Abstract

The use of medicine in adults has been assessed by some population-based studies in Brazil, but to date there has been no overall estimate of the prevalence of drug consumption. We therefore aimed to estimate the prevalence of medicine use as measured in previously reported cross-sectional studies among Brazilian adults. We conducted a systematic review of the literature, searching in MEDLINE, Embase among others to a date ending January 2017. Two researchers selected the studies, extracted data and assessed methodological quality of those chosen for inclusion. The consumption prevalence were combined in meta-analyses, the heterogeneity measured by I² and investigated by subgroup analyses and meta-regression. The search identified 4,005 publications, of which 14 were ultimately included in the study. Most studies (12/14) measured the consumption over the previous 15 days, finding a consumption prevalence of 49.1% (95% CI: 48.5-49.6%, I² = 100%). The recall period explains part of the heterogeneity found (R² = 23%, p = 0.048), however the subgroup analysis did not allow for more homogeneous results. The use of medications occurs among almost half of all Brazilian adults. Appropriate pharmaceutical assistance and care are necessary to ensure the rational use of these technologies.

Drug utilization; Cross-sectional studies; Review; Adult; Brazil

Introduction

Medicines play an important role in the delivery of care and in the impact on health. Therefore, issues of access and quality of consumption in Brazil have been at the center of several public policies over the years¹1. Brasil. Ministério da Saúde (MS). Política Nacional de Medicamentos. Brasília: MS; 2001.

2. Brasil. Ministério da Saúde (MS). Resolução nº 8.338, de 06 de maio de 2004. Política Nacional de Assistência Farmacêutica e estabelecimento dos princípios gerais e eixos estratégicos. Diário Oficial da União 2004; 7 maio.

3. Brasil. Ministério da Saúde (MS). Lei nº 9.787, de 10 de fevereiro de 1999. Dispõe sobre a vigilância sanitária, estabelece o medicamento genérico, dispõe sobre a utilização de nomes genéricos em produtos farmacêuticos e dá outras providências. Diário Oficial da União 1999; 11 fev.-⁴4. Brasil. Ministério da Saúde (MS). Portaria nº 1.214, de 13 de junho de 2012. Institui o Programa Nacional de Qualificação da Assistência Farmacêutica âmbito do Sistema Único de Saúde (QUALIFAR- SUS). Diário Oficial da União 2012; 14 jun.. The improvement of pharmaceutical services has also been one of the millennium goals as a commitment to guarantee the right to health⁵5. United Nations. United Nations Millennium Declaration. Lisbon: United Nations Information; 2001., highlighting the relevance of access to these technologies by the population.

Increased access to medicines is a benefit that carries inherent risks, such as adverse reactions and medication errors, generating more public spending on health⁶6. Pfaffenbach G, Carvalho OM, Bergsten-Mendes G. Reações adversas a medicamentos como determinantes da admissão hospitalar. Rev Assoc Med Bras 2002; 48(3):237-241.,⁷7. Souza TT, Godoy RR, Rotta I, Pontarolo R, Fernandez F. Morbidade e mortalidade relacionadas a medicamentos no Brasil: revisão sistemática de estudos observacionais. Rev de Cien Farm Básica e Apl. 2014; 35(4):519-532.. Drug use studies can be useful tools in the development of strategies that favor proper and continuous consumption and access⁸8. Wettermark B, Elseviers M, Almarsdóttir AB, Andersen M, Benko R, Bennie M, Eriksson I, Godman B, Krska J, Poluzzi E, Taxis K, Stichele RV, Vlahovic-Palcevski V. Introduction to drug utilization research. In: Poluzzi E, Eriksson I, Godman B, Bennie M, Krska J, Stichele RV, editors. Drug Utilization Research. New Jersey: John Wiley & Sons Ltd; 2016. p. 1-12..

A review of drug use studies conducted in Brazil found that the analysis of the consumption pattern of these technologies and the profile of this consumption is the most common objective among surveys that draw mostly on population-based data⁹9. Eriksson I, Ibáñez L. Secondary data sources for drug utilization research. In: Poluzzi E, Eriksson I, Godman B, Bennie M, Krska J, Stichele RV, editors. Drug Utilization Research. New Jersey: John Wiley & Sons, Ltd; 2016. p. 39-48.,¹⁰10. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet 373(9659):240-249..

Data regarding availability and access, required for the study of drug use, may also come from computerized systems¹¹11. Wettermark B, Martino MD, Elseviers M. Study designs in drug utilization research. In: Poluzzi E, Eriksson I, Godman B, Bennie M, Krska J, Stichele RV, editors. Drug Utilization Research. New Jersey: John Wiley & Sons Ltd.; 2016. p. 13-28.. Although these digital resources can offer a practical way of obtaining prescription data and consumption patterns, such systems are still not common in many countries including Brazil¹²12. Baldoni AdO, Guidoni CM, Pereira LRL. A farmacoepidemiologia no Brasil: estado da arte da produção científica. Revista da Universidade Vale do Rio Verde 2011; 9(1).,¹³13. Leite SN, Vieira M, Veber AP. Estudos de utilização de medicamentos: uma síntese de artigos publicados no Brasil e América Latina. Cien Saude Colet 2008; 13(Supl.):793-802..

While the use of drugs in adults has been evaluated by some population-based studies in Brazil, summaries of the prevalence of drug consumption obtained in these studies have yet to be recorded.

The objective of the present study was to estimate the prevalence of drug use in adults in Brazil through a systematic review of cross-sectional population-based studies.

Methods

Outline and protocol recording

This is a systematic literature review, whose protocol was recorded in the International Prospective Register of Systematic Reviews (PROSPERO).

Eligibility criteria

We selected cross-sectional population-based studies that evaluated the prevalence of medicine use in adults (≥ 18 years) living in Brazil. Other delineations were not eligible due to the low external validity of studies lacking population representativeness.

Studies limited to the consumption of drugs in a particular class of medications, specific diseases or other special conditions were excluded, as well as those that restricted the research to the elderly or children, in order to ensure the population representativeness concerning consumption.

Information sources

We searched the Medline, Embase, Scopus, Latin American and Caribbean Health Sciences Center (Lilacs), Scientific Eletronic Library Online (SciELO) and Bank of Thesis of the Coordination of Improvement of Higher Education Personnel (CAPES) databases. The microdata of national surveys were also researched through contact with experts and surveys on institutional websites. (Last update was on 1/17/2017.) There was no restriction regarding language or date of publication in the search.

Search strategy

Search strategy on Medline (via PubMed) was: (“Drug Utilization”[TIAB] OR “Drug Utilizations”[TIAB] OR “Drug Utilization”[Mesh] OR “Pharmacoepidemiology”[Mesh] OR “Pharmacoepidemiology”[TIAB] OR “Pharmaceutical Epidemiology”[TIAB]) OR ((“Health Surveys”[Mesh] OR “Surveys”[TIAB] OR “Survey”[TIAB] OR “Cross-Sectional Studies”[Mesh] OR “Prevalence”[TIAB] OR “Frequency”[TIAB]) AND (“Pharmacology”[TIAB] OR “Drug”[TIAB] OR “Drugs”[TIAB] OR “Medicine”[TIAB] OR “Remedy”[TIAB] OR “Medication”[TIAB])) AND (“Brazil”[Mesh] OR “Brazil”[TIAB] OR “Brasil”[TIAB]) AND (“Population”[Mesh] OR “Population” [TIAB] OR “Populations” [TIAB] OR “population-based study”[TIAB]). We adapted this strategy to the other bibliographic sources.

Study selection

Two researchers performed the selection (VPG, EBA) by screening the titles and abstracts. In cases of conflict, a third reviewer (TFG) took the decision. The selected articles were then analyzed in full text for quality assessment and data extraction. This step was performed in the Covidence system (www.covidence.org). The reviewers were not blind to the authorship of the manuscripts.

Extraction of data

Data were extracted by one author (VPG) and confirmed by another (TFG). The following variables were extracted: year of survey, location, sample type, age group, sample size, recall period, prevalence of drug use and type of drug evaluation. (In cases where information was not available or unclear, we contacted the authors.) From the studies that employed statistical models, we extracted factors positively associated with consumption and variables. The information needed to measure the consumption of drugs was extracted from adults between the ages of 18 and 65, when possible, or in the closest age group.

Quality assessment

For the assessment of quality we adapted the tool standardized by Loney et al.¹⁴14. Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can 1998; 19(4):170-176.. Nine items were evaluated: (i) Adequate sampling (probabilistic sampling or universe), (ii) Source of the sample list (census of the Brazilian Institute of Geography and Statistics [IBGE]), (iii) Size of adequate sample (statistically calculated) , (iv) Adequate measurement of outcome (confirmation of medical prescription and/or packaging of medication), (v) Recall period (up to 15 days) 14, (vi) Unbiased raters (trained interviewers), (vii) Adequate response rate (refusals and attrition of up to 70%), (viii) Presentation of results (prevalence with confidence intervals and relevant subgroups), (ix) Participants similar to the study (adults only included in sample). For each item that met the criteria, the study received a point.

Data analysis

Initially the local populations were obtained from the period in which each study was performed according to the IBGE¹⁵15. Instituto Brasileiro de Geografia e Estatística (IBGE). 2016. [cited 2017 jan 17]. Available from: http://cidades.ibge.gov.br/xtras/home.php?lang=
http://cidades.ibge.gov.br/xtras/home.ph... census, then the meta-analysis of the prevalence of medication consumption was calculated by means of the Freeman-Tukey double-arcosene transformation to stabilize the variances¹⁶16. Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J epidemiol Comm Health 2013; 67(11):974-978..

The prevalence was stratified by the recall period and heterogeneity was estimated using the inverse of the variance to calculate I²2. Brasil. Ministério da Saúde (MS). Resolução nº 8.338, de 06 de maio de 2004. Política Nacional de Assistência Farmacêutica e estabelecimento dos princípios gerais e eixos estratégicos. Diário Oficial da União 2004; 7 maio. and chi-square (p <0.10).

To verify the possible causes of heterogeneity we performed meta-regression and sensitivity analysis.

In the meta-regression by the modified Knapp-Hartung method¹⁷17. Knapp G, Hartung J. Improved tests for a random effects meta regression with a single covariate. Statistics in medicine 2003; 22(17):2693-2710. the effect of the variables (recall period, proportion of women, quality score, minimum age and year of research) was investigated in the variability observed among the prevalence studies. Surveys with discrepant results were excluded to verify their influence on the result.

In the subgroup analysis, only those studies with similar characteristics were included in the meta-analysis: recall period less than or equal to 15 days, research performed after year 2000, quality score = 9 and southeast region. Stata software version 14.1 was used for all analyzes.

Results

Selection of studies

In the literature review, 4,005 publications were retrieved, of which 37 were evaluated in full text. In the end, 14 studies¹⁸18. Barros M. Saúde e calsse social: um estudo sobre morbidade e consumo de medicamentos. Ribeirão Preto: Universidade de são Paulo; 1983.

19. Simões MJ, Farache Filho A. Consumption of drugs in a region of the State of São Paulo (Brazil), 1985. Rev Saude Publica 1988; 22(6):494-949.

20. Simões MJ. Consumo de medicamentos e morbidade em humaitá estado do Amazonas (Brasil), 1987. Rev Ciên Farm 1991; 13:12.

21. Vilarino JF, Soares IC, da Silveira CM, Rödel AP, Bortoli R, Lemos RR. Self-medication profile in a city of south Brazil. Rev Saude Publica 1998; 32(1):43-49.

22. Loyola Filho AI, Uchoa E, Guerra HL, Firmo JO, Lima-Costa MF. Prevalence and factors associated with self-medication: the Bambuí health survey. Rev Saude Publica 2002; 36(1):55-62.

23. Bertoldi AD, Barros AJ, Hallal PC, Lima RC. Drug utilization in adults: prevalence and individuals determinants. Rev Saude Publica 2004; 38(2):228-238.

24. Pelicioni A. Padrão de consumo de medicamentos em duas áreas da região metropolitana de São Paulo. São Paulo: Universidade de São Paulo; 2005

25. Arrais PS, Brito LL, Barreto ML, Coelho HL. Prevalence and determinants of medicines consumption in Fortaleza, Ceará, Brazil. Cad Saude Publica 2005; 21(6):1737-1746.

26. Carvalho MF, Pascom AR, Souza-Júnior PR, Damacena GN, Szwarcwald CL. Utilization of medicines by the Brazilian population, 2003. Cad Saude Publica 2005; 21(Supl.):100-108.

27. Lima MC, Menezes PR, Carandina L, Cesar CL, Barros MB, Goldbaum M. Common mental disorders and the use of psychoactive drugs: the impact of socioeconomic conditions. Rev Saude Publica 2008; 42(4):717-723.

28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658.

29. Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014; 23(5):507-514.

30. Costa KS, Francisco PMSB, Barros MBA. Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saude Publica. 2016; 32(1).-³¹31. Brasil. Ministério da Saúde (MS). Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM): resultados preliminares. Brasília: MS; 2014. were judged to be worthy of inclusion, which in total involved the assessment of some 57,700 adults (Figure 1).

Study characteristics

Of the 14 articles included, nine collected data from the year 2000²³23. Bertoldi AD, Barros AJ, Hallal PC, Lima RC. Drug utilization in adults: prevalence and individuals determinants. Rev Saude Publica 2004; 38(2):228-238.

24. Pelicioni A. Padrão de consumo de medicamentos em duas áreas da região metropolitana de São Paulo. São Paulo: Universidade de São Paulo; 2005

25. Arrais PS, Brito LL, Barreto ML, Coelho HL. Prevalence and determinants of medicines consumption in Fortaleza, Ceará, Brazil. Cad Saude Publica 2005; 21(6):1737-1746.

26. Carvalho MF, Pascom AR, Souza-Júnior PR, Damacena GN, Szwarcwald CL. Utilization of medicines by the Brazilian population, 2003. Cad Saude Publica 2005; 21(Supl.):100-108.

27. Lima MC, Menezes PR, Carandina L, Cesar CL, Barros MB, Goldbaum M. Common mental disorders and the use of psychoactive drugs: the impact of socioeconomic conditions. Rev Saude Publica 2008; 42(4):717-723.

28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658.

29. Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014; 23(5):507-514.

30. Costa KS, Francisco PMSB, Barros MBA. Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saude Publica. 2016; 32(1).-³¹31. Brasil. Ministério da Saúde (MS). Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM): resultados preliminares. Brasília: MS; 2014. and seven occurred in the southeast region¹⁸18. Barros M. Saúde e calsse social: um estudo sobre morbidade e consumo de medicamentos. Ribeirão Preto: Universidade de são Paulo; 1983.,¹⁹19. Simões MJ, Farache Filho A. Consumption of drugs in a region of the State of São Paulo (Brazil), 1985. Rev Saude Publica 1988; 22(6):494-949.,²²22. Loyola Filho AI, Uchoa E, Guerra HL, Firmo JO, Lima-Costa MF. Prevalence and factors associated with self-medication: the Bambuí health survey. Rev Saude Publica 2002; 36(1):55-62.,²⁴24. Pelicioni A. Padrão de consumo de medicamentos em duas áreas da região metropolitana de São Paulo. São Paulo: Universidade de São Paulo; 2005,²⁷27. Lima MC, Menezes PR, Carandina L, Cesar CL, Barros MB, Goldbaum M. Common mental disorders and the use of psychoactive drugs: the impact of socioeconomic conditions. Rev Saude Publica 2008; 42(4):717-723.,²⁸28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658.,³⁰30. Costa KS, Francisco PMSB, Barros MBA. Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saude Publica. 2016; 32(1).. All studies used probabilistic sampling based on the IBGE census. The recall period ranged from three to 90 days prior to the interview. Confirmation of the name of the drug occurred in half of the studies through the package or prescription (Table 1).

Quality assessment

Six studies met all criteria for methodological quality²³23. Bertoldi AD, Barros AJ, Hallal PC, Lima RC. Drug utilization in adults: prevalence and individuals determinants. Rev Saude Publica 2004; 38(2):228-238.,²⁴24. Pelicioni A. Padrão de consumo de medicamentos em duas áreas da região metropolitana de São Paulo. São Paulo: Universidade de São Paulo; 2005,²⁷27. Lima MC, Menezes PR, Carandina L, Cesar CL, Barros MB, Goldbaum M. Common mental disorders and the use of psychoactive drugs: the impact of socioeconomic conditions. Rev Saude Publica 2008; 42(4):717-723.

28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658.

29. Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014; 23(5):507-514.-³⁰30. Costa KS, Francisco PMSB, Barros MBA. Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saude Publica. 2016; 32(1). as described in Table 1. With the exception of one study involving only adults aged 18-65 years²⁹29. Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014; 23(5):507-514., the others involved the elderly¹⁸18. Barros M. Saúde e calsse social: um estudo sobre morbidade e consumo de medicamentos. Ribeirão Preto: Universidade de são Paulo; 1983.

19. Simões MJ, Farache Filho A. Consumption of drugs in a region of the State of São Paulo (Brazil), 1985. Rev Saude Publica 1988; 22(6):494-949.

20. Simões MJ. Consumo de medicamentos e morbidade em humaitá estado do Amazonas (Brasil), 1987. Rev Ciên Farm 1991; 13:12.

21. Vilarino JF, Soares IC, da Silveira CM, Rödel AP, Bortoli R, Lemos RR. Self-medication profile in a city of south Brazil. Rev Saude Publica 1998; 32(1):43-49.

22. Loyola Filho AI, Uchoa E, Guerra HL, Firmo JO, Lima-Costa MF. Prevalence and factors associated with self-medication: the Bambuí health survey. Rev Saude Publica 2002; 36(1):55-62.

23. Bertoldi AD, Barros AJ, Hallal PC, Lima RC. Drug utilization in adults: prevalence and individuals determinants. Rev Saude Publica 2004; 38(2):228-238.

24. Pelicioni A. Padrão de consumo de medicamentos em duas áreas da região metropolitana de São Paulo. São Paulo: Universidade de São Paulo; 2005

25. Arrais PS, Brito LL, Barreto ML, Coelho HL. Prevalence and determinants of medicines consumption in Fortaleza, Ceará, Brazil. Cad Saude Publica 2005; 21(6):1737-1746.

26. Carvalho MF, Pascom AR, Souza-Júnior PR, Damacena GN, Szwarcwald CL. Utilization of medicines by the Brazilian population, 2003. Cad Saude Publica 2005; 21(Supl.):100-108.

27. Lima MC, Menezes PR, Carandina L, Cesar CL, Barros MB, Goldbaum M. Common mental disorders and the use of psychoactive drugs: the impact of socioeconomic conditions. Rev Saude Publica 2008; 42(4):717-723.-²⁸28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658.,³⁰30. Costa KS, Francisco PMSB, Barros MBA. Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saude Publica. 2016; 32(1).,³¹31. Brasil. Ministério da Saúde (MS). Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM): resultados preliminares. Brasília: MS; 2014. and / or children¹⁸18. Barros M. Saúde e calsse social: um estudo sobre morbidade e consumo de medicamentos. Ribeirão Preto: Universidade de são Paulo; 1983.

19. Simões MJ, Farache Filho A. Consumption of drugs in a region of the State of São Paulo (Brazil), 1985. Rev Saude Publica 1988; 22(6):494-949.

20. Simões MJ. Consumo de medicamentos e morbidade em humaitá estado do Amazonas (Brasil), 1987. Rev Ciên Farm 1991; 13:12.-²¹21. Vilarino JF, Soares IC, da Silveira CM, Rödel AP, Bortoli R, Lemos RR. Self-medication profile in a city of south Brazil. Rev Saude Publica 1998; 32(1):43-49.,²⁴24. Pelicioni A. Padrão de consumo de medicamentos em duas áreas da região metropolitana de São Paulo. São Paulo: Universidade de São Paulo; 2005,²⁵25. Arrais PS, Brito LL, Barreto ML, Coelho HL. Prevalence and determinants of medicines consumption in Fortaleza, Ceará, Brazil. Cad Saude Publica 2005; 21(6):1737-1746.,²⁸28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658. (Table 1). It was possible to obtain data on drug consumption of adults aged 18 years or older in 13 studies¹⁸18. Barros M. Saúde e calsse social: um estudo sobre morbidade e consumo de medicamentos. Ribeirão Preto: Universidade de são Paulo; 1983.

19. Simões MJ, Farache Filho A. Consumption of drugs in a region of the State of São Paulo (Brazil), 1985. Rev Saude Publica 1988; 22(6):494-949.-²⁰20. Simões MJ. Consumo de medicamentos e morbidade em humaitá estado do Amazonas (Brasil), 1987. Rev Ciên Farm 1991; 13:12.,²²22. Loyola Filho AI, Uchoa E, Guerra HL, Firmo JO, Lima-Costa MF. Prevalence and factors associated with self-medication: the Bambuí health survey. Rev Saude Publica 2002; 36(1):55-62.

23. Bertoldi AD, Barros AJ, Hallal PC, Lima RC. Drug utilization in adults: prevalence and individuals determinants. Rev Saude Publica 2004; 38(2):228-238.

24. Pelicioni A. Padrão de consumo de medicamentos em duas áreas da região metropolitana de São Paulo. São Paulo: Universidade de São Paulo; 2005

25. Arrais PS, Brito LL, Barreto ML, Coelho HL. Prevalence and determinants of medicines consumption in Fortaleza, Ceará, Brazil. Cad Saude Publica 2005; 21(6):1737-1746.

26. Carvalho MF, Pascom AR, Souza-Júnior PR, Damacena GN, Szwarcwald CL. Utilization of medicines by the Brazilian population, 2003. Cad Saude Publica 2005; 21(Supl.):100-108.

27. Lima MC, Menezes PR, Carandina L, Cesar CL, Barros MB, Goldbaum M. Common mental disorders and the use of psychoactive drugs: the impact of socioeconomic conditions. Rev Saude Publica 2008; 42(4):717-723.

28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658.

29. Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014; 23(5):507-514.

30. Costa KS, Francisco PMSB, Barros MBA. Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saude Publica. 2016; 32(1).-³¹31. Brasil. Ministério da Saúde (MS). Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM): resultados preliminares. Brasília: MS; 2014.. One survey did not report data from adults separately from those of children; For the purpose of calculations, we separated out participants over 12 years of age²¹21. Vilarino JF, Soares IC, da Silveira CM, Rödel AP, Bortoli R, Lemos RR. Self-medication profile in a city of south Brazil. Rev Saude Publica 1998; 32(1):43-49..

One study measured the use of medications for continuous use for chronic diseases without mentioning the recall period, and for drugs of occasional use the period measured was the previous 15 days³¹31. Brasil. Ministério da Saúde (MS). Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM): resultados preliminares. Brasília: MS; 2014.. In the present analysis, we therefore consider 15 days as the study recall period, with the interpretation that continuous use was also involved during the period.

Outcomes

Most of the studies (12) evaluated the consumption in the last 15 days prior to the interview, and the use of drugs was reported by 49.1%¹⁸18. Barros M. Saúde e calsse social: um estudo sobre morbidade e consumo de medicamentos. Ribeirão Preto: Universidade de são Paulo; 1983.

19. Simões MJ, Farache Filho A. Consumption of drugs in a region of the State of São Paulo (Brazil), 1985. Rev Saude Publica 1988; 22(6):494-949.-²⁰20. Simões MJ. Consumo de medicamentos e morbidade em humaitá estado do Amazonas (Brasil), 1987. Rev Ciên Farm 1991; 13:12.,²³23. Bertoldi AD, Barros AJ, Hallal PC, Lima RC. Drug utilization in adults: prevalence and individuals determinants. Rev Saude Publica 2004; 38(2):228-238.

24. Pelicioni A. Padrão de consumo de medicamentos em duas áreas da região metropolitana de São Paulo. São Paulo: Universidade de São Paulo; 2005

25. Arrais PS, Brito LL, Barreto ML, Coelho HL. Prevalence and determinants of medicines consumption in Fortaleza, Ceará, Brazil. Cad Saude Publica 2005; 21(6):1737-1746.

26. Carvalho MF, Pascom AR, Souza-Júnior PR, Damacena GN, Szwarcwald CL. Utilization of medicines by the Brazilian population, 2003. Cad Saude Publica 2005; 21(Supl.):100-108.

27. Lima MC, Menezes PR, Carandina L, Cesar CL, Barros MB, Goldbaum M. Common mental disorders and the use of psychoactive drugs: the impact of socioeconomic conditions. Rev Saude Publica 2008; 42(4):717-723.

28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658.

29. Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014; 23(5):507-514.

30. Costa KS, Francisco PMSB, Barros MBA. Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saude Publica. 2016; 32(1).-³¹31. Brasil. Ministério da Saúde (MS). Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM): resultados preliminares. Brasília: MS; 2014. The highest prevalence of drug consumption was 71.4% recalling the previous 90 days²²22. Loyola Filho AI, Uchoa E, Guerra HL, Firmo JO, Lima-Costa MF. Prevalence and factors associated with self-medication: the Bambuí health survey. Rev Saude Publica 2002; 36(1):55-62., followed by the prevalence of 70.0% in the month²¹21. Vilarino JF, Soares IC, da Silveira CM, Rödel AP, Bortoli R, Lemos RR. Self-medication profile in a city of south Brazil. Rev Saude Publica 1998; 32(1):43-49.. The prevalence in the previous week was evaluated in an investigation²⁹29. Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014; 23(5):507-514., being 35.7%; in the previous three days it was 44.7%, evaluated by four investigations²⁴24. Pelicioni A. Padrão de consumo de medicamentos em duas áreas da região metropolitana de São Paulo. São Paulo: Universidade de São Paulo; 2005,²⁷27. Lima MC, Menezes PR, Carandina L, Cesar CL, Barros MB, Goldbaum M. Common mental disorders and the use of psychoactive drugs: the impact of socioeconomic conditions. Rev Saude Publica 2008; 42(4):717-723.,²⁸28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658.,³⁰30. Costa KS, Francisco PMSB, Barros MBA. Utilização e fontes de obtenção de medicamentos: um estudo de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saude Publica. 2016; 32(1).. The prevalence summary and respective confidence intervals (95% CI) are presented in the meta-analysis as a proportion, not converted to a percentage (Figure 2).

Estimates were of high heterogeneity, the subgroup analysis did not identify the possible causes for the differences between the results of the studies, nor did it lead to more homogeneous results (Table 2). The recall period explains 22.9% of the variance found (p = 0.048). A discrepant point was observed in the meta-regression in the study of a longer recall period (90 days)²²22. Loyola Filho AI, Uchoa E, Guerra HL, Firmo JO, Lima-Costa MF. Prevalence and factors associated with self-medication: the Bambuí health survey. Rev Saude Publica 2002; 36(1):55-62.. In order to ascertain the influence of this study it was excluded, and the association between the recall period and the variation between the studies lost significance. The other variables explored – year of data collection, methodological quality, proportion of women and minimum age of study participation’ – were not significant (p > 0.05).

Among the articles included in the review, five performed adjustment models for drug consumption²²22. Loyola Filho AI, Uchoa E, Guerra HL, Firmo JO, Lima-Costa MF. Prevalence and factors associated with self-medication: the Bambuí health survey. Rev Saude Publica 2002; 36(1):55-62.,²³23. Bertoldi AD, Barros AJ, Hallal PC, Lima RC. Drug utilization in adults: prevalence and individuals determinants. Rev Saude Publica 2004; 38(2):228-238.,²⁵25. Arrais PS, Brito LL, Barreto ML, Coelho HL. Prevalence and determinants of medicines consumption in Fortaleza, Ceará, Brazil. Cad Saude Publica 2005; 21(6):1737-1746.,²⁸28. Costa KS, Barros MB, Francisco PM, César CL, Goldbaum M, Carandina L. Use of medication and associated factors: a population-based study in Campinas, São Paulo State, Brazil. Cad Saude Publica 2011; 27(4):649-658.,²⁹29. Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014; 23(5):507-514.. Among the associated factors, females were positively associated in all studies, while advanced age was associated in four of these and presence of chronic disease in three (Chart 1).

Discussion

About half of the Brazilian population has been using or has used some sort of medication in recent weeks. The estimates emerging from the studies suggest great variability in the results, but nonetheless provide an approximate picture of drug use among Brazilian adults.

The recall period was the only factor significantly associated with the variability found. Large heterogeneity are indicative of the differences among the primary studies that provided the data to inform the meta-analyses. Because they are studies conducted in different periods and regions, differences between the estimated prevalence would be expected, despite being from the same population (adults) from the same country (Brazil).

High heterogeneity in prevalence studies is common¹⁶16. Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J epidemiol Comm Health 2013; 67(11):974-978.. Regional differences (income, access to services), outcome measures, population, year and/or period of the year in which the survey was conducted and rate of refusal were common causes of heterogeneity in prevalence reviews. In order to reduce and investigate heterogeneous results, we used proximal ages, categorized by similar recall period. We further evaluated the quality of the studies, analyzing separately those of higher quality – including only population-based studies – and explored the results by subgroup analysis and meta-regression⁴⁴44. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions. London: Cochrane; 2011..

The lack of methodological standardization and categorization of the age range of the included studies may have been some of the factors responsible for the high heterogeneity. Some recommendations such as a 15-day recall period, categorization of age groups (children, adults, and the elderly) are proposed in the study area of medication use²⁹29. Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014; 23(5):507-514.. Such guidelines favor the measurement of the data and help in monitoring the drug use. Other important data, like the proportion of people with chronic diseases and the main drugs involved, would aid in the evaluation and explanation of the results, but were not systematically reported in the studies.

In spite of the heterogeneity found, the considerable proportion of the population that uses drugs underscores the importance that this consumption be accompanied by the necessary information for its rational use. Guidelines made by the pharmaceutical professional can minimize problems related to the use of medication and promote the quality, safety and efficacy of the drug through pharmaceutical care⁴⁵45. Viswanathan M, Kahwati LC, Golin CE, Blalock SJ, Coker-Schwimmer E, Posey R, Lhor KN. Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA Intern Med 2015; 175(1):76-87.,⁴⁶46. Araujo ALA, Pereira LRL, Ueta JM, Freitas O. Perfil da assistência farmacêutica na atenção primária do Sistema Único de Saúde. Cien Saude Colet 2008; 13(Supl.):611-617..

In addition to these aspects of the included studies, the present study has as a limitation the non-inclusion of primary data directly from health systems such as the National System of Controlled Products Management (SNGPC) and others from the Unified Health System (SUS), such as the National Pharmaceutical Services Management System (Horus), SUS electronic systems (e-SUS) and Outpatient Information System of the National Health System (SIA/SUS). On the other hand, it was sensitive and robust as far as it included studies published with population representativeness, bringing to light national estimates of drug consumption in the population. The results presented here therefore provide information about the general use of these technologies in the Brazilian population, allowing insight into its general scope and comparability with other contexts.

Of the factors associated with drug consumption, female sex stood out most significantly, supporting the findings of other countries⁴⁷47. Zhang F, Mamtani R, Scott FI, Goldberg DS, Haynes K, Lewis JD. Increasing use of prescription drugs in the United Kingdom. Pharmacoepidemiol Drug Saf 2016; 25(6):628-636.

48. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 2002; 287(3):337-344.-⁴⁹49. Hovstadius B, Astrand B, Petersson G. Dispensed drugs and multiple medications in the Swedish population: an individual-based register study. BMC Clin Pharmacol 2009; 9:11.. The search for health care services is higher among women, with the concomitant effect of greater prescription and use of medicines among that demographic⁴⁹49. Hovstadius B, Astrand B, Petersson G. Dispensed drugs and multiple medications in the Swedish population: an individual-based register study. BMC Clin Pharmacol 2009; 9:11.,⁵⁰50. Loikas D, Wettermark B, von Euler M, Bergman U, Schenck-Gustafsson K. Differences in drug utilisation between men and women: a cross-sectional analysis of all dispensed drugs in Sweden. BMJ Open 2013; 3(5).. A survey of five community pharmacies randomly selected in northern Italy found that women are the most frequent patrons in the purchase of medications and supplements after obtaining information on the internet (30% compared to 20% of men, p < 0.01)⁵¹51. Lombardo S, Cosentino M. Internet Use for Searching Information on Medicines and Disease: A Community Pharmacy-Based Survey Among Adult Pharmacy Customers. Interact J Med Res 2016; 5(3):e22..

Other factors that were associated were age and presence of chronic diseases. A population survey carried out in Spain in 2013 of 2,700 people observed that drug consumption increases with age and with the prevalence of chronic diseases: people over 65 years old consume about five more drugs than adults below this age⁵²52. Carrera-Lasfuentes P, Aguilar-Palacio I, Clemente Roldan E, Malo Fumanal S, Rabanaque Hernandez MJ. Medicine consumption in the adult population: Influence of self-medication. Aten Primaria 2013; 45(10):528-535.. The association between advanced age and the use of polypharmacy are factors that favor the occurrence of adverse reactions⁵³53. Blasco Patiño F, Pérez Maestu R, Martínez López de Letona J, Jiménez AI, García Navarro MJ. Estudio del consumo de fármacos inadecuados o no indicados en el anciano que ingresa en un Servicio de Medicina Interna. Anales de Medicina Interna 2008; 25(6):269-274..

In Brazil, a descriptive study with data from the National Health Survey of 2013 observed that the prevalence of the use of drugs to treat chronic diseases was approximately 80% in the treatment of hypertension, diabetes and asthma⁵⁴54. Tavares NUL, Costa KS, Mengue SS, Vieira MLFP, Malta DC, Silva Júnior JB. Uso de medicamentos para tratamento de doenças crônicas não transmissíveis no Brasil: resultados da Pesquisa Nacional de Saúde, 2013. Epidemiologia e Serviços de Saúde. 2015; 24(2):315-323.. The use changed according to region, sex and age. In hypertensive patients, for example, the prevalence of consumption was 82%, with greater use by women and individuals over 75 years of age⁵⁴54. Tavares NUL, Costa KS, Mengue SS, Vieira MLFP, Malta DC, Silva Júnior JB. Uso de medicamentos para tratamento de doenças crônicas não transmissíveis no Brasil: resultados da Pesquisa Nacional de Saúde, 2013. Epidemiologia e Serviços de Saúde. 2015; 24(2):315-323. – a result similar to the one found in the present review in which drug use was shown to be influenced by gender, advanced age and presence of chronic diseases.

Although drug use is part of health care, it is important to emphasize that these technologies also pose risks to health, requiring their use in a rational way⁵⁵55. World Health Organization (WHO). The world medicines situation 2011: rational use of medicines. Geneva: WHO; 2011.. The consumption of medicines must be accompanied by the essential orientation for their proper use. A systematic review of clinical trials has shown that intervention through pharmaceutical care has significantly improved health-related quality of life, presenting itself as an auxiliary tool to promote well-being⁵⁶56. Mohammed MA, Moles RJ, Chen TF. The Impact of Pharmaceutical Care Interventions on Health-Related Quality-of-Life Outcomes: A Systematic Review and Meta-analysis. Ann Pharmacother 2016; 50(10):862-881..

Medicines are the main cause of poisoning registered by Poison Control Centers (PCC) in different contexts. In the United States, about 2 million cases of exposure to toxic agents were reported in 2015, of which 1,473,638 were caused by pharmaceuticals⁵⁷57. Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 33rd Annual Report. Clinical Toxicology 2016; 54(10):924-1109.. Of the total number of drug poisonings, 275,979 (20%) were caused by therapeutic errors caused by: duplication of dose (30%), wrong product (17%), wrong dose (15%), wrong interval between doses (11%) and medication by another person (8%). In addition to causing most of the poisonings, medicines were the main responsible for deaths resulting from poisoning (1,108 cases, 80% of the total). Among the most involved were analgesics, stimulants and those acting on the cardiovascular system⁵⁷57. Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 33rd Annual Report. Clinical Toxicology 2016; 54(10):924-1109..

In Brazil, although there are no data identifying the most common class or active principle, the use of medicine has proven to be the main cause of poisoning attended by Brazilian PCC in recent years⁵⁸58. Fundação Oswaldo Cruz (Fiocruz). Casos registrados de intoxicação e/ou envenenamento em 2013. Rio de Janeiro: Fiocruz; 2013.. The reason for poisoning in general (drug specific data not available) is mainly individual accident (57%) and suicide attempt (16%).

An analysis of the 30-year time trend of toxicological treatment of North American PCC (1984-2013) revealed increased deaths and severity of poisoning⁵⁹59. Greenwald PW, Farmer BM, O’Neill M, Essner RA, Flomenbaum NE. Increasing frequency and fatality of poison control center reported exposures involving medication and multiple substances: data from reports of the American Association of Poison Control Centers 1984-2013. Clin Toxicol (Phila) 2016:1-7.. Severity and lethality increased with exposure to a greater number of substances. During the period 2006-2013, it was observed that each additional product involved in one exposure led to an additional 221 deaths, an increase of 18% in the growth in fatalities related to consumption of three or more substances⁵⁹59. Greenwald PW, Farmer BM, O’Neill M, Essner RA, Flomenbaum NE. Increasing frequency and fatality of poison control center reported exposures involving medication and multiple substances: data from reports of the American Association of Poison Control Centers 1984-2013. Clin Toxicol (Phila) 2016:1-7..

The increase in the number of poisonings per drug over the years in the United States has been accompanied by the growth of adult drug use. An analysis of the National Health and Nutrition Examination Survey surveys conducted between 1999 and 2012 noted that the prevalence of drug use in the last 30 days was 51% in the first decade, rising to 59% in the years 2011-2012⁶⁰60. Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. JAMA 2015; 314(17):1818-1831.. This growth was statistically significant (p <0.001), and the proportion of increase (around 10%) was similar to the increase in poisoning in the period⁵⁹59. Greenwald PW, Farmer BM, O’Neill M, Essner RA, Flomenbaum NE. Increasing frequency and fatality of poison control center reported exposures involving medication and multiple substances: data from reports of the American Association of Poison Control Centers 1984-2013. Clin Toxicol (Phila) 2016:1-7.. Surveys included 37,959 adults in total.

Electronic health systems are tools that can provide useful information for both administrative and managerial purposes as well as patient care. Some information available on outpatient records includes laboratory results, procedures performed, diagnoses, dispensing records and the possibility of monitoring possible drug interactions¹¹11. Wettermark B, Martino MD, Elseviers M. Study designs in drug utilization research. In: Poluzzi E, Eriksson I, Godman B, Bennie M, Krska J, Stichele RV, editors. Drug Utilization Research. New Jersey: John Wiley & Sons Ltd.; 2016. p. 13-28..

In Brazil, the availability of electronic information is still limited, but enough to study the use of drugs in specific populations. The SIA/SUS⁶¹61. Brasil. Ministério da Saúde (MS). Departamento de Regulação, Avaliação e Controle/Coordenação Geral de Sistemas de Informação: SIA – Sistema de Informação Ambulatorial do SUS: Manual de Operação do Sistema. Brasília: MS; 2016. makes it possible to evaluate the dispensing of drugs from the Specialized Component of Pharmaceutical Care, released through the Authorization of High Complexity Procedures (APAC)⁶²62. Nita ME, Secoli SR, Nobre MRC, Ono-Nita SK, Campino ACC, Sarti FM, Costa AMN, Carrilho FJ. Avaliação de tecnologias em saúde: Evidência Clínica, Análise Econômica e Análise de Decisão. São Paulo: Artmed Editora; 2009.,⁶³63. Soares C, Silva GA. Uso de registros de assistência farmacêutica do Sistema de Informações Ambulatorial para avaliação longitudinal de utilização e adesão a medicamentos. Cad Saude Colet 2013; 21(3):245-252.. The analysis of these data requires linkage of large databases in order to group the data of the patients who obtain the medicines every three months. Such studies are still not frequent, but can nevertheless provide strategic information: a cohort of patients with Alzheimer’s disease was elaborated from the APAC subsystem of the SIA/SUS. Developments in this cohort will enable the evaluation of the drug utilization profile through validated adherence measures, as well as patient follow-up within six months of replenishing prescription⁶³63. Soares C, Silva GA. Uso de registros de assistência farmacêutica do Sistema de Informações Ambulatorial para avaliação longitudinal de utilização e adesão a medicamentos. Cad Saude Colet 2013; 21(3):245-252..

Another tool available from drug sales data is SNGPC, which contains the daily movements of drugs and substances subject to special control that are sent to the National Sanitary Surveillance Agency electronically from all pharmacies and drugstores licensed for sale⁶⁴64. Brasil. Ministério da Saúde (MS).Resolução da Diretoria Colegiada- RDC Nº 22, de 29 de abril de 2014.Dispõe sobre o Sistema Nacional de Gerenciamento de Produtos Controlados –SNGPC, revoga a Resolução de Diretoria Colegiada nº 27, de 30 de março de 2007, e dá outras providências. Diário Oficial da União 2014; 30 abr.. From these data, an ecological study was developed that correlated the consumption of benzodiazepine anxiolytics and demographic characteristics of the regions⁶⁵65. Azevedo ÂJPd, Araújo AAd, Ferreira MÂF. Consumo de ansiolíticos benzodiazepínicos: uma correlação entre dados do SNGPC e indicadores sociodemográficos nas capitais brasileiras. Cien Saude Colet 2016; 21(1):83-90.. Cities with a higher demographic density and higher concentrations of physicians had higher consumption of these drugs⁶⁵65. Azevedo ÂJPd, Araújo AAd, Ferreira MÂF. Consumo de ansiolíticos benzodiazepínicos: uma correlação entre dados do SNGPC e indicadores sociodemográficos nas capitais brasileiras. Cien Saude Colet 2016; 21(1):83-90., which may be related to the higher purchasing power of the population of these cities⁶⁶66. Barata RB. Como e por que as desigualdades sociais fazem mal à saúde. Rio de Janeiro: Editora Fiocruz; 2009., since the data used for this research were of commercial origin.

The Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) have electronic systems that record all drugs dispensed and a database with potential for linkage in the follow-up of adverse reactions, routine care and the use of medicines. These systems are comprehensive in informing public and private data on the consumption of all types of drugs, not only those subject to special control⁶⁷67. Wettermark B, Zoega H, Furu K, Korhonen M, Hallas J, Norgaard M, Almarsdottir A, Andersen M, Andersson Sundell K, Bergman U, Helin-Salmivaara A, Hoffmann M, Kieler H, Martikainen J, Mortensen M, Petzold M, Wallach-Kildemoes H, Wallin C, Sørensen H. The Nordic prescription databases as a resource for pharmacoepidemiological research-a literature review. Pharmacoepidemiol Drug Saf 2013; 22(7):691-699..

In Brazil, electronic systems are fragmented, not providing complete and comprehensive information: the same patient may appear in more than one system and identifying that it is the same person is not always possible⁶³63. Soares C, Silva GA. Uso de registros de assistência farmacêutica do Sistema de Informações Ambulatorial para avaliação longitudinal de utilização e adesão a medicamentos. Cad Saude Colet 2013; 21(3):245-252.,⁶⁵65. Azevedo ÂJPd, Araújo AAd, Ferreira MÂF. Consumo de ansiolíticos benzodiazepínicos: uma correlação entre dados do SNGPC e indicadores sociodemográficos nas capitais brasileiras. Cien Saude Colet 2016; 21(1):83-90.,⁶⁸68. Martins ELM, Amaral MdPHd, Ferreira MBC, Mendonça AÉd, Pereira MCS, Pereira DC, Ribeiro PM, Brumano LP. Dispensações de psicotrópicos anorexígenos no município de Juiz de Fora, Minas Gerais, Brasil. Cien Saude Colet 2012; 17(12):3331-3342.. These limitations make cross-sectional population-based studies a necessity to properly assess the patterns of access and use of these technologies. A concrete example of this demand was the funding by the Ministry of Health of the National Survey on Access, Use and Promotion of the Rational Use of Medicines (PNAUM), with 41 thousand people interviewed throughout Brazil between 2013 and 2014⁶⁹69. Bermudez JAZ, Barros MBA. Profile of access and use of medicines in the Brazilian population contributions and challenges of PNAUM Household Survey. Rev Saude Publica 2016; 50(Supl. 2):2s..

In conclusion, the use of drugs is common among Brazilian adults and is more frequent in women. The results reported here have limitations due to differences between studies. In terms of practice, the results reveal a high demand for pharmaceutical care in society to enable the rational use of these technologies. Future investments should prioritize the development and analysis of comprehensive computer systems that provide better information regarding products and groups at greater risk.

Acknowledgements

The authors would like to thank Eliana Brasil Alves, from the University Hospital Getúlio Vargas, Federal University of Amazonas, for her assistance in the selection of studies and Paulo Henrique Faria Domingues, Emília Vitória da Silva and Mauricio Gomes Pereira, from the University of Brasília, for their collaboration in initial and pilot design of the study.

The research was funded by the Foundation for Research Support of the State of Amazonas (FAPEAM), which awarded a master’s degree to VP Gomes.

This publication was funded by the Program for the Publication of Scientific Papers (PAPAC) of FAPEAM, granted to TF Galvão.

References

Publication Dates

History