The pharmacist in the Brazilian Primary Health Care: a comparative analysis between 2014 and 2017

Peixoto, Rafaela Tavares; Campos, Mônica Rodrigues; Luiza, Vera Lucia; Mendes, Luiz Villarinho

doi:10.1590/0103-1104202213308I

Rafaela Tavares Peixoto

Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (Ensp) – Rio de Janeiro (RJ), Brasil. rafaelatpeixoto@gmail.com

https://orcid.org/0000-0002-9362-3770

Mônica Rodrigues Campos

Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (Ensp) – Rio de Janeiro (RJ), Brasil. rafaelatpeixoto@gmail.com

https://orcid.org/0000-0002-7443-5977

Vera Lucia Luiza

Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (Ensp) – Rio de Janeiro (RJ), Brasil. rafaelatpeixoto@gmail.com

https://orcid.org/0000-0001-6245-7522

Luiz Villarinho Mendes

Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (Ensp) – Rio de Janeiro (RJ), Brasil. rafaelatpeixoto@gmail.com

https://orcid.org/0000-0002-9027-0287

Collaborators

Peixoto RT (0000-0002-9362-3770) ^* * Orcid (Open Researcher and Contributor ID). and Campos MR (0000-0002-7443-5977)^* * Orcid (Open Researcher and Contributor ID). contributed to the design, calculations, data analysis, and drafting and approval of the final version of the manuscript. Luiza VL (0000-0001-6245-7522)^* * Orcid (Open Researcher and Contributor ID). contributed to the design, data analysis, participation in drafting the paper, and approving the final version of the manuscript. Mendes LV (0000-0002-9027-0287) ^* * Orcid (Open Researcher and Contributor ID). contributed to data analysis and review of the final version of the manuscript. ■

Conflict of interests: non-existent

Subdimension	Variable description	Variable Code 2^nd Cycle (2014)	Variable Code 3^rd Cycle (2017)
General Identification	Federative Unit	UF	ESTADO
	Municipality’s IBGE code	IBGE	IBGE
	Municipality’s name	CIDADE	MUNICIPIO
	National Register of Health Establishments	CNES	CNES_FI-NAL
PHC Unit Professionals	No. of Pharmaceutical Professionals in the Unit	I.3.5.6	I.3.2.6
Health unit opening hours (2nd Cycle)/Medicines part of the Basic Pharmacy (3rd Cycle)	Dispensing medications in the unit	I.8.6.6	I.15.1
Structural characteristics and ambience of the health unit	Medication dispensing area	I.10.1.8	I.6.2.1
	Fractionation area	I.10.1.9	I.6.2.2
	Pharmacotherapeutic follow-up room	I.10.1.10	I.6.2.3
	Medication storage room	I.10.1.11	I.6.2.4
	Adequate storage and packaging of medicines (clean place without mold, cool and airy, the boxes are on shelves away from the wall and foor)	I.10.1.12	I.6.2.6
	Computer in the pharmacy (2nd Cycle) / No. of operating computers in the Pharmacy (3rd Cycle)	I.10.1.13	I.6.2.7
Equipment and materials	Refrigerator for pharmacy (2nd Cycle) / No. of exclusive operating refrigerators for medicines in the pharmacy (3rd Cycle)	I.12.12	I.8.22
Medicines part of the Basic Pharmacy (2nd Cycle) / Pharmaceutical Care (Electronic Module 3rd Cycle)	The dispensing of medicines in the municipality is decentralized? (2nd Cycle - Response by eSF) The dispensing of medicines in the municipality is: Centralized/Decentralized (3rd Cycle - Electronic Module - Response by municipality)	I.18.1	8.1
Medicines part of the Basic Pharmacy	Which professional dispenses the medicines in the unit? The pharmacist	I.18.2.1	No equivalent
Medicines part of the Basic Pharmacy (2nd Cycle) / Pharmaceutical Care (Electronic Module 3rd Cycle)	Is the dispensing of controlled medicines decentralized? (2nd Cycle - Response by eSF) Is the dispensing of controlled medicines centralized? (3rd Cycle - Electronic Module - Response by municipality)	I.21.7	8.4
Medicines part of the Basic Pharmacy	Antianemic drugs / vitamins / multivitamins / mineral salts (In sufficient quantity)
	Oral rehydration salts	I.18.3/1	I.15.2
	Ferrous sulphate	I.18.13/1	I.15.4.1
	Folic acid	I.18.14/1	I.15.4.2
	Anti-asthmatic drugs (In sufficient quantity)
	Salbutamol sulfate	I.18.19/1	I.15.5.1
	Beclomethasone dipropionate	I.18.21/1	I.15.5.3
	Hormonal contraceptive drugs/sex hormones (In sufficient quantity)
	Norethisterone Enanthate + Estradiol Valerate	I.18.26/1	I.15.6.1
	Ethinylestradiol + Levonorgestrel	I.18.27/1	I.15.6.2
	Medroxyprogesterone Acetate	I.18.29/1	I.15.6.4
	Antihypertensive drugs (In sufficient quantity)
	Captopril	I.19.1/1	I.15.7.1
	Enalapril maleate	I.19.2/1	I.15.7.2
	Atenolol	I.19.4/1	I.15.7.4
	Hydrochlorothiazide	I.19.8/1	I.15.7.8
	Cardiological drugs (In sufficient quantity)
	Propranolol hydrochloride	I.19.3/1	I.15.7.3
	Simvastatin	I.19.11/1	I.15.7.11
	Antidiabetic drugs (In sufficient quantity)
	Glibenclamide	I.19.20/1	I.15.8.1
	Metformin Hydrochloride	I.19.21/1	I.15.8.2
	NPH insulin	I.19.22/1	I.15.8.3
	Regular insulin	I.19.23/1	I.15.8.4
	Antibiotic and antifungal medicines (In sufficient quantity)
	Amoxicillin	I.20.1/1	I.15.9.1
	Ciprofloxacin hydrochloride	I.20.2/1	I.15.9.2
	Benzathine benzylpenicillin	I.20.3/1	I.15.9.3
	Erythromycin stearate	I.20.11/1	I.15.9.11
	Gentamicin sulfate	I.20.12/1	I.15.9.12
	Sulfadiazine tablet	I.20.14/1	I.15.9.14
	Fluconazole	I.20.15/1	I.15.9.15
	Miconazole nitrate	I.20.17/1	I.15.9.17
	Nystatin	I.20.19/1	I.15.9.19
	Azithromycin	I.20.20/1	I.15.9.20
	Analgesic/antipyretic drugs (In sufficient quantity)	I.20.21/1	I.15.9.21
	Ibuprofen
	Paracetamol	I.20.23/1	I.15.10.2
	Paracetamol	I.20.24/1	I.15.10.3
	Anticonvulsant / antidepressant / antipsychotic / anxiolytic and hypnosedative drugs (In sufficient quantity)
	Diazepam	I.21.10/1	I.15.19.4

Variables	PMAQ 2 (2014)		PMAQ 3 (2017)
Variables	N	%	N	%
General characteristics
UBS visited (proportion against the 38,812 who joined PMAQ1)	24,055	62.0	30,346	78.2
Aspects related to pharmaceutical care
UBS that dispensed medication *1	18,776	78.1	20,286	66.8
UBS that dispensed psychotropics *1	3,882	16.1	3,976	13.1
Medication dispensing area *	15,737	65.4	15,497	51.1
Fractionation area *	3,131	13.0	4,952	16.3
Drug therapy follow-up room *	2,063	8.6	3,221	10.6
Is there a computer in the pharmacy? *	5,227	21.7	8,291	27.3
Does the pharmacist dispense medication in the unit? *	3,565	19.9	-	-
Are there pharmacists at the UBS (CNES)?	3,467	14.4	4,475	14.7
Are medicines stored and packaged properly (clean place without mold, cool and ventilated, boxes are on shelves away from the wall and floor)? *	14,814	67.6	17,281	56.9
UBS with refrigerator for the pharmacy *2	6,001	24.0	9,806	32.3
UBS with storage room for medicines *2	10,303	42.8	15,412	50.8

Populational strata (inhabitants)	Up to 10 thousand	10 – 20 thousand	20 – 50 thousand	50 – 100 thousand	100 – 500 thousand	+500 thousand	General
Total municipalities	2,493	1,400	1,042	325	245	38	5,543
Total de inhabitants^* *Population estimates released by the IBGE for 2014 and 2017.	12,838,821	19,738,829	31,353,194	22,384,297	48,788,676	58,572,721	193,676,537
UBS	6,120	7,719	9,759	5,116	6,505	3,593	38,812
UBS /10.000 inhabitants	4.8	3.9	3.1	2.3	1.3	0.6	2.0
Mean HDI (2010)	0.7	0.6	0.7	0.7	0.7	0.8	0.7
PMAQ 2 (adhering units)
Adhering UBS	3,547	4,705	6,180	3,195	4,074	2,354	24,055
Dispensing UBS (N)	2,441	3,307	4,794	2,664	3,449	2121	18,776
Dispensing UBS (%)	68.8%	70.3%	77.6%	83.4%	84.7%	90.1%	78.1%
Dispensing UBS / 10.000 inhabitants	1.9	1.7	1.5	1.2	0.7	0.4	1.0
Dispensing UBS psychotropics (N)	1,195	596	455	254	483	899	3,882
Dispensing UBS psychotropics (%)	33.7%	12.7%	7.4 %	7.9 %	11.9%	38.2%	16.1%
UBS with availability of medicines ≥80% (N)	784	569	647	405	693	774	3,868
UBS with availability of medicines ≥80% (%)	32.1%	17.2%	13.5%	15.2%	20.1%	36.5%	20.6%
% UBS with pharmacists (CNES)	32.4%	10.6%	6.6%	7.7 %	12.2%	28.4%	14.4%
PMAQ 3 (adhering units)
Adhering UBS	4,152	5,840	7595	3,978	4,804	2,570	2,8939
Dispensing UBS (N)	2,544	3,709	5,260	2,928	3,669	2,176	20,286
Dispensing UBS (%)	61.3%	63.5%	69.3%	73.6%	76.4%	84.7%	70.1%
Dispensing UBS / 10.000 inhabitants	2.0	1.9	1.7	1.3	0.8	0.4	1.0
Dispensing UBS psychotropics (N)	263	492	522	265	964	1470	3,976
Dispensing UBS psychotropics (%)	6.3%	8.4%	6.9%	6.7%	20.1%	5 7.2 %	13.7%
UBS with availability of medicines ≥80% (N)	1,096	983	1,226	717	1,090	883	6,005
UBS with availability of medicines ≥80% (%)	43.1%	26.5%	23.3%	24.5%	29.7%	40.6%	29.6%
% UBS with pharmacists (CNES)	31.7%	10.4%	6.8%	7.2 %	14.1%	32.2%	14.7%

Total availability by pharmacological group	Populational strata (thousands of inhabitants)						Total (adherents)	Presence of pharmacist at the UBS	OR (95% CI)
Total availability by pharmacological group	Up to 10	10 – 20	20 – 50	50 – 100	100 – 500	+ 500	Total (adherents)	Presence of pharmacist at the UBS	OR (95% CI)
PMAQ 2nd Cycle - 2014 (N=18.776)
Pharmacological group	% UBS with full availability (in sufficient quantity)
Antianemics/vitamins/minerals^* *p-value > 0.05 Chi-square test. For all other drug groups p-value < 0.05.	62.3	62.2	58.7	58.7	64.6	64.0	61.5	70.5	1.6
Antiasthmatics	23.9	20.0	19.7	24.0	28.8	45.1	25.5	42.4	2.6
Contraceptives/sex hormones	37.5	30.4	30.3	37.7	44.9	61.9	38.5	55.7	2.3
Antihypertensives	47.8	41.1	39.2	40.0	42.6	40.4	41.5	54.7	1.9
Antidiabetics	43.4	26.3	21.0	24.2	33.4	49.5	30.8	54.6	3.4
Anti-infectives	3.9	3.2	2.2	1.4	1.6	4.3	2.6	5.7	3.0
Analgesics / antipyretics	65.2	63.9	64.0	65.3	72 .1	71.0	66.6	74.6	1.6
Cardiological drugs	50.8	46.0	48.1	48.0	54.7	48.2	49.3	59.9	1.7
Psychotropics (N=3.882)	92.0	84.7	78.5	79.1	83.2	79.5	84.5	88.6	1.7
Mean percentage availability of key drugs (PMAQ 2)	60.5	57.3	56.6	59.3	63.3	66.5	60.0	69.7	-
PMAQ 3rd Cycle - 2017 (N=20.286)
Pharmacological group	% UBS with full availability (in sufficient quantity)
Antianemics/vitamins/minerals	75.7	73.1	74.3	75.1	73.1	74.5	74.2	79.7	1.5
Antiasthmatics	18.8	14.1	14.0	16.5	25.3	51.7	21.1	40.8	3.4
Contraceptives/sex hormones	64.3	59.2	60.8	63.6	63.3	59.5	61.6	65.2	1.2
Antihypertensives	65.1	60.6	62.2	61.4	57.2	58.1	60.8	6 7.1	1.4
Antidiabetics	58.4	39.9	35.9	37.7	43.7	61.0	43.8	61.9	2.4
Anti-infectives	4.0	3.2	2.5	2.8	1.7	3.9	2.9	5.5	2.5
Analgesics / antipyretics	84.3	81.6	81.3	83.0	79.5	81.8	81.7	87.2	1.6
Cardiological drugs	64.5	59.5	62.5	62.6	61.7	64.7	62.3	69.8	1.5
Psychotropics (N=3.976)	63.9	49.0	41.6	52.1	39.6	57.0	49.9	73.7	4.5
Mean percentage availability of key drugs (PMAQ3)	73.6	67.7	67.2	68.1	69.2	72.9	69.2	77.9	-

Indicators	PMAQ-AB 2nd CYCLe - 2014				PMAQ-AB 3rd CYCLE- 2017
	N UBS with pharmacists	Presence of pharmacist registered at UBS - CNES			NUBS with pharmacists	Presence of pharmacist registered at UBS - CNES
	N UBS with pharmacists	N (%)	OR¹ 1 Crude Odds Ratio. (95% CI)	ORadj² 2 Odds Ratio adjusted by logistic regression. (95% CI)	NUBS with pharmacists	N (%)	OR¹ 1 Crude Odds Ratio. (95% CI)	ORadj² 2 Odds Ratio adjusted by logistic regression. (95% CI)
Drug dispensing area	2986	2767 (92.7%)	3.04 (2.63-3.51)	1.23 (1.09-1.38)	3548	3268 (92.1%)	4.59 (4.04-5.21)	2.02 (1.73-2.35)
Fractionation area	2986	590 (19.8%)	1.35 (1.22-1.49)	1.06^ p-value > 0.05. (0.94-1.19)	3548	887 (25.0%)	1.08^ p-value > 0.05. (0.99-1.17)	1.40 (1.26-1.55)
Drug therapy follow-up room	2986	528 (17.7%)	2.19 (1.96-2.44)	1.27 (1.12-1.44)	3548	960 (27.1%)	2.46 (2.25-2.68)	1.64 (1.47-1.82)
UBS with storage room for medicines	2986	2070 (69.3%)	2.26 (2.08-2.46)	1.15 (1.05-1.26)	3548	2983 (84.1%)	2.03 (1.84-2.23)	1.29 (1.15-1.45)
Are medicines safely stored and packaged^* * Clean place without the presence of mold, cool and airy, the boxes are on shelves away from the wall and floor. ?	2958	2501 (84.6%)	1.76 (1.58-1.96)	1.09^ p-value > 0.05. (0.98-1.21)	3469	3220 (92.8%)	1.61 (1.40-1.84)	1.11^ p-value > 0.05. (0.95-1.30)
Is there a computer in the pharmacy?	2986	2024 (67.8%)	8.49 (7.79-9.26)	4.07 (3.69-4.49)	3469	2883 (83.1%)	9.32 (8.48-10.25)	5.03 (4.55-5.57)
UBS with refrigerator for the pharmacy	2986	2003 (67.1%)	6.61 (6.07-7.19)	2.60 (2.36-2.87)	3548	274 4 (77.3%)	6.17 (5.67-6.72)	2.71 (2.46-2.98)
% UBS with availability > 80%	2986	1377 (46.1%)	4.57 (4.20-4.98)	1.79 (1.62-1.97)	3548	1942 (54.7%)	3.79 (3.51-4.08)	1.86 (1.71-2.03)

[1] Collaborators

Peixoto RT (0000-0002-9362-3770) ^* * Orcid (Open Researcher and Contributor ID). and Campos MR (0000-0002-7443-5977)^* * Orcid (Open Researcher and Contributor ID). contributed to the design, calculations, data analysis, and drafting and approval of the final version of the manuscript. Luiza VL (0000-0001-6245-7522)^* * Orcid (Open Researcher and Contributor ID). contributed to the design, data analysis, participation in drafting the paper, and approving the final version of the manuscript. Mendes LV (0000-0002-9027-0287) ^* * Orcid (Open Researcher and Contributor ID). contributed to data analysis and review of the final version of the manuscript. ■

Brasil

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The pharmacist in the Brazilian Primary Health Care: a comparative analysis between 2014 and 2017

ABSTRACT