Prescrições medicamentosas de pacientes atendidos no ambulatório de geriatria de um hospital universitário: estudo transversal descritivoDrug prescriptions of patients treated in a geriatric outpatient ward of a university hospital: a descriptive cross-sectional study

OBJECTIVE To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS).METHODS This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions.RESULTS We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators.CONCLUSIONS Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

Objetivos: Descrever o processo de elaboração de oficinas de promoção da saúde voltadas a um grupo de convivência para idosos e compartilhar a experiência de uma equipe de residentes multiprofissionais na construção de metodologias para se discutir saúde dentro de grupos. Métodos: Entre 2007 e 2009, a equipe de residentes multiprofissionais acompanhou um grupo de convivência, constituído de aproximadamente quarenta idosos. Foram observadas as principais demandas em saúde a serem trabalhadas junto ao grupo e desenvolvidas oficinas para promoção da saúde. Resultados: Os temas trabalhados nas oficinas foram osteoporose, diabetes mellitus, dislipidemia, planejando o futuro e relações de cuidado. Os residentes construíram materiais didáticos, como cartazes, folders, bolsas coloridas, cartões ilustrativos, que ilustraram os temas abordados de forma lúdica. As oficinas possibilitaram que os participantes fossem agentes ativos no processo de aprendizagem e de fazer saúde, o que pressupõe benefícios à saúde física, mental e social desse grupo.

OBJECTIVE To characterize the process of selection of medicines for primary health care in the Brazilian regions.METHODS This article 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), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05.RESULTS The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands.CONCLUSIONS As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.

Objetivo desse artigo foi caracterizar as interações medicamentosas observadas na farmacoterapia prescrita para idosos residentes em uma Instituição de Longa Permanência. Foi realizado um estudo transversal, descritivo e analítico, desenvolvido no sul do Brasil, incluindo 111 idosos, com idade igual ou superior a 60 anos. Foi aplicado um questionário semi-estruturado, constituído de variáveis sócio-demográficas, problemas de saúde e medicamentos utilizados. As interações medicamentosas foram analisadas e ordenadas de acordo com a gravidade de ocorrência. O número de medicamentos utilizados variou de 1 a 13, com média de uso de 4,9 + 2,3 medicamentos por idoso. As classes farmacológicas mais empregadas foram: sistema cardiovascular (33.1%) e sistema nervoso central (26.7%). Em 40 (36%) das prescrições foram observadas 99 interações medicamentosas. As de gravidade consideradas moderadas foram as mais frequentes (64,9%). Os resultados refletem uma necessidade de monitoramento da farmacoterapia com vistas a prevenir problemas de saúde evitáveis decorrentes do uso de medicamentos.

Revisão integrativa da literatura realizada na Biblioteca Virtual em Saúde (BVS), buscou identificar os principais problemas relacionados ao uso de psicotrópicos em idosos e propor soluções. Os principais problemas identificados foram reações adversas, risco de quedas e interações medicamentosas. Foram sugeridas três propostas para a redução de suas ocorrências: a adoção de um programa de prescrição eletrônica, a adoção de medidas educativas e/ou realização de acompanhamento farmacoterapêutico com estes pacientes.

Access can be understood as the sum of a number of elements of the interface between patients and the health care system. This study took a comprehensive approach to the dimensions of access to medications, employing indicators to evaluate the dimensions of access to antihypertensive medications in Ceilândia, DF, Brazil. This was a cross-sectional epidemiological study, administering questionnaires during home visits. The survey covered epidemiological and socioeconomic profiles, behavioral habits and the dimensions of access to antihypertensive medications comprising physical, financial, and geographic availability and accept ability according to the hypertensive population of Ceilândia. The total sample comprised 400 individuals and the hypertensive subset numbered 140 (35%). Indicators of physical availability of medications revealed that users found it difficult to acquire their drugs on almost one third of occasions and in some cases were unable to access any of these products. The greatest barriers to access were reported by users of pharmacies belonging to the Brazilian National Health Service (SUS) and on the "People's Pharmacies" network. More than one third of the hypertensive sample spent their own money on medications they could not find at these pharmacies. The majority of the hypertensive subsets were overweight/obese, a minority engaged in physical activity and 40% were smokers/ex-smokers. More women reduced their salt intake. Men had higher incomes, educational level, and socioeconomic status. Failure to keep the public health care system supplied has prejudiced access to essential medications for hypertension treatment, transferring the costs onto users. This population has lifestyle habits that increase the risk of exacerbation of hypertension. These results reveal a F. X. C. Salgado et al. 1518 need for effective public policies to ensure access to antihypertensive medications and involve users of the health care system in changing their habits and behaviors in order to achieve adequate and lasting control of systemic arterial hypertension.

Relatar as ações realizadas pela equipe Saúde do Idoso do Programa de Residência Multiprofissional em Saúde (PREMUS/PUCRS). Descrição da experiência: Na atenção básica, os residentes participaram na assistência domiciliar, ambulatorial e desenvolveram ações de educação popular em saúde em um grupo de idosos. A equipe também atuou em um hospital universitário, prestando assistência nos âmbitos ambulatorial e unidades de internação. Conclusão: O Programa de Residência Multiprofissional em Saúde, com ênfase na saúde do idoso, proporcionou aos residentes uma dinâmica assistencial fundamentada nos conceitos da interdisciplinaridade, integralidade e humanização do cuidado, tal como orientado pelas diretrizes do Sistema Único de Saúde (SUS). Palavras-chave: saúde do idoso; equipe interdisciplinar de saúde; sistema único de saúde.