Estamos de fato medindo acesso? revisão sistemática das medidas de acesso a medicamentos no Brasil

Abstract

Introduction: Access to medicines (AAM) is a key component in enabling and measuring the performance of health systems. Objectives: This study aims to determine, through a systematic review, the profile of studies and results of AAM indicators in Brazil. Methods: A systematic review of observational studies was performed using articles found in US National Library of Medicine (PubMed), CENTRAL, LILACS and Essential Medicines and Health Products Information Portal (WHO) databases, including a manual search in the references provided by the studies included and the grey literature (Thesis Databases: Capes, Biblioteca Digital de Teses e Dissertações da USP, ProQuest Dissertação e Teses; Technical reports: WHO Medicines Strategy and research reports: PNAD, Ministério da Saúde, IBGE). Results: 29 studies were included. Among these, 19 evaluated access at municipal level, 9 to the public sector, 12 from the perspective of users, 22 discussed access to essential medicines, 14 evaluated more than one dimension of access and 24 presented indicators related to availability. Among all dimensions of AAM, 19 different indicators were found. The indicator “physical availability” (PA) was used in 12 studies. Conclusion: These studies focus on availability and no studies so far have evaluated all dimensions of AAM. Patterns of access varied in the studies. This review stresses the need to develop proper guidelines to evaluate AAM, allowing for comparisons and evaluations of health systems over time.