Objective: To present the results of a pilot study of medical reconciliation performed on admission of onco-haematological patients, implemented in a public hospital in the South of Brazil. Method: This pilot study, descriptive and observational, which was conducted during January to March 2013, included patients admitted in the Hematology and Oncology Unit of Hospital Nossa Senhora da Conceição - Porto Alegre - RS. Patients and their caregivers were interviewed and their prescriptions (home and hospital) reconciled. The differences between the list of drugs that the patient is taking at home and the hospital prescriptions were categorized as intentional or unintentional discrepancies. The therapeutic drug class involved in the discrepancies was classified according to the Anatomical Therapeutic Chemical (ATC) classification. Results: From January to March 2013 were conducted 101 interviews corresponding to 89 patients. Seventeen patients were excluded from the study. The median age of patients enrolled was 55 years (14-84 years). A total of 227 medications were reconciled and identifyed 52.9% of discrepancies, with 83.3% of those, classified as intentional. An average of 1.4 discrepancies and previous use of 2.7 drugs per interview were observed. Twenty discrepancies were categorized as unintentional (17.7%). In 60% of these cases, the prescriber was reported and in 35% of cases the problem was solved, thus avoiding seven medication errors by omission of continuous use drugs. Conclusions: The results of the pilot study demonstrated that the proposed strategy was able to identify a significant percentage of discrepancies (52.9%), approaching the pharmacist of the health care team and reinforcing the importance of the implementation of this routine in the institution. Descriptors: Medication Reconciliation , Medication Errors, Patient Safety.

Resumo O tratamento da aids implica a utilização de diversos medicamentos que compõem a terapia antirretroviral, sendo o controle logístico monitorado por um sistema nacional informatizado de dispensação, o Sistema de Controle Logístico de Medicamentos (SICLOM). O objetivo foi investigar a utilização da terapia antirretroviral de pacientes de dois hospitais universitários no Estado do Rio de Janeiro a partir do SICLOM. Foi realizado um estudo seccional com coleta de dados sociodemográficos e de dispensação, a partir do SICLOM. A avaliação da posse para estimativa de pacientes não aderidos foi realizada através do indicador de proporção de dias cobertos (PDC). Foram incluídos 538 pacientes com cadastro ativo no SICLOM, maiores de 18 anos de ambos os sexos. O ARV mais utilizado em ambos os hospitais foi lamivudina, dentre 58 esquemas diferentes identificados. A maior parte dos pacientes utilizava esquemas classificados como de primeira linha de tratamento. Em média, a proporção de dias cobertos (posse) pelo tratamento foi 88% (± 0,16). A linha de tratamento mostrou associação estatística com a posse, sendo observado melhor PDC 91% (p < 0,001) para os esquemas resgate. Este estudo corroborou o SICLOM como uma boa fonte para conhecimento do perfil de utilização de ARV.

Treatment of AIDS involves the use of the cocktail of drugs that make up the antiretroviral therapy. Its logistic control is monitored by a computerized national system of dispensation, the Logistic Control System of Medication (SICLOM). This study aimed to investigate, by means of SICLOM data, the use of antiretroviral therapy in patients treated at two University Hospitals in the state of Rio de Janeiro. A cross-sectional study was conducted with sociodemographic and dispensation data collected from SICLOM. The evaluation of drug ownership was done by calculating the Proportion of Days Covered (PDC). Five hundred and thirty-eight patients of both genders with active registration in SICLOM and over 18 years of age were included. The ART most used in both hospitals was lamivudine, considering the total of 58 different schemes identified. The mean of possession of groups was 88% (+/- 0,16). The factor associated with possession of drugs was the ART scheme, with PDC of 91% (p<0,001) for rescue schemes. This study confirmed that SICLOM was a reliable source to establish the profile of the population assisted.

Através de estímulos por parte da Organização Mundial de Saúde vem ocorrendo um aumento gradual da inserção das práticas integrativas e complementares (PIC) nos sistemas de saúde. No Brasil, no contexto de implantação do Sistema Único de Saúde (SUS), reforçou-se que a integralidade do cuidado deve incluir práticas assentadas em pressupostos holísticos. Em 2006, foi aprovada a Política Nacional de Práticas Integrativas e Complementares (PNPIC). O presente estudo teve como objetivo descrever e analisar a oferta de PIC no SUS no município do Rio de Janeiro como parte da implementação da PNPIC. Realizou-se levantamento de dados públicos disponíveis nas bases de dados da Secretaria Municipal de Saúde e do Ministério da Saúde (DATASUS). Selecionou-se o período de 2005 a 2016 para a análise, abordando-se o histórico de registros de PIC neste período, bem como os dados de produção de consultas e sessões de PIC, além dos dados disponíveis de planejamento e execução orçamentária para o período selecionado. Houve um aumento de 7 para 592 serviços de PIC registradas, 29% das unidades públicas de saúde municipais oferecem pelo menos um tipo de PIC em 2016, sendo mais prevalente a prática corporal/atividade física. A regularidade da previsão de PIC no planejamento municipal a partir de 2014 parece ter tido impacto positivo no aumento de PIC registradas. Um esforço na regularização desse registro facilitaria a análise da situação e permitiria que se fizessem planejamentos mais precisos para a implementação de PIC, favorecendo a ampliação do acesso a estas práticas.

Pharmaceutical services and the formulation of a medicines policy are SUS areas ensured by the organic health care law 8,080/90. Thus, after a widely participative process, involving stakeholders, the National Medicines Policy (NMP) was approved in 1998 by Ordinance 3,916. The NMP presents directives and priorities, aligned with organic health care law, which should guide the federal, states and municipals entities actions to achieve the policy goals. Considering almost 20 years of the NMP, this paper took stock discussed some of the directives in light of the SUS principles. It was not the objective to provide an exhaustive review of all the activities performed during this period. The authors tried to get close to those that have brought advances and dilemmas, with potential risk of regression. Efforts to implement an ambitious agenda applied to pharmaceutical services were identified. This agenda tried to deal with different challenges like the dynamics of the pharmaceutical market and the operation of pharmaceutical services to guarantee the supply of medicines aligned with principles and directives of SUS.

Resumo A assistência farmacêutica (AF) e a formulação de políticas de medicamentos são campos de atuação do Sistema Único de Saúde (SUS). Assim, em 1998, após um processo participativo, a Política Nacional de Medicamentos (PNM) foi aprovada e publicada em portaria. A PNM traz em seu cerne, baseadas nos princípios e diretrizes do SUS, diretrizes e prioridades para balizar as ações das três esferas de Governo no alcance do objetivo essencial da política. A fim de conduzir o leitor a momentos de reflexão sobre esse período de vida da política, o artigo se propõe a fazer um balanço dos quase 20 anos da PNM, com a discussão de algumas diretrizes específicas à luz de princípios do SUS. Não se pretendeu exaurir todas as atividades do período, mas aproximar se daquelas que se destacaram por apontar avanços e dilemas, com potenciais riscos de retrocessos. Vislumbrou-se esforços de implementação de uma agenda ambiciosa para a AF, que tentou lidar com desafios de enfrentamento do mercado farmacêutico, da operacionalização da AF dentro do SUS. Apesar dos princípios do SUS serem reconhecidos nas diferentes iniciativas, identifica-se também que a operacionalização traz uma série de contradições e riscos que podem comprometer alguns desses princípios.

The current frame of reference on adherence to pharmacotherapy includes a set of behaviors experienced by the user, with observation of the detailed and continuous history of the use of each dose of the medication. Indicators based on pharmacy records have been used to measure adherence. The current review aimed to identify and describe indicators based on pharmacy records and to discuss their adequacy and limitations for measuring adherence. An exploratory literature review was conducted in three databases using the terms "adherence", "pharmacy records/administrative data", and "measure" to compose the descriptors for the selection of 81 articles and the elaboration of a chart with the denomination, sources, methods for calculation, description, and interpretation of the operational and referential meaning of 14 indicators. Given the most recent taxonomy for adherence proposed in the literature, we concluded that the indicators can be useful for identifying patients with medication-seeking behavior-related problems and analysis of persistence. The distance between supply-related events and difficulties in treatment follow-up can influence an analysis based exclusively on the use of these indicators.

The provision of ARVs is central to HIV/AIDS programs, because of its impact on the course of the disease and on quality of life. Although first-line treatments costs have declined, treatment-associated expenses are steeper each year. Sustainability is therefore an important variable for the success of treatment programs. A conceptual framework on sustainability of ARV provision was developed, followed by data collection instruments. The pilot study was undertaken in Brazil. Bolivia, Peru and Mozambique, were visited. Key informants were identified and interviewed. Investigation of sustainability related to ARV provision involved implementation and routinization events of provision schemes. Evidence of greater sustainability potential was observed in Peru, where provision is implemented and routinized by the National HIV/ AIDS program and expenditures met by the government. In Mozambique, provision is dependent on donations and external aid, but the country displays a great effort to incorporate ARV provision and care in routine healthcare activities. Bolivia, in addition to external dependence on financing and management of drug supply, presents problems regarding implementation and routinization. The conceptual framework was useful in recognizing events that influence sustainable ARV provision in these countries.

Brazil has had a National Essential Medicines List (EML) since 1964. From 2000 to 2010, five consecutive evidence-based editions were produced, building on the essential medicine concept. In 2012, the government changed course to establish a new paradigm, introducing adoption of new medicines as the main aim within the recommendation process. The objective of the article was to report efforts to develop Brazil's national EML, policy changes from 2000 to 2014, discussing results, challenges and perspectives. Brazilian EML history and development process were collected from legislation, minutes, reports and legal ordinances, from 2000 to 2014. The Brazilian EML and the WHO Model Lists were compared using the Anatomical Therapeutic Chemical system. Overlap between lists was verified, and linear trends were produced. Type of membership, inclusion criteria, procedures, flow and listed medicines varied greatly between the selection committees acting before and after 2012. Paradigm-changing legislation aiming at linking list compliance to public financing in 2012 produced (i) greater importance given to political and administrative stakeholders, (ii) increasing trends in number of medicines over the years, (iii) decrease in use of WHO Model List as a reference and (iv) substitution of an essential medicines list review and update process by an adoption decision output. Other issues remained unchanged. Insufficient efforts for list implementation, such as lack of physician education, presented consequences to the health system. Substantial efforts were made to produce and update the list from 2000 to 2014. However, continuous and intense health litigation disproves process outcome effectiveness.

ABSTRACT This paper aims to analyze the measurement equivalence aspects (internal consistency and interrater reliability) of a Brazilian version of Martín-Bayarre-Grau (MBG) adherence questionnaire as part of its cross-cultural adaptation. Item-total correlation and Cronbach's alpha coefficients were used as internal consistency estimates. Stability was evaluated through test and retest comparison and expressed through intraclass correlation coefficient (ICC) and kappa with quadratic weighting. ICC for the overall scale was 0.81, indicating an "almost perfect" agreement. However, some cases of "poor" and "slight" agreements were found while analyzing individual items. The translated version of the MBG questionnaire showed good homogeneity (alpha 0.78), higher than cutoff points suggested in the literature. The scale has proved capable of measuring the level of adherence to treatment in hypertensive and/or diabetic patients in a reliable way.

Background: This study aims to rank policy concerns and policy-related research issues in order to identify policy and research gaps on access to medicines (ATM) in low-and middle-income countries in Latin America and the Caribbean (LAC), as perceived by policy makers, researchers, NGO and international organization representatives, as part of a global prioritization exercise.Methods: Data collection, conducted between January and May 2011, involved face-to-face interviews in El Salvador, Colombia, Dominican Republic, and Suriname, and an e-mail survey with key-stakeholders. Respondents were asked to choose the five most relevant criteria for research prioritization and to score policy/research items according to the degree to which they represented current policies, desired policies, current research topics, and/or desired research topics. Mean scores and summary rankings were obtained. Linear regressions were performed to contrast rankings concerning current and desired policies (policy gaps), and current and desired research (research gaps).Results: Relevance, feasibility, and research utilization were the top ranked criteria for prioritizing research. Technical capacity, research and development for new drugs, and responsiveness, were the main policy gaps. Quality assurance, staff technical capacity, price regulation, out-of-pocket payments, and cost containment policies, were the main research gaps. There was high level of coherence between current and desired policies: coefficients of determination (R-2) varied from 0.46 (Health system structure; r = 0.68, P < 0.01) to 0.86 (Sustainable financing; r = 0.93, P < 0.01). There was also high coherence between current and desired research on Rational selection and use of medicines (r = 0.71, P < 0.05, R-2 = 0.51), Pricing/affordability (r = 0.82, P < 0.01, R-2 = 0.67), and Sustainable financing (r = 0.76, P < 0.01, R-2 = 0.58). Coherence was less for Health system structure (r = 0.61, P < 0.01, R-2 = 0.38).Conclusions: This study combines metrics approaches, contributing to priority setting methodology development, with country and regional level stakeholder participation. Stakeholders received feedback with the results, and we hope to have contributed to the discussion and implementation of ATM research and policy priorities in LAC.

Objective. Examine the social determinants that affect population behavior with regard to the search for and acquisition of medicines, and their relationship to exclusion from health services based on aggregate data from three Central American countries: Guatemala, Honduras, and Nicaragua.Methods. A descriptive, observational cross-sectional study was conducted by administration of a household survey. The study sample was selected in accordance with the conglomerate method. Data was analyzed with the SPSS (R) V. 17 program using descriptive statistics, bivariate, multivariate, and principal components analysis (PCA).Results. Although the majority of the persons could access health care, health exclusion (odds ratio [OR] 4.10; 95% confidence interval [95% CI]) was the main determinant of lack of access to medicines. The characteristics of housing (OR 0.747, 95% CI), formal employment of head of the household (OR 0.707, 95% CI), and socioeconomic status of the household (OR 0.462, 95% CI) were also important determinants of lack of access to medicines.Conclusions. The phenomena of lack of access to health services and medicines are not independent from one another. It was corroborated that the health system, as an intermediate social determinant of health, is an important factor for improvement of access to medicines. Public policies that aim to achieve universal coverage should consider this relationship in order to be effective.

OBJETIVO: Examinar los determinantes sociales que afectan la conducta de la poblacion en relacion con la busqueda y obtencion de medicamentos, y su relacion con la exclusion de los servicios de salud para datos agregados de tres paises de America Central: Guatemala, Honduras y Nicaragua. METODOS: Estudio observacional descriptivo de corte transversal, mediante la aplicacion de una encuesta de hogares. La muestra del estudio se selecciono de acuerdo al metodo de conglomerados. Los datos fueron analizados con el programa SPSS® V.17, utilizando estadistica descriptiva y analisis bivariado, multivariado y por componentes principales (ACP). RESULTADOS: Aunque la mayoria de las personas pudo acceder a la atencion en salud, la exclusion en salud (razon de probabilidades [RP] 4,10; intervalo de confianza de 95% [IC95%]) fue el principal determinante de la falta de acceso a los medicamentos. Las caracteristicas de la vivienda (RP 0,747, IC95%), la formalidad del empleo del jefe(a) de hogar (RP 0,707, IC95%) y las condiciones socioeconomicas del hogar (RP 0,462, IC95%) fueron tambien importantes determinantes de la falta de acceso a los medicamentos. CONCLUSIONES: Los fenomenos de la falta de acceso a servicios de salud y a medicamentos no son independientes entre si. Se corroboro que el sistema de salud, como determinante social intermediario de la salud, es un factor importante para la mejora del acceso a medicamentos. Las politicas publicas orientadas a alcanzar la cobertura universal deben contemplar esta relacion para ser eficaces.

OBJETIVO: Descrever etapas da adaptação transcultural de questionário de avaliação de adesão terapêutica em hipertensão arterial, desenvolvido no idioma espanhol, para aplicação ao contexto brasileiro. MÉTODOS: A fim de estabelecer equivalências conceitual, de itens, semântica e operacional, foram realizadas duas traduções para o português de modo independente e duas retraduções para o espanhol. Traduções e retraduções foram avaliadas quanto à alteração nos significados referencial e geral. Realizaram-se duas aplicações de pré-testes com pacientes hipertensos e/ou diabéticos, com a versão síntese, que contribuíram para identificar diferentes problemas e confirmar decisões tomadas. RESULTADOS: A segunda tradução e retradução foram mais bem avaliadas, pois não houve alteração dos significados para cinco dos 12 itens do questionário. Foram feitas alterações operacionais, e uma vinheta com as opções de resposta e um exemplo no enunciado do instrumento facilitaram a aplicação nas entrevistas. CONCLUSÕES: Os resultados obtidos na avaliação das equivalências conceitual, de itens, semântica e operacional permitiram chegar a uma versão em português do questionário MBG para avaliar adesão terapêutica para aplicação no contexto brasileiro.

OBJECTIVE To describe the cross-cultural adaptation of the questionnaire evaluating adhesion to treatment for arterial hypertension from its original Spanish version to a Portuguese version, to be applied in Brazil. METHODS In order to establish conceptual, semantic and operational equivalents of the items, two independent translations to Portuguese, and two back-translations into Spanish were performed. The translations and back-translations were assessed for changes in referential and general meanings. The synthesis of the translations was applied in pre-tests with patients with arterial hypertension and/or diabetes, which were important to identify different problems and confirm earlier decisions. RESULTS In general, the second translation and back translation were evaluated more positively because the translation process did not affect the meanings in five of the twelve items of the questionnaire. Operational changes were made and a vignette with response options and an example included in the instrument facilitated application in interviews. CONCLUSIONS The results obtained in the process of evaluating the items’ conceptual, semantic and operational equivalence allowed the construction of a Portuguese version of the MBG questionnaire to assess adherence to treatment which can be applied in the Brazilian context.

OBJECTIVE: To describe the cross-cultural adaptation of the questionnaire evaluating adhesion to treatment for arterial hypertension from its original Spanish version to a Portuguese version, to be applied in Brazil.METHODS: In order to establish conceptual, semantic and operational equivalents of the items, two independent translations to Portuguese, and two back-translations into Spanish were performed. The translations and back-translations were assessed for changes in referential and general meanings. The synthesis of the translations was applied in pre-tests with patients with arterial hypertension and/or diabetes, which were important to identify different problems and confirm earlier decisions.RESULTS: In general, the second translation and back translation were evaluated more positively because the translation process did not affect the meanings in five of the twelve items of the questionnaire. Operational changes were made and a vignette with response options and an example included in the instrument facilitated application in interviews.CONCLUSIONS: The results obtained in the process of evaluating the items' conceptual, semantic and operational equivalence allowed the construction of a Portuguese version of the MBG questionnaire to assess adherence to treatment which can be applied in the Brazilian context.

Objective: To assess scientific publication and map research gaps on access to medicines (ATM) in Latin American and the Caribbean low-income and middleincome countries (LMIC). Design: Scoping review. Two independent reviewers assessed studies for inclusion and extracted data from each study. Information sources: Search strategies were developed and the following databases were searched: MEDLINE, ISI, SCOPUS and Lilacs, from 2000 to 2010. Eligibility criteria: Research articles and reviews published in English, Spanish and Portuguese were included. Studies including only high-income countries were excluded, as well as those carried out in very limited settings and discussion papers. Results: The 77 articles retained were categorised through consensus among the research team according to the level of the health system addressed, ATM domain and research issues covered. Publications on ATM have increased over time during the study period (r 0.93, p=0.00; R 2 0.85). The top five countries covered were Brazil (68.8%), Mexico (15.6%), Colombia (11.7%), Argentina (10.4%) and Peru (10.4%). ‘Health services delivery’ and ‘patients, household and communities’ were the health system levels most frequently covered. The ATM domains ‘leadership and governance’, ‘sustainable financing, affordability and price of medicines’, ‘medicines selection and use’ and ‘availability of medicines’ were the top four explored. There are research gaps in important areas such as ‘human resources for health’, ‘global policies and human rights’, ‘production of medicines’ and ‘traditional medicine’. Conclusions: The upward trend on scientific publication reflects a growing research capacity in the region, which is concentrated on research teams in selected countries. The gaps on research capacity could be overcome through research collaboration among countries. It is important to strengthen these collaborations, assuring that interests and needs from the LMIC are addressed and local capacity building is promoted.