Medicine dispensing service in primary health care of SUS

Leite, Silvana Nair; Bernardo, Noemia Liege Maria da Cunha; Álvares, Juliana; Guerra Junior, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Soares, Luciano

doi:10.11606/S1518-8787.2017051007121

person Silvana Nair Leite

schoolDepartamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil

person Noemia Liege Maria da Cunha Bernardo

schoolUniversidade do Vale do Itajaí. Itajaí, SC, Brasil

person Juliana Álvares

schoolDepartamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil

person Augusto Afonso Guerra Junior

schoolDepartamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil

person Ediná Alves Costa

schoolInstituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil

person Francisco de Assis Acurcio

schoolDepartamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil

person Ione Aquemi Guibu

schoolFaculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil

person Karen Sarmento Costa

schoolNúcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, BrasilschoolPrograma de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, BrasilschoolPrograma de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil

person Margô Gomes de Oliveira Karnikowski

schoolFaculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil

person Orlando Mario Soeiro

schoolFaculdade de Ceilândia. Universidade de Brasília. Brasília, DF, Brasil

person Luciano Soares

schoolPrograma de Pós-Graduação em Saúde e Meio Ambiente. Universidade da Região de Joinville. Joinville, SC, Brasil

Correspondence: Silvana Nair Leite. Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina – Campus Trindade 88.040-900. Florianópolis, SC, Brasil. E-mail:
silvana.nair.leite@ufsc.br

Authors’ Contribution: LS, NLB, and SNL analyzed the data and wrote the text. SNL, KSC, JA, GAA Jr., FAA, EAC, IAG, OMS, and MGOK developed the research project, coordinated data collection, reviewed and approved the text. All authors declare to be responsible for all aspects of the study, ensuring its accuracy and completeness.

Conflict of Interest: KSC declares conflict of interest for being former director of the Brazilian Ministry of Health, the research funding institution. The other authors declare no conflict of interest.

Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil

Universidade do Vale do Itajaí. Itajaí, SC, Brasil

Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil

Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil

Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil

Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil

Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, Brasil

Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil

Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil

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

Programa de Pós-Graduação em Saúde e Meio Ambiente. Universidade da Região de Joinville. Joinville, SC, Brasil

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)

[TFN1] STD: sexually transmitted disease; HIV: human immunodeficiency virus

[TFN2] * p < 0,01

[TFN3] Source: PNAUM – Services, 2015.

Medicine dispensing service in primary health care of SUS

ABSTRACT