Clinical pharmaceutical services of primary health care of the Federal District: A discussion based on the SWOT matrix

Barros, Débora Santos Lula; Silva, Dayde Lane Mendonça da; Leite, Silvana Nair

doi:10.1590/s2175-97902022e18593

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Pharmaceutical Sciences

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Article • Braz. J. Pharm. Sci. 58 • 2022 • https://doi.org/10.1590/s2175-97902022e18593 copy

Clinical pharmaceutical services of primary health care of the Federal District: A discussion based on the SWOT matrix

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

In the epistemic field, several studies demonstrate the importance of pharmaceutical services in health care networks. Nonetheless, literature still addresses the strengths and barriers present in the provision of these services in an incipient way. Thus, this study aimed to understand these contexts in the development of clinical services for primary health care in the Federal District, Brazil. A qualitative study adopted the technique of open-script interview, structured based on the logic of the SWOT matrix. Pharmacists reported weaknesses such as precariousness and scarcity of physical infrastructure, material, and human resources. As threats, they discussed the lack of social recognition, discontinuities of government actions, and lack of preparation of the pharmacist for the provision of clinical services. Regarding themes pertaining to the service’s strengths and opportunities, the advances in propositions and executions of public policies, actions, and governmental programs that have expanded the pharmaceutical workforce in primary care and that are impelling the accomplishment of clinical services were listed. This study contributes to understanding the scenario of the development of clinical pharmaceutical services, and consequently provides subsidies for the actions of planning, evaluation and qualification of health services.

Keywords:
Pharmacists; Pharmaceutical care; Pharmaceutical services; Primary health care; Health services research

Weaknesses	Participant speeches
Precarious physical infrastructure and furniture	I do not have a room. So, I think it's important to have this privacy. The patient won’t stay here in the middle of all the people (pharmacist 19).
	[...] Sometimes we do not have a shelf! The closets are falling apart, we do not have the space here to put a computer [...] How will you file patient records? [...](pharmacist 20).
	[...]There is infiltration, cracks, old furniture. That is, you do not have the basics for the inventory, imagine for attending to the patient? (pharmacist 32).
Information technology	There is no internet here, so I bring my computer and pay for the internet and access to the health portal to study cases (pharmacist 3).
Resources to support educational activities	There is a lack of material resources, no visual, audiovisual material... It makes it difficult to give lectures to a group of patients, and such things [...] (pharmacist 25).
Resources to support educational activities	I think the pharmacy needed a color printer, because it's no use if you´re treating an illiterate patient without having any color [...] (pharmacist 33).
Transport	To move around in the activities here I always need my car. Many times we stop going home because we do not have a car (pharmacist 3).
Drug shortages	I've worked at the secretariat for about 10 years. I've never gotten to at least 90% of the index of drugs. So we've been doing war medicine for a long time [...] I go to a doctor and say: "This beta-blocker causes interaction. Let's change the other!" "Come on! Good idea!" But then I do not have that one available, see? (pharmacist 10).
Scarcity of human resources and work overload	I see colleagues who have only the pharmacist in the pharmacy. Then, he has to control stock, to supply material [...]to enter everything in the computer, to make a request, to program. So how do you want a person like this to still be careful? (pharmacist 17).
Scarcity of human resources and work overload	The secretary shoots itself in the foot when it there is none (pharmacist). We are very cheap professionals for the waste and loss that happens when there’s none of us. Everyone tells me that this was open, and everyone was coming in and picking it up (pharmacist 5).

Strengths	Participant speeches
Pharmaceutical Care Program	[...] I think this proposal of pharmaceutical care [...] The Ministry of Health is proposing based on the experience of Curitiba. Now we're going to have it here in the Federal District [...] I think this is a very important step (pharmacist 5).
Training offered by SES	About a year and a half ago, the secretary shifted its focus to the pharmacist and began investing in a clinical pharmacy course. This is all for us to do clinic service too. In the hospital, this is already more advanced (pharmacist 25).
Destination of servers for primary health care pharmacies	Hiring more colleagues is one thing we can name and that is a very positive thing. [...] The secretary's orders, for me, were great advances (pharmacist 15).
Expansion of family health strategy	The ordinance was published last week, that I even told you that you can have everything in family health strategy. This also includes pharmaceutical care in basic care (pharmacist 11).

Threats	Participant speeches
Deficiencies in academic training, little training and experience in the clinical area	I would like to feel calmer and more confident in what I would be doing because it turns out that the academic training I had was very much in need of it. I think that whoever graduated before 2002 had a disability in relation to this [...] (pharmacist 1).
Lack of social recognition of the pharmacist as a healthcare professional	Primary care professionals have no idea what we can do. Today, even talking to a medical colleague, he was surprised to know that I have already done a home visit. A nurse to whom I have a lot of affection, who is a colleague, he already turned to me and said: if I wanted to work with patient care, I should have done nursing (pharmacist 17).
	Because until then, they do not know, most managers don’t even know what the duties of the pharmacist are. They think we'll get there and fix the supplies. They just see the logistics part. The technical-assistance part nobody knows, and sometimes don’t want to (pharmacist 29).
Layoff with public products and services	Otherwise they believe: 'If I shout, if I make a scandal, I get things.' In the emergency room of a private hospital you stay two, three hours, sitting without breaking anything. In the public, it is to pick up a chair, break the glass... The person does that scandal, feels mistreated, because she has arrived, she has the right to have that answer at the time. 'It's just a question.' He does not understand that sometimes he is explaining something to another patient and that if he stops, he breaks up a whole line of reasoning [...] (pharmacist 29).
Oscillations of the political-economic scenario	The NASF is at a standstill. It’s not having matriciality, but when it does, we participate [...] (pharmacist 7).
Oscillations of the political-economic scenario	Until a while ago, we had some groups here. Groups of hypertensive and diabetic, I liked to give lectures. Groups of pregnant women as well. For now, it's kind of stopped because of these political changes (Pharmacist 2).

Opportunities	Participant speeches
The actions of inspection, standardization, training, elaboration of public policies by the Ministry of Health and Federal Council of Pharmacy	The action of the pharmacy council fines the establishments that do not have a pharmacist, checking the question of the workload, I see all this contributed. We are in transition. Now they have the courses that they offer as well. I did a prescription distance pharmacist one (pharmacist 13).
	Collaborate, I think these advances in legislation. Public policies that prioritize this issue including financing. Because funding is very important for pharmaceutical care (pharmacist 18).
	So, I think we have improved a lot. Because in the old days the pharmacist was a being in the worst place in the hospital. Not today. The pharmacist is already inserted in much. I believe that it will value even more, not only in basic care, but in every segment of society... These campaigns to spread the profession by the council... all this helps (pharmacist 27).
NASF as a space that promotes creativity	Look, it's great working with the NASF. Here they support me in everything, we are a family. Me and the doctor set up this medical garden here in the back of the health center. So every time we do a workshop, we already explain with the plants here (pharmacist 22).
NASF as a space that promotes creativity	As I am from the NASF, I always demand the explanation of how the population should keep the medicines. So, because we do not have the resources, I and NASF staff have developed these boxes to store medicines at home, all with recyclables. We also use materials that the community brings (pharmacist 12).

Universidade de São Paulo, Faculdade de Ciências Farmacêuticas Av. Prof. Lineu Prestes, n. 580, 05508-000 S. Paulo/SP Brasil, Tel.: (55 11) 3091-3824 - São Paulo - SP - Brazil
E-mail: bjps@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Correspondence: D. S. Lula-Barros. Secretaria de Estado de Saúde do Distrito Federal. CEP 72215-170 - Brasília. E-mail: debora.farmacia9@gmail.com. ORCID: https://orcid.org/0000-0001-6459-7457. S. N. Leite. ORCID: https://orcid.org/0000-0002-5258-9684