Ciencia & saude coletiva最新文献

This article analyzes the evolution of pharmaceutical policies and services in Brazil, emphasizing the development of the latter and the political disputes and influence networks shaping governance in the sector. Based on an ethnography of documents, the study examines the institutional pathways and decision-making processes involved in the formulation of the National Pharmaceutical Services Policy, tracing its development from the National Medicines Policy. The findings reveal that the proposed model for pharmaceutical services was strongly influenced by social control mechanisms, establishing itself as a key coordinating axis of intersectoral policies. The incorporation of principles such as pharmaceutical care, initially promoted by the Pan American Health Organization, shows the strategic role played by this institution in shaping the policy. This new approach to pharmacotherapeutic care redefined the role of pharmacists, expanding their responsibilities beyond the mere distribution of medicines. The article thus presents innovative conceptual and methodological tools to theorize and analyze the functioning of public policies, offering insights for a critical understanding of the development of pharmaceutical services.

In the intersectoral political context covered by the National Pharmaceutical Policy (Política Nacional de Assistência Farmacêutica - PNAF), the Drug Market Regulation Chamber (Câmara de Regulação do Mercado de Medicamentos - CMED) is responsible for regulating and monitoring the medicines market. To identify medicines with a provisional price in Brazil and those incorporated into the Unified Health System (SUS), and to understand the transition to a definitive price, a case study was conducted based on a documentary analysis of technical-scientific reports on medicines pricing between 2017 and 2023, prepared by CMED, as well as public documents on medicines incorporated into SUS. Twenty-nine medicines by trade name and 95 presentations with provisional prices were identified, five of which were incorporated by SUS. The main reason for establishing a provisional price was that they only had a price in the United States. Four medicines had their provisional price confirmed after being sold in at least three other countries, resulting in a definitive price. Practical and regulatory improvements are being implemented to enhance the completeness of the PNAF's strategic axis related to the regulation and monitoring of the pharmaceutical market.

The present study aims to create a unified relational database (BEM-SUS) to analyze the use of medicines from the assistance program called Specialized Component of Pharmaceutical Assistance (Componente Especializado da Assistência Farmacêutica - CEAF) within the Brazilian National Health System (SUS). It integrates information from different SUS data sources and considers data on CEAF medicines dispensing from 2013 to 2022. The study is based on 5,991 public datafiles from the SUS Outpatient Information System, including data on outpatient production (produção ambulatorial - PA) and APAC Medicines (APAC-M). The PA data contains 239,125,819 records, while the APAC-M data contains 180,692,466 records. APAC-M accounts for 75.6% of the PA records, and PA lacks variables in the APAC-M files. The BEM-SUS was constructed from PA data in addition to APAC-M data. Deterministic linking enabled the matching of 99.96% of the records, resulting in 239,027,991 records from 6,431,208 different users. This study emphasizes the importance of prior data treatment and linkage between available databases for a correct interpretation of the data in drug utilization studies (DUS).

Studies have demonstrated racial selectivity in homicides in Brazil. This study analyzes racial and regional inequalities in homicides using geostatistical techniques and propensity score methods. Clusters of municipalities with high (hot spots) and low (cold spots) homicide rates were identified and, with demographic variables, were used to calculate propensity scores. After matching, Black individuals had a 49% higher likelihood of dying by homicide compared with White individuals. Homicides occurred predominantly among young, single men with low educational attainment. Geostatistical analysis showed that municipalities in hot spot clusters had homicide rates five times higher than in cold spot clusters, with the Northeast region being the most affected. Skin color remained an independent factor associated with homicide, even after adjusting for demographic and spatial variables, underscoring the racial selectivity of homicide in Brazil. This study proposes an integrated approach combining geospatial analysis and propensity score methods to assess social and spatial inequalities of homicides in the country, providing for more equitable allocation of public policy resources to reduce homicides.

This study aimed to characterize the organization of the Specialized Components of Pharmaceutical Care (Componente Especializado da Assistência Farmacêutica - CEAF) in Brazil and to categorize the different strategies as centralized or decentralized, pointing out the limits, challenges, and potentialities for access to medicines. A retrospective quantitative study of CEAF drug dispensing data in 2023 was carried out in the 26 Brazilian states and the Federal District, with a special focus on medicines recommended for the treatment of rheumatoid arthritis (RA). Data were obtained mainly from the High-Cost Procedure Authorization (Autorização de Procedimento de Alto Custo - APAC) system. A set of indicators has been developed. Data from 210,640 users, residents of 5,086 (91%) Brazilian municipalities were analyzed. Dispensation was carried out in 189 municipalities (3.4%). Approximately half of the users of RA medications in the CEAF are in the Southeast, followed by the South and the Northeast, according to the order of demographic density. The CEAF dispensing is essentially centralized, especially in the North and Northeast. The divergences and incompleteness of databases is a problem that needs to be resolved in order to enhance their use in guiding decision-making.

The National Pharmaceutical Policy (PNAF) is consolidated through historical and regulatory milestones that ensured its inclusion in the government agenda. Using Kingdon's multiple streams model, this study describes how Health Conferences, Laws No. 8,080 and No. 8,142 of 1990, the National Medicines Policy, and the First National Conference on Medicines and Pharmaceutical Services led to PNAF's approval by the National Health Council (CNS). The study conducts a documentary analysis of the proposals approved at the 17th National Health Conference, identifying the PNAF's strategic lines, emphasizing social participation. The multiple streams model is used to correlate decisions and issues identified throughout the policy formulation process, highlighting how the PNAF was structured and the influences of civil society. The sustainability of pharmaceutical services in the Unified Health System (SUS) stems from effective social participation, and CNS is the key body for this achievement, ensuring the continuity of pharmaceutical services as a public policy. The approved proposals reflect the commitment to the universalization and improvement of access to essential medicines, which are vital for the health of Brazilians.

The National Pharmaceutical Policy (PNAF) is a significant milestone for pharmaceutical services (PS) within the Unified Health System (SUS). Besides defining PS, the PNAF's strategic lines highlight the need for complementary sectoral policies, research, and development to ensure its effective implementation. In this context, considering the extensive Brazilian scientific production on PS and the role of primary health care (PHC) as the main strategy for access to SUS, this scoping review aims to map the studies published on PS in PHC over the past 20 years, from the perspective of the PNAF's strategic lines. One hundred thirty-four of the 266 articles included addressed the rational use of medicines-RUM, followed by articles on the qualification and maintenance of PS services (72) and access to medicines (25). The promotion of research in PS through agencies and the Ministry of Health and the National Survey on Access and RUM has led to a growing number of publications, especially in the last decade. Producing evidence to inform public policies is essential for planning actions in health services and systems management, as well as for advancing training, practices, and scientific research aligned with the state and needs of PS in Brazil.

Historical, documentary and bibliographical research, adopting the coalition theory as a reference to analyze the sinuosity of the trajectory of the National Health Promotion Policy (PNPS). The time frame covered the period between 1986 and 2023. Among the documents available in official websites and scientific journals, and with the aid of an expert and snowball technique, 31 milestones/events related to the institutionalization, implementation and related movements of the national and international historical context of health promotion were identified. The analysis elucidated PNPS itineraries demarcated into three periods: from 1986 to 2006, the paths of construction of PNPS; from 2006 to 2014, from institutionalization to policy review; and from 2014 to 2023, PNPS implementation movements. The tortuous timeline of the PNPS reveals gaps, slowdowns and advances in the period analyzed. These call for the recognition of the influences of global governance instruments (WHO and UN) and the search for sustainability mechanisms. The counter-hegemonic and complex nature of the PNPS calls for new institutional arrangements to address inequalities. Furthermore, movements are identified to resume coordination with segments and groups of the population.

Little is known about the perception of healthcare professionals working in the management of the Specialized Component of Pharmaceutical Service (Componente Especializado da Assistência Farmacêutica - CEAF) regarding the clearness of the clinical practice guidelines (protocolos clínicos e diretrizes terapêuticas - PCDT) related to the inclusion and exclusion of patients and the discontinuation of medicines. Thus, the present study used a mixed-methods approach, with a quantitative phase to assess the objectivity of the criteria established in the PCDT, published from 2012 to 2022, and a qualitative phase through a focus group with healthcare professionals working in CEAF management. The 36 PCDTs analyzed in our study covered 1,972 criteria, of which 57.1% were objective. The thematic analysis of the focus group discourse indicated that the criteria, due to ambiguity and lack of clarity, have different interpretations, leading to inequality of access and compromising the principles of the SUS, especially equity. Improvements were suggested, including summarized versions of PCDTs, a version for pharmaceutical service management tasks, an additional document presenting the criteria clearly and objectively, exams, and information to verify the criteria.

The National Pharmaceutical Policy (PNAF) originated from social participation, making its role in monitoring and addressing issues related to this policy essential. In this context, this article aims to identify and analyze how the Pharmaceutical Policy (PP) (considering access to medicines and pharmaceutical services) have been addressed and discussed in the Brazilian Health Councils from 2019 to 2021. It was conducted a quantitative and qualitative documentary analysis of documents from all the states (including the Federal District) and municipal councils in the Brazilian capitals. It was identified 806 excerpts referencing the PNAF, of which 186 excerpts were included in the thematic analysis. These excerpts were organized into eight analytical categories, indicating that while PP is a contemporary topic in the councils and gained prominence and qualification during the COVID-19 pandemic, there are still gaps in the discussion, particularly regarding service organization. The development of appropriate tools for monitoring and evaluating the PNAF, ongoing training for council members, and investment in dedicated committees are highlighted as key elements for advancing the role of social participation at all health organization levels.