Fatores que podem influenciar a disponibilidade dos medicamentos essenciais na Atenção Primária à Saúde (APS) do Sistema Único de Saúde (SUS)

Abstract

Introduction: Most health interventions involve the use of medications and this could be determinant for obtaining therapeutic results. Ensuring access to medicines is particularly important in Primary Health Care and their physical availability is relevant and challenging for access, especially when considering universal systems and public funding. Objective: To verify the influence of organizational structure and technical-managerial activities on the availability of essential tracer medicines in pharmaceutical services in the primary care of the Unified Health System. Methods: A cross-sectional, exploratory, evaluative study, 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). For the analysis of availability of essential medicines, 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename - National List of Essential Medicines) were verified, according to parameters established by the World Health Organization. The data were obtained throughout interviews with those responsible for dispensing medications and observation scripts in the pharmacy sample of the primary health care services. The availability rate was presented as the percentage of dispensing units, where essential medicines standardized in the municipalities were available. The categorical variables were presented as absolute and relative frequencies, and the availability rates as mean and 95% confidence intervals. The comparison of groups was carried out by linear model for complex samples. Results: There were conducted 1,139 interviews with medicine dispensers and observation scripts were completed at 1,175 dispensing units. The average availability of standardized essential medicines in Brazil was 83.3%, and the averages were higher than 80% in the three groups of municipalities (capitals, major and minor municipalities). Among the therapeutic groups evaluated, the lowest average availabilities were in the tuberculostatic class (24.1%), followed by psychotropic / special control medicines (30.3%). The national average availability of essential medicines purchased centrally by the Brazilian Ministry of Health was 73.3%. Among the municipalities’ strata, the only mean below 80% was for the smaller municipalities (72.1%). As a whole, having a pharmacist responsible for the medicine dispensing unit, having a computerized system for recording pharmaceutical care activities, and conducting inventories bimonthly or less frequently were associated with higher average availability in all groups of medicines evaluated. Conclusion: The study pointed out that most municipalities have the Relação Municipal de Medicamentos Essenciais (Remume - Municipal Relation of Essential Medicines), but it was not enough to guarantee the average availability above 80% in all the evaluated aspects. The availability of essential medicines was positively influenced by the presence of the pharmacist as responsible for the dispensing unit and by the computerized system deployed, and negatively associated with essential medicines purchased centrally by the federal government and influenced by logistics of distribution to smaller municipalities. The low average availability of psychotropic/special control and tuberculostatics medicines evidences the need for improvements in public pharmaceutical assistance and studies that could evaluate its impact in two important areas of the Primary Health Care: mental health and infectious diseases of compulsory notification.