Influence of pharmaceutical services organization on the availability of essential medicines in a public health system

Objective: To evaluate the influence of organizational structure and technical-management activities on the availability of essential medicines in the primary healthcare. Materials & methods: Cross-sectional, exploratory and evaluative study. The availability was evaluated according to parameters established by the WHO. Results: The average availability of standardized essential medicines was 83.3 and 73.3% for medicines purchased centrally by the Brazilian government. Among the therapeutic groups evaluated, the lowest average availability were for the tuberculostatics (24.1%) and psychotropic/special control medicines (30.3%). Conclusion: The availability of essential medicines was positively influenced by the presence of the pharmacist and by the computerized system deployed, and negatively associated with essential medicines purchased centrally by the federal government, especially in the smaller municipalities.

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Vaccination knowledge, attitudes and practices in patients with HIV: a cross-sectional survey

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.824 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Rousset ◽

G Voglino ◽

E Boietti ◽

A Corradi ◽

M R Gualano ◽

...

Keyword(s):

Public Health ◽

Infectious Diseases ◽

Health System ◽

Vaccination Coverage ◽

Public Health System ◽

Cross Sectional Survey ◽

Hiv Patients ◽

Cross Sectional ◽

Contagion Risk ◽

High Level

Abstract Background Infectious diseases are more common and severe in patients with HIV, which show different response to vaccines and a diminished protection. It is therefore very important to assess knowledge and attitudes towards vaccination in people with HIV, since precise vaccination coverage and vaccine hesitancy are not well established in this subgroup of patients. Methods A sample of 119 patients with HIV completed a cross-sectional survey. Patients were recruited during their routine medical examination at the infectious diseases clinic in Turin. The survey explored these main areas: demographics and history of HIV infection, vaccination history, attitudes towards vaccination, confidence in the public health system, contagion risk and disease seriousness perception. In this preliminary phase descriptive analysis were conducted. Results Preliminary data show that mean age of the participants was 49.51 years, 80% were males. The median of HIV infection duration was 10 years, while the median of the lymphocyte count was 762.50 cells/mm3. The disease with the highest vaccination coverage was tetanus (88.7%), considered a serious or very serious disease by 85.6% of the participants, despite low or very low contagion risk perception (84.1%). The disease with the lowest vaccination coverage was Herpes Zoster (7.3%), despite high or very high seriousness perception (70%). Furthermore, 99.1% of the participants showed high or very high confidence toward public health system professionals, and the majority of them (59.5%) stated that vaccines are more useful for the community than for the single person. Conclusions Vaccination coverage is still not fully satisfactory regarding diseases considered infrequent or mild. Considering the high level of confidence toward the public health system that has emerged, it is necessary to implement informative and operative strategies about vaccination for European HIV patients, which are particularly at risk regarding infectious diseases. Key messages Vaccination coverage and risk perception in HIV patients is not satisfactory for many diseases and an effort to implement informative strategies in Europe is needed. The role of vaccination in preventing infectious diseases in HIV patients should be recognized and strengthened by relying on the high level of confidence toward European public health systems.

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Frequency and Severity of Adverse Drug Reactions to Medications Prescribed for Alzheimer’s Disease in a Brazilian City: Cross-Sectional Study

Frontiers in Pharmacology ◽

10.3389/fphar.2020.538095 ◽

2020 ◽

Vol 11 ◽

Author(s):

Tânia Regina Ferreira ◽

Luciane Cruz Lopes ◽

Cristiane de Càssia Bergamaschi

Keyword(s):

Public Health ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Health System ◽

Psychiatric Disorders ◽

Public Health System ◽

Cross Sectional Study ◽

Sectional Study ◽

Drug Reactions ◽

Cross Sectional

Background: There is lack of national studies that assess the risks associated with the drugs provided under the Brazilian public health system for treating Alzheimer’s disease. Then, this study determined the prevalence and severity of self-reported adverse drug reactions (ADRs) prescribed to patients with Alzheimer’s disease in the Brazilian public health system.Methods: A cross-sectional study was carried out based on public data from the MEDEX system (information on dispensing data, known as exceptional dispensing medications) and interviews with patients and/or caregivers who get access to Alzheimer’s drugs at a public pharmacy in a large Brazilian city, between July and September 2017, inquiring about ADRs and serious adverse events (SAEs).Results: The subjects were asked about ADRs and SAEs related to the use of donepezil, galantamine, rivastigmine and memantine. Out of 285 patients enrolled on the database, 250 participated in the study (87.7%). Among the participants, approximately 63.0% were female, 70.3% aged ≥75 years and 70.3% had comorbidities. Overall, 209 patients (83.6%) reported at least one ADR (total 1,149 ADRs) and rivastigmine was associated with the largest number of ADRs per patient (7.9 ADRs/patient). The predominant adverse effects were psychiatric disorders with common frequency (57.1%) and mild severity (89.0%). Six patients (2.4%) had SAEs that required hospitalization. The use of antipsychotics was the variable associated with ADR (OR = 4.95; 95% CI: 1.45–16.93; p = 0.011).Conclusion: There was a large number of reported ADRs and most of them were of common frequency and mild severity, being mainly related to psychiatric disorders. Considering the fragility of these patients, it is important to improve safety-related care in the use of drugs for treating this disease.

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A cross-sectional study on dental surgeons’ immune status against hepatitis B virus in the Public Health System

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s1678-9946202062018 ◽

2020 ◽

Vol 62 ◽

Author(s):

Clea Adas Saliba Garbin ◽

Bruno Wakayama ◽

Tânia Adas Saliba ◽

Orlando Adas Saliba Junior ◽

Artênio José Ísper Garbin

Keyword(s):

Public Health ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Immune Status ◽

Public Health System ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

The Public ◽

B Virus

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Characteristics of citizens and their use of teleconsultation in Primary Care in the Catalan public health system before and during COVID: Retrospective Descriptive Cross-Sectional Study (Preprint)

Journal of Medical Internet Research ◽

10.2196/28629 ◽

2021 ◽

Author(s):

Oscar Solans ◽

Josep Vidal-Alaball ◽

Pasqual Roig Cabo ◽

Núria Mora ◽

Ermengol Coma ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Health System ◽

Public Health System ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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Evaluation of prenatal care according to indicators for the Prenatal and Birth Humanization Program

Revista Brasileira de Saúde Materno Infantil ◽

10.1590/1806-93042021000200006 ◽

2021 ◽

Vol 21 (2) ◽

pp. 441-450

Author(s):

Carla Gisele Vaichulonis ◽

Rodrigo Ribeiro e Silva ◽

Andreza Iolanda Apati Pinto ◽

Indianara Rodrigues Cruz ◽

Ana Clara Mazzetti ◽

...

Keyword(s):

Public Health ◽

Prenatal Care ◽

Observational Study ◽

Public Health System ◽

First Trimester ◽

Sharp Decline ◽

Cross Sectional ◽

The Third ◽

Universal Accessibility ◽

The City

Abstract Objectives: to evaluate prenatal care provided to low-risk pregnant women users of the Sistema Único de Saúde (SUS) (Public Health System) in the city of Joinville, SC. Methods: this is a cross-sectional observational study carried out from March 2018 to February 2019, through interview and analysis of the Pregnant Card of puerperal over 18 years old, from Joinville, who underwent prenatal care at SUS, excluding recent given up puerperal. Prenatal care was evaluated according to the recommended criteria by the Prenatal and Birth Humanization Program. Results: 683 mothers were interviewed. The criteria with the highest levels of adequacy were accessibility (99.6%), early initiation on prenatal care (92.7%) and 6 or more consultations (87.1%) and the criteria with the lowest rates of adequacy were the set of guidelines (17.7%) and the third and first trimester exams (42.5% and 63.5% respectively). Conclusion: it is concluded that the prenatal care provided by SUS in the city of Joinville, despite the almost universal accessibility, the early onset and the prevalence of puerperal women with more than 6 consultations, showed a sharp decline in the analysis of the recommended indicators.

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Profile of patients with rheumatic diseases undergoing treatment with anti-TNF agents in the Brazilian Public Health System (SUS), Belo Horizonte - MG

Brazilian Journal of Pharmaceutical Sciences ◽

10.1590/s1984-82502015000300023 ◽

2015 ◽

Vol 51 (3) ◽

pp. 709-719 ◽

Cited By ~ 1

Author(s):

Haliton Alves de Oliveira Junior ◽

Alessandra Maciel Almeida ◽

Francisco Assis Acurcio ◽

Jéssica Barreto dos Santos ◽

Adriana Maria Kakehasi ◽

...

Keyword(s):

Public Health ◽

Health System ◽

Rheumatic Diseases ◽

Public Health System ◽

Standard Form ◽

Female Gender ◽

Well Being ◽

Cross Sectional ◽

The Mean ◽

Belo Horizonte

The aim of this study was to describe the baseline demographic and clinical characteristics as well as the functional status of a prospective cohort of patients with rheumatic diseases assisted by the Brazilian Public Health System (SUS). Data for 302 patients receiving tumor necrosis factor α inhibitors (anti-TNF agents) was collected through a standard form. Among patients, 229 (75.8%) were female and 155 (51.3%) were Caucasian; the mean age was 50.3 ± 12.8 years, and the mean disease duration was 9.9 ± 8.7 years. Among them 214 patients (70.9%) received adalimumab, 72 (23.8%) etanercept, and 16 (5.3%) infliximab. Mean Health Assessment Questionnaire-Disability Index (HAQ-DI) was 1.37 ± 0.67 for all participants. Poor functional response was associated with female gender, married patients and with a score of < 0.6 on the EuroQoL-5 dimensions (EQ-5D). Significant correlation was found between the HAQ-DI values, disease activity and quality of life (QOL). The results obtained in this study contribute to a better understanding of the clinical and demographic characteristics of patients with rheumatic diseases at the beginning of anti-TNF-agent treatment by SUS. Furthermore, our findings are consistent with another Brazilian and foreign cross-sectional investigations. This knowledge can be of great importance for further studies evaluating the effectiveness of biological agents, as well as, to contribute to improve the well-being of the patients with rheumatic diseases.

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Primary Care Doctor Characteristics That Determine the Use of Teleconsultations in the Catalan Public Health System: Retrospective Descriptive Cross-Sectional Study (Preprint)

10.2196/preprints.16484 ◽

2019 ◽

Author(s):

Oscar Solans Fernández ◽

Francesc López Seguí ◽

Josep Vidal-Alaball ◽

Josep Maria Bonet Simo ◽

Oscar Hernandez Vian ◽

...

Keyword(s):

Public Health ◽

Health System ◽

General Practitioners ◽

Public Health System ◽

Multivariate Logistic Regression Analysis ◽

Sociodemographic Factors ◽

Urban Setting ◽

Primary Care Doctor ◽

Sociodemographic Characteristics ◽

Cross Sectional

BACKGROUND eConsulta is a tele-consultation service involving doctors and patients, and is part of Catalonia's public health information technology system. The service has been in operation since the end of 2015 as an adjunct to face-to-face consultations. A key factor in understanding the barriers and facilitators to the acceptance of the tool is understanding the sociodemographic characteristics of general practitioners who determine its use. OBJECTIVE This study aimed to analyze the sociodemographic factors that affect the likelihood of doctors using eConsulta. METHODS A retrospective cross-sectional analysis of administrative data was used to perform a multivariate logistic regression analysis on the use of eConsulta in relation to sociodemographic variables. RESULTS The model shows that the doctors who use eConsulta are 45-54 years of age, score higher than the 80th percentile on the quality of care index, have a high degree of accessibility, are involved in teaching, and work on a health team in a high socioeconomic urban setting. CONCLUSIONS The results suggest that certain sociodemographic characteristics associated with general practitioners determine whether they use eConsulta. These results must be taken into account if its deployment is to be encouraged in the context of a public health system.

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Risk Factors and Diagnosis of Diabetic Foot Ulceration in Users of the Brazilian Public Health System

Journal of Diabetes Research ◽

10.1155/2019/5319892 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Hígor Chagas Cardoso ◽

Ana Laura de Sene Amâncio Zara ◽

Suélia de Siqueira Rodrigues Fleury Rosa ◽

Gabriel Alves Rocha ◽

João Victor Costa Rocha ◽

...

Keyword(s):

Public Health ◽

Diabetes Mellitus ◽

Health System ◽

Diabetic Foot ◽

Soft Tissues ◽

Public Health System ◽

Public Healthcare ◽

Cross Sectional ◽

Foot Ulceration ◽

Chi Squared

Background. An individual with diabetes mellitus (DM) has an approximately 25% risk of developing ulcerations and/or destruction of the feet’s soft tissues. These wounds represent approximately 20% of all causes of hospitalizations due to DM. Objective. To identify the factors for the development of diabetic foot ulceration (DFU) among individuals treated by the Brazilian public health system. Methods. This cross-sectional study was conducted on individuals with diabetes mellitus, aged above 18 years, of both sexes, and during July-October 2018 within a public healthcare unit in Brazil. All participants were assessed based on their socioeconomic, behavioral, and clinical characteristics, along with vascular and neurological evaluations. All participants were also classified according to the classification of risk of developing DFU, in accordance with the International Working Group on the Diabetic Foot (IWGDF). Statistical analyses were conducted using the chi-squared test, chi-squared test for trend, and Fisher’s exact test, with a significance level of 5% (p<0.05). Results. The study consisted of 85 individuals. The DFU condition was prevalent in 10.6% of the participants. Adopting the classification proposed by IWGDF, observed risks for stratification categories 0, 1, 2, and 3 were 28.2%, 29.4%, 23.5%, and 8.2%, respectively. A statistically significant (p<0.05) association was observed between the development of DFU and the following variables: time since the diagnosis of diabetes and the appearance of the nails, humidity, and deformations on the feet. Conclusion. The present study found an elevated predominance of DM patients in the Brazilian public health system (SUS) featuring cutaneous alterations that may lead to ulcers; these individuals had elevated risks of developing DFU. Furthermore, it was revealed that the feet of patients were not physically examined during treatment.

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Access to medication in the Public Health System and equity: populational health surveys in São Paulo, Brazil

Revista Brasileira de Epidemiologia ◽

10.1590/1980-5497201600010003 ◽

2016 ◽

Vol 19 (1) ◽

pp. 26-37 ◽

Cited By ~ 5

Author(s):

Camila Nascimento Monteiro ◽

Reinaldo José Gianini ◽

Marilisa Berti de Azevedo Barros ◽

Chester Luiz Galvão Cesar ◽

Moisés Goldbaum

Keyword(s):

Public Health ◽

Public Sector ◽

Health System ◽

Socioeconomic Position ◽

Concentration Index ◽

Public Health System ◽

Sao Paulo ◽

São Paulo ◽

Cross Sectional ◽

The Public

ABSTRACT: Introduction: Since 2003, the access to medication has been increasing in Brazil and particularly in São Paulo. The present study aimed to analyze the access to medication obtained in the public sector and the socioeconomic differences in this access in 2003 and 2008. Also, we explored the difference in access to medication from 2003 to 2008. Method: Data were obtained from two cross-sectional population-based household surveys from São Paulo, Brazil (ISA-Capital 2003 and ISA-Capital 2008). Concentration curve and concentration index were calculated to analyze the associations between socioeconomic factors and access to medication in the public sector. Additionally, the differences between 2003 and 2008 regarding socioeconomic characteristics and access to medication were studied. Results: Access to medication was 89.55% in 2003 and 92.99% in 2008, and the proportion of access to medication did not change in the period. Access in the public sector increased from 26.40% in 2003 to 48.55% in 2008 and there was a decrease in the concentration index between 2003 and 2008 in access to medication in the public sector. Conclusions: The findings indicate an expansion of Brazilian Unified Health System (Sistema Único de Saúde ) users, with the inclusion of people of higher socioeconomic position in the public sector. As the SUS gives more support to people of lower socioeconomic position in terms of medication provision, the SUS tends to equity. Nevertheless, universal coverage for medication and equity in access to medication in the public sector are still challenges for the Brazilian public health system.

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