User evaluation of public pharmacy services in Brazil

Costa, Karen Sarmento; Zaccolo, Anamaria Vargas; Tavares, Noemia Urruth Leão; Arrais, Paulo Sérgio Dourado; Luiza, Vera Lucia; Oliveira, Maria Auxiliadora; Mengue, Sotero Serrate; Bertoldi, Andrêa Damaso; Ramos, Luiz Roberto; Farias, Mareni Rocha; Pizzol, Tatiane da Silva Dal

doi:10.1590/1413-81232020258.00202018

Karen Sarmento Costa

Programa de Pós- Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2400, Campus Saúde. 90035-003 Porto Alegre RS Brasil. karen.costa@gmail.com

http://orcid.org/0000-0002-2218-6024

Anamaria Vargas Zaccolo

Programa de Pós- Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2400, Campus Saúde. 90035-003 Porto Alegre RS Brasil. karen.costa@gmail.com

http://orcid.org/0000-0001-6195-9301

Noemia Urruth Leão Tavares

Faculdade de Farmácia, Universidade de Brasília. Brasília DF Brasil.

http://orcid.org/0000-0001-6180-7527

Paulo Sérgio Dourado Arrais

Departamento de Farmácia, Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará. Fortaleza CE Brasil.

http://orcid.org/0000-0002-4502-8467

Vera Lucia Luiza

Núcleo de Assistência Farmacêutica, Fundação Oswaldo Cruz (Fiocruz). Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0001-6245-7522

Maria Auxiliadora Oliveira

Departamento de Política de Medicamentos e Assistência Farmacêutica, Escola Nacional de Saúde Pública Sérgio Arouca, Fiocruz. Rio de Janeiro RJ Brasil.

http://orcid.org/0000-0001-6203-823X

Sotero Serrate Mengue

Programa de Pós- Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2400, Campus Saúde. 90035-003 Porto Alegre RS Brasil. karen.costa@gmail.com

http://orcid.org/0000-0002-3349-8541

Andrêa Damaso Bertoldi

Grupo PNAUM. Porto Alegre RS Brasil.

http://orcid.org/0000-0002-4680-3197

Luiz Roberto Ramos

Grupo PNAUM. Porto Alegre RS Brasil.

http://orcid.org/0000-0003-3143-8315

Mareni Rocha Farias

Grupo PNAUM. Porto Alegre RS Brasil.

http://orcid.org/0000-0002-4319-9318

Tatiane da Silva Dal Pizzol

Grupo PNAUM. Porto Alegre RS Brasil.

http://orcid.org/0000-0002-7566-7745

Collaborations

KS Costa, A Zaccolo, NUL Tavares and SS Mengue participated in the design of the communication, analysis and interpretation of the data, writing and revision of the content. MA Oliveira, PSD Arrais and VL Luiza participated in the analysis and interpretation of data and content review. All authors approved the version to be published.

Questions	Alternatives
Questions answered by individuals who obtained some medication in SUS
Is this the same place where you are attended to treat your health problems?	( ) Yes ( ) No
In this place do you get all the drugs you need?	( ) Yes ( ) No
Have drugs ever been unavailable?	( ) Yes ( ) No
How often?	( ) Always ( ) Sometimes ( ) Almost always
Does this place accept a prescription from a private physician or from the health insurance plan to obtain the medication?	( ) Yes ( ) No
To obtain the medication do you need to participate in any group or meeting?	( ) Yes ( ) No
Can the drugs be obtained any day of the week?	( ) Yes ( ) No
Arriving at this place is:	( ) Very difficult ( ) Little difficult ( ) Not difficult
Is this place far?	( ) Yes ( ) More or less ( ) No
How long do you usually wait for attendance?	( ) No waiting ( ) A little ( ) A long time
The opening hours are:	( ) Very good ( ) Good ( ) Regular ( ) Bad ( ) Very bad
The service in this place to obtain the medication is:	( ) Very good ( ) Good ( ) Regular ( ) Bad ( ) Very bad
Reasons for not using public pharmacies
Why didn't you try to get it from SUS?	( ) Because I never thought about that ( ) Because I have health insurance plan ( ) Because it is far ( ) Because it takes time ( ) Because the service is bad

Characteristics of SUS users	Male sex		Female sex		Total
Characteristics of SUS users	%^a	95%CI	%^a	95%CI	%^a	95%CI
Age group
0-9	17.0	14.7-19.7	15.7	13.1-18.7	16.4	14.3-18.7
10-14	12.8	9.7-16.7	14.6	11.4-18.4	13.7	11.2-16.6
15-19	5.9	4.0-8.6	12.5	9.6-16.2	9.3	7.3-11.8
20-24	6.8	4.5-10.1	22.4	18.8-26.3	14.8	12.4-17.5
25-29	11.7	7.3-18.2	26.8	22.8-31.2	19.2	15.9-23.0
30-34	10.1	7.2-14.1	23.0	20.1-26.2	16.8	14.5-19.3
35-39	15.2	11.1-20.5	28.8	25.2-32.7	22.7	20.0-25.6
40-44	17.4	14.7-20.4	31.3	27.9-35.0	24.7	22.2-27.5
45-49	18.1	15.4-21.2	33.0	29.4-36.9	26.0	23.4-28.8
50-54	22.1	19.0-25.5	43.0	39.1-47.0	33.8	31.0-36.6
55-59	28.3	24.7-32.1	43.9	39.6-48.2	37.0	34.2-39.9
60-64	37.9	34.5-41.4	47.8	43.8-51.8	43.5	40.5-46.5
65-69	43.3	38.5-48.3	52.1	47.7-56.5	48.3	44.5-52.1
70 or more	45.6	41.7-49.5	48.9	45.0-52.8	47.5	44.3-50.8
Country region
North	15.5	12.1-19.5	21.8	17.8-26.4	18.8	15.2-22.9
Northeast	14.7	12.6-17	25.1	22.8-27.4	20.3	18.4-22.3
Southeast	19.5	16.8-22.4	31.6	28.4-35.1	25.9	23.2-28.8
South	20.0	17.3-22.9	31.9	29.2-34.8	26.3	23.7-29.0
Midwest	15.0	12.7-17.6	25.1	21.8-28.6	20.1	17.6-22.8
Years of schooling^b,c
No schooling	41.6	36.0-47.3	44.9	41.2-48.7	43.7	40.3-47.2
1 to 8 years	39.0	35.1-43.2	45.2	42.2-48.3	43.1	40.2-46.1
More than 8 years	42.2	38.2-46.3	44.9	42.0-47.7	44.0	41.3-46.6

Variables^b b Population aged 20 or over.	Brazilian Regions
	North		Northeast		Midwest		Southeast		South
	%^a a Percentages weighted by sample weights and post-stratification according to age and sex;	95%CI	%^a a Percentages weighted by sample weights and post-stratification according to age and sex;	95%CI	%^a a Percentages weighted by sample weights and post-stratification according to age and sex;	95%CI	%^a a Percentages weighted by sample weights and post-stratification according to age and sex;	95%CI	%^a a Percentages weighted by sample weights and post-stratification according to age and sex;	95%CI
Acquisition of all the drugs that the user needs in SUS pharmacies
Yes	44.1	36.4-52	50.2	45.7-54.8	46.1	42.1-50.2	63.1	58.9-67	61.2	57.2-65.2
No	36.6	29.7-44.1	33.4	29.4-37.5	33.4	29.1-37.9	22.3	19.3-25.5	27.0	23.8-30.4
Sometimes	19.3	15.5-23.7	16.4	12.9-20.7	20.5	16.9-24.7	14.7	11.7-18.3	11.7	9.4-14.5
ave drugs ever been unavailable?
Yes	52.0	42.8-61	56.3	51.8-60.7	55.3	51.2-59.4	37.9	33.3-42.7	43.4	39.2-47.8
No	48.0	39.0-57.2	43.7	39.3-48.2	44.7	40.6-48.8	62.1	57.3-66.7	56.6	52.2-60.8
Frequency of drug shortage
Always	36.3	30.3-42.9	25	21.2-29.3	30.9	26.9-35.1	28.3	24.1-32.9	24.6	19.7-30.3
Sometimes	53.1	46.7-59.5	67.1	61.2-72.5	60.4	56.5-64.3	62.7	58.1-67.1	67.9	62.2-73.1
Almost always	10.5	7.2-15.3	7.9	5.5-11.1	8.7	6.6-11.5	9.0	7.0-11.6	7.5	5.4-10.2
Acquisition of drugs in the same place of health care
Yes	80.4	74.7-85.0	69.4	64.1-74.2	63.7	57.5-69.4	67.5	63.9-70.9	74	70.0-77.6
No	13.2	10.0-17.3	25.7	21.0-31.0	32.9	26.9-39.4	27.2	23.9-30.7	22	18.6-25.9
Sometimes	6.4	3.6-11.1	4.9	3.4-7.0	3.5	2.5-4.8	5.3	3.9-7.3	4.0	3.1-5.1
SUS pharmacies accept prescription from private physician or health insurance plan to provide medication
Yes	19.8	12.6-29.8	32.3	25.7-39.7	25.3	21.5-29.5	50.2	43.5-56.9	33.2	21.5-29.5
No	80.2	70.2-87.4	67.7	60.3-74.3	74.7	70.5-78.5	49.8	43.1-56.5	66.8	60.4-72.6
Acquisition of drugs conditioned to participation in groups or meetings
Yes	3.7	2.7-5	3.3	2.2-4.9	7.1	5.4-9.3	3.8	2.6-5.5	10.4	7.9-13.7
No	96.3	95.0-97.3	96.7	95.1-97.8	92.9	90.7-94.6	96.2	94.5-97.4	89.6	86.3-92.1
Evaluation of care in SUS pharmacies
Very good	8.6	5.1-14	6.5	4.8-8.8	6.0	4.6-7.6	6.5	5.1-8.4	10.5	7.0-15.4
Good	61.5	56.3-66.4	72.4	68.8-75.7	71.7	67.0-76	77.2	73.7-80.4	78.9	74.3-82.8
Regular	25.7	21.3-30.7	16.2	13.5-19.3	16.3	13.8-19.1	12.7	10.4-15.5	8.6	6.7-10.8
Bad	3.7	2.4-5.7	3.3	2.4-4.6	4.7	2.7-8.2	2.4	1.6-3.7	1.3	0.8-2.1
Very bad	0.5	0.3-1.0	1.6	0.9-2.8	1.3	0.8-2.2	1.1	0.6-1.9	0.8	0.4-1.4
Dispensing of drugs on any day of the week
Yes	73.3	59.4-83.7	87.0	83.9-89.5	81.7	78.0-84.9	90.0	86.6-92.5	83.7	78.6-87.9
No	26.7	16.3-40.6	13.0	10.5-7.5	18.3	15.122	10.0	7.5-13.4	16.3	12.121.4
Difficulty arriving at SUS Pharmacies
Very difficult	2.0	1.3-2.9	2.6	1.9-3.7	4.9	3.6-6.4	2.6	1.9-3.6	2.3	1.7-3.2
Little difficult	11.9	8.9-15.8	5.8	4.5-7.4	10.9	8.2-14.3	7.8	6.3-9.7	6.4	5.0-8.3
Not difficult	86.1	82.0-89.4	91.6	89.5-93.3	84.2	80.5-87.4	89.6	87.4-91.4	91.3	89.5-93.3
SUS pharmacies are far
Yes	7.7	5.4-10.9	8.3	6.5-10.6	12.8	10.1-16	6.0	4.5-7.9	6.4	4.8-8.6
More or less	26.7	21.8-32.3	12.9	10.2-16.3	18.2	14.8-22.1	21.5	17.226.4	13.5	11.0-16.4
No	65.6	59.7-71	78.7	73.9-82.8	69.1	64.0-73.7	72.6	67.0-77.5	80.1	76.1-83.5
Need to wait to get drugs from SUS
No waiting	28.4	23.2-34.3	44.2	38.5-50.1	40.9	35.2-46.9	32.8	28.1-37.9	39	34.1-44.2
A little	53.6	47.0-60.1	44.4	39.1-49.8	41.5	37.6-45.5	56.1	51.9-60.2	48.9	44.1-53.8
A long time	17.1	13.3-21.6	9.9	7.8-12.4	16.6	11.8-22.7	8.8	6.8-11.5	10.1	7.8-13.2
Evaluation of opening hours in SUS pharmacies
Very good	7.9	4.7-13	5.2	3.7-7.3	4.8	3.4-6.8	4.4	3.1-6.3	9.3	5.7-14.7
Good	67.6	61.3-73.3	77	73.5-80.1	74.3	68.5-79.3	81.5	78.6-84.1	80.3	75.3-84.4
Regular	22.2	18.0-26.9	14	11.6-16.7	15.6	12.4-19.4	11.5	9.4-13.9	8.2	6.5-10.3
Bad	2.2	1.4-3.4	3.1	2.1-4.6	4.2	1.8-9.4	1.8	1.2-2.9	1.6	1.1-2.4
Very bad	0.2	0.1-0.5	0.7	0.3-1.4	1.1	0.6-1.9	0.7	0.4-1.5	0.6	0.3-1.4

Variables	Gross analysis			Adjusted analysis
Variables	**RP	95%CI	*p	***RP	95%CI	*p
Acquisition of all the drugs that the user needs in SUS pharmacies	1.13	1.08-1.17	0.000	1.03	1.00-1.07	0.019
The place for obtaining drugs in SUS is far	0.93	0.89-0.98	0.012	0.97	0.93-1.00	0.116
Normally, no waiting much to receive drugs in SUS	1.79	1.61-1.99	<0.001	1.31	1.20 - 1.43	<0.001
Positive evaluation of opening hours of the place where the drugs are obtained from SUS	2.94	2.58-3.35	<0.001	2.65	2.28-3.06	<0.001
SUS pharmacy accepts prescription from private physicians or health insurance plans to release medication	1.07	1.03-1.12	<0.001	1.05	1.01-1.09	0.005
Obtaining medication in SUS conditioned to participation in groups or meetings	1.12	1.08-1.16	<0.001	1.03	1.00-1.07	0.020

[1] Collaborations

KS Costa, A Zaccolo, NUL Tavares and SS Mengue participated in the design of the communication, analysis and interpretation of the data, writing and revision of the content. MA Oliveira, PSD Arrais and VL Luiza participated in the analysis and interpretation of data and content review. All authors approved the version to be published.

Brasil

Brasil

User evaluation of public pharmacy services in Brazil

Abstract