Use of medicines in São Paulo, Brazil, and State Health Care Coverage, 2003 and 2015

OBJECTIVES: To analyze the use and acquisition of medicines in São Paulo, Brazil, in 2003 and 2015, according to sociodemographic factors, socioeconomic status, and health conditions of the population. METHODS: Data were obtained from population health surveys "ISA-Capital". Descriptive analysis, bivariate analysis, and logistic regression models were used to evaluate the use of medicines and coverage by the Brazilian Unified Health System (SUS) according to socioeconomic status and health conditions in two periods: 2003 and 2015. RESULTS: From 2003 to 2015, the surveys showed an increase in the income and education level of the study population. There was no increase in the prevalence of chronic diseases and use of medicines from 2003 to 2015. The provision of medicines by SUS was higher in 2015 than in 2003, and the coverage by SUS was higher in the population with lower education level and income in both 2003 and 2015. CONCLUSIONS: The use of medicines, mainly for chronic disease control, did not change over the years, and there was an increase in SUS coverage for medicines during 2003-2015 in all population groups, with a greater impact on the lower socioeconomic status population. The programs of the provision of medicines implanted since 2003 had influenced the greater SUS coverage for medicines and in the reduction of inequalities in access to medicines.

Avaliação dos usuários sobre as farmácias públicas no Brasil / User evaluation of public pharmacy services in Brazil

Resumo O objetivo deste artigo é avaliar aspectos relacionados aos serviços prestados nas farmácias do SUS do Brasil, segundo a percepção dos usuários. Utilizou-se dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos, realizada entre 2013 e 2014. Analisou-se indivíduos que obtiveram algum medicamento nas farmácias públicas. Para o cálculo das estimativas de prevalências, foi usado como denominador o total de usuários de medicamentos com IC95%. A partir da faixa etária de 20 a 24 anos até 60 a 64 anos observa-se diferenças significativas entre homens e mulheres, em relação ao uso de farmácias públicas. Mais de 30% das pessoas de todas as classes socioeconômica que não obtiveram medicamentos nas farmácias do SUS, nunca pensaram nessa possibilidade. Não costumam esperar para obtenção dos medicamentos e avaliação positiva do horário de funcionamento tiveram uma associação mais forte em relação a avaliação positiva dos usuários das farmácias do SUS. O horário de funcionamento e o tempo de espera são potenciais barreiras nas farmácias do SUS. A avaliação dos usuários que utilizam o SUS é positiva, mas aponta diferenças regionais e a identificação da magnitude dessas pode contribuir na formulação de políticas mais eficazes e equânimes.

Abstract Objective of this article is to evaluate aspects related to the services provided in SUS pharmacies in Brazil, according to users' perception. Data from the National Survey of Access, Use and Promotion of Rational Use of Medicines carried out between 2013 and 2014 were used. Individuals who obtained drugs from public pharmacies were analyzed. To calculate prevalence estimates, the total number of users of drugs with 95%CI was used as denominator. From the age group of 20 to 24 years up to 60 to 64 years, there were significant differences between men and women in terms of use of public pharmacies. More than 30% of people from all socioeconomic classes who did not obtain drugs from SUS pharmacies never thought about this possibility. Not having to wait much time to obtain the medication and a positive evaluation of the opening hours had a strong association with the positive evaluation of users of SUS pharmacies. Opening hours and waiting time are potential barriers in SUS pharmacies. The evaluation of users of SUS was positive, but it pointed to regional differences, and the identification of the magnitude of such differences can contribute to the planning of more effective and equitable policies.

¿Cuál es el impacto de permitir la venta de medicamentos sin prescripción médica fuera de farmacias?: síntesis rápida de evidencia / What is the impact of allowing the sale of over-the-counter medicines outside pharmacies?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO El acceso a medicamentos es un elemento fundamental para avanzar en la cobertura universal de la salud. En este ámbito, el precio es un elemento esencial para mejorar el acceso a medicamentos, lo que podría lograrse a través del aumento de la competencia dentro del mercado farmacéutico. Con el objetivo de reducir los precios de los medicamentos e introducir competencia en este mercado, el Ministerio de Salud está intentando impulsar una política para permitir que fármacos sin necesidad de una prescripción médica, puedan ser comercializados en establecimientos diferentes a una farmacia. En este contexto el departamento de políticas Farmacéuticas y Profesiones Médicas solicita esta síntesis de evidencia con el objetivo de aportar con la evidencia disponible que sobre este tipo de intervenciones. METODOLOGÍA Se formuló una estrategia de búsqueda para ser utilizada en 4 bases de datos, con el objetivo de identificar revisiones sistemáticas que abordaran la pregunta formulada. Al no encontrarse revisiones que abordaran las comparaciones deseadas, se realizó una búsqueda de estudios primarios en PubMed y CENTRAL. Se utiliza la metodología de certeza de la evidencia GRADE. Se incluyeron todos los estudios que evaluaran el impacto de este tipo de medidas en cualquier país. Se excluyeron estudios que evaluaran el impacto de cambiar medicamentos en cuanto a su obligatoriedad de ser comercializados con prescripción, así como también la venta de medicamentos que no están autorizados a venderse sin prescripción. RESULTADOS Se utilizan 3 estudios primarios -Un estudio realizado en Corea, muestra que la venta de medicamentos fuera de farmacias podría reducir la tasa de consultas ambulatorias para migrañas. Este mismo estudio muestra un efecto sutil sobre la dispepsia, y sin resultados en infecciones respiratorias. -Otro estudio realizado en Noruega, muestra que esta intervención reduciría levemente el consumo de analgésicos en la población. -Muchos países han implementado políticas similares, tales como Islandia, Noruega, Israel, Reino Unido y Corea. Sin embargo, no se encontró evidencia de evaluaciones de cada uno de estos países. ­Es necesario monitorear la publicación de nueva evidencia sobre el impacto de esta interven ción, de manera de contar con una respuesta más robusta.

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.

Generic substitution in Malaysia: Recommendations from a systematic review.

Generic substitution is the act of switching from a branded drug to its therapeutically equivalent generic version. This study aims to systematically review the literature with regards to generic substitution around the globe. Studies compared generic and brand-name drugs for clinical efficacy and cost effectiveness. The current findings show that the new policies are aimed at supporting the development of the generics industry in the respective countries. Further investigation is needed to explore the implementation of the current generic substitution policies and how to increase their accessibility to the general population. Generic substitution policies comparison between countries were conducted among 9 countries, that is, Australia, Canada, Czech Republic, Ireland, Japan, Switzerland, Indonesia, United State and United Kingdom. From 27 journals that were reviewed, only 14 were selected based on the fulfilled criteria appropriate to the journals that we had searched. All these policies were then studied to propose recommendations for generic substitution.