Acessibilidade / Reportar erro

Brasil

Revista de Saúde Pública

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Rev. Saúde Pública 51 (suppl 2) • 2017 • https://doi.org/10.11606/S1518-8787.2017051007121 copy

Medicine dispensing service in primary health care of SUS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To characterize the medicine dispensing services in the primary health care network in Brazil and in its different regions, aiming to promote the access and rational use of medicines.

METHODS

This is a cross-sectional, quantitative study with data obtained from the Pesquisa Nacional sobre Acesso, Utilização e Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), 2015. Observation visits were carried out in 1,175 dispensing units, and interviews were held with 1,139 professionals responsible for the dispensation of medicines in the dispensing units and 495 municipal coordinators of pharmaceutical services.

RESULTS

More than half (53%) of the units presented a space smaller than 10 m² for dispensing of medicines; 23.8% had bars or barriers between users and dispenser; 41.7% had computerized system; and 23.7% had counters for individual care. Among those responsible for dispensation, 87.4% said they always or repeatedly inform users how to use the medicines, and 18.1% reported developing some type of clinical activity. Isolated pharmacies presented a more developed physical and personal structure than those belonging to health units, but we found no significant differences regarding the information provided and the development of clinical activities.

CONCLUSIONS

There are major differences in the organization models of dispensation between cities, with regional differences regarding the physical structure and professionals involved. The centralization of medicine dispensing in pharmacies separated from the health services is associated with better structural and professional conditions, as in the dispensing units of the South, Southeast, and Midwest regions. However, the development of dispensation as health service does not prevail in any pharmacy or region of the Country yet.

Good Dispensing Practices; Pharmaceutical Services; Primary Health Care; Health Services Research; Brazilian Unified Health System

Type of dispensed medicines	All dispensing units	Some dispensing units	Specialized Centers	Centralized Pharmacy	Pharmaceutical Supply Center	Specialized Pharmacy	Other	Cannot answer

	% (95%CI)	% (95%CI)	% (95%CI)	% (95%CI)	% (95%CI)	% (95%CI)	% (95%CI)	% (95%CI)
Basic Component*	52.0 (47.1–56.9)	7.7 (5.3–11.0)	4.5 (2.8–7.4)	28.3 (23.9–33.2)	29.1 (24.6–34.0)	2.0 (1.0–4.2)	6.3 (4.2–9.2)	0.3 (0.1–1.4)
Specialized Component	71.0 (13.8)	29.0 (6.6)	13.0 (2.0)	113.0 (23.3)*	131.0 (28.1)	29.0 (5.1)	78.0 (13.8)	16.0 (3.3)
Ordinance 344	18.4 (14.7–22.7)	6.5 (4.4–9.7)	3.8 (2.2–6.4)	29.8 (25.4–34.7)	31.2 (26.5–36.2)	3.6 (2.1–6.2)	13.3 (10.2–17.1)	0.6 (0.1–2.2)
STD/HIV	5.7 (3.7–8.7)	3.1 (1.8–5.2)	6.2 (4.1–9.2)	9.7 (7.1–13.1)	10.2 (7.5–13.9)	3.30 (2.0–5.5)	19.2 (15.5–23.6)	8.7 (6.2–12.1)
Tuberculosis	15.3 (11.9–19.4)	3.6 (2.2–5.9)	4.5 (2.8–7.4)	14.7 (11.4–18.8)	19.1 (15.3–23.7)	3.1 (1.7–5.4)	24.6 (20.5–29.3)	4.0 (2.4–6.6)

Variable	Brazilian regions % (95%CI)					Total

	North	Northeast	Midwest	Southeast	South
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)
Exclusive area for dispensing medicines*
Yes	60.1 (53.5–66.4)	57.9 (49.6–65.8)	78.1 (64.2–87.6)	72.4 (62.5–80.5)	72.3 (64.1–79.3)	66.2 (61.3–70.7)
Computerized system for the pharmacy
Yes	17.4 (13.0–22.9)	14.3 (7.9–24.6)	59.0 (44.8–71.9)	60.9 (46.9–73.3)	68.8 (59.8–76.6)	41.7 (36.2–47.5)
Individual service counters 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)
Service counter 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 (54.0–63.9)
Presence of bars or barriers between dispenser and user*	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)
Hours/week of care*
Up to 40	79.4 (73.7–84.2)	93 (83.1–97.3)	81.7 (71.7–88.7)	43.2 (31.3–55.9)	63.0 (51.1–73.5)	70.8 (64.5–76.4)
More than 40	20.6 (15.8–26.3)	7.0 (2.7–16.9)	18.3 (11.3–28.3)	56.8 (44.1–68.7)	37.0 (26.5–48.9)	29.2 (23.6–35.5)
Average number of users attended per day*
Up to 100	91.7 (87.7–94.6)	90.6 (82.8–95.0)	64.7 (51.6–75.9)	47.5 (34.9–60.4)	71.5 (58.7–81.6)	72.6 (65.9)
From 100 to 500	07.7 (04.9–11.7)	1.2 (4.8–17.0)	34.9 (23.7–48.1)	33.2 (22.9–45.5)	22.1 (15.0–31.3)	20.2 (16.2–24.9)
More than 500	0.6 (0.2–1.8)	0.2 (0.1–0.6)	0.4 (0.1–2.7)	19.3 (7.2–42.4)	6.4 (1.0–32.1)	7.2 (2.9–16.8)
Waiting time to be attended < 15 min
Always or repeatedly	6.4 (3.8–10.8)	4.9 (2.6–9.2)	9.2 (5.1–16.2)	2.9 (1.5–5.7)	8.4 (5.2–13.4)	5.3 (3.9–7.1)
Sometimes or rarely	29.5 (23.8–35.8)	22.2 (14.8–31.8)	27.2 (13.9–46.3)	52.7 (39.6–65.4)	43.5 (32.7–54.9)	36.6 (30.4–43.2)
Never	64.1 (57.4–70.2)	72.9 (63.5–80.6)	63.6 (43.1–80.1)	44.4 (32.4–57.1)	48.1 (37.7–58.6)	58.2 (51.9–64.2)
Exclusive professionals
Pharmacy*
Pharmacist	23.2 (18.6–28.5)	22.9 (15.8–31.9)	71.7 (59.7–81.2)	79.0 (70.5–85.5)	40.7 (30.1–52.3)	46.2 (40.9–51.6)
Responsible for the Pharmacy
Pharmacist*	26.8 (21.9–32.2)	18.5 (11.7–28.1)	66.9 (55.6–76.6)	72.0 (57.3–83.1)	44.8 (34.5–55.6)	43.0 (37.8–48.4)
Information on how to use
Always or repeatedly	90.8 (86.0–94.1)	93.1 (87.2–96.4)	95.6 (89.7–98.2)	77.2 (55.7–90.1)	90.1 (79.6–95.5)	87.4 (79.3–92.6)
Sometimes or rarely	6.4 (3.8–10.7)	6.0 (2.9–11.9)	4.1 (1.6–10.3)	22.8 (9.9–44.3)	8.1 (3.4–18.3)	11.7 (6.6–20.0)
Never	2.8 (1.2–6.2)	0.9 (0.2–3.8)	0.3 (0.1–1.1)	00 (0.0)	1.7 (0.2–11.4)	0.9 (0.4–2.2)
Conduction of some activity of clinical nature
Yes	17.9 (13.7–23.1)	12.6 (7.0–21.6)	21.7 (12.1–35.8)	23.0 (15.2–33.0)	19.6 (13.9–26.9)	18.1 (14.5–22.4)

Variable	Type of unit

	Isolated Pharmacy	Center/Joint Unit

	% (95%CI)	% (95%CI)
Dispensing area*
≤ 10 m²	26.1 (15.3–40.9)	63.2 (56.3–69.7)
> 10 m²	73.9 (59.1–84.7)	36.8 (30.3–43.7)
Exclusive area for dispensing of medicines
Yes	84.7 (63.2–94.7)	62.0 (56.7–67.0)
Computerized system for the pharmacy*
Yes	75.5 (61.2–85.7)	35.1 (29.6–41.1)
Individual service counters with chairs*	43.7 (27.7–61.0)	20.5 (14.3–28.6)
Presence of bars or barriers between users and dispenser*	25.8 (13.6–43.5)	23.5 (19.5–28.5)
Hours/week care
≤ 40	55.2 (37.2–71.9)	73.0 (66.2–78.8)
> 40	44.8 (28.1–62.8)	27.0 (21.2–33.8)
Average number care/day (patients)
Up to 100	46.9 (31.2–63.3)	78.0 (70.5–84.1)
100–500	40.0 (25.3–56.7)	15.5 (12.3–19.3)
> 500	13.1 (3.5–38.7)	6.5 (2.1–18.7)
Waiting time to be attended >15 min*
Always or repeatedly	2.1 (0.6–6.6)	6.0 (4.4–8.2)
Sometimes or rarely	62.6 (47.1–75.9)	31.4 (24.9–38.6)
Never	35.3 (22.2–51.0)	62.6 (55.8–69.0)
Exclusive professionals for the pharmacy*
Pharmacist	85.1 (75.7–91.3)	37.9 (32.1–44.0)
Nurse	5.1 (2.5–9.9)	17.6 (14.4–21.4)
Assistant, technician, other	88.0 (76.0–94.4)	66.3 (61.3–71.0)
Responsible for the pharmacy*
Pharmacist	87.1 (76.6–93.2)	33.7 (28.5–39.4)
Information on how to use
Always or repeatedly	85.0 (68.1–93.8)	88.2 (78.3–94.0)
Conduction of some activity of clinical nature
Yes	26.8 (12.8–47.7)	17.4 (14.2–21.1)

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS