Pharmacist's contribution to the promotion of access and rational use of essential medicines in SUS

DOI: 10.1590/1413-81232017221.16202015 Daniela Oliveira de Melo 1 Lia Lusitana Cardozo de Castro 2 Instituto de Ciências Ambientais, Químicas e Farmacêuticas, Universidade Federal de São Paulo. R. Professor Arthur Riedel 275, Eldorado. 09972-270 Diadema SP Brasil. melo. 2 Centro de Ciências Biológicas e da Saúde. Universidade Federal do Mato Grosso do Sul. Campo Grande MS Brasil. 1 Abstract Objective: to describe the pharmaceutical inclusion process in a Basic Health Unit multidisciplinary team and evaluate results related to rational use and promotion of access to essential medicines. Methods: This is a descriptive, cross-sectional study conducted in a primary care health unit in the city of São Paulo. Pharmacist’s activities were evaluated regarding the service structure and organization and prescribing quality improvement, guidance method creation, and implementation of clinical pharmacy service. Data measured before and after the interventions and between 2010 and 2011 were analyzed using Pearson´s chi-square test with a significance level of 5%, and odds ratio. Results: Pharmacist’s activities had statistically significant result in drug shortage reduction; prescribing quality improvement associated with an increased proportion of prescriptions met; decrease in the total of prescribed drugs among patients receiving pharmacotherapeutic follow-up and, comparing the years 2010 and 2011, changes in the pharmacotherapy recommendations have gained increased acceptance level. Conclusions: Pharmacist’s activities may effectively provide rational use and promotion of access to essential medicines. Key-words Pharmaceutical services, Primary Health Care, Unified Health System FREE THEMES Pharmacist’s contribution to the promotion of access and rational use of essential medicines in SUS 235 Melo DO, Castro LLC 236 Introduction Several studies have shown that the insertion of the pharmacist in the multidisciplinary team results in more cost-effective outcomes, but most of these studies were directed to the study of specific public, disease or situation1-7. A recently published systematic review has observed that most studies related to the provision of pharmaceutical services in primary care were conducted in the United States, United Kingdom and Canada, respectively8. Considering only the studies in which the pharmacist worked in the same unit as the general practitioner, in order to evaluate the impact of the insertion of this professional in the team and their interventions, most of the studies (25/38) were found to report positive effects in at least one aspect of care. More expressive results were achieved when the pharmacist interacted with the prescriber personally, reinforcing the observation that the presence of the pharmacist in the primary care services is essential to ensure effective communication and the establishment of interpersonal relationships in order to increase the probability of success in the interventions8. Brazil’s progress in public health policies and the promotion of access to essential medicines since the National Drug Policy (PNM) in 1998 is indisputable. Studies evaluating the federal government’s pharmaceutical care programs have shown a significant increase in supply of medicines through these programs as well as the fact that public procurement has become more efficient9-11. Although the programs for free distribution of medicines in SUS were initiated shortly after the publication of the PNM, pharmaceutical care on a systemic basis beyond the logistics aspect to include service delivery has only been prioritized more recently. In particular, for the increased supply of training in pharmaceutical and management services and funding line for this purpose. Despite these efforts, according to a study carried out by the Ministry of Health in partnership with the Pan American Health Organization (PAHO), the availability of the main medicines in inventory was 73% in health units. As for prescribed medicines, the proportion dispensed or administered at health facilities was 66%, which suggests lack of medication or compliance to selected medicines12. The number of pharmacists in the Unified Health System (SUS) is recent and still insufficient, especially in the dispensation of medicines in the UBS. According to data from the Region- al Pharmacy Council of the State of São Paulo (CRF-SP), 2346 (73%) of the 3214 public pharmacies in the municipalities of the State of São Paulo had no pharmacist13. There is no available literature that identifies how many pharmacies of the Basic Health Unit (UBS) have a pharmacist in Brazil, but a study carried out by the National Agency of Sanitary Surveillance (ANVISA) in 2009 to evaluate the influence of the pharmaceutical industry on SUS, identified lack of pharmacists in 7 out of 10 SUS pharmacies14. The basic elements of primary care and pharmaceutical services are the same and include centrality of patient care, treatment of acute and chronic disorders, emphasis on the prevention of diseases; documentation of the service provided, access, continuous and systematic care, integral care, responsibility for treatment, training/ promotion of education and health15. Although the clinical impact of the pharmacist has already been studied, there is a shortage of studies that demonstrate improved access to medication, prescription quality and promotion of rational use of medicines after insertion in primary health care teams, especially when this professional accumulates administrative functions. The objective of this work is to describe and evaluate the results of the insertion of a pharmacist in the multiprofessional team of a basic health unit regarding the promotion of access and rational use of essential medicines. Material and methods The work was carried out in a health unit of the Municipal Health Department of São Paulo, which is under the management contract of a social organization (Western Region Project, School of Medicine of USP). This unit includes a Medical Ambulatory Care Service (AMA), a Basic Health Unit (UBS) with four Family Health Strategy (ESF) teams, comprising 42,479 inhabitants in its area of coverage. With the hiring of the pharmacist, in May 2007, a series of actions were initiated whose results will be presented considering different aspects of the pharmacist’s performance: a) Structuring and organization of the service; b) Study and interventions to improve the medication prescription standard; c) Elaboration and adoption of a method for standardized guidance for patients with polypharmacy or difficulties in complying with the prescribed dosing schedule; d) Clinical Pharmaceutical Services. 237 tionally, to evaluate the association between the result and the intervention, ODDs Ratio was calculated using Epi Info® program. From the observation that a) there were medicines whose packaging was very similar, and could confuse the patients; b) some of the patients treated were il (...truncated)