra fue de 138 usuarios de droguerías urbanas en una ciudad del noroccidente del departamento del Meta, mayores de 18 años, que expresaron su deseo de participar en el estudio cuando se les abordó al salir de la droguería. Se construyó un cuestionario revisado por 5 expertos. Resultados: las personas que compran medicamentos en las droguerías son, principalmente, del estrato 2; el 75 % de los usuarios no recibió información sobre los productos adquiridos; el 30 % leyó información del envase del medicamento, el 32.3 % de los usuarios de las droguerías recomienda medicamentos para el dolor de cabeza, la automedicación en la ciudad estudiada alcanza el 78 %, el 21 % de los usuarios se asesoran del personal de la droguería. Los grupos farmacológicos que más compran son analgésicos, antiinflamatorios, antibióticos y antigripales. Conclusiones: el gran reconocimiento del personal que labora en la droguería, como personal idóneo para recomendar el uso de medicamentos, lo debe llevar a liderar los procesos de dispensación pensando más en las personas y dejar de ver al medicamento como una mercancía.

Objective: identify the factors related with the acquisition of medication, from the drugstore customers. Materials and Methods: a descriptive study of cross section. The sample was of 138 customers from urban drugstores in a city on the northwest of the Meta department, older than 18, that expressed their desire to participate in the study when they were asked when leaving the store. A questionnaire was made and revised by 5 experts. Results: the people that buy medicine are, mainly from social stratum 2; 75% of the customers did not receive information about the products; only 30% read the information of the packaging, 32,3% of the customers from the drugstore recommend medicine used for headaches, the self-medication on the analyzed city reaches 78%, 21% of the customers consult the drugstore staff. The best-bought pharmacological groups are painkillers, antiinflammatory, antibiotics and flu remedies. Conclusions: the great recognition of the drugstore staff, as qualified staff, to recommend the use of medicine, should lead to the processes of dispensation thinking more about the people and stop seeing medicine as merchandise.

Objetivo: identificar os fatores relacionados com a aquisição de medicamentos, dos usuários de drogarias. Materiais e Métodos: estudo descritivo de corte transversal. A amostra foi de 138 usuários de drogarias urbanas em uma cidade do noroeste do estado de Meta, maiores de 18 anos, que expressaram seu desejo de participar no estudo quando foram entrevistados ao sair da drogaria. Construiu-se um questionário revisado por 5 peritos. Resultados: as pessoas que compraram medicamentos nas drogarias eram principalmente de classe baixa (estratificação 2); o 75% dos usuários não recebeu informação sobre os produtos adquiridos; o 30% leu informação da embalagem do medicamento, o 32,3% dos usuários das drogarias procuram medicamentos para a dor de cabeça, a automedicação na cidade estudada alcançou o 78%, o 21% dos usuários foram aconselhados pelo pessoal da drogaria. Os grupos farmacológicos que mais compraram foram analgésicos, antiinflamatórios, antibióticos e remédios para a gripe. Conclusões: o importante reconhecimento do pessoal que trabalha na drogaria, como pessoal idóneo para recomendar o uso de medicamentos, deve leva-os a liderar os processos de dispensação pensando mais nas pessoas e deixar de perceber ao medicamento como uma mercancia.

Costs of Public Pharmaceutical Services in Rio de Janeiro Compared to Farmácia Popular Program / Custos da assistência farmacêutica pública frente ao Programa Farmácia Popular

ABSTRACT OBJECTIVE To analyze the costs of public pharmaceutical services compared to Farmácia Popular Program (Popular Pharmacy Program). METHODS Comparison between prices paid by Aqui Tem Farmácia Popular Program (Farmácia Popular is available here) with the full costs of medicine provision by the Municipal Health Department of Rio de Janeiro. The comparison comprised 25 medicines supplied by both the municipal pharmaceutical service and Aqui Tem Farmácia Popular Program. Calculating the cost per pharmaceutical unit of each medicine included expenditure by Municipal Health Department of Rio de Janeiro with procurement (price), logistics, and local dispensation. The reference price of medicines paid by Aqui Tem Farmácia Popular was taken from the Brazilian Ministry of Health standard in force in 2012. Comparisons included full reference price; reference price minus 10.0% copayment by users; and maximum reference paid by the Ministry of Health (minus copayment and taxes). Simulations were carried out of the differences between the costs of Municipal Health Department of Rio de Janeiro with the common medicines and those potentially incurred based on the reference price of Aqui Tem Farmácia Popular. RESULTS The Municipal Health Department of Rio de Janeiro spent R$28,526,526.57 with 25 medicines of the common list in 2012; 58.7% accounted for direct procurement costs. The estimated costs of the Health Department were generally lower than the reference prices of the Aqui Tem Farmácia Popular Program for 20 medicines, regardless of reference prices. The potential costs incurred by Health Department if expenditure of its consumption pattern were based on the reference prices of Aqui Tem Farmácia Popular would be R$124,170,777.76, considering the best scenario of payment by the Brazilian Ministry of Health (90.0% of the reference price, minus taxes). CONCLUSIONS The difference in costs between public provision by Municipal Health Department of Rio de Janeiro and Farmácia Popular Program indicates that some reference prices could be reviewed aiming at their reduction.

RESUMO OBJETIVO Analisar custos da assistência farmacêutica pública frente ao Programa Farmácia Popular. MÉTODOS Comparação entre os valores pagos pelo Programa Aqui Tem Farmácia Popular com os custos integrais relativos à provisão de medicamentos pela Secretaria Municipal de Saúde do Rio de Janeiro. A comparação compreendeu 25 medicamentos, comuns tanto à provisão pela assistência farmacêutica pública municipal quanto pelo Programa Aqui Tem Farmácia Popular. O cálculo do custo unitário por unidade farmacotécnica de cada medicamento envolveu os gastos da Secretaria Municipal de Saúde com custos de aquisição (preço), logísticos e com a dispensação em nível local. O valor de referência dos medicamentos pago pelo Aqui Tem Farmácia Popular foi extraído da norma ministerial em vigor em 2012. As comparações envolveram o valor de referência pleno; valor de referência com desconto dos 10,0% pagos de contrapartida pelos usuários; e valor de referência máximo pago pelo Ministério da Saúde (descontados contrapartida e sem impostos).Foram realizadas simulações das diferenças entre os gastos da Secretaria Municipal de Saúde do Rio de Janeiro com os medicamentos do elenco comum e os que seriam incorridos se esses tivessem sido executados com base no valor de referência do Aqui Tem Farmácia Popular. RESULTADOS A Secretaria Municipal de Saúde do Rio de Janeiro gastou R$28.526.526,57 com 25 medicamentos do rol comum em 2012; 58,7% corresponderam a custos diretos com a aquisição dos produtos. Os custos estimados da Secretaria Municipal de Saúde do Rio de Janeiro foram, em geral, menores que os valores de referência do Programa Aqui Tem Farmácia Popular em 20 medicamentos, independentemente dos valores de referência. Os custos que seriam incorridos pela Secretaria Municipal de Saúde do Rio de Janeiro, caso seu padrão de consumo tivesse como valor de pagamento os valores de referência do Aqui Tem Farmácia Popular seriam de R$124.170.777,76 considerando a melhor situação de pagamento pelo Ministério da Saúde (90,0% do valor de referência, com impostos descontados). CONCLUSÕES A diferença de custos entre a provisão pública pela Secretaria Municipal de Saúde do Rio de Janeiro e o Programa Aqui Tem Farmácia Popular sinaliza que alguns valores de referência poderiam ser objetos de exame para sua redução.

Acesso a medicamentos para tratamento de condições agudas prescritos a adultos nas regiões Sul e Nordeste do Brasil / Access to medicines prescribed for acute health conditions in adults in South and Northeast Brazil / Acceso a medicamentos prescritos para adultos en el tratamiento de enfermedades graves en las regiones sur y nordeste de Brasil

Estudo transversal no âmbito do Projeto de Expansão e Consolidação Saúde da Família de 2005, com o objetivo de avaliar o acesso total e gratuito a medicamentos prescritos na última consulta médica, para problemas agudos de saúde, e estimar quanto o acesso pode ter melhorado com a inclusão dos medicamentos em políticas e programas vigentes. A amostra incluiu 4.060 adultos residentes na área das unidades básicas de saúde de 41 municípios do Sul e Nordeste do Brasil. O acesso foi maior no Sul (83,2%) do que no Nordeste (71%) e o acesso gratuito foi semelhante (37%), com maior participação do Programa Saúde da Família (PSF) em relação ao modelo tradicional especialmente no Nordeste. Cerca de 60% dos medicamentos prescritos e 50% dos presentes na Relação Nacional de Medicamentos Essenciais (RENAME) foram pagos. Nenhuma variação foi observada na proporção de medicamentos presentes na RENAME vigente e acesso. Contudo, 40% dos medicamentos que foram pagos podem atualmente ser obtidos por meio do Programa Farmácia Popular. Esse programa parece surgir como uma nova forma de garantir o acesso a medicamentos prescritos no sistema de saúde.

This was a cross-sectional study within Brazil's Project for the Expansion and Consolidation of Family Health, 2005, with the objective of universal and free access to the medication prescribed in the last medical appointment for acute health problems and to estimate the degree to which access may have improved with inclusion of the medicines in prevailing policies and programs. The sample included 4,060 adults living in the area of primary health care units in 41 municipalities in South and Northeast Brazil. Access was greater in the South (83.2%) than in the Northeast (71%), and free access was similar (37%), with a greater share by the Family Health Program (FHP) when compared to the traditional model, especially in the Northeast. Some 60% of prescribed medicines and 50% of those on the National List of Essential Medicines (RENAME) were paid for. No variation was observed in the proportion of medicines present on the prevailing RENAME list and access. However, 40% of the medicines that were paid for can currently be obtained through the Popular Pharmacy Program. The latter program appears to emerge as a new way to guarantee access to medicines prescribed in the health system.

Estudio transversal en el ámbito del Proyecto de Expansión y Consolidación Salud de la Familia de 2005, con el objetivo de evaluar el acceso total y gratuito a medicamentos prescritos en la última consulta médica, para problemas graves de salud, y estimar la mejora en su acceso con la inclusión de los mismos en las políticas y programas vigentes. La muestra incluyó a 4.060 adultos, residentes en el área de las unidades básicas de salud de 41 municipios del Sur y Nordeste de Brasil. el acceso fue mayor en el Sur (83,2%) que en el Nordeste (71%) y el acceso gratuito fue semejante (37%) con una mayor participación del Programa Salud de la Familia (PSF), en relación con el modelo tradicional, especialmente en el Nordeste. Cerca de un 60% de los medicamentos prescritos y un 50% de los presentes en la Relación Nacional de Medicamentos Esenciales (RENAME) fueron pagados. No se observó ninguna variación en la proporción de medicamentos presentes en la RENAME vigentes y en acceso. No obstante, un 40% de los medicamentos que fueron pagados pueden ser actualmente obtenidos mediante el Programa Farmacia Popular. Este programa parece surgir como una nueva forma de garantizar el acceso a medicamentos prescritos en el sistema de salud.