Master of Public Health - MPH / Background: Drugs are essential components of the health system and their rational use is vital to delivering quality and efficient healthcare services. However, inappropriate prescribing is a common rational drug use problem globally, particularly in developing countries including Nigeria. Despite measures to address this problem, inappropriate drug use continues to be a major public health problem in Nigeria. Aim: This study assessed rational drug use (RDU), with a focus on rational prescribing and factors affecting it, among primary healthcare providers working in primary healthcare facilities of a LGA in Northwestern Nigeria. Methods: The study was a cross sectional descriptive study and it included retrospective review of patient encounters and interviews with prescribing healthcare providers in sampled health facilities. Stratified random sampling method was used to select 20 public primary healthcare facilities and 30 patient encounters were drawn by systematic random sampling from each facility. One hundred and sixty three prescribing healthcare providers in the health facilities were also included in the study. Adapted WHO's drug use study tools and a structured self-administered questionnaire were used to collect data. Data were analysed using Statistical Package for Social Sciences (SPSS Version 17) software and presented as contingency table with chi square test used to test for relationship between variables with statistical significance taken at p < 0.05. Ethical approval was obtained from the University of the Western Cape Research Ethics Committee and Kaduna State Ministry of Health, and permission from local stakeholders. Confidentiality of individual patients, healthcare providers and health facilities data was maintained. Results: The prescribing staff at the selected facilities were predominantly Nurses/Midwives and community health assistants with SCHEWs constituting the majority (60.8%). More than half (54.4%) of providers did not know about the concept of RDU. Similarly, the computed knowledge score of RDU revealed that the majority (74.4%) had poor knowledge of the concept. Knowledge was significantly associated with duration of service, providers' previous training in rational drug use and professional status (p<0.05), with the CHOs having better knowledge of RDU compared with other professional cadres. High antibiotic use (68.3% in retrospective review and 82.9% in survey) and injection use (9.5% in retrospective review and 12% in survey) were found in the study with significant proportions of providers admitting that all cases of URTI should receive antibiotics (72.3% ) and that patients could be prescribed injections if they requested for it (35.3%). The Standing Order was the main source of information for the majority (50.6%) of providers and it served as the major influence affecting prescribing practices. Conclusion: This study revealed a poor understanding and knowledge of RDU among healthcare providers. High antibiotic and injection use also reflected providers' poor attitude to rational prescribing of these commodities. To improve prescribing practices at the PHC level, adequate staff skill mix, including physicians should be established. Since RDU knowledge was associated with prior training, curriculum development towards RDU and opportunities for in-service training should be provided to build prescribers capacity, in addition to instituting a system of rational drug use monitoring. Further research into rational drug use among different cadres of PHC healthcare providers is also recommended.

O farmacêutico, uma vez inserido na equipe multidisciplinar, tem um papel importante a desempenhar na educação em saúde com o objetivo de melhorar o conhecimento sobre as condições crônicas, refletindo positivamente na adesão ao tratamento e em conseqüência nos resultados clínicos e na qualidade de vida dos indivíduos. O objetivo deste estudo foi elaborar, implementar e avaliar o modelo de intervenções educativas para o uso racional de medicamentos. O estudo clínico longitudinal, prospectivo, randomizado foi conduzido por uma equipe multidisciplinar com 119 pacientes asmáticos (60/grupo controle e 59/grupo intervenção) atendidos no Ambulatório Especializado em Asma do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. A elaboração do modelo foi composto de cinco módulos contendo informações básicas sobre a doença, adesão ao tratamento proposto, medicamentos, técnicas de uso de dispositivos e cuidados com os medicamentos, complementado com material impresso e visual. O modelo foi implementado por meio de reuniões de educação dirigidas por profissional farmacêutico e avaliado de acordo com as recomendações da Organização Mundial da Saúde. As intervenções educativas para o uso racional de medicamentos proporcionaram ao grupo intervenção o aumento de 21% no conhecimento sobre a doença e aprimoramento das técnicas de utilização dos dispositivos inalatórios com significância estatística intra e intergrupos (p<.0001). Os resultados também mostraram aumento do número de pacientes classificados como mais aderentes após a intervenção mensurada pelo Teste de Morisky Green com significância estatística (p. 0.0244) e pelo reabastecimento da receita com significância intragrupo (p = 0.0113). Em relação à função pulmonar, a diferença intergrupos de CVF (p=0.0287) e de 8% do valor de VEF1 (p. 0,0461) sugerem relevância clínica. Os resultados mostram aumento das pontuações com significância estatística intragrupo em todos os domínios do questionário de qualidade de vida com significância estatística. Após a finalização do estudo o modelo foi implementado para o grupo controle e a avaliação mostrou aumento do conhecimento em asma e melhoria da qualidade de vida. Este modelo foi eficaz e economicamente viável para ser implantado pelo SUS quando testado para pacientes com a condição clínica asma e poderá ser adaptado e reproduzido para outras condições crônicas. / The pharmacist, once inserted into the multidisciplinary team has an important role to play in health education with the goal of improving the knowledge about the chronic conditions, reflecting positively on treatment adherence and consequently clinical outcomes and quality of life individuals. The aim of this study was to develop, implement and evaluate a model of educational interventions for the rational drug use. The clinical study longitudinal, prospective, randomized study was conducted by a multidisciplinary team with 119 asthmatic patients (60/control group and 59/ intervention group) in the Specializing in Asthma Clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto. The development of the model was composed of five modules containing basic information about the disease, treatment compliance, drugs, techniques and drug cares and supplemented with visual and printed material. The model was implemented through educational meetings led by pharmacist professional and evaluated according to the recommendations of the World Health Organization. Educational interventions for the rational drug use provided to the intervention group 21% increase in knowledge about the disease and improvement of inhalers techniques with statistical significance within and between groups (p <.0001). The results also showed an increase patients number classified as more adherent after the intervention measured by test Morisky Green with statistical significance (p. 0.0244) and the replenishment of medical prescription with intragroup significance (p = 0.0113). Regarding lung function, the difference between groups in FVC (p = 0.0287) and 8% of the value of FEV1 (p. 0.0461) suggest clinical relevance. The results show increase in scores statistically significant intragroup in all domains of quality of life questionnaire with statistical significance. After completion of the study, the model was implemented for the control group and the evaluation showed an increase in asthma knowledge and quality of life improvement. This model was effective and economically viable to be implemented by the SUS when tested for patients with asthma and the clinical condition may be reproduced and adapted for other chronic conditions.

O farmacêutico, uma vez inserido na equipe multidisciplinar, tem um papel importante a desempenhar na educação em saúde com o objetivo de melhorar o conhecimento sobre as condições crônicas, refletindo positivamente na adesão ao tratamento e em conseqüência nos resultados clínicos e na qualidade de vida dos indivíduos. O objetivo deste estudo foi elaborar, implementar e avaliar o modelo de intervenções educativas para o uso racional de medicamentos. O estudo clínico longitudinal, prospectivo, randomizado foi conduzido por uma equipe multidisciplinar com 119 pacientes asmáticos (60/grupo controle e 59/grupo intervenção) atendidos no Ambulatório Especializado em Asma do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. A elaboração do modelo foi composto de cinco módulos contendo informações básicas sobre a doença, adesão ao tratamento proposto, medicamentos, técnicas de uso de dispositivos e cuidados com os medicamentos, complementado com material impresso e visual. O modelo foi implementado por meio de reuniões de educação dirigidas por profissional farmacêutico e avaliado de acordo com as recomendações da Organização Mundial da Saúde. As intervenções educativas para o uso racional de medicamentos proporcionaram ao grupo intervenção o aumento de 21% no conhecimento sobre a doença e aprimoramento das técnicas de utilização dos dispositivos inalatórios com significância estatística intra e intergrupos (p<.0001). Os resultados também mostraram aumento do número de pacientes classificados como mais aderentes após a intervenção mensurada pelo Teste de Morisky Green com significância estatística (p. 0.0244) e pelo reabastecimento da receita com significância intragrupo (p = 0.0113). Em relação à função pulmonar, a diferença intergrupos de CVF (p=0.0287) e de 8% do valor de VEF1 (p. 0,0461) sugerem relevância clínica. Os resultados mostram aumento das pontuações com significância estatística intragrupo em todos os domínios do questionário de qualidade de vida com significância estatística. Após a finalização do estudo o modelo foi implementado para o grupo controle e a avaliação mostrou aumento do conhecimento em asma e melhoria da qualidade de vida. Este modelo foi eficaz e economicamente viável para ser implantado pelo SUS quando testado para pacientes com a condição clínica asma e poderá ser adaptado e reproduzido para outras condições crônicas. / The pharmacist, once inserted into the multidisciplinary team has an important role to play in health education with the goal of improving the knowledge about the chronic conditions, reflecting positively on treatment adherence and consequently clinical outcomes and quality of life individuals. The aim of this study was to develop, implement and evaluate a model of educational interventions for the rational drug use. The clinical study longitudinal, prospective, randomized study was conducted by a multidisciplinary team with 119 asthmatic patients (60/control group and 59/ intervention group) in the Specializing in Asthma Clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto. The development of the model was composed of five modules containing basic information about the disease, treatment compliance, drugs, techniques and drug cares and supplemented with visual and printed material. The model was implemented through educational meetings led by pharmacist professional and evaluated according to the recommendations of the World Health Organization. Educational interventions for the rational drug use provided to the intervention group 21% increase in knowledge about the disease and improvement of inhalers techniques with statistical significance within and between groups (p <.0001). The results also showed an increase patients number classified as more adherent after the intervention measured by test Morisky Green with statistical significance (p. 0.0244) and the replenishment of medical prescription with intragroup significance (p = 0.0113). Regarding lung function, the difference between groups in FVC (p = 0.0287) and 8% of the value of FEV1 (p. 0.0461) suggest clinical relevance. The results show increase in scores statistically significant intragroup in all domains of quality of life questionnaire with statistical significance. After completion of the study, the model was implemented for the control group and the evaluation showed an increase in asthma knowledge and quality of life improvement. This model was effective and economically viable to be implemented by the SUS when tested for patients with asthma and the clinical condition may be reproduced and adapted for other chronic conditions.

The South African national drug policy (NDP) was implemented in 1994 to ensure the availability and accessibility of essential drugs to all citizens. The NDP also hoped to ensure the safety, efficacy and quality of drugs as well as to promote the concepts of individual responsibility for health, preventative care and informed decision making. However, drug utilisation studies performed after the implementation of the national drug policy showed that South Africa's pharmaceutical sector was characterised by indiscriminate and irrational drug use, high drug prices and polypharmacy. A retrospective study that was done in 2001 in the clinics supplied by Evander Hospital showed that only 11.9% of prescriptions for acid-related disorders complied with the standard treatment guidelines (STG). It became evident that there was need for an intervention. The general objective of this study was to determine the effect of an education intervention, implemented in 2003, on the prescribing patterns of drugs for acid-related disorders in the Govan Mbeki municipal clinics serviced by Evander Hospital. An empirical pre-intervention and post-intervention study using primary data obtained from patient files at the clinics was done. A quantitative survey of the use of the drugs included in the study (magnesium trisilicate, aluminium hydroxide/magnesium trisilicate combination tablets, cimetidine or omeprazole) was conducted. To determine a baseline, all prescriptions where the drugs selected for this study were prescribed from 1 July 2001 to 31 December 2001 were collected. For the period I January 2002 to 31 December 2002 retrospective data was collected in the form of all prescriptions where the relevant drugs were prescribed. Additional retrospective data was collected for the period January 2002 to 30 June 2003 to determine the outcome of treatment given. The phi coefficient was calculated, and although statistical correlation could not be proven, important tendencies could be detected in the data. Only 8% of the prescriptions adhered to the STG before the presentation of the face to face education intervention. In the first six months following the intervention, STG compliance increased to 15.2%. In the following six-month period, the STG compliance decreased to 14.1 %. The assumption was made that patients were cured if they did not return with the same complaint. Based on this assumption the conclusion was drawn that, before the intervention, 50.2% of the patients were cured. In the first six months after the intervention had taken place the percentage patients who did not return increased from 50.2% to 60.6%. In the second six months after the intervention the percentage of patients who did not return increased to 70.7%. It may be concluded that compliance with the STG improved as a result of the face to face education intervention. Moreover, it was found that cost efficiency improved in parallel and the cure rate seemed to be positively affected by the intervention. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

The South African national drug policy (NDP) was implemented in 1994 to ensure the availability and accessibility of essential drugs to all citizens. The NDP also hoped to ensure the safety, efficacy and quality of drugs as well as to promote the concepts of individual responsibility for health, preventative care and informed decision making. However, drug utilisation studies performed after the implementation of the national drug policy showed that South Africa's pharmaceutical sector was characterised by indiscriminate and irrational drug use, high drug prices and polypharmacy. A retrospective study that was done in 2001 in the clinics supplied by Evander Hospital showed that only 11.9% of prescriptions for acid-related disorders complied with the standard treatment guidelines (STG). It became evident that there was need for an intervention. The general objective of this study was to determine the effect of an education intervention, implemented in 2003, on the prescribing patterns of drugs for acid-related disorders in the Govan Mbeki municipal clinics serviced by Evander Hospital. An empirical pre-intervention and post-intervention study using primary data obtained from patient files at the clinics was done. A quantitative survey of the use of the drugs included in the study (magnesium trisilicate, aluminium hydroxide/magnesium trisilicate combination tablets, cimetidine or omeprazole) was conducted. To determine a baseline, all prescriptions where the drugs selected for this study were prescribed from 1 July 2001 to 31 December 2001 were collected. For the period I January 2002 to 31 December 2002 retrospective data was collected in the form of all prescriptions where the relevant drugs were prescribed. Additional retrospective data was collected for the period January 2002 to 30 June 2003 to determine the outcome of treatment given. The phi coefficient was calculated, and although statistical correlation could not be proven, important tendencies could be detected in the data. Only 8% of the prescriptions adhered to the STG before the presentation of the face to face education intervention. In the first six months following the intervention, STG compliance increased to 15.2%. In the following six-month period, the STG compliance decreased to 14.1 %. The assumption was made that patients were cured if they did not return with the same complaint. Based on this assumption the conclusion was drawn that, before the intervention, 50.2% of the patients were cured. In the first six months after the intervention had taken place the percentage patients who did not return increased from 50.2% to 60.6%. In the second six months after the intervention the percentage of patients who did not return increased to 70.7%. It may be concluded that compliance with the STG improved as a result of the face to face education intervention. Moreover, it was found that cost efficiency improved in parallel and the cure rate seemed to be positively affected by the intervention. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2007.

Submitted by Isac Macêdo (isac@ioc.fiocruz.br) on 2013-09-22T01:45:36Z No. of bitstreams: 1 DO 2008 - Anderson Dominguês Corrêa.pdf: 2812522 bytes, checksum: 1449190f80d87130eac09d34edb27e01 (MD5) / Made available in DSpace on 2013-09-22T01:45:36Z (GMT). No. of bitstreams: 1 DO 2008 - Anderson Dominguês Corrêa.pdf: 2812522 bytes, checksum: 1449190f80d87130eac09d34edb27e01 (MD5) / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil. / O uso inadequado de medicamentos constitui uma grande ameaça à saúde pública e pode ter consequências como o atraso no tratamento adequado ou até mesmo a morte. A Organização Mundial de Saúde identificou que aproximadamente metade dos medicamentos consumidos no mundo é utilizada de modo inadequado, e tem alertado sobre a necessidade crescente de se ampliar os aspectos educacionais relacionados aos medicamentos. Esta tese está estruturada na forma de artigos, sendo constituída por três artigos. Este estudo tem o seu foco direcionado ao ensino de ciências e apresenta uma abordagem qualitativa, apoiada em dados numéricos e depoimentos obtidos a partir de questionários e de entrevistas elaboradas de forma semiestruturadas. Inicialmente, foi realizada uma análise dos conteúdos sobre medicamentos em livros didáticos de Biologia do Ensino Médio. Foi identificado o conhecimento dos alunos e dos professores do IFRJ, sobre o uso de medicamentos, dados estes que junto aos estudos da literatura, fundamentaram a forma e os temas a serem abordados no material educativo criado (história em quadrinhos). Para esta tese, foi realizada uma análise do impacto da história em quadrinhos criada – sobre o uso de medicamentos e intoxicação alimentar – junto ao público alvo e trabalhamos com a aplicação, antes e depois das intervenções, de questionários e entrevistas de forma semiestruturadas. Como resultado dos estudos encontramos: 1 – que os livros didáticos analisados, no que diz respeito ao conteúdo sobre medicamentos, necessitam ser adequados às novas legislações e conteúdos que abordem o Uso Racional de Medicamentos, para que dessa forma possam atender as recomendações dos Parâmetros Curriculares do Ensino Médio; 2 – os habitus criados no convívio familiar em relação ao uso e representações sociais de medicamentos são transmitidos de geração a geração ix e, desta forma, é perpetuado o uso inadequado de medicamentos e 3 – a História em Quadrinhos elaborada contribuiu para o aprendizado dos estudantes sobre os riscos da automedicação. Dessa forma, os resultados sugerem que o ensino de ciências e a divulgação científica sobre o tema com materiais didáticos lúdicos podem contribuir para a apropriação de práticas saudáveis em relação ao uso de medicamentos. Esperamos que nosso trabalho possa contribuir para os debates sobre a divulgação científica de temas relacionados à saúde, capacitando professores para atuarem como facilitadores de ações preventivas em saúde, tornando os alunos multiplicadores dos conteúdos para familiares e amigos, e assim contribuir para a promoção da melhoria na qualidade de vida da população com o objetivo de minimizar os agravos e danos causados pelo uso incorreto de medicamentos. / Inappropriate use of medicine is a major threat to public health and can bring consequences such as delays in appropriate treatment or even death. The World Health Organization found that nearly half of drugs consumed worldwide is used improperly, and has warned of the increasing need to broaden the educational aspects related to drugs. This study is structured in the form of articles and being made of three them. This study has its focus directed to the teaching of science and presents a qualitative approach based on numerical data and testimonials obtained from questionnaires and interviews in a semistrutured fashion. Initially, we carried out an analysis of the contents on drugs on Biology texts books for Middle School. The knowledge of students and teachers of IFRJ on the use of drugs was identified, which added to the literature formed the basis for the topics to be addressed in the educational material created (comics). For this thesis an analyze of the impact of the comics created was performed – on the use of drugs and food poisoning – with the target audience. We worked with the application before and after the questioners interventions and semi structured interviews. As a result of the studies we found: 1) the text books analyzed showed that the part related to the contents about the drugs and the contents that address the rational use of drugs need to be suitable to the new legislations. Only thus, can be met the recommendations of the parameters of the Middle School Curriculum; 2) the habitus created in the family sphere in relation to the use of drugs and it social representations are transmitted from generation to generation, and thereby the inappropriate use of drugs is perpetuated and 3) the comics created contributed to the student learning about the risks of the self-medication. Therefore, the results suggest that the teaching of science and scientific publication on the subject with playful didactic materials can contribute to appropriate healthy practices regarding the use of drugs. We expect our work can contribute to the instrumentalization of the scientific issues dissemination related to the health, field enabling teachers to act as facilitators in preventive health actions. Thus, contributing to the promotion of improved quality of life in order to minimize the injuries and damages caused by the misuse of drugs.

A atenção farmacêutica (ATENFAR) é uma nova prática clínica, inerente ao profissional farmacêutico, que tem como principais objetivos a prevenção de doenças, a promoção e a recuperação da saúde de usuários de serviços sanitários, através do fomento ao uso racional de medicamentos. Vários estudos realizados no Brasil e no exterior mostram que a atividade de ATENFAR pode propiciar muitos benefícios aos tratamentos de saúde que fazem uso de farmacoterapia, resultando no aumento da efetividade do tratamento e na melhoria da qualidade de vida dos pacientes. Além disso, alguns estudos mostram que a ATENFAR exerce influência sobre os custos assistenciais, sendo esta informação de grande importância para que se discuta a inserção desta prática em programas de saúde coletiva. Devido à escassez de estudos econômicos sobre serviços de ATENFAR, este trabalho visou, através de pesquisa bibliográfica, levantar informações acerca dos temas Economia da Saúde, Atenção Farmacêutica e Avaliação em Saúde e discutir criticamente a aplicabilidade e adequação dessas informações aos referidos estudos. A análise das publicações encontradas através da revisão bibliográfica realizada permitiu concluir que: o As análises econômicas tipo custo-minimização, tipo custo-efetividade, tipo custo-utilidade e tipo custo-benefício são aplicáveis a serviços de ATENFAR; o Os custos relativos aos salários dos farmacêuticos, dos auxiliares e dos demais membros da equipe de saúde; ao transporte do paciente ou da equipe de saúde; aos materiais de consumo; aos medicamentos; às internações hospita lares; aos atendimentos médicos de urgência; às sensações de dor, de tristeza, de mal estar; aos dias de trabalho perdidos; à necessidade de um cuidador; ao aluguel do espaço desti nado ao serviço; são custos que devem ser levantados em uma avaliação econômica de serviços de ATENFAR; o A melhoria em parâmetros clínicos e na qualidade de vida de pacientes atendidos por serviços de ATENFAR e a economia de recursos financeiros, são possíveis resultados gerados por esses serviços; o As análises econômicas de serviços de ATENFAR podem ser realizadas sob a perspectiva do paciente, da instituição de saúde, do plano de saúde, do sistema de saúde, da sociedade ou de qualquer outro agente que tenha inte resse em realizar uma avaliação econômica de tais serviços; o Os modelos de estudos epidemiológicos mais indicados para serem utilizados em análises econômicas de serviços de ATENFAR são o modelo experimental e o modelo observacional longitudinal tipo coorte prospectivo. / The pharmaceutical care is a new practical clinic, inherent to the pharmaceutical professional, who has as main objectives the prevention of illnesses, the promotion and recovery of health of sanitary services users, through the fomentation of rational drug use. Several studies accomplished in Brazil and the exterior show that the pharmaceutical care activity can propitiate many benefits to the health treatments which use the pharmacotherapy, resulting in the increase of treatment effectiveness and in the improvement of life quality of patients. Moreover, some studies show that the pharmaceutical care exerts influence on the assistance costs, being this information of great importance to discuss the insert of this practical in collective health programs. Due to scarcity of economic studies on pharmaceutical care services, the present work aimed at, through bibliographical research, raise information about the topics Health Economics, Pharmaceutical Care and Health Evaluation and to critically discuss the applicability and adequacy of this information to the related studies. The analysis of publications found by means of bibliographic revision lead to the conclusion that: o The economic analyses type cost-minimization, type cost-effectiveness, type costutility and type cost-benefit are applicable to pharmaceutical care services; o The cost concerning to the wages of the pharmacist, the assistant and others members of the health team; to the patients or health team transport; to the consumption materials; to medicines; to the hospital internments; to the medical attends of urgency; to the sensations of pain, sadness and badly being; to the lost days of work; to the necessity of attendant; to the rent of the space destined to the service; they are costs that must be raised in a economic evaluation of pharmaceutical care services; o The improvement in clinical parameters and the life quality of patients taken care for pharmaceutical care services and the economy of financial resources are possible results from these services; o The system of assumption of costs by absorption or traditional and the system of activity based costs (ABC) are the most indicated to be established in health units that offer pharmaceutical care services; o The economic analyses of pharmaceu tical care services might be carried through under the patient perspective, the health institution, the health plan, the health system, the society or any other agent who has interest in realize an economic evaluation of such services; o The most indicated models of epidemiological studies to be used in economic analyses of pharmaceutical care services are the experimental model and the longitudinal observational model type prospective cohort.

A atenção farmacêutica (ATENFAR) é uma nova prática clínica, inerente ao profissional farmacêutico, que tem como principais objetivos a prevenção de doenças, a promoção e a recuperação da saúde de usuários de serviços sanitários, através do fomento ao uso racional de medicamentos. Vários estudos realizados no Brasil e no exterior mostram que a atividade de ATENFAR pode propiciar muitos benefícios aos tratamentos de saúde que fazem uso de farmacoterapia, resultando no aumento da efetividade do tratamento e na melhoria da qualidade de vida dos pacientes. Além disso, alguns estudos mostram que a ATENFAR exerce influência sobre os custos assistenciais, sendo esta informação de grande importância para que se discuta a inserção desta prática em programas de saúde coletiva. Devido à escassez de estudos econômicos sobre serviços de ATENFAR, este trabalho visou, através de pesquisa bibliográfica, levantar informações acerca dos temas Economia da Saúde, Atenção Farmacêutica e Avaliação em Saúde e discutir criticamente a aplicabilidade e adequação dessas informações aos referidos estudos. A análise das publicações encontradas através da revisão bibliográfica realizada permitiu concluir que: o As análises econômicas tipo custo-minimização, tipo custo-efetividade, tipo custo-utilidade e tipo custo-benefício são aplicáveis a serviços de ATENFAR; o Os custos relativos aos salários dos farmacêuticos, dos auxiliares e dos demais membros da equipe de saúde; ao transporte do paciente ou da equipe de saúde; aos materiais de consumo; aos medicamentos; às internações hospita lares; aos atendimentos médicos de urgência; às sensações de dor, de tristeza, de mal estar; aos dias de trabalho perdidos; à necessidade de um cuidador; ao aluguel do espaço desti nado ao serviço; são custos que devem ser levantados em uma avaliação econômica de serviços de ATENFAR; o A melhoria em parâmetros clínicos e na qualidade de vida de pacientes atendidos por serviços de ATENFAR e a economia de recursos financeiros, são possíveis resultados gerados por esses serviços; o As análises econômicas de serviços de ATENFAR podem ser realizadas sob a perspectiva do paciente, da instituição de saúde, do plano de saúde, do sistema de saúde, da sociedade ou de qualquer outro agente que tenha inte resse em realizar uma avaliação econômica de tais serviços; o Os modelos de estudos epidemiológicos mais indicados para serem utilizados em análises econômicas de serviços de ATENFAR são o modelo experimental e o modelo observacional longitudinal tipo coorte prospectivo. / The pharmaceutical care is a new practical clinic, inherent to the pharmaceutical professional, who has as main objectives the prevention of illnesses, the promotion and recovery of health of sanitary services users, through the fomentation of rational drug use. Several studies accomplished in Brazil and the exterior show that the pharmaceutical care activity can propitiate many benefits to the health treatments which use the pharmacotherapy, resulting in the increase of treatment effectiveness and in the improvement of life quality of patients. Moreover, some studies show that the pharmaceutical care exerts influence on the assistance costs, being this information of great importance to discuss the insert of this practical in collective health programs. Due to scarcity of economic studies on pharmaceutical care services, the present work aimed at, through bibliographical research, raise information about the topics Health Economics, Pharmaceutical Care and Health Evaluation and to critically discuss the applicability and adequacy of this information to the related studies. The analysis of publications found by means of bibliographic revision lead to the conclusion that: o The economic analyses type cost-minimization, type cost-effectiveness, type costutility and type cost-benefit are applicable to pharmaceutical care services; o The cost concerning to the wages of the pharmacist, the assistant and others members of the health team; to the patients or health team transport; to the consumption materials; to medicines; to the hospital internments; to the medical attends of urgency; to the sensations of pain, sadness and badly being; to the lost days of work; to the necessity of attendant; to the rent of the space destined to the service; they are costs that must be raised in a economic evaluation of pharmaceutical care services; o The improvement in clinical parameters and the life quality of patients taken care for pharmaceutical care services and the economy of financial resources are possible results from these services; o The system of assumption of costs by absorption or traditional and the system of activity based costs (ABC) are the most indicated to be established in health units that offer pharmaceutical care services; o The economic analyses of pharmaceu tical care services might be carried through under the patient perspective, the health institution, the health plan, the health system, the society or any other agent who has interest in realize an economic evaluation of such services; o The most indicated models of epidemiological studies to be used in economic analyses of pharmaceutical care services are the experimental model and the longitudinal observational model type prospective cohort.

Made available in DSpace on 2016-12-12T20:34:13Z (GMT). No. of bitstreams: 1 Dissertacao Paulo em 17-9.pdf: 465544 bytes, checksum: 33b5b1a2b098715556b9cc2171800076 (MD5) Previous issue date: 2007-10-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In order to contribute for the evaluation of the Brazilian policies on generic drugs and their social relevance, this study investigated, by means of a case study on a public health unit, the knowledge that prescribers, dispensers, and users possess on generic drugs and their confidence on those drugs. First, the study investigated the history of the production and use of drugs in Brazil, from the colonial times to the present days. Then, by means of an examination of the legislation, the study investigated the characteristics of the Brazilian National Policy on Drugs, drawing a distinction between generic, similar and brand name drugs. Data were also obtained on the production and sales of drugs in Brazil. After that, by means of a case study, information was collected on the attitudes of health professionals and patients towards generics (knowledge, confidence, use, etc.). Subjects of this study were 62 patients of a policlinic in São José, Santa Catarina, Brazil, plus 14 prescribers (11 doctors and 3 dentists) and 2 dispensers (pharmacists), all of which work at the policlinic. The data were collected by means of questionnaires. Patients had a great difficulty to distinguish the classes of drugs based on the Law 9787/99 (Law of Generic Drugs). Most of them have the wrong conception that generics are cheaper than similar drugs. Prescribers also were also confused by the definitions of generic and similar drugs presented in the legal text. On the other hand, most of them are aware of the fact that generic drugs have the obligation to be cheaper than brand-name drugs only. Most of the prescribers rely on the quality of generic drugs, but they do not always make their prescriptions using the Brazilian Common Denomination, which would facilitate the acquisition of generics by patients. The pharmacists could easily identify drug classes, as presented in the legal text. They were also knowledgeable about the fact generics are normally more expensive than similar drugs. This research allowed for the following general findings, among others: a) Brazilian national policy for generics has warranted safety and efficacy of drugs, by establishing accurate criteria for the certification of the centers that test bioequivalence/bioavailability and pharmaceutical equivalence; b) the national policy for generics has favored the development of the Brazilian drug industry, because most the great majority of the generics sold in Brazil are produced by national laboratories; c) the national policy for generics has attended the principle of rational drug use, because it presupposes surveillance and control of drug production, prescription, and dispensing; d) generics are cheap enough to provoke a significant reduction on the cost of some treatments and bring some economy for the government concerning the acquisition of pharmaceuticals; e) in the last ten years, raises in drug prices caused a reduction in the consumption of drugs in Brazil, but it is probable that the increase in the use of generics forces a decrease in the price of brand name drugs; f) new public campaigns seem necessary in order to restate the distinctions among drug classes and to reinforce prescribers confidence in generics / Como forma de contribuir para a avaliação da política nacional de medicamentos genéricos e sua relevância social, este trabalho investigou, mediante estudo de caso em uma unidade pública de saúde, o conhecimento que têm prescritores, dispensadores e usuários relativamente aos medicamentos genéricos e a confiança que neles depositam. Para situar historicamente a pesquisa, traçou-se inicialmente um histórico da produção e uso de medicamentos no Brasil, desde os tempos coloniais até os dias atuais. A seguir, mediante exame da documentação oficial, procurou-se conhecer as características da Política Nacional de Medicamentos, distinguindo medicamentos genéricos de similares e de referência e obtendo também dados sobre a produção e comercialização de medicamentos no País. Depois, mediante estudo de caso, buscou-se obter informações quanto à relação de profissionais da saúde e usuários com os medicamentos genéricos (conhecimento, confiança, uso, etc.). Foram informantes da pesquisa 62 usuários da Policlínica Municipal de Campinas - São José/SC, 14 prescritores (11 médicos e 3 cirurgiões-dentistas) e 2 dispensadores (farmacêuticos), todos atuantes na Policlínica. Os dados foram colhidos mediante a aplicação de questionários. Os usuários tiveram bastante dificuldade para distinguir as classes de medicamentos a partir do texto da Lei 9.787/99 (Lei dos Genéricos). Mais da metade deles têm a percepção equivocada de que os genéricos são mais baratos que os similares. Já os prescritores também confundiram as definições para medicamento genérico e similar oferecidas no texto legal. Por outro lado, a maioria dos prescritores mostraram-se cientes de que os genéricos têm por obrigação serem mais baratos apenas que os medicamentos de referência. A maioria dos prescritores confiam na qualidade dos medicamentos genéricos, mas nem sempre fazem suas prescrições usando a DCB, o que facilitaria a aquisição de genéricos pelos pacientes. Os dispensadores identificaram sem dificuldade as classes de medicamentos, a partir do texto legal. Também sabem que os genéricos geralmente têm preço mais elevado que os similares. Entre outras, o trabalho permitiu as seguintes constatações gerais: a) a política nacional de genéricos tem garantido a segurança e eficácia dos medicamentos, mediante o estabelecimento de critérios apurados para certificação dos centros que realizam os testes de bioequivalência/biodisponibilidade e equivalência farmacêutica; b) a política de genéricos tem favorecido o desenvolvimento da indústria nacional de medicamentos, pois a grande maioria dos genéricos consumidos no País são produzidos por laboratórios nacionais; c) a política de genéricos tem favorecido ao princípio de uso racional de medicamentos, pois prevê acompanhamento e controle da produção, da prescrição e da dispensação de medicamentos; d) os genéricos são suficientemente baratos para provocar redução considerável no custo de alguns tratamentos e propiciar ao poder público alguma economia na aquisição de medicamentos; e) nos últimos dez anos, aumentos acima das taxas de inflação provocaram uma redução no consumo de medicamentos no País, mas é provável que o crescimento que se vem verificando no uso dos genéricos provoque uma queda no preço dos medicamentos de referência; f) parecem ser necessárias novas campanhas estabelecendo a distinção entre as classes de medicamentos e reforçando, nos prescritores, a confiança nos genéricos