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Boing AC, Andrade FBD, Bertoldi AD, Peres KGDA, Massuda A, Boing AF. [Prevalence rates and inequalities in access to medicines by users of the Brazilian Unified National Health System in 2013 and 2019]. CAD SAUDE PUBLICA 2022; 38:e00114721. [PMID: 35703669 DOI: 10.1590/0102-311xpt114721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 03/10/2022] [Indexed: 08/26/2023] Open
Abstract
The study aimed to analyze and compare the prevalence of access to medicines and associated factors among users of the Brazilian Unified National Health System (SUS). The authors analyzed data from the 2013 and 2019 editions of the Brazilian National Health Survey, a nationwide health study, representative of the Brazilian population. The outcomes were: (1) obtaining from the SUS all the medicines prescribed during care received in the SUS itself in the two weeks prior to the interview (2) and obtaining all the medicines, regardless of the source. Demographic and socioeconomic characteristics were included as independent variables. In 2019, 29.7% of the interviewees obtained all the prescribed medicines from the SUS, 81.8% obtained all the medicines in general (considering all sources), and 56.4% paid some amount for the medicines. The proportion who did obtain any medicine from the SUS and that made some out-of-pocket payment increased from 2013 to 2019. The likelihood of obtaining all the medicines in the SUS was higher among the poorest, and that of obtaining the medicines regardless of source was higher among the wealthiest. Approximately two out of three persons that were unable to access all the medicines reported difficulties obtaining them in services funded by the public sector. There was an increase in out-of-pocket expenditure on medicines in Brazil and a reduction in access through the SUS, among users of the system.
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Affiliation(s)
| | | | | | | | - Adriano Massuda
- Escola de Administração de Empresas de São Paulo, Fundação Getulio Vargas, São Paulo, Brasil.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, U.S.A
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Bueno MAM, Simões TC, Luz TCB. Differences in prescribed medicine availability in Primary Health Care: evidence from the Prover Project. CIENCIA & SAUDE COLETIVA 2022; 27:1191-1203. [PMID: 35293455 DOI: 10.1590/1413-81232022273.38782020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 03/05/2021] [Indexed: 01/02/2023] Open
Abstract
This is a cross-sectional study on the availability of prescribed medicines in Primary Health Care (PHC), with a probabilistic sample of 1,221 users of public pharmacies in a health pole municipality in Minas Gerais, in 2017. Medicine availability indicators were estimated, and a hierarchical logistic regression was performed, according to the behavioral model of health service use. Only 39.3% of patients received all medicines in the prescribed quantities. The most and the least available medicines were, respectively, those for the digestive system/metabolism, and for blood and hematopoietic organs. Full availability of the prescribed treatment was associated with higher schooling (≥ 8 years OR: 1.7; 95% CI: 1.3-2.4); proximity to the pharmacy (≤15 min OR: 1.7; 95% CI: 1.2-2.3); absence of out-of-pocket expenditure on medicines (OR: 2.2; 95% CI: 1.7-2.9), and a smaller number of prescription drugs (≤ 2 OR: 3.2; 95% CI: 2.3-4.4; 3/4 OR: 1.6; 95% CI: 1.2-2.1). These results showed differences in medicine availability within the Brazilian Unified Health System (SUS), and highlighted the need to reorganize the dispensing services network and pharmaceutical procurement planning, as well as to develop public policies to protect the vulnerable population.
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Affiliation(s)
- Maria Angélica Martins Bueno
- Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente, Instituto René Rachou, Fundação Oswaldo Cruz. Av. Augusto de Lima 1715 Anexo, Barro Preto. 30190-002 Belo Horizonte MG Brasil.
| | - Taynãna César Simões
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz. Belo Horizonte MG Brasil
| | - Tatiana Chama Borges Luz
- Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente, Instituto René Rachou, Fundação Oswaldo Cruz. Av. Augusto de Lima 1715 Anexo, Barro Preto. 30190-002 Belo Horizonte MG Brasil. .,Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Scotland
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Chaves ZJL, Silva LS, Nascimento RCRMD. Public Programs for Essential Medicine Access in a Small Municipality: A Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20200287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Gilardino RE, Valanzasca P, Rifkin SB. Has Latin America achieved universal health coverage yet? Lessons from four countries. Arch Public Health 2022; 80:38. [PMID: 35063033 PMCID: PMC8777418 DOI: 10.1186/s13690-022-00793-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Seven years after the commitment to United Nations’ call for Universal Health Coverage, healthcare services in Argentina, Brazil, Colombia, Mexico are generally accessible and affordable; but they still struggle to meet population health demands and address the rising health care costs. We aim to describe measures taken by these four countries to commit by Universal Health Coverage, addressing their barriers and challenges. Methods Scoping literature review, supplemented with targeted stakeholders survey. Results The four countries analysed achieved an overall index of essential coverage of 76–77%, and households out of pocket health expenditures fall below 25%. Services coverage was improved by expanding access to primary healthcare systems and coverage for non-communicable diseases, while provided community outreach by the increase in the number of skilled healthcare workers. New pharmaceutical support programs provided access to treatments for chronic conditions at zero cost, while high-costs drugs and cancer treatments were partially guaranteed. However, the countries lack with effective financial protection mechanisms, that continue to increase out of pocket expenditure as noted by lowest financial protection scores, and lack of effective financial mechanisms besides cash transfers. Conclusions Argentina, Brazil, Colombia, and Mexico have made progress towards UHC. Although, better financial protection is urgently required. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00793-7. This review presents the current situation of UHC implementation in Argentina, Brazil, Colombia, and Mexico, using different elements from the WHO in their 13th Program of Work to compare service coverage and financial protection. During the 1990s, health systems within several Latin American countries, anticipating to Universal Health Coverage increasing the service coverage, but struggling to fulfill financial protection standards. Still the four countries struggle to find mechanisms that could increase pooling mechanisms capable of increasing service coverage, while reducing financial inequities among people. The decentralization of the primary healthcare system, the development of public-private partnerships, and the implementation of progressive financing mechanisms like conditional cash transfers are potential manners to improve service delivery and financial protection contributing to effective UHC.
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de Souza RC, Godoy AA, Kummrow F, Dos Santos TL, Brandão CJ, Pinto E. Occurrence of caffeine, fluoxetine, bezafibrate and levothyroxine in surface freshwater of São Paulo State (Brazil) and risk assessment for aquatic life protection. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:20751-20761. [PMID: 33410054 DOI: 10.1007/s11356-020-11799-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
The prioritization of active pharmaceutical ingredients (APIs) for monitoring programmes and/or environmental risk assessment (ERA) purposes is based on several criteria, including environmental occurrence data. However, data on API occurrence in Brazilian surface freshwaters are still scarce. The Brazilian Unified Health System (SUS) provides several medicines free-of-charge, including medications that have bezafibrate, fluoxetine and levothyroxine as the API. Thus, our objective was to investigate the occurrence of bezafibrate, fluoxetine and levothyroxine in samples collected at sampling sites included in the surface freshwater monitoring program of the São Paulo State Environmental Agency (CETESB); caffeine was also included in the analysis because it is commonly used as an anthropogenic marker of aquatic environment contamination. Monitoring results showed that levothyroxine was not found in any of the analysed samples. Caffeine was ubiquitous in the analysed samples, thus indicating anthropic contamination in the studied water bodies. Caffeine and bezafibrate presented risk quotient (RQ) < 1 for all the sampling sites and periods evaluated in this study. For fluoxetine, RQs > 1 were found in all water samples in which this API was found, indicating a potential risk for freshwater pelagic biota. Thus, fluoxetine should be regulated in São Paulo State in order to protect the aquatic biota. Additional occurrence studies in other Brazilian states are still needed to evaluate if fluoxetine is a nationwide pollutant.
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Affiliation(s)
- Raquel Cardoso de Souza
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), Avenida Professor Lineu Prestes, 580, São Paulo, SP, 05508-000, Brazil
| | - Aline Andrade Godoy
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), Avenida Professor Lineu Prestes, 580, São Paulo, SP, 05508-000, Brazil
- Science and Technology Institute, Federal University of Alfenas (Unifal-MG), Rodovia José Aurélio Vilela, 11999, Poços de Caldas, MG, 37715-400, Brazil
| | - Fábio Kummrow
- Institute of Environmental, Chemical and Pharmaceutical Sciences, Federal University of São Paulo (Unifesp), Rua São Nicolau, 210, Diadema, SP, 09972-270, Brazil.
| | - Thyago Leandro Dos Santos
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), Avenida Professor Lineu Prestes, 580, São Paulo, SP, 05508-000, Brazil
| | - Carlos Jesus Brandão
- Environmental Company of State of São Paulo (CETESB), Av. Professor Frederico Hermann Júnior, 345, Alto de Pinheiros, São Paulo, SP, 05459-900, Brazil
| | - Ernani Pinto
- Department of Clinical and Toxicological Analyses, Faculty of Pharmaceutical Sciences, University of São Paulo (USP), Avenida Professor Lineu Prestes, 580, São Paulo, SP, 05508-000, Brazil
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Restrepo SF, Vieira MRDS, Barros CRDS, Bousquat A. Medicines' private costs among elderly and the impairment of family income in a medium-sized municipality in the state of São Paulo. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200042. [PMID: 32428191 DOI: 10.1590/1980-549720200042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 05/30/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The acquisition of medicines accounts for a significant proportion of private health expenditures. The objective of this study was to analyse the private spending with the purchase of medicines and the commitment of the family income, by the elderly. METHODS Population survey conducted in Praia Grande, São Paulo, Brazil. The monthly expenditure and the per capita family income commitment with the purchase of medicines were calculated from the information obtained in the interviews. The variables were described in absolute and relative frequencies and the hypothesis test was Pearson's χ2, Student's t and Anova, with a significance level of 5%. RESULTS The prevalence of drug use was 61.2%. The average monthly expenditure per capita was R$ 34.59, with significantly higher income impairment for individuals with higher levels of education, without chronic diseases and health plan beneficiaries. CONCLUSION The prevalence of drug use was low. The cost generated by the purchase of medicines is one of the ways in which inequality can manifest in society. The expansion of free drug provision would be necessary to expand access and avoid spending, especially those who have private health plans but cannot afford drug treatment.
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Affiliation(s)
- Sylvia Fortes Restrepo
- Centro de Ciências Sociais Aplicadas e Saúde, Universidade Católica de Santos, Santos, SP, Brazil
| | | | | | - Aylene Bousquat
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
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Oliveira LCFD, Nascimento MAAD, Lima IMSO. O acesso a medicamentos em sistemas universais de saúde – perspectivas e desafios. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Este estudo objetivou analisar os desafios do acesso a medicamentos em quatro sistemas universais de saúde da Austrália, do Brasil, do Canadá e do Reino Unido. Estudo qualitativo crítico-reflexivo por meio de revisão integrativa da literatura. Um dos grandes desafios dos sistemas estudados é o da incorporação de medicamentos de alto custo, via análises de custo-efetividade para cumprir a difícil tarefa de conciliar a justiça social e a equidade no acesso com sustentabilidade econômica. Particularmente o Canadá, mesmo sendo um país desenvolvido, ainda vive o dilema de como financiar um sistema de saúde no qual o acesso a medicamentos também seja universal. O Brasil convive com duas realidades problemáticas: primeiro, dar acesso a medicamentos, já padronizados pelo Sistema Único de Saúde (SUS), diante de um financiamento diminuto, segundo, de maneira semelhante aos sistemas australiano, canadense e inglês, vive o dilema de como incorporar novos medicamentos eficazes e com viabilidade econômica, além da questão da judicialização da saúde, um fenômeno complexo resultante da fragilidade pública na organização, financiamento, consolidação do SUS.
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Meiners MMMDA, Tavares NUL, Guimarães LSP, Bertoldi AD, Pizzol TDSD, Luiza VL, Mengue SS, Merchan-Hamann E. Access and adherence to medication among people with diabetes in Brazil: evidences from PNAUM. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 20:445-459. [PMID: 29160437 DOI: 10.1590/1980-5497201700030008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/20/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe people with diabetes in Brazil and to compare their sociodemographic characteristics, access and self-reported adherence to diabetes prescribed drugs. METHODS Data analysis from the National Survey on Access, Use and Promotion of the Rational Use of Medicines, a household survey, with sampling by clusters, according to sex and age domains and national and macro-regional representativeness. Adults (≥ 20 years old) who reported having diabetes constituted the sample. The weighted frequencies of the variables in the sample were analyzed and the Pearson χ2 test was applied to evaluate the statistical significance of the differences between the strata for the data of access, form of financing and adherence to the drugs, considering the level of significance of 5%. RESULTS We found a higher proportion of women, people over 60 years and economy class C. Most participants reported having two or more comorbidities, in addition to diabetes, and taking five or more drugs. Regarding access, 97.8% say they have access to prescription drugs for diabetes and 70.7% say they get them totally free of charge. There was low adherence to anti-diabetic treatment, with significant macro-regional differences (p = 0,001), and greater vulnerability in the South and Northeast regions. CONCLUSION Better access to diabetes medicines in the country has been demonstrated. However, to improve the efficiency of health public spending, it is necessary to achieve higher rates of adherence to treatment.
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Affiliation(s)
| | - Noemia Urruth Leão Tavares
- Programa de Pós-graduação em Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília - Brasília (DF), Brasil
| | - Luciano Santos Pinto Guimarães
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas - Pelotas (RS), Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Vera Lucia Luiza
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Edgar Merchan-Hamann
- Programa de Pós-graduação em Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília - Brasília (DF), Brasil
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de Barros RD, Costa EA, dos Santos DB, Souza GS, Álvares J, Guerra AA, Acurcio FDA, Guibu IA, Costa KS, Karnikowski MGDO, Soeiro OM, Leite SN. Access to medicines: relations with the institutionalization of pharmaceutical services. Rev Saude Publica 2017; 51:8s. [PMID: 29160462 PMCID: PMC5676401 DOI: 10.11606/s1518-8787.2017051007138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 02/08/2017] [Indexed: 11/25/2022] Open
Abstract
OBJETIVE To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services 2015), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis. RESULTS Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: "management tools," "participation and social control," "financing," and "personnel structure," with significant associations in the bivariate analysis. The "pharmaceutical care" dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5). CONCLUSIONS Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies.
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Affiliation(s)
| | - Ediná Alves Costa
- Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA, Brasil
| | | | | | - Juliana Álvares
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Augusto Afonso Guerra
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Ione Aquemi Guibu
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil
| | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva. Faculdade de Medicina. Universidade Estadual de Campinas. Campinas, SP, Brasil
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | | | - Orlando Mario Soeiro
- Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de Campinas. Campinas, SP, Brasil
| | - Silvana Nair Leite
- Departamento de Ciências Farmacêuticas. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
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Tavares NUL, Luiza VL, Oliveira MA, Costa KS, Mengue SS, Arrais PSD, Ramos LR, Farias MR, Pizzol TDSD, Bertoldi AD. Free access to medicines for the treatment of chronic diseases in Brazil. Rev Saude Publica 2016; 50:7s. [PMID: 27982374 PMCID: PMC5157908 DOI: 10.1590/s1518-8787.2016050006118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/25/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the free access to medicines for the treatment of chronic diseases in the Brazilian population, according to demographic and socioeconomic factors. We also analyzed the most used pharmacological groups, according to funding source: free-of-charge or out-of-pocket paid. METHODS Analysis of data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a population-based household survey, of cross-sectional design, based on probabilistic sample of the Brazilian population. We analyzed as outcome the prevalence of free access (free-of-charge) to all medicines for treatment of the reported chronic diseases, in the last 30 days. We studied the following independent variables: sex, age group, education in complete years of school, economic class, health plan, and geographical region of residence. We estimated the prevalences and 95% confidence intervals (95%CI) and applied the Pearson's Chi-squared test to assess the differences between the groups, considering a 5% significance level. RESULTS About half of adults and older adults who have had full access to the treatment of chronic diseases in Brazil obtained all needed medicines for free (47.5%; 95%CI 45.1-50.0). The prevalences of free access were higher among men (51.4%; 95%CI 48.1-54.8), age group of 40-59 years (51.1%; 95%CI 48.1-54.2), and in the poorest social classes (53.9%; 95%CI 50.2-57.7). The majority of medicines that act on the cardiovascular system, such as diuretics (C03) (78.0%; 95%CI 75.2-80.5), beta-blockers (C07) (62.7%; 95%CI 59.4-65.8), and the agents that work in the renin-angiotensin system (C09) (73.4%; 95%CI 70.8-75.8), were obtained for free. Medicines that act on the respiratory system, such as agents against obstructive airway diseases (R03) (60.0%; 95%CI 52.7-66.9) were mostly paid with own resources. CONCLUSIONS Free access to medicines for treatment of chronic diseases occurs to a considerable portion of the Brazilian population, especially for the poorest ones, indicating decreased socioeconomic inequalities, but with differences between regions and between some classes of medicines. OBJETIVO Analisar o acesso gratuito ao tratamento medicamentoso para doenças crônicas na população brasileira, segundo fatores socioeconômicos e demográficos. Analisaram-se também os grupos farmacológicos mais utilizados, segundo fonte de financiamento: gratuito ou pago do próprio bolso. MÉTODOS Análise de dados oriundos da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM), inquérito domiciliar de base populacional, de delineamento transversal, baseado em amostra probabilística da população brasileira. O desfecho analisado foi a prevalência de acesso gratuito (sem pagamento) a todos os medicamentos para tratamento das doenças crônicas referidas, nos últimos 30 dias. As variáveis independentes investigadas foram: sexo, faixa etária, escolaridade em anos completos de estudo, classe econômica, plano de saúde e região geográfica de residência. Foram estimadas as prevalências e calculados intervalos de 95% de confiança (IC95%) e aplicado o teste Qui-quadrado de Pearson para avaliação das diferenças entre os grupos, considerando nível de significância de 5%. RESULTADOS Cerca de metade dos adultos e idosos que tiveram acesso total ao tratamento de doenças crônicas no Brasil obtiveram todos os medicamentos que necessitavam gratuitamente (47,5%; IC95% 45,1-50,0). As prevalências de acesso gratuito foram maiores entre os homens (51,4%; IC95% 48,1-54,8), na faixa etária de 40-59 anos (51,1%; IC95% 48,1-54,2) e nas classes sociais mais pobres (53,9%; IC95% 50,2-57,7). Grande parte dos medicamentos que atuam no sistema cardiovascular, como os diuréticos (C03) (78,0%; IC95% 75,2-80,5), betabloqueadores (C07) (62,7%; IC95% 59,4-65,8) e os agentes que atuam no sistema renina-angiotensina (C09) (73,4%; IC95% 70,8-75,8) foram obtidos de forma gratuita. Os medicamentos que atuam no sistema respiratório como os agentes contra doenças obstrutivas das vias aéreas (R03) (60,0%; IC95% 52,7-66,9) foram na sua maioria pagos do próprio bolso. CONCLUSÕES O acesso gratuito aos medicamentos para tratamento das doenças crônicas ocorre para uma considerável parcela da população brasileira, principalmente para os mais pobres, indicando diminuição das desigualdades socioeconômicas, mas com diferenças regionais e entre algumas classes de medicamentos.
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Affiliation(s)
- Noemia Urruth Leão Tavares
- Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de Brasília. Brasília, DF, Brasil
| | - Vera Lucia Luiza
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Maria Auxiliadora Oliveira
- Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Karen Sarmento Costa
- Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-graduação em Epidemiologia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Paulo Sergio Dourado Arrais
- Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Luiz Roberto Ramos
- Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade Federal de São Paulo. São Paulo, SP, Brasil
| | - Mareni Rocha Farias
- Departamento de Ciências Farmacêuticas, Centro de Ciências da Saúde. Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil
| | - Tatiane da Silva Dal Pizzol
- Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
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