Nascimento Renata Cristina Rezende Macedo do, Álvares Juliana, Guerra Augusto Afonso, Gomes Isabel Cristina, Costa Ediná Alves, Leite Silvana Nair, Costa Karen Sarmento, Soeiro Orlando Mario, Guibu Ione Aquemi, Karnikowski Margô Gomes de Oliveira, Acurcio Francisco de Assis
Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil.
Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil.
Rev Saude Publica. 2017 Nov 13;51(suppl 2):10s. doi: 10.11606/S1518-8787.2017051007062.
To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS).
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.
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.
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.
描述巴西统一卫生系统（SUS）初级卫生保健中药物服务中示踪药物的可及性。
这是一项横断面评估研究，是2015年全国药物获取、使用及合理用药促进调查 - 服务（PNAUM - 全国药物获取、使用及合理用药促进调查 - 服务，2015年）的一部分。为分析药物的可及性，我们核查了从2012年《国家基本药物目录》（Rename）中选取的50种药品。观察脚本应用于初级卫生保健中的药品调配服务。使用半结构化问卷对患者、医护人员和公共管理人员进行访谈。可及性指数以药品可及的卫生单位的百分比表示。统计分析时，列出绝对频率、相对频率和平均频率（95%置信区间）。必要时，通过Pearson卡方检验或方差分析进行组间比较。
在由273个城市组成的全国代表性样本中填写了1175份观察脚本。巴西各地区在单位类型、基础设施和药剂师配备方面存在统计学显著差异。初级卫生保健中示踪药物的平均可及性为52.9%，各地区和抽样层之间存在差异。排除植物药后，该指数升至62.5%。我们发现用于治疗慢性和流行性疾病（如结核病和先天性梅毒）的药物可及性有限。
巴西卫生部集中采购的基本药物可及性低表明供应链管理存在缺陷。对SUS中示踪药物可及性的不同看法证实了本研究中验证的总体可及性情况。在患者中，约60%表示他们在SUS单位获取药品，这一数据与药品调配人员报告的药品短缺情况一致，也与医生的评估相符。
