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Original Articles • Rev. Saúde Pública 51 (suppl 2) • 2017 • https://doi.org/10.11606/S1518-8787.2017051007120 copy

Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM – Services data

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services.

METHODS

This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research.

RESULTS

The pharmacy area was greater than 14 m² in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m², while in 46.2% these areas were superior to 10m². Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation.

CONCLUSION

Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities.

Pharmaceutical Services, supply & distribution; Infrastructure; Primary Health Care; Health Services Research; Unified Health System

Variable	Brazilian regions % (95%CI)					Total

	North	Northeast	Midwest	Southeast	South
Pharmacy total area*
≤ 14 m²	68.0 (61.3–74.0)	73.7 (63.8–81.6)	43.1 (31.4–55.8)	43.8 (32.1–56.3)	60.2 (48.2–71.1)	59.7 (53.4–65.7)
> 14 m²	32.0 (26.0–38.07)	26.3 (18.4–36.2)	56.9 (44.2–68.6)	56.2 (43.7–67.9)	39.8 (28.9–51.8)	40.3 (34.3–46.6)
Waiting room for patients
Yes, exclusive	13.1 (9.3–18.2)	26.0 (19.0–34.5)	48.6 (35.4–61.9)	53.4 (40.6–65.8)	28.4 (18.3–41.2)	35.2 (29.3–41.6)
Yes, shared	63.0 (56.5–69.1)	62.3 (53.9–70.0)	39.4 (28.3–51.6)	40.0 (29.1–51.9)	62.1 (50.1–72.7)	54.1 (48.3–59.7)
No	23.9 (18.7–30.0)	11.7 (7.8–17.2)	12.1 (6.5–21.4)	6.6 (3.4–12.3)	9.5 (4.6–18.7)	10.8 (8.4–13.7)
Area for medicine dispensing*
Yes, exclusive	60.1 (53.5–66.4)	57.9 (49.6–65.8)	78.1 (64.2–87.6)	72.3 (49.6–65.8)	57.9 (49.6–65.8)	66.2 (61.3–70.7)
Yes, shared	39.3 (33.1–45.9)	39.8 (32.0–48.1)	21.8 (12.3–35.7)	27.6 (19.5–37.5)	26.8 (20.0–35.0)	32.7 (28.2–37.6)
No	0.6 (0.1–2.4)	2.3 (1.0–5.5)	0.1 (0.0–0.9)	0	0.9 (0.2–3.4)	1.1 (0.5–2.3)
Dispensing area*
≤ 5 m²	24.9 (19.5–31.2)	44.5 (36.3–53.1)	18.0 (11.3–27.4)	28.7 (20.3–38.9)	18.8 (13.4–25.8)	31.8 (27.5–36.6)
> 5 m²	75.1 (68.8–80.5)	55.5 (46.9–63.7)	82.0 (72.6–88.7)	71.3 (61.1–79.7)	81.2 (74.2–86.6)	68.2 (63.4–72.5)
Dispensing area*
≤ 10 m²	60.3 (53.5–66.7)	68.5 (58.5–77.0)	42.7 (30.3–56.1)	45.3 (33.1–58.0)	53.2 (42.1–64.0)	53.8 (48.4–59.1)
> 10 m²	39.7 (33.3–46.5)	31.5 (23.0–41.5)	57.3 (43.9–69.7)	54.7 (42.0–66.9)	46.8 (36.0–57.9)	46.2 (40.9–51.6)
Area for pharmaceutical consultation or pharmacotherapeutic follow-up*
Yes, exclusive	2.1 (1.0–4.2)	3.0 (1.4–6.3)	13.6 (5.4–30.1)	18.6 (8.2–36.7)	5.1 (2.2–11.2)	8.8 (4.9–15.1)
Yes, shared	4.8 (2.6–8.8)	2.4 (0.5–10.3)	3.9 (1.8–8.2)	4.4 (1.7–10.8)	11.6 (3.7–31.2)	4.9 (2.6–8.8)
No	93.1 (89.0–95.8)	94.6 (88.5–97.5)	82.5 (68.1–91.2)	77.0 (60.3–88.1)	83.3 (66.8–92.5)	86.4 (79.9–90.9)
Area for medicine storage apart from the dispensing area	22.3 (17.4–28.1)	18.4 (11.8–27.7)	44.2 (31.5–57.6)	56.2 (43.8–67.9)	50.3 (39.9–60.6)	37.3 (31.4–43.5)
Area for medicine storage*
Exclusive	73.4 (67.3–78.7)	77.3 (70.3–83.0)	91.4 (84.6–95.4)	88.6 (81.4–93.2)	81.3 (74.2–86.7)	82.0 (78.4–85.1)
Shared	26.6 (21.3–32.7)	22.7 (17.0–29.7)	8.6 (4.6–15.4)	11.4 (6.8–18.6)	18.7 (13.3–25.8)	18.0 (14.9–21.6)
Storage area*
≤ 10 m²	62.3 (55.5–68.6)	73.9 (64.4–81.6)	41.9 (32.0–52.5)	42.5 (31.0–54.8)	57.9 (46.1–68.9)	58.1 (52.0–64.0)
> 10 m²	37.7 (31.4–44.5)	26.1 (18.4–35.6)	58.1 (47.5–68.0)	57.5 (45.2–69.0)	26.1 (18.4–35.6)	41.9 (36.0–48.0)
Area for storage of expired/unsuitable for use products*	32.4 (26.5–38.9)	15.0 (9.8–22.3)	54.8 (41.6–67.4)	63.2 (50.8–74.1)	45.9 (35.3–56.8)	38.9 (33.4–44.6)
Has electric generator	4.1 (2.1–7.7)	1.0 (0.3–3.9)	5.8 (2.2–14.1)	3.7 (1.7–8.0)	2.9 (0.8–9.8)	2.7 (1.7–4.3)

Variable	Brazilian regions % (95%CI)					Total

	North	Northeast	Midwest	Southeast	South
Has password system for meeting patients*	2.1 (0.7–6.2)	1.3 (0.5–3.7)	0.6 (0.1–2.8)	21.3 (8.3–44.7)	14.1 (9.6–20.1)	10.0 (5.0–19.0)
Has chairs*	80.9 (74.1–86.2)	68.8 (59.8–76.5)	85.5 (72.1–93.1)	88.4 (80.2–93.4)	88.1 (81.4–92.6)	80.2 (75.7–84.1)
Has a billboard*	57.3 (49.7–64.6)	45.7 (36.8–54.8)	78.9 (69.8–85.7)	75.4 (64.8–83.6)	67.3 (56.8–76.3)	61.7 (56.2–66.9)
Has a television*	28.9 (22.5–36.3)	18.7 (13.2–25.8)	30.5 (19.3–44.5)	37.6 (24.9–52.2)	41.1 (31.5–51.4)	30.0 (24.8–35.8)
Provides educational materials on health	61.2 (53.8–68.1)	45.5 (36.7–54.5)	68.2 (55.5–78.6)	66.7 (51.1–79.3)	67.6 (54.3–78.6)	58.5 (52.4–64.4)
Has a water fountain/water purifier/filter	70.2 (62.8–76.6)	67.9 (59.4–75.4)	70.6 (49.0–85.8)	70.4 (57.4–80.7)	63.3 (50.8–74.3)	68.2 (62.5–73.5)
Has access to restrooms	84.8 (78.6–89.4)	89.7 (82.8–91.4)	66.1 (43.3–83.3)	73.6 (56.2–85.9)	79.3 (69.2–86.6)	81.0 (74.3–86.3)
Has protection from the sun and rain	97.5 (93.6–99.0)	94.6 (85.8–98.1)	98.5 (93.9–99.6)	97.9 (93.0–99.4)	97.4 (92.1–99.1)	96.6 (93.3–98.3)

Variable	Brazilian regions % (95%CI)					Total

	North	Northeast	Midwest	Southeast	South
Has password system for meeting patients*	2.1 (0.9–5.1)	1.1 (0.3–3.4)	0.5 (0.1–2.4)	20.3 (8.0–42.7)	13.1 (9.0–18.6)	9.2 (4.6–17.4)
Has individual service counters/tables with chairs*	23.4 (18.2–29.4)	12.2 (7.1–20.3)	23.6 (15.0–35.2)	38.4 (24.5–54.6)	22.1 (12.6–35.7)	23.7 (17.8–30.8)
Has service counters without chairs*	48.6 (42.0–55.2)	38.7 (30.8–47.1)	68.0 (54.4–79.1)	76.7 (67.1–84.1)	73.8 (65.6–80.6)	59.0 (54.0–3.9)
Has service counters with bars that separate professionals from patients*	24.0 (19.2–29.5)	14.3 (8.9–22.1)	41.4 (26.3–58.3)	41.8 (30.3–54.2)	5.4 (3.1–9.0)	23.8 (19.8–28.2)
Has computerized system to register activities of pharmaceutical services*	11.4 (8.0–16.0)	15.3 (9.1–25.4)	57.8 (43.4–71.0)	57.7 (44.0–70.3)	66.6 (57.5–74.5)	39.4 (34.0–45.0)
Has a computer*	23.3 (18.8–28.4)	16.4 (10.0–25.7)	65.6 (51.8–77.1)	74.7 (64.9–82.5)	69.9 (61.3–77.2)	47.1 (41.8–52.5)
Has internet access*	19.3 (15.3–24.2)	16.4 (10.0–25.8)	69.6 (57.1–79.8)	66.7 (52.6–78.4)	66.9 (58.1–74.7)	44.1 (38.7–49.5)
Has a printer*	12.0 (8.5–16.7)	11.1 (5.5–21.0)	49.2 (36.8–61.6)	39.5 (27.0–53.5)	46.6 (36.2–57.2)	28.3 (23.0–34.2)
Has a phone*	4.7 (3.0–7.2)	8.2 (3.9–16.7)	50.5 (38.0–63.0)	55.4 (42.6–67.4)	48.3 (37.9–58.9)	31.9 (26.3–38.2)
Has a table for the professional*	72.6 (66.2–78.2)	63.3 (55.3–70.6)	94.3 (89.3–97.1)	91.0 (85.3–94.7)	81.1 (72.4–87.5)	77.6 (73.7–81.0)
Has a chair for the professional*	75.4 (69.2–80.7)	68.5 (60.8–75.3)	94.6 (89.7–97.3)	91.3 (84.4–95.3)	83.8 (75.4–89.7)	80.3 (76.5–83.7)
Has a chair for the patient	40.9 (34.6–47.6)	37.9 (30.0–46.5)	47.3 (34.8–60.2)	47.3 (33.9–61.1)	37.4 (27.4–48.7)	41.6 (35.7–47.7)
Controls the entry and transit of people*	44.4 (37.9–51.1)	64.7 (56.1–72.5)	54.0 (41.1–66.5)	54.2 (40.0–67.7)	79.1 (69.6–86.2)	61.5 (55.4–67.4)
Has air conditioning*	62.4 (55.9–68.6)	29.0 (21.2–38.1)	76.3 (67.1–83.5)	43.7 (31.8–56.3)	44.7 (34.1–55.7)	41.7 (36.5–47.2)

Variable	Brazilian regions % (95%CI)					Total

	North	Northeast	Midwest	Southeast	South
Has refrigerator/freezer for the exclusive storage of medicines*	37.2 (31.0–43.8)	21.3 (16.1–27.6)	50.7 (36.6–64.7)	76.0 (65.9–83.9)	56.8 (46.7–66.4)	47.2 (42.0–52.5)
Has refrigerator/freezer for shared storage of medicines and other products and/or food	5.9 (3.4–10.0)	8.5 (5.3–13.4)	12.7 (7.6–20.6)	9.1 (5.5–14.7)	8.5 (5.3–13.4)	7.8 (5.9–10.1)
Controls the entry and transit of people	49.5 (42.9–56.1)	63.8 (55.3–71.5)	58.8 (46.0–70.6)	64.4 (49.5–76.9)	81.0 (73.8–86.6)	65.4 (59.4–70.7)
Has a digital thermometer to verify the temperature of the environment*	11.3 (7.9–16.0)	6.1 (3.2–11.4)	39.5 (25.0–56.0)	51.6 (38.3–64.7)	28.9 (19.2–41.0)	26.4 (21.5–32.0)
Has a digital thermometer to verify the temperature of the refrigerator*	25.0 (19.7–31.2)	16.2 (11.7–22.0)	43.5 (30.2–57.7)	71.4 (60.4–80.4)	50.2 (39.9–60.6)	41.3 (36.0–46.8)

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