The perspective of graduates and other stakeholders on a training on pharmaceutical services in primary health care

Dóczy, Andréa de Paiva; Santos, Gideon Borges dos; Luiza, Vera Lucia; Silva, Rondineli Mendes da

doi:10.1590/interface.230396

Andréa de Paiva Dóczy apdoczy@gmail.com

Programa de Pós-Graduação em Saúde Pública, Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Fundação Oswaldo Cruz(Fiocruz). Rua Leopoldo Bulhões, 1480, Manguinhos. Rio de Janeiro, RJ, Brasil. 21041-210.

http://orcid.org/0000-0002-4511-4840

Gideon Borges dos Santos gideon.borges@fiocruz.br

Centro de Estudos da Saúde do Trabalhador e Ecologia Humana, ENSP, Fiocruz. Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0003-1179-9404

Vera Lucia Luiza vera.luiza@fiocruz.br

Departamento de Política de Medicamentos e Assistência Farmacêutica, ENSP, Fiocruz. Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0001-6245-7522

Rondineli Mendes da Silva rondineli.mendes@fiocruz.br

Departamento de Política de Medicamentos e Assistência Farmacêutica, ENSP, Fiocruz. Rio de Janeiro, RJ, Brasil.

http://orcid.org/0000-0002-6243-5179

apdoczy@gmail.com

gideon.borges@fiocruz.br

vera.luiza@fiocruz.br

rondineli.mendes@fiocruz.br

Authors’ contribution

All authors actively participated in all stages of preparing the manuscript.

Conflict of interest

The authors have no conflict of interest to declare.

Editor

Roseli Esquerdo Lopes

Associated editor

Flávio Adriano Borges

Modules	Competencies	Topics	Time (hours)
1. National Policy for Primary Care (PNAB)	• Knowledge of the core aspects of PNAB	• General knowledge of the organization of SUS and the pact for health • PHC, territorialization and the operational proposal in the municipality • Health-disease process and its determinants • Health promotion and prevention	12
2. Planning and management	• Knowledge of their role in teamwork and knowing how to stimulate teamwork • Motivation to be a leader and skills to make decisions, be communicative, have empathy and ethics • Ability to plan	• Management tools • Leadership • Teamwork • Consensus-building techniques • Planning matrix: SWOT, ZOPP method	12
3. Medicine management	• Critical reflection of the organization of pharmaceutical services • Understanding of the public procurement cycle and stock management	• Logistical components of pharmaceutical services	16
4. Clinical management of the patient	• General knowledge of the health-disease process, social determinants of health • Identification of the role of medicines in the health-disease process • Ability to intervene in drug-related problems, and/or supporting the therapeutic decision	• Clinical and epidemiological aspects of the main diseases addressed in PHC • Applied pharmacotherapy • Dispensing • Ethics • Pharmaceutical guidance and care • Patient safety • Pharmacovigilance • Studies on medicine use • Risks related to medicine use	24
5. Information system	• Understanding and use of information systems (IS) for health and PC	• Information management • General aspects of IS of PC: Siclom, Sigma, Dispensamed, e-SUS electronic medical record • Recording of information	4
6. Final work	• Applying theoretical knowledge to reality	• Term paper	12
Total			80

Characteristics	N	%
Gender
Female	81	74.3
Male	28	25.7
Works in PHC
No	48	44.0
Yes	61	56.0
Current education
Doctorate	1	0.9
Specialization	76	69.7
Graduation	15	13.8
Master	17	15.6
Current employment link
CLT (Consolidated Labor Laws)	62	56.9
Single Legal Regime (Public Servant)	20	18.3
Others	10	9.2
Unemployed	8	7.3
CLT (Consolidated Labor Laws) and Single Legal Regime (Public Servant)	6	5.5
Military	2	1.8
No longer works as a pharmacist	1	0.9
Current professional activity
Exclusive primary care	54	49.5
Exclusive hospital pharmacy	16	14.7
Management/Administration in Pharmaceutical Care	7	6.4
Not working	6	5.5
Primary Care and hospital pharmacy	5	4.6
I changed my career/pharmaceutical job	5	4.6
Primary Care and management/administration in Pharmaceutical Care	4	3.7
Commercial pharmacy	2	1.8
Research institution	2	1.8
Others	8	7.3
Overall total	109	100.0

Overall perception of the SFAPS Course	Degrees of agreement (%)
Overall perception of the SFAPS Course	0	1 to 3	4 to 5	Does not know
Welcoming relationship with tutors	0.0	12.0	88.0	0.0
Clarity of theoretical content	0.0	9.2	90.8	0.0
Topics covered allowed reflections for professional practice	0.0	10.1	89.0	0.9
Adequate workload	0,9	21.1	78.0	0.0
Exercises and case studies contributed to learning	0.0	11.0	88.1	0.9
New knowledge that improved understanding of PHC	0,0	11.0	88.1	0.9
Improved performance of professional practice in SEFAR	0.0	16.5	83.5	0.0
Personal growth	0.0	15.6	84.4	0.0
Creates or expands professional network	0.0	18.4	81.6	0.0
Expands job opportunities	8.3	40.4	47.6	3.7
Increased integration with multiprofessional team in PHC	0.0	27.4	71.7	0.9
Putting into practice the topics discussed during the SEFAR course	1.8	37.7	60.5	0.0
Putting into practice intervention project of the final work of the course	10.1	44.9	38.6	6.4
Contributes to the elaboration of a work agenda for organization and time optimization	1.8	38.5	59.7	0.0

Contribution of the SFAPS Course	Degrees of agreement (%)
Contribution of the SFAPS Course	0	1 to 3	4 to 5	Does not know
TECHNICAL AND CARE ACTIVITIES
Interventions for individual patients
Pharmaceutical interventions in care management	0.9	24.8	74.3	0.0
Qualified dispensing of medicines at the time of delivery of medicines, involving user welcoming and general guidance	0.9	16.5	82.6	0.0
Therapeutic guidance, including information on the correct use of medicines, follow-up of ADRs or health/disease conditions, among others	1.8	23.0	75.2	0.0
Home visit	4.6	39.5	52.3	3.6
Guidance to users on how to obtain medicines through SUS, even outside the PHC list	1.8	26.5	71.7	0.0
Actions of a technical nature related to medicines
Development of technical-educational material (scientific dissemination, information on medicines to patients or professionals, information on pharmacovigilance)	0.9	36.7	62.4	0.0
Pharmacotherapeutical follow-up	1.8	37.6	59.7	0.9
Medication Reconciliation	3.7	36.6	58.8	0.9
Pharmacotherapy review	2.8	38.5	57.8	0.9
Pharmacovigilance actions	3.7	41.3	55.0	0.0
Actions carried out with patient groups or health team
Participation and/or conduction of health education activities with patients, in the territory or in the health unit	1.8	28.5	68.8	0.9
Participation and/or conduction of education activities with the health team	3.7	28.4	67.9	0.0
The course contributed to begin or increase participation in team meetings	1.8	28.4	69.8	0.0
TECHNICAL-MANAGERIAL ACTIVITIES
Agenda setting (work planning)	2.8	33.1	64.1	0.0
Elaboration of pharmacy POP	1,8	35.8	62.4	0.0
Encouraging and/or increasing the interlocution between health units and services of different levels of complexity	2.8	43.1	53.2	0.9
Adequacy of the list of medicines for the unit (selection)	2.8	33.0	59.6	4.6
Programming the quantity of medicines for consumption by the unit	2.8	26.5	69.7	0.9
Medicine stock management	0.9	22.0	77.1	0.0
Improving the storage of medicines	2.8	23.0	73.3	0.9
Improving the execution of the delivery of medicines	2.8	26.7	69.6	0.9
Developing mechanisms to control the offer and use of medicines for specific groups	2.8	34.9	62.3	0.0
Management of health services waste	5.5	44.1	50.4	0.0
WORK IN PHC AND SUS
Recognition of the social determinants of health in the health-disease process	3.7	29.3	67.0	0.0
Expansion of knowledge on SEFAR in MRJ	0.0	15.6	83.5	0.9
Development of SEFAR centered on people, families and communities	0.9	17.5	81.6	0.0
Strengthening empathy and/or bonding with the population and the work team	1.8	15.6	82.6	0.0
Identification of priority problems in SEFAR	0.0	20.2	79.8	0.0
Construction of action/intervention plans in health services and/or SEFAR	0.9	20.2	78.9	0.0
Expansion of the view of the role of the pharmacist in PHC, as an actor in direct patient care with the team	0.9	11.0	88.1	0.0
Development of communication and information strategies in PHC services	0.9	26.6	72.5	0.0
Development of teamwork	1.8	21.1	77.1	0.0

Categories	%	Quote from the respondent graduates
Strengths of the SFAPS Course
Expanded knowledge and training	18,1	“The course came at a time when I was entering PC [...] without knowledge [...] of the pharmaceutical service [...]. It was a watershed.”
Expanded knowledge and training	18,1	“For a basic knowledge of our work in PC [...] it’s a fundamental course.”
Pedagogical aspects (teaching methodology, curriculum, evaluation)	16,7	“Case studies making classes more dynamic and focused on reality. Discussions between different points of view of our professional colleagues [...] and course tutors were enriching elements.”
		“The fact that they are people who have already worked on the edge makes everything that was said in the course closer to [...] practice.”
		“Tutors who work in the area; very good teaching material; good communication from the coordination with the students.”
Improved performance and/or professional conduct	15,7	“Training and knowledge of the entire flow of pharmaceutical care that are not presented... (during graduation).”
Improved performance and/or professional conduct	15,7	“The course has provided me with a better and greater understanding of the role of the pharmacist in a health team in PHC.”
Exchange of experiences and information	14,4	“(the course) brings together professionals in the area, and this improves the relationship between pharmacists.”
Exchange of experiences and information	14,4	“(during the course) it was possible to have contact with colleagues from other units to exchange theoretical and practical experiences, which were polished and adapted by experienced teachers [...]”
Contribution to the work process	14,4	“The course [...] turned my attention to the care process, thereby dedicating part of the time that was exclusive to the bureaucracy to apply in health promotion and education actions.”
Contribution to the work process	14,4	“The course addresses several practical aspects of the daily routine of the pharmacist in the PHC context and makes it clear that the role of the pharmacist is not limited to dispensing medicines within the pharmacy.”
Professional networking training	9,3	“The course strengthens communication and interaction in the network and provides us with knowledge that we then take into practice.”
Professional networking training	9,3	“Meeting several pharmacists and strengthening the network.”
Qualified faculty	7,4	“[...] the teachers are outstanding […].”
Qualified faculty	7,4	“[...] the tutors were incredible. The fact that they are people who have already worked on the edge makes everything that was said in the course closer to reality in practice.”
Teamwork	4,2	“For better interaction with the team, it expanded the view of our role within the team.”
Teamwork	4,2	“It facilitated the recognition of the pharmacist by the PHC team.”
Weaknesses of the SFAPS Course
Workload	33,6	“[…] Perhaps a higher workload, supplemented with some material for distance learning.”
There was nothing	20,5	“I have nothing negative to say to you [...]”
Deficient methodology (course pedagogy, didactic material, final work)	9,8	“They offered few practical activities.”
		“The didactic material could be more objective.”
		“The content was very comprehensive, but it got a bit lost in the theoretical part”.
Little space for periodic updating or continuing education	7,4	“The course has not been offered more frequently to new pharmacists, nor has refresher courses been made available to pharmacists who have been with the FHS team for a longer time.”
Little space for periodic updating or continuing education	7,4	“There are no more courses organized to learn, exchange, discuss and have feedback on what is happening within the context of the pharmaceutical service [...].”
Low valorization, dismantling of PHC and dismissals	6,6	“Low professional valorization [...] transcends any offered qualification course.”
Low valorization, dismantling of PHC and dismissals	6,6	“Soon after, half of PC 5.2 pharmacists were dismissed.”
Infrastructure shortages and distance	5,7	“The course location could [be] outside the center [of the city], due to public transport and traffic [...]”
Infrastructure shortages and distance	5,7	“Lack of a defined and more adequate space.”
Low practical applicability of the Term Paper	4,9	“I unfortunately couldn’t put my term paper forward.”
Does not remember/does not know	3,3	-
Faculty	2,5	“Lack of greater preparation on the part of knowledge brokers.”

[1] apdoczy@gmail.com