Conceptions on pharmaceutical services in Brazilian primary health care

Costa, Ediná Alves; Araújo, Patrícia Sodré; Penaforte, Thais Rodrigues; Barreto, Joslene Lacerda; Guerra Junior, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Alvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair

doi:10.11606/S1518-8787.2017051007107

person Ediná Alves Costa

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

person Patrícia Sodré Araújo

schoolDepartamento de Ciências da Vida. Universidade do Estado da Bahia. Salvador, BA, Brasil

person Thais Rodrigues Penaforte

schoolDepartamento do Medicamento. Faculdade de Farmácia. Universidade Federal da Bahia. Salvador, BA, Brasil

person Joslene Lacerda Barreto

schoolDepartamento do Medicamento. Faculdade de Farmácia. Universidade Federal da Bahia. Salvador, BA, Brasil

person Augusto Afonso Guerra Junior

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

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

person Karen Sarmento Costa

schoolNúcleo de Estudos de Políticas Públicas. Programa de Pós-Graduação em Saúde Coletiva. 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, Brasilschool Programa 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 Ceilândia. Universidade de Brasília. Brasília, DF, Brasil

person Orlando Mario Soeiro

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

person Silvana Nair Leite

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

Correspondence/Email: Ediná Alves Costa. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Rua Basílio da Gama, s/nº - Canela. 40.110-040 Salvador, BA, Brasil. Email:
edina@ufba.br

Authors’ Contribution: Conception, analysis, and interpretation of results; critical review of the content: EAC, PSA, TRP, JBL, AAG Jr, FAA, IAG, JA, KSC, MGOK, OMS, SNL. All authors contributed to the writing, approved the final version of the manuscript, and 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.

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

Departamento de Ciências da Vida. Universidade do Estado da Bahia. Salvador, BA, Brasil

Departamento do Medicamento. Faculdade de Farmácia. Universidade Federal da Bahia. Salvador, BA, Brasil

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

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

Núcleo de Estudos de Políticas Públicas. Programa de Pós-Graduação em Saúde Coletiva. 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 Ceilândia. Universidade de Brasília. Brasília, DF, Brasil

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

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

Variable/subject	RPS		PHARM		MSH

	%	IC95%	%	IC95%	%	IC95%
Sex
Male	38.0	33.1–43.1	35.4	23.7–49.2	58.0	51.9–63.8
Female	62.0	56.9–66.9	64.6	50.8–76.3	42.0	36.2–48.1
Education level
Some elementary school		––		––	0.6	0.2–2.5
Elementary school		––		––	1.1	0.4–3.0
Some high school					0.5	0.1–3.7
High school	1.2	0.6–2.1		––	16.1	12.2–20.9
Higher education	98.8	97.9–99.4	100.0	100.0–100.0	81.6	76.6–85.7
Age group (years)
18 to 30	36.5	31.7–41.6	31.7	22.3–43.0	12.8	9.1–17.7
31 to 49	54.4	49.1–59.5	56.0	44.5–66.9	61.0	54.6–67.0
50 to 59	7.9	5.5–11.4	9.9	4.4–20.8	22.1	17.2–27.9
60 or more	1.2	0.4–3.5	2.4	1.0–5.5	4.2	2.4–7.0

Conceptions/Subjects	RPS	PHARM	MSH

	% (IC95%)	% (IC95%)	% (IC95%)
Focused on medicines:
In stages of medicine logistic cycle	8.7 (6.2–12.0)	6.8 (3.4–13.2)	8.4 (5.5–12.7)
In stages of logistic cycle with guidance/information to the user of medicines	16.7 (13.2–20.9)	25.7 (14.9–0.40)	12.3 (8.7–17.0)
In the provision/offer of medicines	5.2 (3.3–8.3)	3.6 (1.6–7.8)	11.0 (7.5–15.7)
In controlled provision/offer of medicines	4.5 (2.8–7.1)	2.2 (0.3–13.6)	7.4 (4.7–11.5)
As part of the medical or pharmaceutical care procedure
Activity performed by pharmacists in health care	1.5 (0.7–3.5)	0.4 (0.1–3.1)	0.6 (0.2–2.1)
As a complement or finalization of medical care, medicine dispensing, and user guidance	0.9 (0.3–2.7)	0.3 (0–2.1)	1.9 (0.7–4.6)
Associated with assistance to the poor
As a way of assisting/supporting/helping deprived or low-income populations	0.2 (0–1.6)	––	4.0 (2.1–7.6)
Associated with the care/activities with the user of medicines
Focused on the guidance/information to users on the use of medicines, with or without reference to their rational use	18.5 (14.8–22.8)	36.8 (26.1–48.9)	6.0 (3.6–9.7)
As a way of assisting/supporting/taking care of users/patients or population with guidance/information	8.1 (5.7–11.4)	11.2 (6.1–19.5)	13.9 (10.1–18.9)
Associated with care integrality	2.0 (0.9–4.3)	0.5 (0.1–3.3)	1.0 (0.4–2.7)
As part of the city’s health system management
As a way of supporting/assisting management activities	2.3 (1.1–4.8)	––	4.7 (2.7–7.9)
As a way of organizing the services for the provision of medicines	2.4 (1.2–4.5)	––	6.4 (3.8–10.5)
Others	10.5 (7.8–14.0)	8.8 (4.6–16.1)	15.3 (11.3–20.5)
Did not know how to answer	0.4 (0.1–1.4)	1.3 (0.3–4.8)	3.0 (1.3–6.4)
Did not answer	18.1 (14.4–22.4)	2.5 (1.1–5.3)	4.2 (2.2–7.8)

Conception/subject	North		Northeast		Midwest		Southeast		South

	RPS	PHARM	RPS	PHARM	RPS	PHARM	RPS	PHARM	RPS	PHARM
Focused on medicines
In stages of medicine logistic cycle	11.2	15.8	7.7	8.3	5.3	28.1	7.4	1.9	11.0	13.2
In stages of logistic cycle with guidance or information to medicine users	16.3	23.3	21.5	15.3	22.5	9.1	10.5	27.8	19.5	29.1
In provision or offer of medicines	2.3	4.4	8.8	3.4	––	8.1	5.3	3.9	2.1	1.9
In controlled provision or offer of medicines	4.6	––	2.6	4.2	––	––	5.2	3.6	6.0	––
As part of the medical or pharmaceutical care procedure
Activity performed by pharmacists in health care	1.1	––	––	––	––	––	3.1	0.7	2.0	––
As a complement or finalization of medical care, medicine dispensing, and user guidance	2.6	––	1.3	––	––	––	1.1	––	––	1.9
Associated with assistance to the poor
As a way of assisting/supporting/helping deprived or low-income populations	––	––	––	––	––	––	––	––	1.0	––
Associated with the care/activities with the user of medicines
Focused on the guidance or information to users on the use of medicines, with or without reference to their rational use	20.6	43.9	15.1	19.0	32.0	40.6	17.8	35.1	23.0	42.2
As a way of assisting/supporting/taking care of users/patients or population with guidance/information	10.3	2.2	5.1	9.4	21.3	––	11.6	12.0	6.1	9.7
Associated with care integrality	1.1	––	2.5	2.1	––	––	3.2	0.9	––	––
As part of the city’s health system management
As a way of supporting/assisting management activities	1.1	––	3.8	––	––	––	2.1	––	2.0	––
As way of organizing the services for the provision of medicines	6.0	––	2.6	3.1	––	––	2.1	––	1.0	––
Others	13.8	10.4	5.0	12.5	7.0	5.9	16.8	11.1	7.2	2.1
Did not know how to answer	1.1	––	––	1.0	1.1	8.1	––	0.9	1.0	––
Did not answer	7.7	––	24.0	21.8	10.7	––	13.7	2.3	18.1

Conception	Age (%)

	≤ 30 years	> 30 years	Total
Focused on medicines
In stages of medicine logistic cycle	9.5	5.5	6.8
In stages of logistic cycle with guidance/information to the user of medicines	17.9	29.3	25.7
In the provision/offer of medicines	3.8	3.5	3.6
In controlled provision/offer of medicines	6.7	0.1	2.2
As part of the medical or pharmaceutical care procedure
Activity performed by pharmacists in health care	––	0.6	0.4
As a complement or finalization of medical care, medicine dispensing, and user guidance		0.4	0.3
Associated with assistance to the poor
As a way of assisting/supporting/helping deprived or low-income populations	––	––	––
Associated with the care/activities with the user of medicines
Focused on the guidance/information to users on the use of medicines, with or without reference to their rational use	37.5	36.4	36.8
As a way of assisting/supporting/taking care of users/patients or population with guidance/information	9.8	11.8	11.2
Associated with care integrality		0.8	0.5
As part of the city’s health system management
As a way of supporting/assisting management activities	––	––	––
As way of organizing the services for the provision of medicines	––	––	––
Others	7.4	9.5	8.8
Did not know how to answer	2.2	0.9	1.3
Did not answer	5.3	1.2	2.5

[TFN1] RPS: those responsible for pharmaceutical services; PHARM: pharmacists responsible for medicine dispensing; MSH: Municipal Secretary of Health.

[TFN2] Source: PNAUM – Services, 2015.

Conceptions on pharmaceutical services in Brazilian primary health care

ABSTRACT