ABSTRACT Objectives: to identify whether implementing a supplementary Primary Health Care (PHC) system makes it possible to reduce care costs for older adults with heart diseases. Methods: a retrospective cohort of 223 patients with heart disease aged ≥ 60 years. Data were obtained from medical records and cost databases, assessed for a period of one year before and after PHC implementation. The results were expressed as mean absolute frequencies for number of hospitalizations and as average annual expenses expressed in dollars (US$) in relation to cost data. Results: there was a reduction in hospitalization expenses after implementing supplementary PHC (p=0.01) and a decrease in the frequency of hospitalizations for the entire sample (p=0.006). There was a reduction in the frequency of consultations at the Emergency Room among frail older adults (p=0.011). Conclusions: there was a reduction in hospitalization costs and frequency of visits to the Emergency Room after supplementary PHC.

RESUMEN Objetivos: identificar si la implementación de un sistema complementario de Atención Primaria de Salud (APS) permite reducir los costos de atención a los ancianos con enfermedades del corazón. Métodos: cohorte retrospectiva de 223 pacientes con cardiopatía de edad ≥ 60 años. Los datos fueron obtenidos de prontuarios y bases de datos de costos, evaluados por un período de un año antes y después de la implementación de la APS. Los resultados se expresaron como frecuencias absolutas medias por número de hospitalizaciones y como gasto anual medio expresado en dólares (US$) en relación con los datos de costes. Resultados: hubo reducción de los gastos de hospitalización después de la implementación de la APS complementaria (p=0,01) y disminución de la frecuencia de hospitalizaciones para toda la muestra (p=0,006). Hubo reducción en la frecuencia de consultas en Emergencia entre los ancianos frágiles (p=0,011). Conclusiones: hubo una reducción en los costos de hospitalización y frecuencia de visitas a la Sala de Emergencia después de la APS complementaria.

RESUMO Objetivos: identificar se a implementação de um sistema de Atenção Primária à Saúde (APS) suplementar possibilita a redução dos custos assistenciais de idosos com cardiopatias. Métodos: coorte retrospectiva de 223 pacientes cardiopatas com idade ≥ 60 anos. Os dados foram obtidos em registros médicos e banco de dados de custos, avaliados por período de um ano antes e após a implementação da APS. Os resultados foram expressos como media das frequências absolutas para número de internações e como gasto médio anual expressos em dólares (US$) em relação aos dados de custos. Resultados: houve redução nas despesas de internação após a implementação da APS suplementar (p=0,01) e diminuição da frequência de internação para toda a amostra (p=0,006). Houve redução na frequência de consultas no Pronto Atendimento entre os idosos frágeis (p=0,011). Conclusões: houve redução nos custos de internação e frequência de consulta no Pronto Atendimento após a APS suplementar.

ABSTRACT BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects multiple joints. It is associated with psoriasis and treated with synthetic and biologic drugs. OBJECTIVE: The objective of this study was to assess the outcomes of patients who received biologic therapy with tumor necrosis factor (TNF) inhibitors in terms of effectiveness, safety, functionality, and quality of life. DESIGN AND SETTING: A prospective observational study was performed at a single center in Belo Horizonte, Brazil. METHODS: Patients with PsA who received their first TNF inhibitor treatment were followed up for 12 months. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI). Functionality was measured using the Health Questionnaire Assessment (HAQ), and quality of life was evaluated using the European Quality of Life Five Dimensions (EQ-5D). Multiple linear regression was used to identify predictors of the clinical response at 12 months. RESULTS: A total of 143 patients treated with adalimumab or etanercept were evaluated. Most of the clinical measures were significantly improved at 12 months. However, 31%–51% of the patients did not achieve good clinical control. No differences were observed between adalimumab and etanercept, except for poor functionality at 12 months among patients treated with etanercept. The main predictors of a worse clinical response were female sex, etanercept use, poor functionality, or lower quality of life at baseline. The main adverse reactions were alopecia, headache, injection site reaction, sinusitis, flu, dyslipidemia, and infections. CONCLUSION: TNF inhibitor therapy was effective and safe. However, despite improvements in clinical measures, most patients did not achieve satisfactory control of the disease.

Abstract INTRODUCTION: Pancreatic cancer is increasing worldwide. The burden of pancreatic cancer in Brazil and its states was analyzed and compared with that from the USA and China. METHODS: This is a descriptive study of the incidence and mortality estimates from the Global Burden of Disease 2019 study, from 2000 to 2019. The Brazilian states presenting the highest and lowest socio-demographic index (SDI) were selected from each of the five regions. The SDI consists of the per capita income, education, and fertility rate of each population. RESULTS: A significant increase was found in age-standardized incidence and mortality of pancreatic cancer in all three countries, with differences in magnitude and annual increases. In Brazil, this incidence rose from 5.33 [95% Uncertainty Interval (UI): 5.06- 5.51] to 6.16 (95% UI: 5.68- 6.53) per 100,000 inhabitants. China and the Brazilian states with the lowest SDI, such as Pará and Maranhão, showed lower incidence and mortality rates, although presenting the highest annual increases. No difference was found between the sexes. A higher mortality rate was observed for those individuals of 70+ years, which was three to four times higher than those aged 50 to 69 years. CONCLUSIONS: The increasing burden of pancreatic cancer in the studied countries, and the higher estimates for the elderly in a fast-aging country such as Brazil, indicates that more resources and health policies will be necessary. The greatest increase in the states with lower SDI reflects inequalities in the access to diagnosis and registries of this cancer.

ABSTRACT Objective To evaluate the therapeutic response (functionality) and its associated factors in patients on biological drugs on the Public Health System for treatment of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Methods An open prospective cohort was carried out from 2011 to 2019, in Belo Horizonte (MG). Functionality was assessed using the Health Assessment Questionnaire Disability-Index at baseline, and after 6 and 12 months of follow-up. Factors associated with poor functionality were identified through logistic regression. Results The median Health Assessment Questionnaire Disability-Index at baseline was 1.5 (interquartile range of 0.8-1.9), with poor functionality observed in patients with rheumatoid arthritis. Improved functionality was seen at 6 months of treatment for the three diseases. The predictors of poor functionality at 6 months for psoriatic arthritis and ankylosing spondylitis were female sex, low education levels, and high disease activity; and for rheumatoid arthritis and psoriatic arthritis were female sex, advanced age, and high disease activity. In 12 months, the three diseases had predictors of worse functionality: female sex, low education, and high disease activity. Conclusion There was a significant improvement in functionality during the follow-up, with better response at 6 months of treatment. Poor functionality was observed in older, female patients, with low education and high disease activity.

OBJECTIVES: Evaluate the use of probiotics as an additional therapy in the treatment of children and adolescents with asthma in Belo Horizonte, MG-Brazil. METHODS: A pilot longitudinal, experimental and nonrandomized study with 30 patients from six to 17 years old from Belo Horizonte. In the baseline appointment, all patients received beclomethasone, and one group also received a probiotic containing Lactobacillus reuteri (n=14). The patients were reassessed after at least 60 days with the Asthma Control Test, spirometry and self-report of the symptoms they experienced associated with asthma. RESULTS: A predominance of male patients (56.7%) and a mean age of 10.6 years were observed. The groups using probiotics did not differ in terms of sex, age or atopy. In the longitudinal evaluation, an increase in the Asthma Control Test scores and a reduction in the number of symptoms were observed in the probiotic group. There was an increase in the peak expiratory flow among those who used probiotics. CONCLUSIONS: This pilot study supports the hypothesis that the administration of probiotics as a supplementary therapy for the treatment of children and adolescents with asthma improves the clinical condition of the patients. Further studies are needed to confirm the efficacy of probiotics in asthma treatment.

Abstract Background: Pharmaceutical Assistance (PA) is a dynamic and multidisciplinary process that aims to supply health systems, programs or services with quality medicines, enabling access and health care, in an efficient and timely manner. The objective of the study was to evaluate the profile of administrative processes for the treatment of PsA, identify the time elapsed in the flow of processes and its associated factors. Methods: A cross-sectional study of medication requests for the treatment of PsA was carried out between November 2014 and December 2016. Linear regression was used to verify the factors associated with time to delivery. Results: A total of 218 cases containing 250 drugs were analyzed. The median time between the medical appointment and the first dispensation was 66 days (interquartile range, 44-90). The State proceedings, which includes requesting the drug until the authorization of treatment, was the stage that most contributed to the total time spent. The factors associated with the longer time to delivery of medications were prescriptions coming from clinics and specialty centers, from dermatologists, non-authorized processes and non-persistent patients in the treatment in 12 months. Conclusion: The median time to receive medicines for the PsA treatment in Belo Horizonte health region after a medical prescription was higher than 2 months. The time between the solicitation of the medicines and the authorization of the treatment in the SUS (State administrative procedure) was the main component of the total time spent.

Resumo Fundamentos: A mediastinite é uma infecção grave pós-esternotomia mediana com prognóstico ruim, mesmo com diagnóstico e tratamento precoces. Objetivos: Avaliar o perfil dos pacientes submetidos à esternotomia, identificar fatores de risco para o desenvolvimento da mediastinite e avaliar o diagnóstico bacteriológico dos pacientes com esta infecção. Métodos: Estudo caso-controle realizado em um hospital de Belo Horizonte (MG) com pacientes submetidos à esternotomia mediana entre janeiro de 2015 e janeiro de 2016. A amostra foi de 65 pacientes, sendo 13 casos e 52 controles (1:4). Na análise estatística, foram adotados os testes t de Student, Mann-Whitney e exato de Fisher, além de regressão logística, ao nível de significância de 5%. Resultados: Houve predominância do sexo masculino (63,1%), e a idade média foi 58,8 ±10,3 anos. A evolução a óbito ocorreu em 9,2% dos pacientes e em 23,1% dos que apresentaram mediastinite. A cirurgia de revascularização do miocárdio foi realizada em 75,4% dos casos. Predominância do sexo masculino, maior tempo de internação, febre pós-cirúrgica, óbitos e maior número de fatores de risco foram características mais observadas nos pacientes que desenvolveram mediastinite. O microrganismo mais encontrado em pacientes com infecção mediastinal foi Staphylococcus aureus (30,7%), além de elevada ocorrência de bactérias Gram-negativas (46,2%). Conclusão: Esforços devem ser concentrados para o controle dos fatores de risco antes do procedimento, além do aprimoramento de medidas que possam diminuir ou eliminar o surgimento da mediastinite, visando à prevenção e ao melhor controle de infecções.

Abstract Background: Mediastinitis is a severe post-median sternotomy infection with poor prognosis, even with early diagnosis and treatment. Objectives: To evaluate the profile of patients submitted to sternotomy, identify the risk factors for the development of mediastinitis and evaluate the bacteriological diagnosis of patients with this infection. Methods: Case-control study carried out in a large hospital in Belo Horizonte (MG, Brazil) in patients submitted to median sternotomy, from January 2015 to January 2018. The sample consisted of 65 patients, of which 13 were cases and 52, controls (1:4). For the statistical analysis, Student’s t test, Mann-Whitney test and Fisher exact test were used, in addition to logistic regression, with a level of significance of 5%. Results: There was a predominance of males (63.1%), and the mean age was 58.8 ± 10.3 years. Evolution to death occurred in 9.2% of the patients and in 23.1% of those with mediastinitis. Myocardial revascularization was performed in 75.4% of the cases. Predominance of male gender, longer hospitalization time, post-surgical fever and death, and a greater number of risk factors were more frequent characteristics in patients who developed mediastinitis. The most common microorganism found in patients with mediastinal infection was Staphylococcus aureus (30.7%), in addition to a high occurrence of Gram-negative bacteria (46,2%). Conclusion: The results are in accordance with the literature. Efforts should be focused on the control of risk factors prior to the procedure, in addition to improving measures that can decrease or eliminate the onset of mediastinitis, aiming at infection prevention and control.

Resumo A artrite reumatoide (AR) é uma doença crônica que afeta cerca de 1% da população adulta. No estudo de coorte histórica de pacientes de Minas Gerais, registrados no Sistema de Informações Ambulatoriais (SIA), em 2008-2013, foram identificados 11.573 indivíduos. A perspectiva foi a do financiador público e os valores observados como gastos do Sistema Único de Saúde (SUS) foram ajustados pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA), de dezembro de 2015. O Etanercept foi o tratamento mais caro. A análise múltipla mostrou uma relação negativa entre o aumento das despesas e idade, sexo feminino e diagnóstico de entrada na coorte, e relação positiva para as variáveis Índice de Desenvolvimento Humano Municipal (IDH-M) e o uso de medicamentos bloqueadores do fator de necrose tumoral (ANTI-TNF). Este estudo identificou os fatores que têm impacto sobre o gasto com o tratamento medicamentoso da AR. Também apontou que métodos que permitem extrair dados demográficos e de gastos de sistemas de informação administrativos podem ser ferramentas importantes na construção de estudos econômicos capazes de subsidiar as avaliações econômicas de saúde, especialmente do ponto de vista da gestão.

Abstract Rheumatoid arthritis (RA) is a chronic condition that affects about 1% of the adult population. In a historical cohort of Minas Gerais State, 11,573 RA patients registered in the Outpatient Information System (SIA) between 2008 and 2013 were identified. For this study we adopted the public funding body's perspective and the values were adjusted by the national inflation index (IPCA) of December 2015. Etanercept was the most expensive treatment. The mean cohort age was 52 years old and most of the patients were women. Multiple regression analysis indicated a negative association between higher expenditure and age, female sex, and diagnosis at entry in the cohort and positive association between high expenditure and the Human Development Index (HDI) of the municipality and use of tumor necrosis factor agents. This study identified the factors that have an impact on RA drug treatment expenditure. Also, we showed that methods that enable extracting demographic and expenditure data of administrative information systems may represent important tools in the construction of economic studies to subsidize economic health evaluations, especially from the standpoint of the managers.

Resumo A artrite reumatoide (AR) é uma doença crônica que afeta cerca de 1% da população adulta. No estudo de coorte histórica de pacientes de Minas Gerais, registrados no Sistema de Informações Ambulatoriais (SIA), em 2008-2013, foram identificados 11.573 indivíduos. A perspectiva foi a do financiador público e os valores observados como gastos do Sistema Único de Saúde (SUS) foram ajustados pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA), de dezembro de 2015. O Etanercept foi o tratamento mais caro. A análise múltipla mostrou uma relação negativa entre o aumento das despesas e idade, sexo feminino e diagnóstico de entrada na coorte, e relação positiva para as variáveis Índice de Desenvolvimento Humano Municipal (IDH-M) e o uso de medicamentos bloqueadores do fator de necrose tumoral (ANTI-TNF). Este estudo identificou os fatores que têm impacto sobre o gasto com o tratamento medicamentoso da AR. Também apontou que métodos que permitem extrair dados demográficos e de gastos de sistemas de informação administrativos podem ser ferramentas importantes na construção de estudos econômicos capazes de subsidiar as avaliações econômicas de saúde, especialmente do ponto de vista da gestão.

Abstract Rheumatoid arthritis (RA) is a chronic condition that affects about 1% of the adult population. In a historical cohort of Minas Gerais State, 11,573 RA patients registered in the Outpatient Information System (SIA) between 2008 and 2013 were identified. For this study we adopted the public funding body's perspective and the values were adjusted by the national inflation index (IPCA) of December 2015. Etanercept was the most expensive treatment. The mean cohort age was 52 years old and most of the patients were women. Multiple regression analysis indicated a negative association between higher expenditure and age, female sex, and diagnosis at entry in the cohort and positive association between high expenditure and the Human Development Index (HDI) of the municipality and use of tumor necrosis factor agents. This study identified the factors that have an impact on RA drug treatment expenditure. Also, we showed that methods that enable extracting demographic and expenditure data of administrative information systems may represent important tools in the construction of economic studies to subsidize economic health evaluations, especially from the standpoint of the managers.

RESUMO CONTEXTO Tem sido relatado que cerca de 15% a 40% da população geral apresenta alguma queixa dispéptica e/ou pirose. Os sintomas dispépticos podem surgir em qualquer idade e são mais prevalentes no sexo feminino. OBJETIVO Investigar a prevalência de sintomas dispépticos e pirose em indivíduos com idade superior a 18 anos. MÉTODOS Foram selecionados aleatoriamente indivíduos com idade superior a 18 anos, entrevistados em praças públicas de Belo Horizonte/MG, por meio de um questionário que abordou características sócio-demográficas, questões relacionadas aos hábitos alimentares, sintomas digestivos, consultas médicas, medicamentos, exames, antecedentes cirúrgicos, comorbidades e questionário específico para diagnóstico de dispepsia funcional (Roma III). RESULTADOS Foram entrevistados 548 participantes. Destes, 58,4% eram mulheres, 59,3% da raça branca, 56% solteiros e a idade média foi de 36 anos. Neste grupo, 376 indivíduos (68,6%) declararam ter algum sintoma e/ou utilizar algum medicamento para aliviar sintomas dispépticos. Para esses indivíduos, foi utilizado o questionário Roma III para o diagnóstico de dispepsia sendo sintoma de plenitude pós-prandial (6,7%), saciedade precoce (3,5%) e a dor ou queimação no estômago (azia) presente em 10,6%. A sobreposição desses sintomas foi muito frequente. A prevalência de dispepsia funcional foi de 10,6% (síndrome de desconforto pós-prandial (8,2%), síndrome da dor epigástrica (2,4%)). Dentre os participantes, 52,5% relatavam pirose, sendo que desses 11,1% apresentavam este sintoma, no mínimo, uma vez por semana. O medicamento mais utilizado foi o Omeprazol. CONCLUSÃO A prevalência dos sintomas dispépticos e pirose na população urbana adulta brasileira é semelhante a descrita em outros países.

ABSTRACT BACKGROUND Medical literature has shown dyspepsia and heartburn-related symptoms occur among 15% to 40% of the population. These symptoms can occur at any age and are more prevalent in women. OBJECTIVE Investigate the prevalence of dyspeptic symptoms and heartburn among individuals over 18. METHODS Individuals over 18 were randomly selected in public venues in Belo Horizonte/MG to participate. A standardized questionnaire that included questions related to social-demographic characteristics, eating habits, digestive symptoms, medical appointments, medications, exams, previous surgeries and comorbidities was applied. A questionnaire about functional dyspepsia diagnosis (Rome III) was also applied. RESULTS A total of 548 individuals were interviewed. Among these, 58.4% were women, 59.3% were white, 55.9% were single and the average age was 36 years. Within this group, 376 individuals (68.6%) declared to have some symptom and/or use medication to relieve dyspepsia symptoms, and for these patients were applied the Rome III questionnaire. Based on the diagnostic criteria for the questionnaire proposed by the Rome III consensus, the symptom of postprandial fullness was reported by 6.7% of the individuals, early satiety (3.5%) and epigastric pain (10.6%). The overlap of these symptoms was very frequent. The prevalence of functional dyspepsia was 10.6% (postprandial discomfort syndrome (8.2%) and epigastric pain syndrome (2.4%). Among all participants, 52.5% reported heartburn, and 11.1% presented this symptom at least once a week. The most used drug was omeprazole. CONCLUSION The prevalence of dyspeptic symptoms and heartburn among a Brazilian adult urban population is similar to those described in other countries.

RESUMO A Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM) – componente Serviços teve por objetivo caracterizar a organização dos serviços de assistência farmacêutica na Atenção Básica do Sistema Único Saúde. A PNAUM – Serviços foi um estudo transversal, avaliativo, com amostra planejada de 600 municípios, realizado entre 2014 e 2015, composto por uma fase remota, com entrevistas telefônicas com gestores. Desses 600 municípios foram selecionados 300 para um inquérito em serviços de saúde. Foram selecionadas as 27 capitais, 0,5% dos maiores municípios de cada região e realizado um sorteio dos demais municípios. O cálculo do tamanho da amostra representativa nacional considerou três níveis: municípios, serviços de dispensação de medicamentos e usuários. As entrevistas foram realizadas com a utilização de um questionário estruturado específico para: secretário municipal de saúde, responsável pela assistência farmacêutica no município, responsável pela entrega de medicamentos, médico e usuário. Os dados secundários foram obtidos em bases oficiais, na data mais recente de atualização. A PNAUM – Serviços foi a primeira pesquisa de âmbito nacional visando a avaliação e obtenção de indicadores nacionais e regionais acerca de acesso a medicamentos, bem como utilização e uso racional, sob a ótica de variados atores sociais.

ABSTRACT The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos –Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) aimed to characterize the organization of pharmaceutical services in the Primary Health Care of the Brazilian Unified Health System (SUS). PNAUM – Services is a cross-sectional and evaluative study, with planned sample of 600 cities, held between 2014 and 2015, composed of a remote phase, with telephone interviews with health managers. Of these 600 cities, 300 were selected for a survey on health services. We selected the 27 capitals, the 0.5% largest cities of each region, and the remaining cities were drawn. The estimate of the representative national sample size considered three levels: cities, medicine dispensing services, and patients. The interviews were carried out with a structured questionnaire specific for: municipal secretaries of health, professionals responsible for pharmaceutical services in the city, professionals responsible for the dispensing of medicines, physicians, and patients. The secondary data were obtained in official databases, in the latest update date. PNAUM – Services was the first nationwide research aimed at the assessment and acquisition of national and regional indicators on access to medicines, as well as use and rational use, from the perspective of various social subjects.

RESUMO OBJETIVO Avaliar o acesso aos medicamentos na Atenção Primária em Saúde do Sistema Único de Saúde na perspectiva do usuário. MÉTODOS Estudo transversal que utilizou dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional no Brasil – Serviços, 2015, realizado por meio de entrevistas com 8.591 usuários em municípios das cinco regiões do Brasil. A avaliação do acesso aos medicamentos utilizou conceitos propostos por Penshansky e Thomas (1981), segundo as dimensões: disponibilidade, acessibilidade geográfica, adequação, aceitabilidade e capacidade aquisitiva. Cada uma das dimensões foi avaliada por meio de indicadores próprios. RESULTADOS Para dimensão disponibilidade, 59,8% dos usuários declararam ter acesso total aos medicamentos, sem diferença significante entre regiões. Para acessibilidade geográfica, 60% dos usuários declararam que a unidade básica de saúde não ficava longe de sua residência, 83% afirmaram ser muito fácil/fácil chegar até a unidade e a maioria dos usuários relatou caminhar (64,5%). Para adequação, a unidade foi avaliada como muito bom/bom para os itens conforto (74,2%) e limpeza (90,9%), e 70,8% dos usuários relataram não ter de esperar para retirar seus medicamentos, embora o tempo médio de espera tenha sido 32,9 minutos. Para aceitabilidade: 93,1% dos usuários relataram ser atendidos com respeito e cortesia pelos funcionários das unidades dispensadoras e 90,5% declararam ser muito bom/bom o atendimento das unidades. Para capacidade aquisitiva 13% dos usuários relataram ter deixado de comprar algo importante para cobrir gastos com problemas de saúde, 41,8% dos participantes apontaram a despesa com medicamentos. CONCLUSÕES Os resultados mostram 70%–90% de conformidade, compatível com países desenvolvidos. No entanto, o acesso aos medicamentos continua sendo um desafio pois ainda é fortemente comprometido pela baixa disponibilidade de medicamentos essenciais em unidades públicas de saúde, demonstrando que não ocorre de forma universal, equânime e resolutiva à população.

ABSTRACT OBJECTIVE To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective. METHODS This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population.

RESUMO A Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM) – componente Serviços teve por objetivo caracterizar a organização dos serviços de assistência farmacêutica na Atenção Básica do Sistema Único Saúde. A PNAUM – Serviços foi um estudo transversal, avaliativo, com amostra planejada de 600 municípios, realizado entre 2014 e 2015, composto por uma fase remota, com entrevistas telefônicas com gestores. Desses 600 municípios foram selecionados 300 para um inquérito em serviços de saúde. Foram selecionadas as 27 capitais, 0,5% dos maiores municípios de cada região e realizado um sorteio dos demais municípios. O cálculo do tamanho da amostra representativa nacional considerou três níveis: municípios, serviços de dispensação de medicamentos e usuários. As entrevistas foram realizadas com a utilização de um questionário estruturado específico para: secretário municipal de saúde, responsável pela assistência farmacêutica no município, responsável pela entrega de medicamentos, médico e usuário. Os dados secundários foram obtidos em bases oficiais, na data mais recente de atualização. A PNAUM – Serviços foi a primeira pesquisa de âmbito nacional visando a avaliação e obtenção de indicadores nacionais e regionais acerca de acesso a medicamentos, bem como utilização e uso racional, sob a ótica de variados atores sociais.

ABSTRACT The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos –Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) aimed to characterize the organization of pharmaceutical services in the Primary Health Care of the Brazilian Unified Health System (SUS). PNAUM – Services is a cross-sectional and evaluative study, with planned sample of 600 cities, held between 2014 and 2015, composed of a remote phase, with telephone interviews with health managers. Of these 600 cities, 300 were selected for a survey on health services. We selected the 27 capitals, the 0.5% largest cities of each region, and the remaining cities were drawn. The estimate of the representative national sample size considered three levels: cities, medicine dispensing services, and patients. The interviews were carried out with a structured questionnaire specific for: municipal secretaries of health, professionals responsible for pharmaceutical services in the city, professionals responsible for the dispensing of medicines, physicians, and patients. The secondary data were obtained in official databases, in the latest update date. PNAUM – Services was the first nationwide research aimed at the assessment and acquisition of national and regional indicators on access to medicines, as well as use and rational use, from the perspective of various social subjects.

RESUMO OBJETIVO Avaliar o acesso aos medicamentos na Atenção Primária em Saúde do Sistema Único de Saúde na perspectiva do usuário. MÉTODOS Estudo transversal que utilizou dados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional no Brasil – Serviços, 2015, realizado por meio de entrevistas com 8.591 usuários em municípios das cinco regiões do Brasil. A avaliação do acesso aos medicamentos utilizou conceitos propostos por Penshansky e Thomas (1981), segundo as dimensões: disponibilidade, acessibilidade geográfica, adequação, aceitabilidade e capacidade aquisitiva. Cada uma das dimensões foi avaliada por meio de indicadores próprios. RESULTADOS Para dimensão disponibilidade, 59,8% dos usuários declararam ter acesso total aos medicamentos, sem diferença significante entre regiões. Para acessibilidade geográfica, 60% dos usuários declararam que a unidade básica de saúde não ficava longe de sua residência, 83% afirmaram ser muito fácil/fácil chegar até a unidade e a maioria dos usuários relatou caminhar (64,5%). Para adequação, a unidade foi avaliada como muito bom/bom para os itens conforto (74,2%) e limpeza (90,9%), e 70,8% dos usuários relataram não ter de esperar para retirar seus medicamentos, embora o tempo médio de espera tenha sido 32,9 minutos. Para aceitabilidade: 93,1% dos usuários relataram ser atendidos com respeito e cortesia pelos funcionários das unidades dispensadoras e 90,5% declararam ser muito bom/bom o atendimento das unidades. Para capacidade aquisitiva 13% dos usuários relataram ter deixado de comprar algo importante para cobrir gastos com problemas de saúde, 41,8% dos participantes apontaram a despesa com medicamentos. CONCLUSÕES Os resultados mostram 70%–90% de conformidade, compatível com países desenvolvidos. No entanto, o acesso aos medicamentos continua sendo um desafio pois ainda é fortemente comprometido pela baixa disponibilidade de medicamentos essenciais em unidades públicas de saúde, demonstrando que não ocorre de forma universal, equânime e resolutiva à população.

ABSTRACT OBJECTIVE To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective. METHODS This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population.

Resumo Neste estudo, buscou-se estimar e analisar fatores associados à não adesão ao tratamento com os medicamentos biológicos adalimumabe e etanercepte em pacientes portadores de doenças reumáticas atendidos pelo Sistema Único de Saúde de Minas Gerais, Brasil. Procedeu-se a estudo prospectivo não concorrente com base no registro de dispensação nas farmácias de pacientes adultos em início de tratamento. A taxa de não adesão foi estimada com utilização do método de proporção de dias cobertos (PDC), sendo considerados não aderentes pacientes com PDC < 0,8. Foram identificados 1.150 pacientes, sendo 64,3% portadores de artrite reumatoide, 8,5% de artrite psoriásica e 27,2% de espondilite anquilosante. A taxa de não adesão encontrada foi de 33,5% e os fatores associados foram idade entre 19-39 anos, sexo feminino, diagnóstico de artrite reumatoide e início de tratamento com etanercepte. Os resultados indicam uma alta taxa de não adesão ao tratamento, que pode originar piores resultados em saúde e implicar o aumento da utilização de cuidados e dos custos em saúde.

Abstract This study examined non-adherence to biological therapy with adalimumab and etanercept and associated factors in patients with rheumatic diseases treated under the Brazilian Unified National Health System in Minas Gerais State, Brazil. A non-concurrent cohort study was performed from pharmacy records of adult patients that had recently initiated treatment. Patient non-adherence was measured by proportion of days covered (PDC), and non-adherent patients were defined as PDC < 0.8. A total of 1,150 patients were included, with the following breakdown: 64.3% rheumatoid arthritis, 8.5% psoriatic arthritis , and 27.2% ankylosing spondylitis. In total, 33.5% of patients were non-adherent. Factors such as younger age (19-39 years), female gender, diagnosis of rheumatoid arthritis , and initial treatment with etanercept were associated with low adherence. The results indicate a high prevalence of non-adherence, which can lead to worse health outcomes and increase healthcare use and costs.

Resumen Este estudio tuvo como meta estimar e investigar los factores asociados a la falta de adherencia en el tratamiento con medicamentos biológicos etanercept y adalimumab en pacientes con enfermedades reumáticas, tratados por el Sistema Único de Salud de Minas Gerais, Brasil. Se realizó un estudio prospectivo no concurrente, basado en los registros de ventas en farmacias de adultos al comienzo del tratamiento. Se estimó la no adherencia mediante el método de la proporción de días cubierto (PDC) y se consideraron los pacientes no adherentes con PDC < 0,8. Se identificaron a 1.150 pacientes, de los cuales el 64,3% sufría artritis reumatoide, el 8,5% artritis psoriásica y el 27,2% con espondilitis anquilosante. La no-adhesión fue de un 33,5% y los factores asociados fueron: edad de 19-39 años; diagnóstico de artritis reumatoide; mujer; tratamiento inicial con etanercept y cambio de medicamento. Los resultados indican una alta falta de adherencia, lo que puede conllevar a peores resultados de salud y resultar en el uso de cuidados especializados y suponer costes mayores para el servicio de salud.