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.

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.

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.

Conduta do tratamento medicamentoso por cuidadores de idosos / Management of drug therapy by elderly people’s caregivers / Conducta del tratamiento medicamentoso por cuidadores de ancianos

O envelhecimento populacional está ampliando o número de cuidadores de idosos no Brasil. A farmacoterapia compreende um sistema complexo de atividades e a sua condução está presente no rol de tarefas desempenhadas por esses atores. Além disso, a conduta do tratamento pode estar sujeita a diversos problemas na sua execução, com destaque para: dificuldades de administração dos medicamentos, falta de acesso aos medicamentos, obstáculos na realização de observação clínica, assim como os desafios presentes no estabelecimento de uma comunicação efetiva com os idosos e profissionais de saúde. O presente estudo trata de uma revisão cujo objetivo é ampliar as discussões sobre os aspectos supracitados, de modo que este debate dê subsídios teóricos aos programas e serviços na área de gerontologia.

Aging of the population is increasing the number of caregivers of elderly people in Brazil. Pharmacotherapy involves a complex system of activities and its management is among the tasks performed these caregivers. Moreover, management of drug therapy may be subject to various problems relating to its implementation. In particular, there are difficulties in drug administration, lack of access to drugs, obstacles against conducting clinical observation and challenges in establishing effective communication between elderly people and healthcare professionals. The present study consists of a review that aims to expand the discussions on the abovementioned issues so as to provide theoretical support to programs and services within the field of gerontology.

El envejecimiento poblacional está ampliando el número de cuidadores de ancianos en Brasil. La farmacoterapia incluye un sistema complejo de actividades y su realización está presente en las diversas tareas desempeñadas por esos actores. Además, la conducta del tratamiento puede estar sujeta a diversos problemas en su realización, destacándose los siguientes: las dificultades de administración de los medicamentos, la falta de acceso a los medicamentos, los obstáculos en la realización de observación clínica, así como los desafíos presentes en el establecimiento de una comunicación efectiva con los ancianos y profesionales de la salud. El presente estudiose trata de una revisión cuyo objetivo es ampliar las discusiones sobre los aspectos anteriormente citados, de forma que tal debate proporcione subsidios teóricos a los programas y servicios en el área de la gerontología.