This article analyzes the decentralized management of pharmaceutical care at the municipal (local) IntroduçãoCom a Política Nacional de Medicamentos (PNM) 1 , a assistência farmacêutica passa a ser entendida como parte integrante de um conjunto de práticas voltadas para a promoção, prevenção e recuperação de saúde, contemplando atividades que extrapolam o simples abastecimento de medicamentos. Assim, os municípios passam a assumir uma "série de responsabilidades que exigem mobilização de conhecimento e habilidades técnicas, gerenciais e políticas em relação à assistência farmacêutica" 2 (p. 53).No entanto, as condições da assistência farmacêutica nos municípios brasileiros ainda estão bem distantes daquelas necessárias para que estes assumam suas funções de executores desta política. Estudos realizados sobre a implementação da PNM apontam para problemas na organização das atividades voltadas para o medicamento decorrentes da falta de prioridade para com este campo de assistência, observada historicamente na organização do sistema de saúde no Brasil. Mayorga et al. 3 (p. 208), ao analisarem a situação da assistência farmacêutica no Brasil, concluíram que os municípios e estados, enfrentam "problemas relacionados ao desenvolvimento e qualidade dos serviços farmacêuticos, debilidade na infra-estrutura e operacionalidade, além da dificuldade no atendimento da demanda populacional por medicamentos".ARTIGO ARTICLE
OBJECTIVE To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects.METHODS This study is 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), which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions.RESULTS Among the wide diversity of conceptions on pharmaceutical services (PS), we highlight the ones focused on 1) logistic control of medicines with activities concerning guidance or information on their use and 2) guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services.CONCLUSIONS The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified, in their reorientation process, a movement that reflects a gradual shift in the technical paradigm, from the focus on medicine logistics to a user-oriented approach of health services.
OBJECTIVE To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities.METHODS 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.RESULTS 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.CONCLUSION 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.
Foram caracterizadas as demandas judiciais por medicamentos em quatro municípios do Estado da Bahia, no período de 2006 a 2010, utilizando-se como fontes de dados informações relacionados a estas demandas arquivadas nas secretarias municipais de saúde. Observou-se que foram impetradas 228 ações solicitando 574 medicamentos, perfazendo uma média de 2,5 medicamentos. Informações relevantes, como relatórios médicos, não estavam presentes na maioria das solicitações arquivadas. Em três municípios, a maioria dos medicamentos solicitados não constava em nenhum elenco de programas da Assistência Farmacêutica do SUS. Entretanto, entre aqueles incluídos, chama atenção a demanda por via judicial por medicamentos do componente básico da assistência farmacêutica, que chega a 50% em um dos municípios. Nos quatro municípios prevalecem solicitações de medicamentos das classes Sistema Cardiovascular, Aparelho Digestivo e Metabolismo e Sistema Nervoso Central, segundo a classificação ATC. Os resultados revelam que a área técnica responsável pelo uso racional de medicamentos é reduzida a mero fornecedor destes insumos e evidenciam a necessidade de melhorias na gestão desse setor e de uma sistemática de comunicação e parceria com o judiciário, viabilizando uma tomada de decisão melhor fundamentada, sem riscos para o paciente, mas considerando também as normas técnicas que orientam o funcionamento do SUS.
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