Almeida Aléssio Tony Cavalcanti de, Sá Edvaldo Batista de, Vieira Fabiola Sulpino, Benevides Rodrigo Pucci de Sá E
Universidade Federal da Paraíba. Centro de Ciências Sociais Aplicadas. Departamento de Economia. João Pessoa, PB, Brasil.
Instituto de Pesquisa Econômica Aplicada. Diretoria de Estudos e Políticas Sociais. Brasília, DF, Brasil.
Rev Saude Publica. 2019 Jan 31;53:20. doi: 10.11606/S1518-8787.2019053000733.
To evaluate the impact of the expansion of access to medicines by the Programa Farmácia Popular do Brasil (PFPB - Brazilian Popular Pharmacy Program) on the indicators of hospitalizations and deaths by hypertension and diabetes.
To estimate the impact of the Brazilian Popular Pharmacy Program, the statistical model of fixed-effect difference in differences was used, considering: the divisions Rede Própria (RP - Proprietary Network) and Rede Conveniada (RC - Partnership Network); the exposure time of the municipality to the program; intramunicipal density, measured by the number of accredited establishments; and the coverage spillover effect into patients from nonparticipating municipalities. Data from 5,566 municipalities were used, for the period from 2003 to 2016, including: (i) administrative records of the PFPB, Sistema de Informações sobre Mortalidade (SIM - Information System on Mortality), and Sistema de Informações Hospitalares (SIH - Hospital Information System); ii) other health data managed by the Departamento de Informática do SUS (DATASUS - Department of Informatics of SUS); iii) sociodemographic data produced by the Brazilian Institute of Geography and Statistics (IBGE); and iv) data from the Relação Anual de Informações Sociais (RAIS - Annual List of Social Information).
The expansion of access to medicines for treatment of hypertension and diabetes resulted in a meaningful and statistically significant reduction (p < 0.05) of the number of hospitalizations and deaths by these diseases, in an average annual rate of 27.6% and 8.0%, respectively. The observed impacts were induced by the partnership network, highlighting the density of establishments per 100,000 inhabitants and, above all, the exposure time of the municipality to the program as relevant to the effect. Evidence of a spillover effect and of the maintenance of impacts on different age groups, especially older people, were also observed.
The strategy to expand access to medicines through the PFPB was effective in reducing hospitalizations and deaths by hypertension and diabetes in Brazil during the investigated period. Better understanding the impacts of the program is important to improve the pharmaceutical care policy, to ensure access to cost-effective treatments.
评估巴西大众药房计划（PFPB）扩大药品可及性对高血压和糖尿病住院及死亡指标的影响。
为估算巴西大众药房计划的影响，采用了固定效应差分统计模型，考虑因素包括：自有网络（RP）和合作网络（RC）分区；各市镇对该计划的接触时间；以经认可机构数量衡量的市内密度；以及对来自未参与市镇患者的覆盖溢出效应。使用了2003年至2016年期间5566个市镇的数据，包括：（i）PFPB、死亡信息系统（SIM）和医院信息系统（SIH）的行政记录；（ii）巴西统一卫生系统信息部（DATASUS）管理的其他健康数据；（iii）巴西地理与统计研究所（IBGE）生成的社会人口数据；以及（iv）社会信息年度报告（RAIS）的数据。
高血压和糖尿病治疗药品可及性的扩大导致这些疾病的住院和死亡人数出现显著且具有统计学意义的减少（p<0.05），平均年降幅分别为27.6%和8.0%。观察到的影响是由合作网络引发的，突出了每10万居民的机构密度，最重要的是，市镇对该计划的接触时间与效果相关。还观察到了溢出效应以及对不同年龄组（尤其是老年人）影响持续存在的证据。
在调查期间，通过PFPB扩大药品可及性的策略在巴西有效减少了高血压和糖尿病导致的住院和死亡。更好地理解该计划的影响对于改进药学服务政策、确保获得具有成本效益的治疗至关重要。
