Characterization of the institutionalization of pharmaceutical services in Brazilian primary health care

Souza, Gisélia Santana; Costa, Ediná Alves; Barros, Rafael Damasceno de; Pereira, Marcelo Tavares; Barreto, Joslene Lacerda; Guerra Junior, 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

doi:10.11606/S1518-8787.2017051007135

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Brasil

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Sumário

Original Articles • Rev. Saúde Pública 51 (suppl 2) • 2017 • https://doi.org/10.11606/S1518-8787.2017051007135 copy

Characterization of the institutionalization of pharmaceutical services in Brazilian primary health care

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

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.

Health Manager; Pharmaceutical Services, organization & administration; Primary Health Care; Health Services Research; Unified Health System

Dimension of PS	Selected Variables
Formal structures	The coordination of PS is present in the organization chart of the Municipal Secretariat of Health
	PS are present in the Municipal Health Plan
	Existence of Comissões de Farmácia e Terapêutica (PTC – Pharmacy and Therapeutics Committees)
	Existence of standardized list of medicines
	Existence of Comissão Permanente de Licitação (CPL – Permanent Bidding Committee)
Organization, structure, and financing	Expenditure with the structuring of municipal PS
	Total application of the funds for PS
	The professional responsible for PS is a pharmacist
Management tools	The coordination of PS has total or partial autonomy in the management of financial resources
	Existence of SOP for reception, storage, dispensing, and delivery of medicines
	Existence of computerized system for PS management
	Provision of information on the medicine delivery locations to the population
	Existence of training for PS professionals
Practices and activities pertaining to PS	Performance of clinical activities
Social participation and control	Existence of mechanisms to receive criticism and suggestions from workers
	Existence of mechanisms to receive criticism and suggestion from users
	Municipal Health Council (CMS) discusses and deliberates about PS
	Existence of accountability of PS in the Municipal Health Council (CMS)
	Users participate in the decisions related to the PS management

Dimension/variable	RPS% (95%CI)	SMS% (95%CI)
Formal structures
The coordination of PS is present in the organization chart	82.7 (78.3–86.4)	91.7 (87.7–94.5)
PS are present in the Municipal Health Plan	92.3 (89.1–94.6)	97.2 (94.3–98.7)
Existence of Comissão de Farmácia e Terapêutica (PTC – Pharmacy and Therapeutic Committee)	13.2 (10.1–17.1)	10.7 (7.4–15.2)
Existence of standardized list of medicines	85.9 (82.1–89.0)	85.5 (80.9–89.1)
Existence of exclusive CPL for medicine acquisition	37.7 (32.6–43.0)	40.0 (34.0–46.3)
Organization, structure, and financing
Expenditure with PS structuring	54.8 (49.1–60.5)	67.3 (61.1–73.0)
Total application of funds	86.4 (81.1–90.4)	97.1 (94.1–98.6)
Management tools
The coordination of PS has total or partial autonomy in the management of financial resources	57.9 (48.7–68.0)	68.3 (62.3–73.8)
Existence of computerized system for PS management	70.8 (66.0–75.1)	74.7 (69.2–79.5)
Existence of training for PS professionals	11.9 (8.6–16.2)	37.7 (31.8–44.0)
Social participation and control
Existence of mechanisms to receive criticism and suggestions from workers about PS	32.8 (27.8–38.3)	63.0 (56.8–68.8)
Existence of mechanisms to receive criticism and suggestions from users about PS	40.7 (35.2–46.4)	68.2 (62.2–73.7)
Municipal Health Council (CMS) discusses and deliberates always or repeatedly about PS	42.3 (35.9–48.8)	53.7 (47.3–59.9)
Existence of accountability of PS in the CMS	82.8 (76.4–87.7)	93.5 (89.4–96.1)

Dimension/variable	Regions

	North	Northeast	Midwest	Southeast	South	Brazil

	% (IC95%)	% (IC95%)	% (IC95%)	% (IC95%)	% (IC95%)	% (IC95%)
Formal structures
The coordination of PS is present in the organizational chart	71.8 (61.0–80.6)	82.5 (72.2–89.6)	85.8 (76.5–91.8)	87.3 (78.5–92.8)	79.2 (69.6–86.3)	82.7 (78.3–86.4)
PS is present in the Municipal Health Plan^b	88.0 (78.4–93.7)	100.0 (100.0–100.0)	91.3 (82.7–95.8)	88.8 (79.8–94.1)	88.3 (80.2–93.4)	92.3 (89.1–94.6)
Existence of Pharmacy and Therapeutic Committee	11.4 (6.4–19.5)	10.2 (5.1–19.1)	14.7 (8.9–23.5)	14.1 (8.3–22.8)	15.9 (10.0–24.3)	13.2 (10.1–17.1)
Existence of standardized list of medicines^b	70.6 (60.3–79.1)	92.0 (83.2–96.4)	83.7 (74.7–90.0)	86.9 (78.3–92.4)	82.9 (74.1–89.1)	85.9 (82.1–89.0)
Existence of exclusive CPL for medicine acquisition	41.4 (31.2–52.4)	33.6 (23.5–45.6)	49.0 (38.5–59.5)	38.1 (28.5–48.7)	36.9 (27.8–46.9)	37.7 (32.6–43.0)
Organization, structure, and financing
Expenditure with PS structuring	44.0 (32.9–55.8)	62.5 (50.5–73.2)	58.5 (47.0–69.1)	44.3 (33.0–56.2)	59.1 (48.4–69.0)	54.8 (49.1–60.5)
Total application of funds	73.7 (59.8–84.1)	80.5 (67.0–89.4)	85.3 (70.8–93.3)	90.2 (79.8–95.5)	92.7 (83.0–97.0)	86.4 (81.1–90.4)
The professional responsible for PS is a pharmacist^b	86.6 (77.7–92.2)	83.7 (73.8–90.3)	88.1 (80.0–93.2)	94.8 (88.0–97.8)	95.0 (88.6–97.9)	90.3 (86.8–93.0)
Management tools
The coordination of PS has total or partial autonomy in the management of financial resources	35.8 (26.1–46.8)	53.7 (42.3–64.6)	50.4 (40.1–60.7)	62.6 (51.8–72.3)	66.6 (56.6–75.3)	57.9 (52.4–63.1)
Existence of computerized system for PS management^b	40.1 (30.5–50.5)	61.2 (50.0–71.4)	53.5 (43.5–63.3)	78.7 (69.2–85.8)	88.8 (80.9–93.7)	70.8 (66.0–75.1)
Existence of SOP for medicine reception^b	62.0 (51.0–71.9)	68.7 (57.0–78.4)	66.4 (55.8–75.6)	78.8 (69.0–86.1)	58.7 (48.7–68.1)	68.9 (63.8–73.5)
Existence of SOP for storage^b	60.8 (49.7–70.8)	72.0 (60.5–81.1)	70.2 (59.8–78.9)	80.5 (71.1–87.4)	60.9 (50.8–70.1)	71.2 (66.2–75.6)
Existence of SOP for dispensing^b	53.3 (42.4–63.8)	67.2 (55.5–77.2)	68.8 (58.3–77.6)	77.2 (67.6–84.7)	56.8 (46.7–66.3)	67.1 (62.0–71.9)
Existence of SOP for delivery^b	55.0 (44.1–65.5)	67.1 (55.4–77.0)	71.9 (61.5–80.4)	83.4 (74.2–89.7)	57.7 (47.7–67.1)	69.6 (64.6–74.1)
Existence of training for PS professionals	10.4 (5.3–19.2)	11.6 (5.6–22.4)	14.8 (8.4–24.9)	13.5 (7.6–22.8)	9.5 (4.8–17.8)	11.9 (8.6–16.2)
Those RPS participate in planning health actions of different technical areas	34.5 (24.8–45.7)	24.9 (15.1–38.0)	30.9 (21.2–42.5)	22.5 (14.7–33.0)	31.5 (22.2–42.4)	26.9 (22.1–32.3)
Provision of information on the standardized medicine delivery locations to the population	50.6 (39.9–61.2)	43.4 (31.5–56.0)	42.1 (31.4–53.6)	35.7 (26.1–46.7)	39.5 (29.5–50.4)	40.5 (35.0–46.2)
Social participation and control
Existence of mechanisms to receive criticism and suggestions from workers about PS	29.2 (20.3–40.0)	24.2 (15.0–36.8)	42.2 (31.6–53.6)	35.9 (26.2–46.9)	36.5 (26.9–47.3)	32.8 (27.8–38.3)
Existence of mechanisms to receive criticism and suggestions from users abour PS	43.6 (33.1–54.7)	32.5 (21.9–45.3)	42.2 (31.6–53.6)	43.1 (32.6–54.2)	45.6 (35.2–56.4)	40.7 (35.2–46.4)
Municipal Health Council discusses and deliberates always or repeatedly about PS	34.0 (23.2–46.8)	30.2 (18.1–45.8)	39.0 (27.6–51.8)	31.7 (21.4–44.1)	36.8 (25.9–49.2)	33.4 (27.5–39.8)
Accountability of PS in the CMS	81.4 (66.9–90.5)	89.4 (73.2–96.3)	83.8 (70.5–91.8)	77.5 (63.7–87.1)	83.8 (70.8–91.6)	82.8 (76.4–87.7)

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[1] Correspondence/Email: Gisélia Santana Souza. Faculdade de Farmácia. Universidade Federal da Bahia. Rua Manoel Barreto, 252, Ap. 1301 – Graça. 40.150-360 Salvador, BA, Brasil. Email: gsantanasouza@gmail.com