DEFAR - Departamento de Farmácia

URI permanente desta comunidadehttp://www.hml.repositorio.ufop.br/handle/123456789/530

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Inteligência regulatória de tecnologias de saúde na Grécia.
(2022) Barbosa, Mariana Michel; Zampirolli, Carolina Dias; Zuppo, Isabella de Figueiredo; Nascimento, Renata Cristina Rezende Macedo do; Kritikou, Persefoni; Acúrcio, Francisco de Assis; Teodoro, Juliana Alvares
A Grécia possui um sistema de saúde público e universal, o Serviço Nacional de Saúde (ESY), com cobertura de seguro obrigatório (IKA) para todos os trabalhadores (empregados ou autônomos). Além disso, os individuos podem ter, voluntariamente, seguro privado. A EOPYY (Organização nacional para provisão de serviços de saúde), a única responsável pela aquisição de serviços de saúde financiados por recursos públicos baseados nas contribuições do Fundo Nacional de Seguridade Social (EFKA) e do orçamento estadual. Há um número limitado de medicamentos fornecidos exclusivamente pelo sistema público de saúde, gratuitamente (farmácias EOPYY), como os medicamentos de alto custo. Além desses, a população pode comprar qualquer medicamento que deseje. National Organization for Medicines (EOF) é a autoridade regulatória e responsável também pela farmacovigilância de medicamentos, produtos médicos, de beleza e medicamentos veterinários. Em 2011, os processos de precificação e reembolso foram separados, sendo que a precificação ocorre após a autorização de comercialização, em seguida, é permitida a análise para reembolso pelo seguro social de saúde com a inclusão numa lista positiva. A precificação de novos produtos farmacêuticos segue um sistema de referenciamento externo de preços, onde o preço de fábrica máximo para medicamentos sob patente é definido pela média dos três menores preços para o mesmo medicamento nos países da União Européia (UE), sendo essa mesma regra aplicada para medicamentos biológicos e biossimilares. Medicamentos genéricos são precificados pela média dos três menores preços praticados na UE ou pela redução em 50% do preço em relação ao período em que o medicamento estava sob patente. Assim, os preços máximos dos medicamentos genéricos são fixados em 65% do preço do respectivo produto de referência. Em 2018, a Avaliação de Tecnologias em Saúde (ATS) foi introduzida no país para avaliar medicamentos e emitir recomendações ao Ministério da Saúde sobre a inclusão ou remoção de produtos da Lista Positiva. Como o processo de ATS ainda está sendo implementado, acredita-se que nos próximos anos, o país terá a oportunidade de aprimorar a implementação dessas técnicas, tendo como um dos grandes desafios a vinculação dos resultados das ATS com as orientações clínicas.
Polypharmacy among adult and older adult users of primary care services delivered through the Unified Health System in Minas Gerais, Brazil.
(2020) Moreira, Thais; Teodoro, Juliana Alvares; Barbosa, Mariana Michel; Nascimento, Renata Cristina Rezende Macedo do; Guerra Júnior, Augusto Afonso; Acúrcio, Francisco de Assis
Objectives: To estimate the prevalence of polypharmacy (≥5 drugs) among adults and to analyze related factors. Methods: Cross-sectional study with 1,159 interviewees distributed across 104 cities and 253 primary healthcare services delivered through the Brazilian Unified Health System. Polypharmacy-related factors were identified using logistic regression model. Results: 949 (81.8%) interviewees were using at least one medication and were included in this analysis. The prevalence of polypharmacy among them was 13.7% (95%CI:11.7–16.0%) in the general population and 33.3%(95%CI:26.1–41.4%) in older adults(≥65 years). Polypharmacy was positively associated with age (45 to 64 years, OR=2.02; 95%CI:1.03–3.94; ≥65 years, OR=4.17; 95%CI:1.92–9.17) and the following chronic diseases: stroke (OR=4.20; 95%CI:1.53–11.55); diabetes mellitus (OR=4.03; 95%CI:2.43–6.68); heart disease (OR=3.18; 95%CI:1.92–5.29); depression (OR=2.85; 95%CI:1.80–4.53); hypertension (OR=2.13; 95%CI:1.17–3.86); and dyslipidemia (OR=1.73; 95%CI:1.07–2.80). Conclusion: This study revealed that polypharmacy is a real concern in primary health care and affects older and middle-aged adults alike. Groups of patients that are more likely to experience polypharmacy were identified. Our findings emphasize the relevance of an appropriate approach to polypharmacy driven by aging and multimorbidity.
Real-world evaluation of the impact of statin intensity on adherence and persistence to therapy : a Scottish population-based study.
(2020) Nascimento, Renata Cristina Rezende Macedo do; Mueller, Tanja; Godman, Brian; Stewart, Sean MacBride; Hurding, Simon; Acúrcio, Francisco de Assis; Guerra Júnior, Augusto Afonso; Teodoro, Juliana Alvares; Morton, Alec; Bennie, Marion; Kurdi, Amanj Baker
Aim: To assess associations between statin intensity and adherence, persistence and discontinuation of statin therapy in Scotland. Method: Retrospective cohort study, using linked electronic health records covering a period from January 2009 to December 2016. The study cohort included adult patients (≥18 years) newly initiating statins within Greater Glasgow and Clyde, Scot land. Study outcomes comprised adherence, discontinuation and persistence to treat ment, stratified by three exposure groups (high, moderate and low intensity). Discontinuation and persistence were calculated using the refill-gap and anniversary methods, respectively. Proportion of days covered (PDC) was used as a proxy for adherence. Kaplan-Meier survival curves and Cox proportional hazard models were used to evaluate discontinuation, and associations between adherence/persistence and statin intensity were assessed using logistic regression. Results: A total of 73 716 patients with a mean age of 61.4 ± 12.6 years were included; the majority (88.3%) received moderate intensity statins. Discontinuation rates differed between intensity levels, with high-intensity patients less likely to dis continue treatment compared to those on moderate intensity (prior cardiovascular disease [CVD]: HR 0.43 [95% CI 0.34-0.55]; no prior CVD: 0.80 [0.74-0.86]). Persis tence declined over time, and high-intensity patients had the highest persistence rates. Overall, 52.6% of patients were adherent to treatment (PDC ≥ 80%), but adher ence was considerably higher among high-intensity patients (63.7%). Conclusion: High-intensity statins were associated with better persistence and adherence to treatment, but overall long-term persistence and adherence remain a challenge, particularly among patients without prior CVD. This needs addressing.
Statin use in Brazil : findings and implications.
(2018) Nascimento, Renata Cristina Rezende Macedo do; Guerra Júnior, Augusto Afonso; Teodoro, Juliana Alvares; Gomes, I. C.; Godman, Brian; Bennie, Marion; Kurdi, Amanj Baker; Acúrcio, Francisco de Assis
Introduction and objectives: Stains have become an integral part of treatment to reduce cardiac events in patients with cardiovascular disease. However, their use within the public healthcare system in Brazil is unknown. Consequently, we sought to determine and characterize statin use in primary healthcare delivered by the public health system (SUS) in Brazil and evaluate associated patient factors to improve future use. Methods: Cross-sectional study with a national representative sample from five Brazilian regions, derived from the National Survey on Access, Use and Promotion of Rational Use of Medicines using a multi-stage complex sampling plan. Patients over 18 years old were interviewed from July/2014 to May/2015. Prevalence of statin use and statins’ self-reported adherence were determined amongst medicine users. The association between statin use and sociodemographic/health condition variables were assessed using logistic regression. Results: 8,803 patients were interviewed; of which, 6,511 were medicines users. The prevalence of statins use was 9.4% with simvastatin (90.3%), atorvastatin (4.7%) and rosuvastatin (1.9%) the most used statins. Poor adherence was described by 6.5% of patients. Statins use was significantly associated with age ≥65 years old, higher educational level, residence in the South, metabolic and heart diseases, alcohol consumption and polypharmacy. Conclusions: This is the first population based study in Brazil to assess statin use in SUS primary healthcare patients. Addressing inequalities in access and use of medicines including statins is an important step in achieving the full benefit of statins in Brazil, with the findings guiding future research and policies.