ABSTRACT
Este trabalho trata de compreender como a categoria pobreza apresenta-se em documentos que referenciam as atuais Políticas Públicas específicas para o campo do Álcool e Outras Drogas, no contexto da Reforma Psiquiátrica brasileira. A análise de documentos internacionais e nacionais foi perpassada pela perspectiva psicossociológica, situada na tradição materialista histórico-dialética. A discussão se deu através de duas categorias temáticas, refletindo acerca das contradições, por um lado, do paradigma proibicionista, quando relacionada à realidade brasileira de pobreza; e, por outro, da tecnificação do cuidado em saúde. Ficou explicito que a relação da sociedade com as drogas está permeada pelo processo de institucionalização, através da tecnificação das práticas, na qual os sujeitos e os grupos são desconsiderados nas suas necessidades específicas, descontextualizados do seu cenário cultural, ficando àmercê da arbitrariedade institucional e da homogeneização das ações.
This study sought to understand how the category of poverty is pre-sented in documents that reference the current local Public Policies in the field of alcohol and other drugs, in the context of the Brazilian Psychiatric Reform. The analysis of international and national documents was crossed by the phytosociological perspective, situated in the materialistic historical-dialectics tradition. The discussion took place through two thematic categories, reflecting the contradiction, on the one hand, the prohibitionist paradigm, when related to the Brazilian reality of poverty, and, on the other hand, on the technicalization of health care. It became evident that the relationship of the society with drugs is permeated by the process of institutionalization through the technicalization of the practices in which individuals and groups are disre-garded in their specific needs, disrespecting the context of the cultural scene, at the mercy of institutional arbitrariness and homogenization of actions.
Este artículo tiene como objetivo analizar como la categoría pobreza se presenta en los documentos que hacen referencia a las actuales políticas públicas específicas para el abuso de alcohol y otras drogas, en el contexto de la reforma psiquiátrica brasileña. El análisis de los documentos nacionales e internacionales se desarrolló desde la perspectiva psicosociológica, situada en la tradición del materialismo histórico dialéctico. La discusión se llevó a cabo a través de dos categorías temáticas. Por un lado, el paradigma prohibicionista - que se relaciona con la realidad brasileña de la pobreza y por otro lado - la atención a la salud. Se ha hecho explícito que la relación con la sociedad es permeada por el proceso de institucionalización a través de la tecnificación de las prácticas en las que los individuos y los grupos sociales son ignorados en sus necesidades específicas, sin que el contexto cultural y a la merced de la arbitrariedad institucional y homogeneización de las acciones.
Ce travail a la tâche de comprendre comment la catégorie pauvreté se présente dans des documents qui font référence aux politiques publiques actuelles spécifiquement pour l'alcool et dautres drogues, dans le cadre de la réforme psychiatrique brésilienne. L'analyse des documents nationaux et internationaux a été imprégné par la perspective psychosociologique, situé dans la tradition matérialiste historique-dialectique. La discussion a été élaborée selon deux catégories thématiques, réfléchissant sur les contradictions d'une part, le paradigme prohibitionniste, en rapport avec la réalité brésilienne de pauvreté; et d'autre part, la technification des soins de santé. C'était explicite que la relation de la société avec les drogues est imprégné par le processus d'institutionnalisation, vers la technification des pratiques, où les individus et les groupes sont ignorés en leurs besoins spécifiques, décontextualisés dans sa scène culturelle, restant soumis à l'arbitrage institutionnelle et l'homogénéisation des actions.
ABSTRACT
OBJECTIVE: To assess the impact of mandatory offer of generic substitution, introduced in South Africa in May 2003, on private sector sales of generic and originator medicines for chronic diseases. METHODS: Private sector sales data (June 2001 to May 2005) were obtained from IMS Health for proton pump inhibitors (PPIs; ATC code A02BC), HMG-CoA reductase inhibitors (statins; C10AA), dihydropyridine calcium antagonists (C08CA), angiotensin-converting enzyme inhibitors (ACE-I; C09AA) and selective serotonin reuptake inhibitors (SSRIs; N06AB). Monthly sales were expressed as defined daily doses per 1000 insured population per month (DDD/TIM). Interrupted time-series models were used to estimate the changes in slope and level of medicines use after the policy change. ARIMA models were used to correct for autocorrelation and stationarity. RESULTS: Only the SSRIs saw a significant rise in level of generic utilisation (0.2 DDD/TIM; P < 0.001) and a fall in originator usage (-0.1 DDD/TIM; P < 0.001) after the policy change. Utilisation of generic PPIs fell (level 0.06 DDD/TIM, P = 0.048; slope 0.01 DDD/TIM, P = 0.043), but utilisation of originator products also grew (level 0.05 DDD/TIM, P < 0.001; slope 0.003, P = 0.001). Generic calcium antagonists and ACE-I showed an increase in slope (0.01 DDD/TIM, P = 0.016; 0.02 DDD/TIM, P < 0.001), while the originators showed a decrease in slope (-0.003 DDD/TIM, P = 0.046; -0.01 DDD/TIM, P < 0.001). There were insufficient data on generic statin use before the policy change to allow for analysis. CONCLUSION: The mandatory offer of generic substitution appeared to have had a quantifiable effect on utilisation patterns in the 2 years after May 2003. Managed care interventions that were already in place before the intervention may have blunted the extent of the changes seen in this period. Generic policies are an important enabling provision for cost-containment efforts. However, decisions taken outside of official policy may anticipate or differ from that policy, with important consequences.
