scholarly journals Polypharmacy: a challenge for the primary health care of the Brazilian Unified Health System

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Renata Cristina Rezende Macedo do Nascimento ◽  
Juliana Álvares ◽  
Augusto Afonso Guerra Junior ◽  
Isabel Cristina Gomes ◽  
Micheline Rosa Silveira ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Emergency Services ◽  
Chi Square ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Unified Health System ◽  
Primary Health ◽  
Main Challenge

OBJECTIVE: To characterize the polypharmacy in primary health care patients and to identify its associated factors. METHODS: This is a cross-sectional, exploratory, and evaluative study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The variable of interest was polypharmacy, defined as the use of five or more medicines. We sought to identify the association of sociodemographic variables and indicators of health conditions to polypharmacy. For group comparison, the Pearson’s Chi-square test was used. The association between polypharmacy and explanatory variables was evaluated by logistic regression model (p < 0.05). The quality of the adjustment was verified by Hosmer-Lemeshow test. RESULTS: The prevalence of polypharmacy among medicine users was 9.4% (95%CI 7.8–12.0) in the general population and 18.1% (95%CI 13.6–22.8) in older adults above 65 years old. We found statistically significant association between polypharmacy and age above 45 years, lower self-perception of health, presence of chronic diseases, having health insurance, care in emergency services, and region of the Country. South users presented the highest chances to polypharmacy. The most used medicines were those of the cardiovascular system, being compatible with the national epidemiological profile. CONCLUSIONS: Polypharmacy is a reality in the population met within the primary care of Brazilian Unified Health System and may be related to excessive or inappropriate use of medicines. The main challenge to qualify health care is to ensure that prescription of multiple medicines be appropriate and safe

scholarly journals Availability of essential medicines in primary health care of the Brazilian Unified Health System

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Renata Cristina Rezende Macedo do Nascimento ◽  
Juliana Álvares ◽  
Augusto Afonso Guerra Junior ◽  
Isabel Cristina Gomes ◽  
Ediná Alves Costa ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Health Care Professionals ◽  
Congenital Syphilis ◽  
Essential Medicines ◽  
Chi Square ◽  
Cross Sectional ◽  
Unified Health System ◽  
Primary Health

OBJECTIVE: To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS). METHODS: This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename – National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed. RESULTS: One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis. CONCLUSIONS: The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer medicines in SUS confirm the general availability verified in this study. Among patients, about 60% said they obtain medicines in SUS units, data consistent with the lack of medicines reported by medicine dispensers and in line with physicians’ evaluations

scholarly journals Availability of dental treatment is associated with satisfaction derived from Primary Health Care Services accessed by elderly

2016 ◽  
Vol 45 (6) ◽  
pp. 344-350 ◽  
Author(s):  
Aline Blaya MARTINS ◽  
Creta SEIBT ◽  
Matheus NEVES ◽  
Juliana Balbinot HILGERT ◽  
Fernando Neves HUGO
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Health Care Services ◽  
Dental Treatment ◽  
Cross Sectional Study ◽  
Cluster Sampling ◽  
Cross Sectional ◽  
Unified Health System ◽  
Primary Health

Abstract Objective This research evaluated whether having dental treatment available in the primary health care centers of the Brazilian Unified Health System was associated with greater satisfaction with the services accessed. The offering of dental care within the health service that elders usually access may improve their satisfaction with the services as a whole. Material and method In this cross-sectional study, 401 elders living in the districts of Lomba do Pinheiro and Partenon in Porto Alegre, Brazil were interviewed. Elders were selected using a cluster sampling design process from census tract drawings. Result Poisson Regression revealed that age and dental treatment supply were associated with outcome, and age, number of teeth, and the presence of dental treatment were associated with a higher prevalence of satisfaction with health services. Conclusion These results provide new contributions for health system qualification because this study demonstrated the importance of having dental treatment available to improve the satisfaction of older people with the Primary Health Care (PHC) services accessed.

scholarly journals Infrastructure of pharmacies of the primary health care in the Brazilian Unified Health System: Analysis of PNAUM – Services data

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Silvana Nair Leite ◽  
Fernanda Manzini ◽  
Juliana Álvares ◽  
Augusto Afonso Guerra Junior ◽  
Ediná Alves Costa ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
System Analysis ◽  
Cross Sectional Study ◽  
Physical Structure ◽  
Pharmacy Services ◽  
Cross Sectional ◽  
Unified Health System ◽  
Primary Health

OBJECTIVE: To characterize the infrastructure of the primary health care pharmacies of the Brazilian Unified Health System, aiming at humanizing the offered services. METHODS: This is a cross-sectional study, of quantitative approach, from data obtained in the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). Information on 1,175 pharmacies/dispensing units were gathered from direct observation and assessment of dispensing units installations conducted by trained researchers who used a standardized form. The analyzed variables refer to the physical structure of pharmacies or medicine dispensing units of the health units under research. RESULTS: The pharmacy area was greater than 14 m2 in 40.3% of the sampled units, highlighting those from Midwest (56.9%) and Southeast (56.2%) regions and those of Northeast, with only 23.3%. About 80.2% units had waiting rooms with chairs for patients, 31.8% of them had dispensing areas inferior to 5m2 , while in 46.2% these areas were superior to 10m2 . Bars were found in service counters in 23.8% of health units, thus separating the patient from the professional; 44.1% had internet access. In most units, the area of medicine storage had no refrigerator or freezer for their exclusive storage and 13.7% had a specific room for pharmaceutical consultation. CONCLUSION: Aiming at achieving care humanization and improving working conditions for professionals, the structuring of the environment of pharmacy services is necessary. This would contribute to the better qualification of pharmacy services, comprising more than medicine delivery. Data on the Northeast region indicated less favorable conditions to the development of adequate dispensing services. Based on the panorama pointed out, we suggest the expansion of stimulus concerning the physical structure of pharmaceutical services, considering regional specificities

scholarly journals Technical issues and conservation conditions of medicines in the primary health care of the Brazilian Unified Health System

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Ediná Alves Costa ◽  
Patrícia Sodré Araújo ◽  
Marcelo Tavares Pereira ◽  
Ana Cristina Souto ◽  
Gisélia Santana Souza ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Pharmaceutical Services ◽  
Cross Sectional ◽  
Unified Health System ◽  
Technical Requirements ◽  
Primary Health ◽  
Wide Range ◽  
Technical Issues

OBJECTIVE: To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance. METHODS: This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines – Services)–, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21.RESULTS: The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance. CONCLUSIONS: The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of requirements essential to the conservation of medicines. We observed a disconnection between the efforts made in the Brazilian Unified Health System to promote access to medicines for all population and the organization and qualification of pharmaceutical services

scholarly journals Management of pharmaceutical services in the Brazilian primary health care

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Letícia Farias Gerlack ◽  
Margô Gomes de Oliveira Karnikowski ◽  
Camila Alves Areda ◽  
Dayani Galato ◽  
Aline Gomes de Oliveira ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Pharmaceutical Services ◽  
Limiting Factors ◽  
Health Board ◽  
Complex Samples ◽  
Financial Autonomy ◽  
Unified Health System ◽  
Primary Health

OBJECTIVE: To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS: This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS: We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS: Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening

scholarly journals Factors associated with delay in seeking care by tuberculosis patients

2018 ◽  
Vol 71 (suppl 1) ◽  
pp. 646-651 ◽  
Author(s):  
Dândara Nayara Azevêdo Dantas ◽  
Bertha Cruz Enders ◽  
Déborah Raquel Carvalho de Oliveira ◽  
Caroline Evelin Nascimento Kluczynic Vieira ◽  
Ana Angélica Rêgo de Queiroz ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Search Time ◽  
Self Medication ◽  
Chi Square ◽  
Cross Sectional ◽  
Tuberculosis Patients ◽  
A Value ◽  
Primary Health ◽  
Behavioral Variables

ABSTRACT Objective: To identify social, clinical and behavioral factors of tuberculosis patients that are associated with delay in the search for primary health care. Method: This is a cross-sectional, quantitative study conducted with 56 people on treatment for pulmonary tuberculosis in the city of Natal, in the state of Rio Grande do Norte, Brazil. The data were collected through a structured instrument. The Chi-square and Fisher tests were applied to test the association between independent and dependent variables (search time). A value of p <0.05 was set as statistically significant. Results: No social or clinical variables were statistically associated with patient delays in the search for primary health care. Among the behavioral variables, self-medication and the first health service sought had a statistically significant association with the time for seeking care (p = 0.020, and p = 0.033, respectively). Conclusion: Self-medication contributes to the delay in the search for primary health care by tuberculosis patients.

scholarly journals Access to medicines by patients of the primary health care in the Brazilian Unified Health System

2017 ◽  
Vol 51 ◽  
pp. 20s ◽  
Author(s):  
Juliana Álvares ◽  
Augusto Afonso Guerra Junior ◽  
Vânia Eloisa de Araújo ◽  
Alessandra Maciel Almeida ◽  
Carolina Zampirolli Dias ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Developed Countries ◽  
Access To Medicines ◽  
Essential Medicines ◽  
Unified Health System ◽  
Primary Health ◽  
Significant Difference ◽  
Good For

OBJECTIVE: To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective. METHODS: This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS: For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS: Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population

scholarly journals Barriers Facing Primary Health Care Physicians When Dealing with Emergency Cases in Jeddah, Saudi Arabia

2015 ◽  
Vol 8 (8) ◽  
pp. 192 ◽  
Author(s):  
Majed A. Aloufi ◽  
Marwan A. Bakarman
Keyword(s):  
Health Care ◽  
Saudi Arabia ◽  
Primary Health Care ◽  
Emergency Services ◽  
Fine Tuning ◽  
Cross Sectional ◽  
Primary Health ◽  
Primary Health Care Centers ◽  
Primary Health Care Physicians ◽  
Health Care Centers

<p><strong>OBJECTIVES:</strong> To estimate the prevalence of emergency cases reporting to Primary Health Care centers (PHC), Jeddah, Saudi Arabia and to explore the barriers facing PHC physicians when dealing with such emergency cases.<strong></strong></p><p><strong>METHODS:</strong> A cross-sectional analytic study, where all physicians working in the PHC of the Ministry of Health (MOH) in Jeddah; were invited to participate (n=247). The study period was from July 2013 till December 2013. Data were collected through two sources. 1- A self-administered questionnaire used to determine the physicians’ perceived competence when dealing with emergency cases. 2- A structured observation sheet used to evaluate availability of equipment, drugs, ambulances and other supporting facilities required to deal with emergency cases.</p><p><strong>RESULTS:</strong> The response rate was 83.4%. The physicians’ age ranged between 25 and 60 years with a mean ±SD of 34.4±7.5 years. Majority of them (83.5%) did not attend ATLS courses at all whereas 60.7% never attended ACLS courses. The majority (97.1%) had however attended BLS courses. Physicians in the age group 36-45 years, non-Saudi, those who had SBFM, those who reported experience in working in emergency departments and physicians who reported more working years in PHCCs (&gt;5 years) had a significant higher score of perceived level of competence in performing emergency skill scale than others (P&lt;0.05). The prevalence of emergency cases attending PHC in Jeddah (2013) was 5.2%.</p><p><strong>CONCLUSION:</strong> Emergency services at PHC in Jeddah are functioning reasonably well, but require fine tuning of services and an upgrade in their quality.</p>

Resolution And Continuity Of Primary Health Care: Reference And Counter-Reference In The Sus (Unified Health System)

2017 ◽  
Vol 04 (01) ◽  
Author(s):  
Maria Beatriz Rodrigues Criscuolo ◽  
Duane Ferreira Melo ◽  
Selma Maria da Fonseca Viegas
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Unified Health System ◽  
Primary Health

scholarly journals An analysis of the meaning of integrated Primary Health Care from the KwaZulu- Natal Primary Health Care context

Curationis ◽  
2009 ◽  
Vol 32 (2) ◽  
Author(s):  
M.N. Sibiya ◽  
N.S. Gwele
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Health Care Services ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Primary Health ◽  
Kwazulu Natal ◽  
Comprehensive Health

In South Africa, integration o f services policy was enacted in 1996 with the aim of increasing health service utilization by increasing accessibility and availability of all health care services at Primary Health Care (PHC) level. Integration of PHC services continues to be seen as a pivotal strategy towards the achievement of the national goals of transformation of health services, and the attainment of a comprehensive and seamless public health system. Although the drive behind the integration of PHC services was to improve accessibility of services to the community, the problem however, arises in the implementation of integrated PHC (IPHC) as there is no agreed upon understanding of what this phenomenon means in the South African context. To date no research studies have been reported on the meaning of the integration of PHC services. Hence, there is a need for shared views on this phenomenon in order to facilitate an effective implementation of this approach. A cross-sectional study, using a qualitative approach was employed in this study in order to analyze the phenomenon, IPHC in KwaZulu-Natal and the meaning attached to it in different levels of the health system. A grounded theory was selected as it is a method known for its ability to make greatest contribution in areas where little research has been done and when new viewpoints are needed to describe the familiar phenomenon that is not clearly understood. Policy makers and co-ordinators of PHC at national, provincial and district levels as well as PHC nurses at functional level participated in the study. The data was collected by means of observations, interviews and document analysis. The sample size for interviews was comprised of 38 participants. Strauss and Corbin’s process of data analysis was used. It emerged that there were three core categories that were used by the participants as discriminatory dimensions of IPHC in South Africa. These core categories were (a) comprehensive health care, (b) supermarket approach and (c) one stop shop.

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