Comments on “The organization of pharmaceutical services by ‘health region’ in Brazil’s Unified Health System”

Araújo, Suetônio Queiroz; Costa, Karen Sarmento; Luiza, Vera Lucia; Lavras, Carmen; Santana, Eucilene Alves; Tavares, Noemia Urruth Leão

doi:10.1590/1413-81232017224.27042016

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ARTCILE • Ciênc. saúde colet. 22 (4) • Apr 2017 • https://doi.org/10.1590/1413-81232017224.27042016 copy

Comments on “The organization of pharmaceutical services by ‘health region’ in Brazil’s Unified Health System”

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to describe and characterize the pharmaceutical services provided in Brazil’s Unified Health System (SUS) from the point of view of the healthcare networks that are organized by region in the QualiSUS-Rede Project. This was a cross-sectional study, with data collected from December 2013 to July 2015, in public health establishments that carried out delivery or warehousing of medications (n = 4,938), in 465 municipalites, and the Federal District, in 43‘Health Regions’. The results show the existence of at least one management service supporting the health network, and warehousing of medications in all the regions (> 90%). It also showed the availability of at least one healthcare service, in healthcare locations, by pharmaceutical professionals is irregular between the Regions, being highest in the Southeastern Region (74.3%), and lowest in the Northeastern Region (43.3%). The results underpine the need for effective structuring of pharmaceutical assistance in the SUS networks, overcoming the current restrictive vision of its activities, which gives value almost exclusively to the logistical component of support to the network, to the detriment of the clinical component. It is also important to expand, and improve the quality of, the population’s access to medical drugs, and improve the quality of the healthcare offered to users of the system.

Health systems; Regionalization; Pharmaceutical services

Service	Operational definition
Service supplied in Healthcare Points (PASs)
Dispensing of drugs	The establishment has a pharmacist, and this pharmacist reported delivering drugs always together with therapeutic guidance.
Therapeutic guidance	The establishment has a pharmacist, and this pharmacist reported giving therapeutic guidance with delivery of the medication and/or in group activities.
Pharmacotherapeutic follow-up	The establishment has a pharmacist and this pharmacist reported making pharmacotherapeutic follow-up.
Therapeutic conciliation	The establishment has a pharmacist and this pharmacist reported carrying out therapeutic conciliation.
Pharmacotherapeutic review	The establishment has a pharmacist and this pharmacist reported making pharmacotherapeutic review.
Drug surveillance	In the establishment the person responsible reports carrying out notification of complaints and/or adverse reactions to drugs
Service carried out at the Diagnosis and Therapy Support Points (PADTs)
Drug delivery	Delivery of drugs in the establishment was carried out by a non-pharmaceutical professional and with therapeutic guidance to the user.
Management services as Healthcare Network Support System (SARAS)
Selection of drugs	The pharmacist of the establishment or referral pharmacist reports participating in the process of selection of drugs; and/or: the person responsible for the pharmacy reports that activities carried out in the establishment include request for inclusion/exclusion of drugs in/from the municipality’s standard list of drugs, and that list was made available to the health professionals and in the consulting offices of the persons prescribing.
Programming of drugs	The establishment’s pharmacist reports participating in the programming of drugs, and/or where the person responsible for the pharmacy reported that there is in the establishment a timetable for sending of information for programming of acquisition of drugs and a timetable for sending of request for supply of the units to Pharmaceutical Central Supply (CAF).
Acquisition of drugs	The establishment’s pharmacist reports participating in the acquisition of drugs.
Warehousing of drugs	Considered to be a criterion for inclusion in the study when there is warehousing of drugs in the establishment.
Distribution of drugs	The establishment’s pharmacist or referral pharmacist reports distribution of drugs by the establishment, for supply of any healthcare post.

	Northern Region		Northeast Region		Southern Region		Southeast Region		Mid-West Region		Total		P value^***

	N	%	N	%	N	%	N	%	N	%	N	%
Services in PASs
Drug surveillance^*	36	7,5	432	24,4	307	34,5	303	24,0	113	21,9	1191	24,2
Clinical pharmaceutical services
Dispensing of drugs	139	48,6	174	14,2	196	27,0	649	59,1	94	23,6	1252	33,5	≤ 0,001
Therapeutic guidance	151	52,8	324	26,5	307	42,2	750	68,2	128	32,1	1660	44,5
Pharmacotherapeutic follow-up	22	7,7	19	1,6	38	5,2	168	15,3	18	4,5	265	7,1
Service in PADTs^**
Drug delivery	174	36,0	1133	63,9	516	57,8	788	61,9	346	66,9	2957	59,9	≤ 0,001

Management services provided as SARAS*	Northern Region		Northeast Region		Southern Region		Southeast Region		Center-West Region		Total		P value^**

	N	%	N	%	N	%	N	%	N	%	N	%
Selection of drugs	300	62,9	1365	77,8	787	88,7	1031	83,5	368	75,6	3851	79,5	≤0,001
Programming of drugs	362	75,9	1431	80,8	784	88,2	1123	88,8	421	81,6	4121	83,8
Acquisition of drugs	18	3,7	130	7,3	67	7,5	284	22,3	14	2,7	513	10,4
Distribution of drugs	29	6,0	142	8,0	143	16,0	447	35,1	35	6,8	796	16,1

Administrative Region	Health Regions (HRs)	Population* of the HRs	PASs^**		PADTs^***		SARAS^***		Valor p

			n	%	n	%	n	%
Northern Region	08	4.064.276	161	56,3	174	36,0	442	92,5	≤ 0,001
Northeast Region	12	8.911.847	528	43,3	1.133	63,9	1.653	93,5
Southern Region	05	8.364.871	420	57,9	516	57,8	869	97,4
Southeast Region	13	19.430.288	815	74,3	788	61,9	1.247	98,9
Mid-West Region	05	4.652.706	186	46,7	346	66,9	476	93,9
Total	43	45.423.988	2.110	56,6	2.957	59,9	4.687	95,6

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[1] Collaborations

SQ Araújo, KS Costa, VL Luiza, C Lavras, EA Santana and NUL Tavares took part in the drafting, contributed to the conception and outlining of the manuscript, critical review of the intellectual content, and the analysis and interpretation of the results, and approved the final version of the manuscript; they declare themselves to be responsible for all the aspects of the work, ensuring its precision and integrity.