Souza Gisélia Santana, Costa Ediná Alves, Barros Rafael Damasceno de, Pereira Marcelo Tavares, Barreto Joslene Lacerda, Guerra Augusto Afonso, Acurcio Francisco de Assis, Guibu Ione Aquemi, Álvares Juliana, Costa Karen Sarmento, Karnikowski Margô Gomes de Oliveira, Soeiro Orlando Mario, Leite Silvana Nair
Faculdade de Farmácia. Universidade Federal da Bahia. Salvador, BA, Brasil.
Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil.
Rev Saude Publica. 2017 Nov 13;51(suppl 2):7s. doi: 10.11606/S1518-8787.2017051007135.
To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities.
This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%), partial (35.0%-69.0%), and advanced (70.0%-100%), estimated based on the interviewees' answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of p<0.05.
Our results show a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazil, and an advanced stage in formal structures, such as the municipal health plans and the existence of a standardized list of medicines. The analysed variables in the "organization, structure, and financing" dimension configured stages that range from partial to advanced. The management presented partial institutionalization, positively showing the existence of computerized system, but also disparate results regarding the autonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences.
The study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional disparities. Variables related to the normative aspects of institutionalization were positively highlighted in all dimensions; however, it is necessary to conduct new studies to evaluate the institutionalization of pharmaceutical services' finalistic activities.
描述巴西各城市药学服务制度化的当前阶段。
本研究是全国药物获取、使用及促进合理用药调查（PNAUM）的一部分，这是一项横断面、探索性和评估性研究，通过对巴西各地区分层的具有代表性的城市样本进行信息调查组成。我们采访了负责药学服务的市政卫生秘书以及负责药品调配的药剂师。从访谈中选取的变量被归为五个维度，这些维度定义了药学服务制度化的三个阶段：初始阶段（0%-34.0%）、部分制度化阶段（35.0%-69.0%）和高级阶段（70.0%-100%），根据受访者的回答进行估算。频率以95%置信区间进行估算。对于统计关联分析，应用卡方检验，显著性水平为p<0.05。
我们的结果显示，巴西药学服务制度化进程处于部分且不均衡状态，在正式结构方面处于高级阶段，如市政卫生计划和标准化药品清单的存在。“组织、结构和融资”维度中分析的变量构成了从部分制度化到高级阶段的不同阶段。管理方面呈现出部分制度化，积极方面表现为存在计算机化系统，但在财务资源管理自主权方面也存在不同结果。与结构相关的必备项目在各地区之间存在差异，具有统计学显著差异。
该研究表明巴西各城市药学服务制度化进程处于部分且不均衡状态，存在地区差异。与制度化规范方面相关的变量在所有维度中都得到了积极体现；然而，有必要开展新的研究来评估药学服务最终活动的制度化情况。
