Community pharmacies and pharmacists in Brazil: A missed opportunity

Keywords: Pharmacies, Primary Health Care, Delivery of Health Care, Integrated, Ambulatory Care, Community Health Services, Pharmacists, Community Pharmacy Services, Professional Practice, Brazil

Abstract

The Brazilian National Health System (BR-NHS) is one of the largest public health systems in the world. In 2019 Brazil had 114,352 community pharmacies (76.8% private owned), that represent the first point of access to healthcare in Brazil due to their wide distribution. Unfortunately, from the government's point of view, the main expected activity of private and public community pharmacies is related to dispensing medicines and other health products. Public community pharmacies can be part of a healthcare center or be in a separate location, sometimes without the presence of a pharmacist. Pharmacists working in these separated locations do not have access to patients’ medical records, and they have difficulty in accessing other members of the patient care team. Pharmacists working in public pharmacies located in healthcare centers may have access to patients’ medical records, but pharmacy activities are frequently under other professional’s supervision (e.g., nurses). Private pharmacies are usually open 24/7 with the presence of a pharmacist for 8 hours on business days. Private community pharmacies have a very limited integration in the BR-NHS and pharmacists are the third largest healthcare workforce in Brazil with more than 221,000 registered in the Brazilian Federal Pharmacist Association [CFF - Conselho Federal de Farmácia]. A University degree in pharmacy is the only requirement to entry into the profession, without any proficiency exam for maintenance or career progression. The Brazilian pharmacist's annual income is ranked as the 2nd better-paid profession with an annual average income of EUR 5,502.37 (in 2020). Description of clinical activities for pharmacies by the CFF increased in the recent years, however there is still a long way to effectively implement them into practice.

Downloads

Download data is not yet available.

References

World Health Organization. Countries: Brazil. 2020. http://who.int/countries/bra/en/ (accessed Mar 8, 2020).

Souza LG, Siviero PCL. Sex differentials in avoidable mortality and potential life expectancy gains in São Paulo, SP, Brazil: a cross-sectional study of the period 2014-2016. Epidemiol Serv Saude. 2020;29(3):e2018451. https://doi.org/10.5123/s1679-49742020000300004

World Bank Data. Mortality rate, under-5 (per 1,000 live births). https://apps.who.int/gho/data/node.home (accessed July 17, 2020).

Secretaria de Vigilância em Saúde. Health Analysis and surveillance of non-communicable diseases. Available at: http://svs.aids.gov.br/dantps/centrais-de-conteudos/paineis-de-monitoramento/mortalidade/cid10/ (accessed July 17, 2020).

Brasil. [Lei Nº 8.080, de 19 de Setembro de 1990: Provides for the conditions for the promotion, protection, and recovery of health, the organization and functioning of the corresponding services and provides other measures]. http://www.planalto.gov.br/ccivil_03/leis/L8080.htm (accessed Jul 09, 2020).

Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011;377(9779):1778-1797. https://doi.org/10.1016/s0140-6736(11)60054-8

Dantas AV. Health and class struggle: determining what to do and how to do it. Saúde e luta de classes: em busca do que e como fazer. Cien Saude Colet. 2018;23(6):1715-1716. https://doi.org/10.1590/1413-81232018236.05692018

Departamento de Informática do SUS. [National register of health establishments. establishments by type]. http://tabnet.datasus.gov.br/cgi/deftohtm.exe?cnes/cnv/estabbr.def (accessed Jul 9, 2020).

Campos GWS. Future prospects for the SUS. SUS: o que e como fazer?. Cien Saude Colet. 2018;23(6):1707-1714. https://doi.org/10.1590/1413-81232018236.05582018

Departamento de Informática do SUS. [Outpatient SUS production: Brazil]. http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sia/cnv/qauf.def (accessed Jun 7, 2020).

Departamento de Informática do SUS. [Human resources - occupations - according to CBO 2002 – Brazil]. http://tabnet.datasus.gov.br/cgi/tabcgi.exe?cnes/cnv/proc02br.def (accessed Jun 7, 2020).

Federação Brasileira de Hospitais. [Report on the situation of private hospitals in Brazil]. http://cnsaude.org.br/wp-content/uploads/2019/05/CenarioDosHospitaisNoBrasil2019CNSaudeFBH.pdf (accessed Jul 09, 2020).

Conselho Nacional de Secretários de Saúde. [The Social Construction Of Primary Health Care. Brasília: 2017]. https://www.conass.org.br/biblioteca/a-construcao-social-da-atencao-primaria-a-saude-2a-edicao/ (accessed Set 17, 2020).

Conselho Nacional de Secretários de Saúde. [Primary Care and Health Care Networks. Brasília: 2015. https://www.conass.org.br/biblioteca/pdf/A-Atencao-Primaria-e-as-Redes-de-Atencao-a-Saude.pdf (accessed Set 17, 2020).

Mendes EV. As redes de atenção à saúde [Health care networks]. Cien Saude Colet. 2010;15(5):2297-2305. https://doi.org/10.1590/s1413-81232010000500005

Gabinete da Presidência. [Lei 5.991, de 17 de dezembro de 1973: Provides for the sanitary control of the trade in drugs, medicines, pharmaceutical inputs and related products, and provides other measures]. http://www.planalto.gov.br/ccivil_03/leis/l5991.htm (accessed Jun 7, 2020).

Gabinete da Presidência. [Decreto no 85.878, de 7 de abril de 1981. Establishes rules for the implementation of Law No. 3,820, of November 11, 1960, on the exercise of the profession of pharmacist, and provides other measures] http://www.planalto.gov.br/ccivil_03/decreto/Antigos/D85878.htm (accessed Jul 21, 2020).

Ministério da Saúde. [Portaria nº 344, de 12 de maio de 1998: Approves the Technical Regulation on substances and drugs subject to special control]. http://bvsms.saude.gov.br/bvs/saudelegis/svs/1998/prt0344_12_05_1998_rep.html (accessed Jul 21, 2020).

Agência Nacional de Vigilância Sanitária. [Resolução de Diretoria Colegiada n.º 20, de 05 de maio de 2011: Provides for the control of drugs based on substances classified as antimicrobials, for use under prescription, alone or in combination]. http://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2011/rdc0020_05_05_2011.html (accessed Jul 21, 2020).

Conselho Federal de Farmácia. [Resolução CFF n.º 499, de 17 de dezembro de 2008: Provides for the provision of pharmaceutical services, in pharmacies and drugstores, and makes other arrangements]. https://www.cff.org.br/userfiles/20%20-%20BRASIL_%20CONSELHO%20FEDERAL%20DE%20FARM%C3%81CIA_%202009%20Resolucao_499_2008_CFF.pdf (accessed Jul 25, 2020).

Conselho Federal de Farmácia. [Resolução CFF n.º 505, de 23 de junho de 2009: Repeals Articles 2 and 34 and gives new wording to articles 1, 10, 11, single paragraph, as well as Chapter III and Annexes I and II of the Resolution No. 499/08 of the Federal Council of Pharmacy]. http://www.crf-rj.org.br/arquivos/fiscalizacao/resolucoes/ResolucaoCFF505.pdf (accessed Mar 4, 2020).

Conselho Federal de Farmácia. [Resolução CFF n.º 578, de 26 de julho de 2013: Regulates technical-managerial duties of the pharmacist in the management of pharmaceutical management within the scope of the National Health System (SUS)]. https://www.cff.org.br/userfiles/file/resolucoes/578.pdf (accessed Mar 4, 2020).

Conselho Federal de Farmácia. [Resolução nº 585 de 29 de Agosto de 2013: Regulates clinical assignments pharmacist and makes other arrangements]. https://www.cff.org.br/userfiles/file/resolucoes/585.pdf (accessed Jul 25, 2020).

Conselho Federal de Farmácia. [Resolução nº 586 de 29 de Agosto de 2013: Regulates pharmaceutical prescription and gives other provisions]. https://www.cff.org.br/userfiles/file/noticias/Resolu%C3%A7%C3%A3o586_13 (accessed Jul 25, 2020).

Gabinete da Presidência. [Lei n.º 13.021, de 08 de agosto de 2014: Provides for the exercise and inspection of pharmaceutical activities]. http://www.planalto.gov.br/ccivil_03/_Ato2011-2014/2014/Lei/L13021.htm#:~:text=Disp%C3%B5e%20sobre%20o%20exerc%C3%ADcio%20e%20a%20fiscaliza%C3%A7%C3%A3o%20das%20atividades%20farmac%C3%AAuticas.&text=Art.,de%20direito%20p%C3%BAblico%20ou%20privado (accessed Marc 04, 2020).

- Agência Nacional de Vigilância Sanitária. [Resolução de Diretoria Colegiada n.º 197, de 26 de dezembro de 2017: Provides for the minimum requirements for the operation of human vaccination services]. http://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2017/rdc0197_26_12_2017.pdf (accessed Jul 21, 2020).

Conselho Federal de Farmácia. [Resolução CFF n.º 654, de 22 de fevereiro de 2018: Provides for the requirements necessary for the provision of the vaccination by the pharmacist and gives other providence]. http://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=27/02/2018&jornal=515&pagina=78&totalArquivos=86 (accessed Jul 25, 2020).

Conselho Federal de Farmácia. [Resolução CFF n.º 661, de 25 de outubro de 2018: Provides for pharmaceutical care related to food supplements and other food categories at community pharmacy, pharmacist's office and commercial food establishments and gives other provisions ]. https://www.poderesaude.com.br/novosite/images/Oficial_-_31.10.18_-_XV.pdf (accessed Jul 25, 2020).

Agência Nacional de Vigilância Sanitária. [Resolução de Diretoria Colegiada n.º 327, de 09 de dezembro de 2019: Provides for procedures for the granting of Sanitary Authorization for manufacture and import, as well as establishes requirements for marketing, prescription, dispensing, monitoring and the inspection of Cannabis products for medicinal purposes, and makes other arrangements]. http://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2019/rdc0327_09_12_2019.pdf (accessed Jul 21, 2020).

Conselho Federal de Farmácia. [Resolução CFF n.º 680, de 20 de fevreiro de 2020: Regulates the role of the Pharmacist in Cannabis-based medicines and products]. http://www.in.gov.br/en/web/dou/-/resolucao-n-680-de-20-fevereiro-de-2020-244862974 (accessed Jul 25, 2020).

Gabinete da Presidência. [Decreto no 85.878, de 7 de abril de 1981. Establishes rules for the implementation of Law No. 3,820, of November 11, 1960, on the exercise of the profession of pharmacist, and provides other measures]. http://www.planalto.gov.br/ccivil_03/decreto/Antigos/D85878.htm (accessed Jul 21, 2020).

Barberato LC, Scherer MDDA, Lacourt RMC. The pharmacist in the Brazilian Primary Health Care: insertion under construction. Cien Saude Colet. 2019;24(10):3717-3726. https://doi.org/10.1590/1413-812320182410.30772017

Ministério da Saúde. [Portaria de Consolidação GM/MS nº 02 de 28 de setembro de 2017]. http://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prc0002_03_10_2017.html (accessed Jul 20, 2020).

Ministério da Saúde. [Portaria de Consolidação nº 06 de 28 de setembro de 2017]. http://svs.aids.gov.br/dantps/cgiae/vigilancia-do-obito/servico-verificacao-obito/portaria-consolidacao-6-28092017.pdf (accessed Jun 07, 2020).

Ministério da Saúde. Strategic Component of Pharmaceutical Assistance (CESAF). https://www.saude.gov.br/assistencia-farmaceutica/medicamentos-rename/cesaf (accessed Jul 20, 2020).

Ministério da Saúde. [Portaria de Consolidação nº 1.554, de 30 de julho de 2013]. http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt1554_30_07_2013.html (accessed Jun 07, 2020).

Ministério da Saúde. Secretaria de Atenção à Saúde. Portfolio of Services Primary Health Care (casaps) Ministry of Health – brazil: Professional Version of Health and Managers. http://189.28.128.100/dab/docs/portaldab/documentos/casaps_versao_profissionais_saude_gestores_completa.pdf (accessed Set 9, 2020).

Melo AC, Resende KA, Queiroz NS, Bezerra VS. Is the reduction of codes of pharmaceutical procedures a concern of society? Rev Bras Farm Hosp Serv Saude. 2019; 10(4):535. https://doi.org/10.30968/rbfhss.2019.104.0535

Brasil. [Portfolio of services in primary helahtcare: version for healthcare professionals and managers]. https://aps.saude.gov.br/biblioteca/visualizar/MTQ1MQ (accessed Set 9, 2020).

Ministério da Saúde. [Results of the project for implementation of pharmaceutical care in Curitiba municipality]. http://bvsms.saude.gov.br/bvs/publicacoes/resultado_projeto_implantacao_cuidados_farmaceuticos.pdf (accessed Set 9, 2020).

Secretária de Estado da Saúde. [Minas Pharmacy Network]. https://www.saude.mg.gov.br/component/gmg/page/351-rede-farmacia-de-minas-sesmg (accessed Jan 7, 2021).

Garcia MM, Guerra AA Júnior, Acúrcio FA. Economic evaluation of the Programs Rede Farmácia de Minas do SUS versus Farmácia Popular do Brasil. Cien Saude Colet. 2017;22(1):221-233. https://doi.org/10.1590/1413-81232017221.15912015

Souza AF, da Silva MR, dos Santos JB, Almeida AM, Acurcio FA, Alvares-Teodoro J. Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study. Pharm Pract (Granada). 2021;19(2):2312. https://doi.org/10.18549/PharmPract.2021.2.2312

Ministério Da Saúde. [Booklet 1: Pharmaceutical services in primary health care]. https://bvsms.saude.gov.br/bvs/publicacoes/servicos_farmaceuticos_atencao_basica_saude.pdf (accessed Mar 14, 2021).

Ministério Da Saúde. [Booklet 2: Training for the implementation of clinical pharmacy services]. http://bvsms.saude.gov.br/bvs/publicacoes/cuidado_farmaceutico_atencao_basica_saude_2.pdf (accessed Mar 14, 2021).

Ministério Da Saúde. [Booklet 3: Planing and implementation of pharmaceutical care in primari care: the Curitiba experioence]. http://bvsms.saude.gov.br/bvs/publicacoes/cuidado_farmaceutico_atencao_basica_saude_3.pdf (accessed Mar 14, 2021).

Ministério Da Saúde. [Booklet 4: Results of the propject for implementation of pharmaceutical care in the Curitiba municipality]. http://bvsms.saude.gov.br/bvs/publicacoes/cuidado_farmaceutico_atencao_basica_saude_4_1ed.pdf (accessed Mar 14, 2021).

Rossignoli P, Pontarolli D, Corrêa LG, Germano LJ, Pontarolo R, Fernandez-Llimos F. Innovating in clinical pharmacy services at the specialized component of pharmaceutical management in the state of Paraná. Rev Saude Públ Parana. 2019;2(1):125-139. https://doi.org/10.32811/25954482-2019v2n1p125

Germano JL, Reis-Pardal J, Tonin FS, Pontarolo R, Melchiors AC, Fernandez-Llimos F. Prevalence of rheumatoid arthritis in South-America: a systematic review and meta-analysis. Cienc Saude Colectiva. 2021 [in press].

Pontarolli D, Nunes MS, Rossignoli P, Limberger PM, Fernandez-Llimos F. Estratégia da SES/PR perante a incorporação de biossimilar de Etanercepte 50 mg no CEAF. Curitiba: SES-PR; 2019. ISBN: 978-85-66800-22-7.

Conselho Federal de Farmácia. [Pharmacists’ succesfull experiences in the SUS]. http://cff.org.br/userfiles/Experiências%20Exitosas%202019.pdf (accessed Mar 14, 2021).

Ministério da Saúde. [People’s pharmacy]. http://www.saude.gov.br/acoes-e-programas/farmacia-popular (accessed Jul 20, 2020).

Santos Vd, Nitrini SM. [Prescription and patient-care indicators in healthcare services]. Rev Saude Publica. 2004;38(6):819-826. https://doi.org/10.1590/s0034-89102004000600010

Conselho Federal de Farmácia. [Boletins: 2018 data]. https://www.cff.org.br/pagina.php?id=801&titulo=Boletins (accessed Jul 17, 2020).

Secretaria da Previdência e Trabalho do Ministério da Economia. [General register of employees and unemployed. https://www.salario.com.br/profissao/farmaceutico-cbo-223405/ (accessed Jul 20, 2020).

Gabinete da Presidência. [Lei n.º 3.820, de 11 de novembro de 1960: Creates the Federal Council and the Regional Pharmacy Councils, and makes other arrangements]. http://www.planalto.gov.br/ccivil_03/leis/L3820.htm (accessed Jul 21, 2020).

Brasil. [Constituição da República Federativa do Brasil de 1988: Constitution of the Federative Republic of Brazil]. http://www.planalto.gov.br/ccivil_03/constituicao/constituicao.htm (accessed Jul 17, 2020).

Conselho Federal de Farmácia. [Pharmaceutical services directly aimed at the patient, family and community contextualization and conceptual framework]. Brasília;CFF;2016. ISBN 978-85-89924-20-7.

Published
2021-06-22
How to Cite
1.
Melo AC, Trindade GM, Freitas AR, Resende KA, Palhano TJ. Community pharmacies and pharmacists in Brazil: A missed opportunity. Pharm Pract (Granada) [Internet]. 2021Jun.22 [cited 2021Jul.30];19(2):2467. Available from: https://www.pharmacypractice.org/journal/index.php/pp/article/view/2467
Section
International Series

Most read articles by the same author(s)