Organização da assistência farmacêutica e acesso aos medicamentos na atenção primária do Sistema Único de Saúde

Abstract

The access to essential medicines is one of the primordial components to assure minimal and prime assistance heatlh care. In 2008, the state of Minas Gerais created the Pharmacy Network of Minas Gerais Program (Rede Farmácia de Minas - RFM), a strategy to increase the access to medications, using for that standardized district pharmacies. Objective: To evaluate the state public policy, comparing the infrastructure, organization of the Pharmaceutical Services (PS), availability and multidimensional access to medicines in public pharmacies of primary care of the Unified Health System. Methods: This is a transversal study that has used the same methodological resource as the National Investigation about Access, Utilization and Promotion of the Rational Use of Medications (Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos). Face to face and/or telephonic interviews have been conducted with users, physicians, managers and drug dispensers involved in the process, as well as observation of facilities in a representative sample of municipalities in the State of Minas Gerais. The data have been collected between 2014/July and 2015/May. Results: Regarding the infrastructure, with a statistically significant difference, the pharmacies of the municipalities with RFM presented higher rates of regularization of legal documentation, better structural data, greater presence of pharmacist during the whole period of pharmacy operation, greater standardization and use of computerized systems integrated, which resulted in better evaluations of professionals and users involved in PS, in municipalities without RFM. The physical availability index of the therapeutic classes in the state of Minas Gerais was 86.0%, and it was also statistically higher in municipalities with RFM (90.7% versus 82.2%) compared to those without RFM. Statistically significant increases were found in the municipalities with RFM of NPH insulin, regular insulin, prednisolone / prednisone, nicotine, Isoniazid 75 mg + Rifampicin 150 mg + Pyrazinamide 400 mg + Etambutol 275 mg and all psychotropic drugs (amitriptyline, carbamazepine, fluoxetine and clonazepam). On the other hand, no medication presented statistically higher availabilities in municipalities without RFM. Among the therapeutic classes, statistically significant differences were found between the groups of municipalities for psychotropic (93.8% in RFM versus 59.2%, p = 0.002) and tuberculostatic (40.6% in RFM versus 16.2%, p = 0.024). Regarding the availability perceived by professionals, a higher number of primary care physicians in the municipalities with RFM considered the availability of drugs very good or good (65.6% versus 29.7%, p = 0.005). Multidimensional and adequate access to medicines in Minas Gerais was 69.9%, 75.8% in municipalities with RFM and 69.2% in municipalities without RFM. The municipalities with RFM had statistically higher percentages in the dimensions of availability, adequacy/accommodation and acceptability; however, they presented less geographical accessibility than the other municipalities. These data have resulted in a higher probability of users residing in counties with RFM having multidimensional access to drugs. Conclusions: The obtained results indicated a better performance of the public PS in the municipalities that adopted RFM. The greater standardization in the PS organization and services in the municipalities with RFM generated better infrastructure conditions and greater drug accesses, which, in turn, resulted in better evaluations of PS, both by health professionals and by users. Thus the present study highlights the importance of investing in infrastructure and human resources of the PS and corroborates with the need to implement projects such as RFM at a national level.