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Background: Drug dispensing is a service provided by pharmacists to ensure the supply of medications and other health-related products. However, despite the importance of dispensing services, Public Community Pharmacies (PCP) in Brazil still focus on the control and distribution of medicines and supplies. Thus, this paper aims to evaluate how the pharmacists in charge conduct and the challenges they encounter in dispensing services in PCP. Methods: This is a mixed methods study, with a representative sample of 26 municipalities (whose populations vary between 37,784 and 409,341 inhabitants) in the state of Minas Gerais, Brazil. Data collection took place between April and October 2019 and included interviews and documentary research. Quantitative data analysis was carried out using descriptive statistics and qualitative data was subjected to thematic content analysis. Results: 24 dispensing services were analyzed. The PCP had, on average, two active pharmacists and operated full-time (40 h per week). In relation to dispensing services, the most frequently mentioned steps were checking the adequacy of the prescription received, followed by providing counseling to the user about the medicines, mainly regarding administration, storage and disposal. The results highlighted a need for improvements in terms of infrastructure, workforce and the pharmacist's work process. Conclusion: It is necessary to invest and to design improvement strategies in dispensing services, especially regarding physical infrastructure, human resources and work processes. [ABSTRACT FROM AUTHOR]

Background: Essential Medicines Policy (EMP) has been adopted in Brazil to improve the provision and use of pharmaceuticals. This mixed methods study aims to bring evidence of the EMP implemented in municipalities in the context of primary care in Minas Gerais (20,997,560 inhabitants), Southeast Brazil. Methods: We analysed the core output of the EMP, i.e., the municipal essential medicines lists (MEML) and the effects of the policy on the procurement and availability of medicines. Data sources included a sample of 1,019 individuals (patients, health managers and health professionals), 995 prescriptions, 2,365 dispensed medicines and policy documents from 26 municipalities. Data were collected between April and October 2019. Document analysis and thematic content analysis were performed, and four availability indexes were estimated. Results: The findings suggest an overall lack of standardised and methodologically sound procedures to elaborate the MEML. Funding and public purchasing processes were found to be the major obstacles to medicine procurement. Only 63% of medicines were available at public community pharmacies and just 46.2% of patients had full access to their pharmaceutical treatment. Conclusion: This study reveals weaknesses in the implementation of EMP and a clear disconnection between medicines selection, procurement, and availability, the three core elements of the supply system. These findings contribute to informing future policy improvement actions to strengthen this system. Other countries aiming to advance towards universal health coverage may learn from the challenges that primary care in Brazil still needs to address. [ABSTRACT FROM AUTHOR]

Background: In 2016, the Brazilian state of Minas Gerais (~20 million people), implemented the ERAF policy ("Regionalization Strategy of Pharmaceutical Services") in an effort to improve medicine procurement and distribution within primary care. We evaluated the impact of the policy on three main goals: price reductions, volume increases, and expansion of therapeutic options. Methods: We analyzed the procurement data from the Integrated System of Management of Pharmaceutical Services database in 2012 and 2018. We estimated the volume, drug mix, and expenditure indicators for all major therapeutic classes, and, in detail, for cardiovascular and nervous system drugs. We evaluated the expenditure drivers using decomposition analyses. Results: Overall, the expenditure increased by 14.5%, drug mix almost doubled, while the volume decreased by a third. Cardiovascular and neurological system drugs followed similar patterns. Decomposition analyses showed that prices and drug mix had positive effects while the volume had negative effects, resulting in an overall increase in expenditure. Conclusion: Our findings suggest that the ERAF policy cannot be considered effective as it has not fulfilled its intended purposes so far. Strategies to address the identified problems and to build a platform for a more sustainable longlasting policy should be put in place by the government. [ABSTRACT FROM AUTHOR]

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Background: Antibacterials for systemic use are widely used and public spending on these drugs has increased considerably. Objective: To evaluate the expenditures with Antibacterials for systemic use and its drivers in the state of Minas Gerais, between 2010 and 2015. Method: Longitudinal Drug Utilization Study, based on data from the public administration database SIAD-MG. Total expenditures and volumes were estimated per year and per therapeutic subgroup. Drug Cost 90% method was used to identify antibacterials responsible for the highest expenditure. Decomposition analysis was used to evaluate the determinants of expenditures (price, volume, or drug mix). Results: There was a reduction in expenditure (22.2%) and in volume (25.5%) from 2010 to 2015. Penicillins corresponded to 42% of the total volume. Amoxicillin plain or in combination was responsible for consuming more than one-third of the budget. The reduction in expenditure between 2010 and 2015 was mainly determined by the reduction in volume (25%) and prices (5%). Conclusion: Volume reduction in the period may harm population coverage. The investment in broad-spectrum agents, drugs considered the second line of treatment, or with little clinical evidence raises the need to create universal clinical protocols that guide the appropriate prescription. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and factors associated with herbal medicinal product use among primary healthcare patients in southeastern Brazil., Methods: A cross-sectional study combined with documentary research was conducted between August and November 2017, involving interviews with 1,221 adults following dispensing from primary healthcare units. The characterization of herbal medicinal product usage included assessing the prevalence, redundancy, and interaction indicators, as well as identifying sources of recommendation and acquisition. Descriptive statistics were used for variable analysis and logistic regression was used to estimate the factors associated with herbal medicinal product usage, calculating odds ratios at a significance level of 5%., Results: The prevalence of herbal medicinal product usage was 3.8%, with 60% of them prescribed by physicians. Private pharmacies (53%) were the main sources, and Valeriana officinalis (42%) was the most cited plant species and the sole herbal medicinal product on the municipal list. The indicators of redundancy and interactions between concurrently prescribed pharmaceutical and herbal medicinal products were 42.9% and 28.6%, respectively. Herbal medicinal products usage correlated with the female sex (OR= 2.50; 95%CI= 1.11-5.59), non-white race (OR= 0.52; 95%CI= 0.28-0.94), monthly income above 1 minimum wage (OR= 3.48; 95%CI= 1.51-8.01), and self-reported of anxiety, mood disorder or depression (OR= 2.97; 95%CI= 1.55-5.66)., Conclusion: Despite the low use of herbal medicinal products, users face a high potential for interactions and therapeutic redundancy. Special attention should be paid to patients taking herbal medicinal products and allopathic medicines concurrently. Women with anxiety, mood disorders, or depression were more likely to use herbal medicinal products, whereas non-white people were 48% less likely to use them, suggesting potential socioeconomic disparities in access.

This is a cross-sectional study on the availability of prescribed medicines in Primary Health Care (PHC), with a probabilistic sample of 1,221 users of public pharmacies in a health pole municipality in Minas Gerais, in 2017. Medicine availability indicators were estimated, and a hierarchical logistic regression was performed, according to the behavioral model of health service use. Only 39.3% of patients received all medicines in the prescribed quantities. The most and the least available medicines were, respectively, those for the digestive system/metabolism, and for blood and hematopoietic organs. Full availability of the prescribed treatment was associated with higher schooling (≥ 8 years OR: 1.7; 95% CI: 1.3-2.4); proximity to the pharmacy (≤15 min OR: 1.7; 95% CI: 1.2-2.3); absence of out-of-pocket expenditure on medicines (OR: 2.2; 95% CI: 1.7-2.9), and a smaller number of prescription drugs (≤ 2 OR: 3.2; 95% CI: 2.3-4.4; 3/4 OR: 1.6; 95% CI: 1.2-2.1). These results showed differences in medicine availability within the Brazilian Unified Health System (SUS), and highlighted the need to reorganize the dispensing services network and pharmaceutical procurement planning, as well as to develop public policies to protect the vulnerable population.