OBJECTIVE To characterize the medicine dispensing services in the primary health care network in Brazil and in its different regions, aiming to promote the access and rational use of medicines.METHODS This is a cross-sectional, quantitative study with data obtained from the Pesquisa Nacional sobre Acesso, Utilização e Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), 2015. Observation visits were carried out in 1,175 dispensing units, and interviews were held with 1,139 professionals responsible for the dispensation of medicines in the dispensing units and 495 municipal coordinators of pharmaceutical services.RESULTS More than half (53%) of the units presented a space smaller than 10 m2 for dispensing of medicines; 23.8% had bars or barriers between users and dispenser; 41.7% had computerized system; and 23.7% had counters for individual care. Among those responsible for dispensation, 87.4% said they always or repeatedly inform users how to use the medicines, and 18.1% reported developing some type of clinical activity. Isolated pharmacies presented a more developed physical and personal structure than those belonging to health units, but we found no significant differences regarding the information provided and the development of clinical activities.CONCLUSIONS There are major differences in the organization models of dispensation between cities, with regional differences regarding the physical structure and professionals involved. The centralization of medicine dispensing in pharmacies separated from the health services is associated with better structural and professional conditions, as in the dispensing units of the South, Southeast, and Midwest regions. However, the development of dispensation as health service does not prevail in any pharmacy or region of the Country yet.
In Brazil, antiviral drugs are the most expensive component of hepatitis C treatment. The cost of follow-up and support to patients is minimal compared with the cost of antiviral drugs.
The decentralization of the Brazilian health system required that municipalities took responsibility for the local Pharmaceutical Policy and Services (PPS) system. This article presents and analyses an innovative experience of diagnosis of municipal PPS as a sociotechnical system. We adopted a multi-methods approach and various data sources. Sociotechnical theory was the framework of the methodology of evaluation and design of systems, analyzing the External System (health system, stakeholders, financing) and Internal System (goals, management, workforce, infrastructure, processes, technology and culture). The “objective” component of the PPS system was identified as the central element. The lack of a unified objective and of a central coordination and unmanaged pharmaceutical services prevented integrated internal planning and planning with other sectors. Stakeholders and documents referred only to technical elements of the system: Infrastructure, technical process, and technology. The social components of the workforce and culture were not mentioned. The organizational culture established was the culture of isolation: “Each one does his own”. The pharmacists working in the municipal health system did not know each other. There was no integration strategy between pharmacists and their work processes. Consequently, the municipal PPS had limited scope as a public policy. It had constrained the characteristics of PPS as a complex and open system. Understanding the municipal PPS as a sociotechnical system can push the development of a new level of policy and practice to ensure the population’s right to the access to and rational use of medicines.
Introduction: Previous results showed a significant decrease in cocaine-using days among cocaine users treated homeopathic fifty-millesimal (LM) potencies of Opium and Erythroxylum coca, as compared to placebo. Those results might have been biased by low adhesion of crack-cocaine users to treatment, trend that has been observed in clinical trials and practice, usually performed in specialized services. Objectives: to investigate 1) the effectiveness and tolerability of LMpotencies of Opium and Erythroxylum coca for cocaine-related disorders and 2) the effectiveness of a qualified primary care setting in increasing treatment attendance and retention. Methods: A randomized, placebo-controlled, double-blind, crossover clinical trial with twelve-week study duration per patient will be performed. 120 participants aged between 18 and 60 years, with Assist score for cocaine between 4 and 26 will be included. Exclusion criterion: urinary benzoylecgonine < 150 ng/mL. Participants will receive verum for 6 weeks followed by placebo for 6 weeks, or vice-versa. Primary endpoint: percentage of reported number of cocaine using days at week 6. Secondary endpoints: percentage of reported number of cocaine using days during participation in the study; percentage of positive benzoylecgonine samples; cocaine craving score, daily craving episodes number, craving episodes mean duration, patient perception of medication action favoring craving reduction (assessed by Minnesota Cocaine Craving Scale); Assist score for cocaine; treatment attendance; retention in treatment; Adverse Events. Discussion: For the first time, this study utilizes a primary care setting as a platform to increase treatment adhesion of cocaine users and assess the effectiveness of homeopathy for cocaine-related disorders.
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