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Original Articles • Rev. Saúde Pública 51 (suppl 2) • 2017 • https://doi.org/10.11606/S1518-8787.2017051007138 copy

Access to medicines: relations with the institutionalization of pharmaceutical services

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJETIVE

To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care.

METHODS

This study is part of the Pesquisa Nacional sobre 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), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis.

RESULTS

Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: “management tools,” “participation and social control,” “financing,” and “personnel structure,” with significant associations in the bivariate analysis. The “pharmaceutical care” dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5).

CONCLUSIONS

Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies.

Pharmaceutical Services, organization & administration; Health Services Accessibility; Primary Health Care; Health Services Research; Unified Health System

Dimension	Variable	Users (n)	Access % (95CI%)			p*

			Full	Partial	Null
Formal PS structures in the SSM	Pharmaceutical services are included in the Municipal Health Plan					0.324
	Yes	4,361	60.6 (58.6–62.6)	35.3 (33.3–37.3)	4.1 (3.3–5.0)
	No	268	54.2 (46.8–61.4)	43.2 (36.1–50.6)	2.6 (0.9–6.9)
	Existence of Pharmacy and Therapeutics Committee					0.102
	Yes	2,268	57.5 (54.3–60.6)	39.4 (36.3–42.6)	3.1 (2.2–4.4)
	In the implementation phase	483	66.1 (60.2–71.6)	30.5 (25.3–36.2)	3.4 (1.7–6.7)
	No	1,993	61.0 (58.4–63.5)	34.6 (32.2–37.1)	4.5 (3.5–5.7)
	Existence of Standardized Medicines List					0.878
	Yes	4,468	60.1 (58.1–62.1)	35.7 (33.8–37.7)	4.1 (3.4–5.1)
	No	316	61.8 (55.1–68.1)	34.6 (28.5–41.1)	3.7 (1.8–7.5)
	Existence of an exclusive Permanent Commission for the purchase of medicines					0.012
	Yes	1,666	64.0 (61.0–67.0)	32.7 (29.8–35.7)	3.3 (2.4–4.6)
	No	3,042	58.1 (55.6–60.6)	37.7 (35.2–40.2)	4.2 (3.3–5.4)

Financing	Expenses with the structuring of PS					0.417
	Yes	2,484	59.2 (56.4–61.9)	36.8 (34.2–39.6)	3.9 (3.0–5.2)
	No	1,969	61.5 (58.6–64.3)	35.3 (32.5–38.2)	3.2 (2.3–4.4)
	Coordination of PS has autonomy in the management of financial resources					0.004
	Yes, completely	924	60.8 (56.9–64.5)	36.5 (32.9–40.3)	2.7 (1.7–4.2)
	Yes, partially	2,324	60.8 (57.9–63.6)	35.3 (32.6–38.2)	3.9 (2.9–5.3)
	No	1,445	56.9 (53.3–60.4)	36.9 (33.5–40.5)	6.2 (4.6–8.3)

Management tools	Existence of computerized system for PS management					< 0.001
	Yes	3,722	62.7 (60.5–64.8)	34.2 (32.2–36.4)	3.1 (2.4–3.9)
	No	1,093	52.8 (48.7–56.8)	40.3 (36.4–44.4)	6.9 (5.0–9.3)
	Existence of protocol for the storage of medicines					< 0.001
	Yes	3,449	64.3 (62.0–66.5)	32.6 (30.4–34.9)	3.1 (2.4–4.0)
	No	1,202	51.1 (47.5–54.8)	43.1 (39.5–46.8)	5.8 (4.2–7.9)
	Existence of protocol for the dispensing of medicines					< 0.001
	Yes	3,268	64.8 (62.4–67.1)	32.0 (29.7–34.3)	3.2 (2.5–4.2)
	No	1,418	52.3 (49.0–55.5)	42.4 (39.2–45.4)	5.3 (4.0–7.1)
	Existence of protocol for the delivery of medicines					< 0.001
	Yes	3,027	61.9 (59.5–64.3)	35.0 (32.7–37.4)	3.1 (2.4–4.0)
	No	1,591	54.6 (51.1–58.0)	39.1 (35.8–42.5)	6.3 (4.7–8.4)
	Existence of control of entry and exit of medicines from the warehouse					0.951
	Yes	4,625	60.5 (58.5–62.4)	35.6 (33.7–37.5)	3.9 (3.2–4.8)
	No	190	60.3 (51.7–68.3)	36.2 (28.5–44–8)	3.4 (1.3–8.4)
	Existence of some type of training or qualification of the PS professionals					< 0.001
	Yes	872	73.0 (69.0–76.7)	25.6 (22.0–29.5)	1.4 (0.8–2.7)
	No	2,951	56.4 (54.0–58.9)	38.5 (36.1–41.0)	5.0 (4.0–6.3)

Participation and social control	Existence of mechanisms for receiving criticism by users about PS					0.051
	Yes	1,938	62.6 (59.6–65.5)	32.3 (29.6–35.2)	5.1 (3.8–6.8)
	No	1,971	58.3 (55.2–61.3)	38.1 (35.1–41.1)	3.6 (2.7–4.9)
	Participation of the RPS in the Municipal Health Council					0.007
	Always or repeatedly	1,138	65.6 (62.0–69.1)	31.8 (28.4–35.3)	2.6 (1.6–4.1)
	Sometimes or rarely	921	59.5 (55.0–63.9)	36.9 (32.7–41.4)	3.6 (2.3–5.5)
	Never	1,493	59.2 (56.0–62.4)	35.8 (32.7–38.9)	5.0 (3.7–6.7)

Dimension	Variable	Users (n)	Access % (95%CI)			p*

			Full	Partial	Null
Personnel structure	Professional category of the RDM					< 0.001
	Pharmacist	1,282	64.9 (61.5–68.3)	32.3 (29.0–35.6)	2.8 (1.9–4.2)
	Pharmacy assist./tech.	370	67.4 (60.8–73.4)	30.3 (24.5–36.8)	2.3 (1.0–5.1)
	Nurse	474	56.6 (51.0–62.1)	38.9 (33.6–44.5)	4.5 (2.6–7.5)
	Nursing assist /tech.	1,312	61.2 (57.2–64.9)	36.0 (32.3–39.9)	2.8 (1.8–4.3)
	Administrative assist.	387	50.4 (42.5–58.3)	35.8 (28.7–43.5)	13.8 (8.7–21.0)
	Community health agent	112	43.9 (29.9–58.9)	53.2 (38.3–67.6)	2.9 (0.6–13.1)
	Others	487	58.2 (51.9–64.3)	35.2 (29.5–41.4)	6.6 (3.4–5.0)
Management tools	Participation in training or course for PS professionals in the city in the past two years					0.009
	Yes	1,491	65.3 (61.8–68.6)	30.3 (27.1–33.6)	4.5 (3.1–6.4)
	No	2,922	59.1 (56.7–61.6)	36.9 (34.5–39.3)	4.0 (3.1–5.0)
	Existence of computerized system for PS management					< 0.001
	Yes	1,979	65.7 (62.8–68.4)	32.0 (29.3–34.8)	2.4 (1.6–3.4)
	No	2,399	57.8 (55.0–60.6)	36.8 (34.1–39.5)	5.4 (4.3–6.8)
	Existence of a computerized system for PS management networked with health units					< 0.001
	Yes	1,533	70.3 (67.1–73.2)	28.0 (25.1–31.1)	1.7 (1.0–2.8)
	No	418	46.3 (39.9–52.9)	48.2 (41.7–54.7)	5.5 (3.0–9.8)
	Pharmacist participates of the scheduling of medicines in the health unit					0.015
	Yes	2,931	62.8 (60.3–65.3)	32.6 (30.3–35.1)	4.6 (3.6–5.8)
	No	1,387	58.3 (54.9–61.7)	38.3 (34.9–41.7)	3.4 (2.4–4.8)
	Pharmacist participates in the stock control in the health unit					< 0.001
	Yes	3,377	64.2 (61.9–66.5)	32.0 (29.8–34.3)	3.8 (3.0–4.8)
	No	1,018	52.1 (48.2–56.1)	42.8 (38.9–46.7)	5.1 (3.5–7.3)
	Pharmacist participates of the medicines dispensing/delivery in the health unit					< 0.001
	Yes	3,045	63.9 (61.5–66.2)	32.1 (29.9–34.5)	4.0 (3.1–5.1)
	No	1,373	54.7 (51.1–58.2)	40.8 (37.3–44.4)	4.5 (3.2–6.3)
	Existence of an inventory control system (entry and exit) of medicines					< 0.001
	Yes, manual	2,327	57.8 (54.9–60.6)	36.9 (34.2–39.7)	5.3 (4.2–6.8)
	Yes, computerized	1,932	65.7 (62.8–68.4)	31.8 (29.2–34.7)	2.5 (1.7–3.5)
	No	160	60.1 (48.1–71.0)	35.5 (25.1–47.4)	4.5 (1.4–13.4)
	Existence of control of the expiration date of medicines					< 0.001
	Yes, manual	2,902	57.1 (54.5–59.6)	37.8 (35.3–40.3)	5.1 (4.1–6.4)
	Yes, computerized	1,437	69.7 (66.5–72.7)	28.5 (25.5–31.6)	1.8 (1.2–2.8)
	No	80	53.4 (37.9–68.3)	36.7 (23.1–52.9)	9.9 (3.7–23.7)
Pharmaceutical care	Performing a clinical activity					0.638
	Yes	343	67.5 (60.2–74.0)	29.3 (23.1–36.5)	3.2 (1.4–6.8)
	No	939	64.3 (60.4–68.1)	33.0 (29.3–36.8)	2.7 (1.7–4.3)

Variable	Null Access OR	Partial Access OR (95%CI)^*		Full Access OR (95%CI)^*
Participation of the RPS always or repeatedly at the Municipal Health Council	1.0	2.3	(1.0–5.1)	3.3	(1.5–7.3)
Existence of protocol for the delivery of medicines	1.0	3.0	(1.3–6.8)	2.7	(1.2–6.1)
Existence of computerized system for PS management	1.0	4.0	(1.9–8.2)	3.9	(1.9–8.0)
Existence of protocol for the storage of medicines	1.0	1.1	(0.4–2.5)	2.9	(1.2–6.9)

Variable	Null Access OR	Partial Access OR (95%CI)^*		Full Access OR (95%CI)^*
Participation in training or course for PS professionals in the city in the past two years	1.0	1.5	(0.8–2.7)	2.0	(1.1–3.5)
Existence of computerized system for PS management	1.0	2.8	(1.6–4.9)	4.3	(2.4–7.5)

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