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BMC Primary Care
Published in: BMC Primary Care 1/2021

Open Access 01-12-2021 | Care | Research article

Implementation of pharmaceutical services in Brazilian primary health care: a cross-sectional study

Authors: Nathália Cano Pereira, Vera Lucia Luiza, Mônica Rodrigues Campos, Luisa Arueira Chaves

Published in: BMC Primary Care | Issue 1/2021

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Abstract

Background

In the Brazilian public health system, primary health care (PHC) is provided by the municipalities and is considered the entry level of the Unified Health System (SUS). Governmental pharmaceutical services (PharmSes) are part of the SUS, including PHC, and are the most significant way in which patients access medicine and services. Considering the diversity of the country, the municipalities have the autonomy to decide how PharmSes are implemented. Even though policies and procedures should be implemented as expected by policy makers and experts, municipality characteristics may interfere with implementation fidelity. Therefore, this study evaluated the degree to which the PharmSes in PHC were delivered as intended in Brazilian municipalities.

Methods

We analysed data from a secondary database originating from a cross-sectional nationwide study carried out by the Ministry of Health and the World Bank from 2013 to 2015. Data on 465 municipalities and the Federal District were collected from 4939 governmental PharmSes. A rating system comprising 43 indicators was developed and applied to the dataset to obtain the implementation degree (ID) of each PharmSe. Additionally, the IDs of the two PharmSes dimensions and the nine components were measured.

Results

Overall, the ID of the PharmSes in Brazilian PHC was evaluated as critical. The ID was critical in 81% of the municipalities (n = 369), incipient in 14% (n = 65) and unsatisfactory in 4.8% (n = 22). Regarding the PharmSes dimensions, the ‘medicine management’ (MM) ID was considered critical (Mean = 46%), while the ‘care management’ (CM) ID was incipient (Mean = 22%). In terms of the PharmSes components, the highest ID was achieved by ‘forecasting’ (58%). In contrast, ‘continuing education and counselling’ showed the lowest figure (ID = 11%) in the whole sample, followed by ‘information and communication’ and ‘teamwork’.

Conclusions

The degree to which PharmSes were implemented was critical (ID< 50%). This analysis demonstrated that PharmSes were implemented with low fidelity, which may be related to the low availability of medicine in PHC. Although the care management component requires more attention, considering their incipient ID, all components must be reviewed. Municipalities must increase their investment in PharmSes implementation in order to maximize the benefits of these services and guarantee the essential right of access to medicine.
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Metadata
Title
Implementation of pharmaceutical services in Brazilian primary health care: a cross-sectional study
Authors
Nathália Cano Pereira
Vera Lucia Luiza
Mônica Rodrigues Campos
Luisa Arueira Chaves
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Care
Published in
BMC Primary Care / Issue 1/2021
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-021-01516-7

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