Abstract Background Studies show that among the drugs most commonly used in judicial litigation in Brazil, are those used to treat diabetes mellitus, especially insulin analogues. Objective Evaluate the use of the Unified Health System (SUS) by patients with type 1 diabetes mellitus (T1DM), who receive insulin analogues through judicial action, before and after this process. Method In a retrospective longitudinal observational study, secondary data was used from these patients in Minas Gerais, Brazil, in 2018. Socio-demographic information was collected and related to the follow-up of these patients in the SUS. The McNemar χ2 test was used to compare the proportions of the variables. Results Of the 89 patients analyzed, women (53.9%) were predominant. Most patients were aged between 20 and 39 years (52.8%), and more than half, 55.1%, use only a private health system. After the judicial action, there was a significant increase (p <0.05) in the number of patients who had consultations in primary health care (from 19.1% to 30.3%) and emergency medical appointments (from 1.1% to 9.0%). Conclusion It is observed that the majority of patients with T1DM via judicial action in the SUS are not monitored by this health system through examinations, consultations, and hospitalizations.

Resumo Introdução Estudos mostram que, dentre os medicamentos mais adquiridos via ação judicial, estão os utilizados para o tratamento do Diabetes Mellitus, especialmente os análogos de insulina. Objetivo Avaliar a utilização do Sistema Único de Saúde (SUS) pelos pacientes com Diabetes Mellitus tipo 1 (DM1), que recebem insulina por meio de judicialização, antes e após este processo. Método Em um estudo observacional longitudinal retrospectivo, foram utilizados dados secundários de pacientes com DM1, que adquiriram insulinas por processos judiciais em Divinópolis-MG, Brasil, em 2018. Foram coletadas informações sociodemográficas e referentes ao acompanhamento destes pacientes no SUS Realizou-se o teste χ2 de McNemar para a comparação das proporções das variáveis utilizadas para a avaliação do acompanhamento antes e após a judicialização. Resultados Dos 89 pacientes analisados, predominou-se o sexo feminino (53,9%), com idade entre 20 e 39 anos (52,8%). 55,1% destes utilizam apenas o sistema privado de saúde. Após a judicialização, houve um aumento significativo (p< 0,05) no número de pacientes que realizaram consultas na atenção primária à saúde (de 19,1% para 30,3%) e consultas médicas de emergência (de 1,1% para 9,0%). Conclusão A maioria dos pacientes com DM1 que judicializam medicamentos no SUS não são acompanhados por este sistema de saúde através de realização de exames, consultas e hospitalizações.

Abstract The present study proposes and evaluates the test-retest reliability of indicators of the correct use of sodium alendronate in elderly patients. This is a test-retest reliability study for use of sodium alendronate. Six questions to evaluate the correct use of this medicine were elaborated after analysis of information in the literature. Data collection was performed through questionnaires in face-to-face in-home interviews by previously trained interviewers. The participants were initially interviewed (test) when they agreed to participate in the study, and secondly (retest), after a period of 7 to 14 days from the first interview. The reliability of the questions was evaluated by means of the agreement percentage and the Kappa coefficient. Fifty-seven pairs (test-retest) were obtained. The mean age was 69.3 (SD = 6.9) years, the majority (92.5%) completed elementary education, and declared themselves white (50.9%). All the questions presented high concordance ranging from 79.0% to 98.3%. The Kappa values ranged from 0.1 (low) to 0.83 (very good). The agreement percentage and the Kappa values suggest adequate reliability of the proposed questions. We suggest that they can be used as a simple and quick way to evaluate the quality of sodium alendronate use among the elderly.

Studies that addressed the profile of pharmaceutical activities and behaviors in community pharmacies in the last decades pointed to a gap between community pharmacy practice and the precepts of the profession. Facing the need to analyze whether the new legislation has impacted this scenario, the objective of this study was to describe the general profile and academic profile of community pharmacists, and the profile of the activities they develop, as well as to know their place of work. This is a descriptive study, to which all pharmacists in charge of community pharmacies in the metropolitan area of Belo Horizonte-MG (n = 1624) were invited. Data collection was performed through a questionnaire validated online, from October to December 2017, via Google Docs®. Responses were obtained from 109 pharmacists, most of them female, aged 31-40 years, being general graduates, and in private institutions. Pharmacotherapeutic follow-up, an activity linked to clinical management, is performed by only 37.60% of pharmacists, evidencing that there is still a lag in relation to the provision of clinical services by community pharmacists. Thus, we emphasize the importance of implementing the precepts established by Brazilian curricular guidelines for undergraduate pharmacy courses which focus on the development of clinical skills, since the insertion of the pharmacist into the health team and the provision of clinical services to the community can add new value to the use of medications, and contribute effectively to their rational use in Brazil.

ABSTRACT Dispensing drug is a moment in which the pharmacist is able to analyze pharmacotherapy and contribute to its rational use. However, research has shown that some pharmacists lack adequate knowledge to perform this service. This study aims to describe a research protocol for a clinical trial to test the effectiveness of a distance learning program to train pharmacists in dispensing drugs. This is a protocol for an open diagnostic, non-randomized, single group clinical trial. A 12-week duration distance learning course was structured on the Moodle platform for training community pharmacists who are registered in the Regional Board of Pharmacy and work as employees or owners in Brazilian community pharmacies. The course curricula involves concepts and practice of dispensing drugs applied to the treatment of hypertension, diabetes mellitus, dyslipidemia and asthma. Pharmacists are divided randomly into groups, to which previously selected tutors give directions to the discussion and clarify questions. A validated questionnaire is being used before and after the course to measure participants’ knowledge. Participant satisfaction with the course is also being measured. Pharmacists who work in the study headquarters municipality receive two visits from a mystery shopper, before and after the course, to evaluate their performance in dispensing drugs. The virtual platform and the content of the course material were evaluated by judges. The study has been approved by the Research Ethics Committee of the School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo. The sample size was estimated to provide desired power for testing the significance of the difference between baseline-to-endpoint change scores. Information about the course is being released through channels such as social networks. The results will be submitted for publication in scientific journals, but information enabling the identification of the study subjects will be kept confidential. The trial has been registered in The Brazilian Clinical Trials Registry with number RBR7mbrp3 on January 15th, 2015.

RESUMO O objetivo desse trabalho foi avaliar a efetividade de um programa de educação continuada (EC) à distância, relacionado ao gerenciamento clínico de problemas autolimitados de saúde em farmácias comunitárias. Realizou-se um ensaio clínico controlado randomizado em farmácias comunitárias no Brasil. Os farmacêuticos comunitários foram alocados em dois grupos: intervenção (n = 61) e controle (n = 60). Os farmacêuticos comunitários do grupo intervenção participaram de um programa de EC à distância. Os farmacêuticos comunitários do grupo controle não receberam intervenção educativa. A percepção dos participantes, os resultados de aprendizagem e hábitos de prática foram avaliados. A satisfação dos estudantes com o programa de CE foi elevada em todos os momentos avaliados (média ± desvio padrão = 4,2 ± 0,4). Os escores de aprendizagem e prática aumentaram significativamente ao final do estudo em relação ao início do estudo (p < 0,001) e foram significativamente melhores que os do grupo controle (p < 0,001). O presente programa de EC à distância é uma estratégia educacional viável para melhorar a percepção dos participantes, os resultados da aprendizagem e hábitos de prática relacionados ao gerenciamento clínico de problemas autolimitados de saúde em farmácias comunitárias.

ABSTRACT The aim of this work was to evaluate the effectiveness of an internet-based continuing education (CE) program on pharmacy-based minor ailment schemes (PMASs). A controlled randomized clinical trial was conducted in community pharmacies in Brazil. Community pharmacists (CPs) were enrolled in two groups: intervention (n = 61) and control (n = 60). CPs who were enrolled to the intervention group participated in an Internet-based CE program. CPs in the control group received no educational intervention. We evaluated participant perception, learning outcomes, and practice performance. Learner satisfaction with the CE program was high for every point evaluated (mean ± standard deviation = 4.2 ± 0.4). Posttest learner outcome scores and practice performance in the intervention group after the conclusion of the CE program significantly improved compared with pretest scores (p < 0.001) and were significantly better compared with the control group (p < 0.001). The present Internet-based CE program is a viable educational strategy for improving participant perception, learning outcomes, and practice performance in PMASs.

Este estudo transversal foi realizado por meio de entrevistas com 1000 idosos atendidos em uma Unidade Básica Distrital de Saúde (UBDS) do Sistema Único de Saúde (SUS) no município de Ribeirão Preto. Analisou-se o perfil clínico, socioeconômico e farmacoepidemiológico a fim de identificar os fatores associados à polifarmácia nessa população. Utilizou-se um modelo binomial negativo truncado para análise da associação da polifarmácia com as variáveis independentes do estudo. O software SAS foi utilizado para a análise estatística. O nível de significância adotado foi de 0,05. Os fármacos com maior prevalência de uso foram do sistema cardiovascular (83,4%). Observou-se média de, aproximadamente, sete fármacos por paciente e 47,9% dos entrevistados usavam >7 fármacos. As variáveis que apresentaram associação com a polifarmácia (p< 0,01) foram: mulheres, idade (>75 anos), automedicação, quantidade de problemas de saúde, número de consultas médicas, uso de medicamentos isentos de prescrição médica, uso de psicotrópicos, não realização de exercícios físicos e uso de adoçante. A exposição a todos esses fatores justifica a alta prevalência de polifarmácia entre os entrevistados. Os resultados mostraram a necessidade de adotar medidas de intervenção clínica e educacional e gerencial para analisar e promover a racionalização do uso de fármacos entre os idosos usuários do SUS.

This cross-sectional study was carried out with 1000 elderly outpatients assisted by a Basic Health District Unit (UBDS) from the Brazilian Public Health System (SUS) in the municipality of Ribeirão Preto. We analyzed the clinical, socioeconomic and pharmacoepidemiological profile of the elderly patients in order to identify factors associated with polypharmacy amongst this population. We used a truncated negative binomial model to examine the association of polypharmacy with the independent variables of the study. The software SAS was used for the statistical analysis and the significance level adopted was 0.05. The most prevalent drugs were those for the cardiovascular system (83.4%). There was a mean use of seven drugs per patient and 47.9% of the interviewees used >7 drugs. The variables that showed association with polypharmacy (P value < 0.01) were female gender, age >75 years, self-medication, number of health problems, number of medical appointments, presence of adverse drug events, use of over-the-counter drugs, use of psychotropic drugs, lack of physical exercise and use of sweeteners. The exposition to all these factors justified the high prevalence of polypharmacy amongst the interviewees. These results showed the need to adopt clinical intervention and educational and managerial measures to analyze and promote rationality in the use of drugs amongst the elderly users of SUS.

O objetivo deste trabalho foi verificar a existência de medicamentos potencialmente inapropriados para uso em idosos (PIM), e de alternativas farmacoterapêuticas mais seguras nas listas padronizadas municipais de medicamentos da atenção primária à saúde. Realizou-se estudo transversal, multicêntrico, exploratório, de natureza quantitativa nos 12 municípios que compõem a microrregião de Ourinhos, São Paulo, Brasil no período de maio a julho de 2009. Utilizamos como técnica a consulta a documentos (listas padronizadas municipais de medicamentos). O critério de Beers foi utilizado como ferramenta para classificação dos PIM. Foi encontrada alta prevalência de PIM, representando de 19,6% a 29,6% do número total de medicamentos padronizados nas listas padronizadas municipais Os PIM que atuam no sistema nervoso foram os mais prevalentes, seguidos pelos que atuam no sistema cardiovascular e no sistema músculoesquelético, respectivamente. O número de PIM, constante das listas padronizadas municipais de medicamentos avaliadas, que apresentavam alguma alternativa farmacoterapêutica mais segura entre as especialidades farmacêuticas padronizadas, variou de 50,0% a 84,2% dos PIM, com um valor médio de 73,2%. Esses resultados indicam a necessidade da adoção de estratégias como a implantação de protocolos clínicos para prescrição para idosos, mudanças no ensino médico e acompanhamento multiprofissional dos pacientes idosos, para evitar a prescrição de PIM para esta faixa da população.

This study aims to verify the use potentially inappropriate medication in elderly people (PIM), and of safer pharmacotherapy choices in the municipal standard lists of drugs of the primary health care. A cross-sectional, multicenter, exploratory, quantitative study was conducted in the 12 municipalities that belong to the Ourinhos micro-region, Sao Paulo, Brazil, from May to July 2009. We used as technical consultation of documents (municipal standard lists of drugs). The Beers criteria was used to identify PIM. A high prevalence of PIM was found, with PIM representing 19.6% to 29.6% of the total number of drugs in the municipal standard lists. The PIM that acts in the nervous system were the most prevalent, followed by drugs that act on the cardiovascular system and skeletal muscle system, respectively. The number of PIM presenting safer pharmacotherapy alternatives in the standardized list studied ranged from 50.0% to 84.2% of the PIM, with a mean value of 73.2%. These results indicate the need to adopt strategies as the implementation of clinical protocols for prescription to the elderly, changes in the medic education and multiprofessional follow-up of the elderly patients, to avoid the prescription of PIM to this range of the population.

A retrospective, exploratory, quantitative study was carried in a team of heath care unit (ESF) in the municipalitie of Maringá, Paraná, Brasil, to evaluate the effectiveness of ESF in the treatment of chronic diseases. It was used data collected between May 2006 to September 2009, of 94 patients with hypertension and/or diabetes, through the analysis of the records of registration of the monitoring system of hypertensive and diabetics and charts. It was found a slight increase in the number of individual with blood pressure (p = 0.773) and fasting glucose levels (p = 0.745) considered appropriate, in the reporting period; despite changes in the pharmacotherapy of patients and home care. It was concluded that only changes in the pharmacotherapy prescribed, are insufficient for an adequate control of these diseases, being necessary the development of interventions of the health team, which promote the practice of self-care in individuals and their families.

Estudio retrospectivo, exploratorio, cuantitativo desarollado en un Equipo de Salud de la Familia (ESF) en la ciudad de Maringá, Paraná, Brasil, con lo objetivo de evaluar la eficacia de la ESF en el tratamiento de las enfermedades crónicas. Se utilizaron dados recogidos entre mayo de 2006 y septiembre de 2009, de 94 pacientes con hipertensión arterial y/o diabetes mellitus, mediante el análisis de los registros del sistema de control de hipertensos y diabéticos y registros. Se observó ligero incremento en el número de individuos con presión arterial (p = 0,773) y glucosa en sangre en ayunas (p = 0,745) considerados adecuados, en el periodo analizado; pesar de los cambios en la farmacoterapia y cuidados en el hogar. Se concluye que solamente cambios en la farmacoterapia no son suficientes para un adecuado control destas enfermedades, siendo necesario el desarrollo de intervenciones de la ESF, que promuevan la práctica de autocuidado en las personas y sus familias.

Estudo retrospectivo, exploratório, de natureza quantitativa realizado em uma Equipe de Saúde da Família (ESF) no município de Maringá, Estado do Paraná, Brasil, com o objetivo de avaliar a efetividade da ESF no tratamento de doenças crônico-degenerativas. Foram utilizados dados do período de maio de 2006 a setembro de 2009, de 94 pacientes portadores de hipertensão arterial sistêmica e/ou diabetes mellitus, por meio da análise do sistema de acompanhamento de hipertensos e diabéticos e prontuários. Foi verificado um pequeno aumento no número de indivíduos com valores de pressão arterial (p = 0,773) e glicemia de jejum (p = 0,745) considerados adequados, no período analisado; apesar das mudanças na farmacoterapia destes pacientes e acompanhamento domiciliar. Conclui-se que apenas alterações na farmacoterapia prescrita são insuficientes para o controle adequado destas enfermidades, sendo necessário o desenvolvimento de intervenções da equipe de saúde, que promova a prática do autocuidado nos indivíduos e seus familiares.

Estudo retrospectivo, exploratório, de natureza quantitativa realizado em uma Equipe de Saúde da Família (ESF) no município de Maringá, Estado do Paraná, Brasil, com o objetivo de avaliar a efetividade da ESF no tratamento de doenças crônico-degenerativas. Foram utilizados dados do período de maio de 2006 a setembro de 2009, de 94 pacientes portadores de hipertensão arterial sistêmica e/ou diabetes mellitus, por meio da análise do sistema de acompanhamento de hipertensos e diabéticos e prontuários. Foi verificado um pequeno aumento no número de indivíduos com valores de pressão arterial (p = 0,773) e glicemia de jejum (p = 0,745) considerados adequados, no período analisado; apesar das mudanças na farmacoterapia destes pacientes e acompanhamento domiciliar. Conclui-se que apenas alterações na farmacoterapia prescrita são insuficientes para o controle adequado destas enfermidades, sendo necessário o desenvolvimento de intervenções da equipe de saúde, que promova a prática do autocuidado nos indivíduos e seus familiares.

A retrospective, exploratory, quantitative study was carried in a team of heath care unit (ESF) in the municipalitie of Maringá, Paraná, Brasil, to evaluate the effectiveness of ESF in the treatment of chronic diseases. It was used data collected between May 2006 to September 2009, of 94 patients with hypertension and/or diabetes, through the analysis of the records of registration of the monitoring system of hypertensive and diabetics and charts. It was found a slight increase in the number of individual with blood pressure (p = 0.773) and fasting glucose levels (p = 0.745) considered appropriate, in the reporting period; despite changes in the pharmacotherapy of patients and home care. It was concluded that only changes in the pharmacotherapy prescribed, are insufficient for an adequate control of these diseases, being necessary the development of interventions of the health team, which promote the practice of self-care in individuals and their families.

Estudio retrospectivo, exploratorio, cuantitativo desarollado en un Equipo de Salud de la Familia (ESF) en la ciudad de Maringá, Paraná, Brasil, con lo objetivo de evaluar la eficacia de la ESF en el tratamiento de las enfermedades crónicas. Se utilizaron dados recogidos entre mayo de 2006 y septiembre de 2009, de 94 pacientes con hipertensión arterial y/o diabetes mellitus, mediante el análisis de los registros del sistema de control de hipertensos y diabéticos y registros. Se observó ligero incremento en el número de individuos con presión arterial (p = 0,773) y glucosa en sangre en ayunas (p = 0,745) considerados adecuados, en el periodo analizado; pesar de los cambios en la farmacoterapia y cuidados en el hogar. Se concluye que solamente cambios en la farmacoterapia no son suficientes para un adecuado control destas enfermedades, siendo necesario el desarrollo de intervenciones de la ESF, que promuevan la práctica de autocuidado en las personas y sus familias.